Bay Pines VA Triumphs with 2023 Ron Hesch Award for Healthcare Innovation and Excellence in Sterile Processing and Patient Care

Welcome to Consensus, a podcast from Sensus Technologies. Welcome back to Consensus Podcast brought to you by Sensus Technologies. Today, we'll be speaking with Cheryl Eder, the acting chief nurse of Periopp Services and Serral Processing Services from the Bay Pines VA in Florida. Their Serral Processing Department is the recipient of the Ron Heche Mission First Award from this year's CTUP Connect twenty twenty three. Welcome, Cheryl. It's great to have you on the podcast today. Thank you. Thank you very much, Vanessa. I'm very excited to be here. Awesome. I'm excited to have you. To start out with, would you please give us a little bit more of an introduction and talk about your role at your facility? Sure. I've worked for the Department of Veterans Affairs for about twenty five years. Initially, I was an operating room nurse and segued into a job during my master's program actually, segued into a program for sterile processing education. I was probably maybe the second or third sterile processing educator in the VA, so it's been quite a while back. My current role involves executive oversight for the operating room, the GI lab, ambulatory surgery, recovery room, and sterile processing service, and that's in two campuses. It's a huge responsibility, and it's one that I couldn't perform at all unless we had built a very strong leadership team. For SPS, our day to day operational leadership is managed by a gentleman by the name of Aaron Cornett. He's our section chief. He brings a level of expertise to our organization that we did not have before. Wow. It sounds like you're busy, but you have the great support of of a wonderful team to help you get through it. I do. That's awesome. Alright. Well, we are just going to, dive right in to discussing what led your team to being the recipient of the Ron Hesch award this year. Okay. So in your nomination, it mentioned that six years ago, Bay Pines faced incredible obstacles. You had infrastructure issues, HVAC failures, staff shortages, and mountains of paper documentation struggles. Can you kind of tell us a little more about what what it was like at that point in time? I can. It was rough initially. My chief and I had come on board at a time when a lot of the leadership of our facility retired at about the same time. They had come on board the same time, worked there for thirty five, forty years, and they all retired within months of each other. So there was a lot of chaos going on, there were a lot of moving parts, first of all, just to make our team run. Then there are a lot of key variables to consider to make the team run efficiently. First, we had to identify all those obstacles, see what was keeping the team from working well. And one of the big problems was due to promotions and retirements, which are celebratory in nature, we were left with enormous gaps, by those departments. Finding a body, a warm body is easy, but finding and hiring the right person or people can be challenging. During this time there were a lot of moving pieces, things were not running in a very fluid manner. Everybody was working very hard, but there weren't enough of them. We needed those missing pieces to get back where we knew we needed to be and should be in terms of performance. It's amazing that we that we didn't have a lot of, issues with bio burden and with canceled surgeries and things like that because we really had very low staffing and very new leadership. My chief at the time, Jason Stuckey, and myself went into search mode for just the best people to fill those key leadership positions. We worked with our top leadership to facilitate implementation of a full SPS renovation. We created an education and advancement plan for SPS. And above all, we changed the culture from one where staff were kind of beat down, you know, they didn't speak up. They didn't let you know when something was wrong. If this if an SOP was incorrect, they didn't tell anybody, you know. And the people writing the SOPs weren't the people doing the work, so they didn't know that it was wrong. Right? So we had to change that. We had to implement field testing of SOPs to get a couple of key high performers to go through an SOP and say, does this really work and is this the best way to do it? That staff has become a group of professionals who speak up when something's not right. As a matter of fact, our staff huddles can be exhausting. That's okay because I would rather hear about something that's not important than miss something that is. You know, so we want them to step up and speak up. One of the big changes we made was to convert a supervisor position into a section chief of SPS operations. When nursing took over sterile processing back in two thousand and eight, a lot of VAs opted to put a registered nurse in that chief role. Registered nurses can do the chief role, but the thing is, is day to day operations are a mystery to a lot of nurses. I'm kind of a purple unicorn in that I started out as an educator. And so I went into SPS and I said orient me like you would a tech. So I learned about SPS from the didactic, you know, the book learning and also the, hands on part. It's like telling somebody to drive a car after they've read the driver's manual. You know, you really have to practice driving the car a little first. Alright? So, when we converted that position into an SPS section chief of operations, Erin's role, we did we created a career ladder that we didn't have before. It stopped at supervisor until we did that. So, that was a big plus. Other small things that we did, we began handing out, our leadership supported this and it was terrific, but something