By Ray Marden, CBET, CHTM

HTM pros on the front lines of health care understand the need for efficiency and completion of tasks, but when the priorities shift from quality to quantity, those with a strong moral compass and a working knowledge of what’s happening on the floor often face the quantity versus quality dilemma. So, how does a single technician help foster a culture of quality without pointing fingers or making unpleasant waves?

According to National Association of Healthcare Quality (NAHQ) principles, quality minded individuals need to find other champions to join their cause if they wish to have any luck fostering a culture of quality. Blaming and finger pointing are not useful tools on the continuous quest for quality.

A few months back I worked through this sensitive issue with BMET II Salvador Ortiz. Follow Salvador’s journey from concerned tech who is ready for leadership to quality champion and peer-leader.

The following is an actual discussion Salvador and I had over the course of a few weeks via LinkedIn:

Salvador Ortiz: Hey Ray, I have a question for you. Do you have any advice on how to approach a coworker who hasn't been completing the full PMs or calibrating the equipment on its annual basis yet is claiming it on work orders?

I've been in this spot a few times now at different hospitals and I haven't found the best way to give the employee the opportunity to learn or to correct their actions. I normally leave those duties to my manager, but since I’m working toward being a leader in my field and life, I need to start learning how to do this. Any advice would be greatly appreciated!

Ray Marden: Great question Sal! My first advice for new leaders is not to take that stuff personally. Make sure it is the operation you want to improve and make sure that you want to help before you try! If it’s making you mad, as a leader, you must face that in yourself or talk it out somewhere else first. Once you're done being mad and you’re not taking it personally, there are plenty of things you can do to lead.

Salvador Ortiz: I've been told in the past when I did approach a co-worker that it would come off accusatory or belittling.

Ray Marden: I hear you. That's one of the dangers of not resolving your own inner issues first.

Salvador Ortiz: I agree

Ray Marden: It's hard to admit that not everyone’s going to do good work! It can be even harder to figure out how to encourage them to change, or deal with their shortcomings.

Let me ask. What if your shop was your own business? Would you fire them?

Then you'd have to create a job opening, interview a million people, spend months orienting and training them just to get caught up to where you are today. It's usually better to restore if possible.

But I’d need more details to help much further.

Salvador Ortiz: Wow! I never thought of it in that perspective!

I can give you the most recent example I've encountered. One of our senior techs has been a BMET II for the last 4 years and recently it's come to light that the PMs he has been completing were not actually complete. PM steps skipped, lick and stick. IBP modules being past due for many years for their mercury calibrations, CO2 modules also not being calibrated on an annual basis.

Ray Marden: Unfortunately, you are likely to find that no matter where you work. It’s sad but true. Tell me a little about why it bothers you. Not that it shouldn't, just bear with me.

Salvador Ortiz: It bothers me because I care for our patients and believe they deserve working medical equipment when they are in our facility. I've had many family members and friends who use my hospital for their surgeries and medical services. It also brothers me to see a senior tech operating this way and it concerns me how long they've been operating like this.

Ray Marden: Ok good! Now, does your leadership provide an environment where PM quality is emphasized? Would they let you teach a quick course on how to do correct PMs?

That helps you feel good, you learn something, you lead and you help establish the quality expectations of your department. Once there’s a healthy culture of quality in your department and it’s still happening, you may want to think about confronting your peer. If you feel like this is a safety issue, act soon. Let your manager in on the whole plan. Let him know you're proactively trying to up the quality of service without disrupting the shop dynamics. You don't have to point out who you feel isn’t meeting the standards. Simply let management know you’ve become aware of some gaps in quality and that you think a little focused training and setting of quality expectations would help.

Salvador Ortiz: I feel there is an emphasis on PM quality, but some months it does feel like the push for quantity PM closure not PM quality. I do believe they would be open to quick PM course once our COVID cases drop. Last year, we all had a crash course on PM quality and PM steps prior to one our most senior techs retirement. Fifty-plus years of knowledge gone.

Ray Marden: Perfect! It sounds like there's an immediate need you can fill. You could step into that role. You can define the role you want to play. Be the PM quality guy. It will give you a chance to become an expert on a very important part of this field and a chance to lead in a formal capacity. People will respect what you're doing and pay attention. It's got way more traction for patient safety than trying to change a tech one on one. And I think you'll grow more and feel better about the outcome than if you get a guy cornered. Which would be unlikely to help you grow even though it might correct the "issue."

Salvador Ortiz: Hi Ray. Thank you so much for your time. I've taken what you've said to heart and have made some great strides at my work. I am hoping that they accept my request to hold peer-to-peer coaching sessions to improve our PM quality.

Ray Marden: Nicely done Sal! It was my pleasure. Good luck and let me know how it goes!

I recently caught up with Sal to see how things have been going and it sounds like it’s been going great!

Since this conversation, Sal’s initiative has led to several departmental discussions on PM quality expectations and training needs. He stated that those meetings alone have had a tremendous impact on morale as well as quality. He’s been encouraged and empowered by the impact of his front-line leadership and his shop is well on its way to creating a sustainable culture of quality.

Salvador Ortiz: One huge change has been the openness of the techs to asking questions and a willingness to learn. There was an unspoken stigma regarding asking questions and requesting further training that came out during our group discussions. Techs are now more comfortable to learn and to teach others." 

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