called an On the Spot Award. It's a fifty dollars card for staff that get caught doing good. We have great catch awards for staff who prevented patient harm by quick action. And we increased nominations for our department for employee of the month. And that award comes with a very generous, like a seven fifty dollars cash award for people that win employee of the month. And I've had two of my SPS employees get that in the last year. Our chief also had an innovative program called Chat with the Chief and it was protected Vegas time. They would go into the office and tell him whatever was on their mind and it was protected. They couldn't be, you know, couldn't get in trouble for it, none of that. They just were able to say, I'm concerned about this. This is a problem for me. And it it just changed the culture. I could talk about this Yeah. All day, but I know you have other questions. That is fantastic that your your leadership from your department to your facility has has really supported you guys supporting your technicians in in a lot of diverse ways. So the cool part was that I I had a lot of history with the organization as a staff nurse As the educator. So they weren't afraid to talk to me. They were accustomed to me kind of being their peer. And I understood what their problems were. And when Jason came on board, he was very young, very bright. He was willing to listen to any idea I had. And you would not expect for two people with such different backgrounds to have been such good partners. He is younger than two of my children. We had just a fantastic hand in glove relationship and that really helped us a lot. It really did help us a lot. I would encourage anyone that's trying to institute a culture change, get in there in the middle of it and see where your staff are struggling. So that's it. Off my soapbox. That's that's a it's a pretty awesome soapbox. Like, that's that's great. Yeah. Yeah. To to really understand your team and to want them to have, you know, like you said, the culture shift. You have to see where they're coming from. Yep. And that's great that you guys put that work in to your team instead of just sweeping it under the rug. You talked about improvements that you all have been making within your team over time. Are there still areas where there's work going on that that maybe those positive improvements you're aiming for aren't quite there yet? So when when I first became an educator there, no one was, at the time ISHIM, now HSPA or CVSPD certified. Within the first year of implementing a formal education program, we went from about forty percent of staff that were they were asked to to sit for the level two, the VA's, certification program, only about forty percent passed it. So we went from forty percent to a hundred percent in eighteen months. And since certification, education and training are not a legal requirement for sterile processing in most states, you know, the knowledge level of sterile processing technicians can be alarmingly variable. So with VHA standard basic knowledge, the level one program, we have all of our employees now doing that within ninety days of hire. We weren't catching those for a long time because we didn't have a way to keep up with it. Now we do. But it's a good start, but, you know, everything that SPS does can't be captured in an initial orientation or a twelve part, you know, certification exam. Yeah. So as part of our competency validation, our education and trainers give about twenty to thirty percent of SPS specific, excuse me, twenty to thirty hours or more of SPS specific education and training every year. They have access to certification training manuals. But I still want to see more of our staff, not just with the VA certification, but with HSPA, HSPA, especially the certified endoscope reprocessing, I think that's extremely necessary. And you know, because we still have a long ways to go with salary for our staff, they don't want to pay for a certification and I get that, I understand that. You know, so we've been working on programs to help offset that cost. At our regular huddles, staff are encouraged to bring up and discuss their reprocessing concerns. Every time there's a process change, every time we change an SOP, almost without exception, when we begin to teach and train about that, staff will ask a question that makes us say, wait a minute, our SOP's wrong, we've got to fix this. Or our process is not right, our flow is not correct. You know, so bringing things to the level of where the work is being done, as they say in Lean, in the Gemba. Getting your information from your subject matter experts, and those are not the people in the office, those are people in decon. They're the people in prep, Right? Those are your SMEs on task based processes. You know, so they ask us questions that make us reevaluate, improve, refine the process In continuous improvement, we have to reinforce continuously with direct supervisors that we listen to our subject matter experts. No one is more expert than the people that do it. We are undergoing a full renovation of our department. It's huge. It's like a nineteen million dollars complete gut, right? And we're doing phases, we're gonna be in mobile units and all of that. But when we first started the plans, we've got all these people in the room talking about what needs to be done and not a single one of them, except me, had ever worked in decon, had ever worked in prep, had ever done that sort of thing. Oh man. So we put the blueprints up on the wall and we got input from the staff. We had a company do a VR video of the walk through of the department and had staff participate in that during sterile processing week a couple of years ago. And they gave us a ton of input. It resulted in major plan changes that will impact, it'll impact flu in the department for decades to come, once we get that thing up and running. The inclusion of frontline SMEs into performance improvement resulted in a project that decreased our number of sterilization cycles by two thirds. It took nearly a year, it was extremely data intensive, way outside of their wheelhouse, but I showed them where to go, they took it and ran with it, it was one hundred percent staff driven. That is incredible. I I love that that you looped in your your regular technicians who are day to day hands on with the instruments for so many massive changes. That's that right there is something that doesn't happen, on a normal basis at all. Well, I think that was a good question for that. I was a staff nurse for eighteen years before I went into leadership. So I knew I knew what it was like to have people making decisions that affected my practice and not always in a positive way without getting any input from the people who were doing the work. Yeah. It's I I'm pretty sure yes. Yep. Yes. Well, I I know me personally. Changes were made or or when they opened up, the the new sterile processing at my old facility. And it was it was, you know, something to adjust to or as we started using it. And then eventually staff started saying, I wish they'd asked us about Where they put this, the way they did this flow. Why didn't they get our input? We're the ones who are stuck with it, you know. And then there's the complaints, you know, they don't know what they're doing. So, yeah, I'm sure there are sterile processing professionals all over the place who wish that they'd had that opportunity that you guys gave your staff. That's fantastic. So you mentioned utilizing data to help your technicians, lead a change in your department, and that was the reduction in number of sterile sterilization cycles that you were using. Can you kind of elaborate a little bit more on using your electronic instrument tracking system. You have SensiTrack on on what exactly you showed them how they used it to the results that that you all wanted. Well, I showed them how to pull sterilization reports for one thing, how to pull a report that tells us, what instruments were going into what cycles. Right? So they were able to go through that. What we wanted to do was look at every single cycle that was not four forty, which is kind of your baseline sterilization cycle. And then all the instruments that went into different cycles, we created a database that on one page, these are all the ones that are on four forty, we don't have to touch them. These are all the other ones. So they, the group, there were six of them, went through all the one source docs and discovered that a lot of them had been revalidated since the instrument was put into Sensitrack and could now be done at four forty. So the ones that give us the most trouble and this is this is not a problem in a lot of SPDs in the country because most SPDs don't do dental, but in the VA, SPS does dental. And their IFUs are squirrely. They are Yes. They are crazy European standards and this, that, and the other, and you've got everything's in, you know, the European, like, some of them were, like, eighteen minute two seventy three cycles for Crutchfield, Jacob. Like if something is made in France or the UK, they would do a Crutchfield, Jacob cycle and we're not doing that. Yeah. So the other thing we had to do was go through and find alternate vendors, like the ones that there was no wiggle room, we began replacing those instruments with an alternate vendor that fit in the four forty, you know. So the staff had to pull all that data together. It probably took maybe eighteen months to two years because they're doing this extra. This is on top of their job. They're they're they're doing this stuff extra. So, it was it was terrific day whenever we could start eliminating ten minute cycles and five minute two seventy five cycles. And, you know, because all these things, a lot of these things had been revalidated. We also had our educators going back to the company and asking for alternate instructions. Alternate validated instructions. Because a lot of times, they'll send something to one source and, you know, they don't have they don't have a nickel in giving one source all the time, you know, accurate information. So sometimes they'll send them an outdated IFU. So a couple of times we've been able to go back to the company and say is this the best you can do for us? You know, and we've been able to and actually even forward that on up to one source. So lots and lots and lots of stuff, good stuff happening whenever you're able to use every person in your service to the max of their potential. Everyone has different giftings, right? And you know, some people are visual and some people are tactile and some people, you know, some people are cerebral but every single one of those, types of people can benefit your organization. You just have to understand who they are, where they are, but we couldn't have done it without the SensTreck software. I mean, we we just couldn't have done it because it it feeds, it feeds change with evidence. Alright? When you're able to pull a report, you know, if you go to a surgeon and say, I wanna get rid of this set because you guys never use it. He's going to say no. We use we use it all the time. But in Sensitrack, I can show that the tray hasn't been used in eight years. Yep. You know? That's the day that they decide to start using it just to be ornery. Yeah. We had that we had that happen whenever I I orchestrated, taking about thirty clamps out of a two hundred, two hundred instrument double tray. It was a tray a and tray b. And, for the next six or eight cases, they asked for those clamps. Yep. Yeah. Yep. So, yeah. Or ornery isn't, it's at every single level of the organization. Can be. Janelle It just manifests in different ways. Janelle So I do have, I do have some improvements that our leadership advocated for, you know, just to really make the department shine. Because leadership, leadership has a big role in this. But one of the biggest things is access to all the instructions for use, through one source. And that is VA wide. You can go on You can go on to any VA computer, log on to one source and you're automatically into it without no password, no anything. Access to the manufacturer's instructions for use is crucial. I mean, it's critical to safe reprocessing because the tech doing the work then has access to what the manufacturer said, so if I have a tech on, on midnight shift at three AM that's reprocessing something that he or she hasn't done in a while, and the SOP looks a little squirrelly to them, they can go straight to the manufacturer's instructions for use and see exactly what the manufacturer validated. I mean people are humans and they make mistakes, you know, so SOPs can get messed up. You know, so it's helpful to them. And it also respects them. It respects their ability to read and understand and use critical thinking skills. You know, which doing all these bullet point instructions, you know, for a facility doesn't always do that. It doesn't always convey respect that I have a sterile processing professional here that can read the manufacturer's instructions for use and follow them. I mean some of them are nuts. I mean some of them are crazy, right? I was just going to say, yeah, some of them, Endoscopy, IFUs are utterly insane. You know, they are bananas. Yeah. It just needs to be done for that just to simplify the one hundred and eighteen steps that need to be done, right, to reprocess the endoscope. SinceTrack software, has been really helpful to us because the staff had a hard time initially finding the SOPs that they were looking for. We didn't have a very good naming convention for them or even, the numbering convention was not good. So one of the things that we did that was very helpful to our staff is we added the facility's SOP number to each count sheet. So if they did need to find it, everybody knows how to pull up the count sheet, you know, you just scan the tray and your count sheet comes up and at the top it's SOP number two thousand one hundred and nineteen And they can go back to that SOP and make sure, you know, to refresh their knowledge or whatever. I can't remember if I'm supposed to do this or this, right? So that's very helpful. It gives them a roadmap when they need additional clarification for something that's exceedingly complex or they haven't done in a while. Leadership on our national and local levels, continue to advocate for better pay, career ladders, creation of quality insurance section in sterile processing, recruitment, retention, and a place at the table. Everybody deserves that. Everybody deserves that. The pay scales for the ACE sterile processing service are not going to be fixed quickly. We've been working on them for years and years and years. So what our, national has done is to create some critical skills incentive money and special salary and recruitment incentives, that are beginning to start paying staff for what they're, for the level of criticality and complexity that the job entails. Sterile processing service local leadership at our facility has veto power over reprocessable devices that come into the healthcare facility. When it goes to the committee sterile processing has to sign off on it. So many things slipped through the cracks under names that didn't seem like they might be reusable medical equipment so I have to review refrigerators too just to make sure that it doesn't have a reprocessable component. But that in itself is huge. We were not equipped for the robot. And surgery wants the robot. Yeah. So we can't have the robot because we can't reprocess the robot yet. Now we're working we're working with, industry, you know, with VA partners. We have another VA pretty close to us, like thirty miles, that we're working on so that we can go ahead and get our robotics program started. But, the fact that it wasn't stuff doesn't show up at our doorstep expecting us to reprocess. Yeah. It it all has to be approved by sterile processing. Years ago, facilities bought what they wanted and expected sterile processing to clean it and sterilize it. We didn't have other reviews. We didn't have the right equipment. No. Do it anyway. That's no longer the case. Our technicians from brand new techs up to supervisors have the authority to refuse to receive instrumentation that shows up at the door that hasn't been properly vetted. They just say, nope, sorry, we won't accept it. We will not accept it. And they all know that they have the authority to do that. The other big accomplishment is the approval of a multi million dollar renovation. Our campus is going to be state of the art. It's going to be, I think it's going to be the best one in the country and one of the reasons because our techs had so much input in it. It's going to take a while but it's, going to be wonderful. I I mean it's just going to be wonderful. Sorry to say I'll be retired by the time it opens but I hope that they'll invite me back for the, ribbon cutting. Yep. Well just make sure you stay in touch with them and Oh. And I'm sure they will. Yeah. They they they got my digits. They're gonna be the day after you retire, they're gonna be calling you with a question. Probably. Yeah. You said that, that your your technicians have that veto power at the door for something new. Has that actually happened where Oh, yeah. The Yeah. How did that go over? So whenever you have a new a new vendor that doesn't realize that we mean what we say and we say what we mean, we give them our loaner policy. We we hand them our loaner policy, when they, the first time they ever come to the facility and we have them sign it. That they've read it and they understand it. So I guess the last time that it happened, and it's so funny because we've got our surgeons trained pretty well. We had a vendor come to the door and say, doctor so and so wants this for his case tomorrow. Turns out doctor so and so didn't know a thing about it. This this vendor wanted to, wanted to spring this surprise on the doctor and have him try it out without it having ever been vetted. And the technician says, we don't have this in our system. We haven't been trained on this. We haven't gotten a request from the operating room for this. We're not gonna receive it. So they said, well, let me talk to your supervisor. And the supervisor said the same thing. And he says, well, let let me talk to your boss. And that was me and I said oh what what do you think you're trying to do here are you trying to circumvent a policy of the United States federal government Oh. I'm not afraid to pull that. I'm not afraid to pull the Federal Government card. I do it I do it when I get spam calls on my government phone. So, yeah. I mean, they all know. You you don't you don't receive anything that's not in the system, not been vetted, not been trained on because the the, vendors have to do an in service with our staff for every new piece of stuff that comes through the door before we process it. And they have to get forty hours. They have to get up to it. And that was a struggle too. The very first time, my chief at the time canceled an elective case because the loaner was late, it was quite the kerfuffle. But I'm sure everybody freaked out. Top leadership know what the problem was and how we were not getting compliance and they had to change. So we went from about a forty eight percent non compliance with our forty eight hour policy to about a four percent non compliance rate for our policy. Wow. Now, we did have to do consignment agreements. We had to, and that took a long time. We had to develop consignment agreements so that we could keep at least one of the most commonly used loaners on the shelf and then they bring in another one for a backup and that one doesn't have to be within forty eight hours. The backup one, you know, we we just sterilize it for a backup in case something gets contaminated. But, our compliance rate's gone through the roof. We had to spend a lot of money though and we had to ruffle some feathers and you can't be afraid of that. You just can't be afraid of it. I've had doctors come in my office and stand over me screaming and I'm just about to sit there and I say okay. And, you know, I'm I'm doing my job and You know, I'm just an employee just like you. Yep. So we're we're gonna follow policy as long as I'm sitting in this seat. Yep. Oh, well, hopefully, whomsoever takes your chair after you retire, is is just as firm in that belief. Well, you know, and I and I think that he will be. I've already met him and once he realizes his leadership backs him, I mean, all the way to our, to our Chief of Staff. I mean, I have a relationship with the Chief of Staff. That's unheard of in a lot of facilities for Yeah. A sterile processing chief to be able to shoot an email or a team's message to the chief of staff and say, you know, I'm really having a problem, with this surgeon throwing away instruments or this surgeon not holding the vendor to our loaner policy. And he supports me, You know? That's It's yeah. It's it's really good. When your when your top leadership understands how crucial it is that sterile processing gets it right, it makes it a lot easier to make the hard decisions. Yep. You, you make sure you stick to your stick to your argument and present them with the facts. I hear horror stories of, of DAs where where the manager tried to enforce policy and was threatened with termination. You know, not in the VA, but in other facility, you know, in outside facilities. You know, where they were like, you know, you've got to figure out a way to make this happen. This doctor makes us a lot of money. You know, and that's where things get dangerous. Yes. If your policy says one thing and you're doing another, you're in more danger than if you didn't have a policy at all. Exactly. Yeah. Well, kudos to your team for sticking up for themselves and standing by the policies and making it better for the veteran population that you guys support. Well, thank you. Yeah. So you've managed to breeze through quite a few of the questions just in the course of conversation, which is fine. This is fun. One of the, one of the things brought up in your award nomination was how you and your team reacted to the COVID nineteen pandemic and how you the process that you utilized for reprocessing n ninety five masks. So can you just tell us about what you all had to do to support, you know, your direct patient care teams? Sure. You know, looking back on COVID, I couldn't be more proud. I I you know, we were all freaking out. I mean, none of us have ever gone through anything like this before. But something, a switch just flipped in our staff. You know, they just they just became an army. As soon as, my chief and my section chief, Erin, and myself showed them that we were willing to lead and do some crazy stuff, I mean they were like, yeah let's go. You know, let me go. So when the COVID shutdowns occurred, of course we stopped elective surgery. We were getting new instructions and directions on a daily basis. So the staff had to display enormous flexibility and adaptability in their assignments cause we weren't doing much reprocessing at all. We weren't, we were doing no elective dental, no elective surgery. And then we found that N95 masks, their availability was in jeopardy. So we started doing some research on what we could do. What they had initially done, was what a lot of places had done. They would use their mask, put it in a paper bag for three days and then use it again and recycle them that way for a little while. I just felt like we could do better and did some research. So I I drew up a room with the Tyvek walls because we had a UV robot and I put clothesline in it. Okay. So we had clotheslines and the little plastic, clothespins that you get at the hobby shop. And so working with national recommendations for that, I think it was the University of Kansas that had done this during a flu epidemic and they couldn't get enough, they couldn't get enough N95s and they had put together this process to decontaminate masks. So SPS, we developed a procedure where they collected, labeled, decontaminated, and stored the masks. We didn't give them back to them right away because we never completely ran out, but we were preparing. So what the end users would do is if at the end of the day their masks didn't have any gross soil on it, they would write their name and their unit on it, put it in a brown paper bag, write their name and their unit on it, and SPS would collect it. We would bring them in, put them on the clothesline, zap them, and put them in a white paper bag with their name and unit on it, which the white paper bag indicated that they had been decontaminated. The reflective wall room was just awesome though, I mean it was just, it was so space age. Later after there was an emergency use authorization for hydrogen peroxide, they made critical pivots again to implement that new process. We moved one of our out by the decontamination area and, and started, you know, started zapping them. And again, we labeled them with their names in their unit. You know, so that I mean, because with the vaporized hydrogen peroxide, anybody could have used the mask, but it just made people feel a little, I don't wanna wear a mask somebody else has worn, you know. So we made sure that they would get their own mask back if they ever had to use it. Besides the mask projects, SPS jumped in to help do COVID screening because we set up big, big shelters over the driveways in and out of the facility and screened every car that came through. And it took dozens of people to do that for all of our entrances. They helped out with sitter needs. And Actually some of them still volunteer for overtime doing sitter work. They were like, I kind of like doing a little patient care. And a lot of other typically non SPS, activities to meet the mission and get us successfully through the pandemic. Big, big, big part of the team. They've just and the same with like hurricanes, hurricane preparedness, helping, we've done two evacuations in eleven months in Southwest Florida. Wow. Hurricanes and SPS played a critical role in moving patients, moving equipment, securing instrumentation, just whatever they could do to fill those roles. I'm so proud of them. Well, the more the more we go through this conversation, the more I understand why you guys were the perfect fit for this award because it seems like there is no obstacle, there's no hurdle that your team is not willing to approach and conquer That's true. In in just over just support of your veteran populate population. That is fantastic. Thank you. So we're we're working on coming to a close for our conversation, but I do have one, couple final questions. One of which is, Cheryl, you were actually friends with Ron Hesch before his passing. Would you be willing to tell us about his vision of care for veterans and if it impacted how you have approached your own, your own duties with serial processing and your VA? I loved Ron. I was I was a nurse educator back in two thousand eight, two thousand nine, when I first met him during our SensiTrack implementation. Ron had a passion to assure that his brothers and sisters in arms, because he was a military veteran, had access to safely reprocessed instrumentation. I mean, it was just so evident in the amount of diligence that he applied to every project. We didn't have an easy roll out for Cinstrac. Staffing was not everything it should be. We didn't have a ton of people who were computer literate and there was just a lot of resistance to it. You know, people wanted to they don't like change. People don't really like change. So we've had a difficult rollout, but his dedication to the mission has just had long reaching effects in our ability to document and access data. And that helps us ensure we're in a state of continuous improvement. We can look at where we were last year. We can look at where we were yesterday. We can, you know, and then we can project from that. I often say you cannot improve an unmeasured process. And Ron taught us how to measure our processes using, using the software. He understood it. He understood that you couldn't improve unless you were measuring and he helped us get a better, to the better point of data reliability. I've never met a single soul that knew Ron that doesn't deeply feel his absence, both as a trusted advisor and as a friend. I miss him, I miss him a lot. Sounds like you had a, just a beautiful relationship with him that covered multiple aspects of your life. Yeah. He was a cool guy. You were very cool guy. Well, I appreciate you taking this time to talk about the journey of your department and your facility and how it connected to Ron Hesch. Would you have some final words of wisdom to pass along to anyone who may be struggling to overcome obstacles or feel like they lack resources to to reach these lofty goals that they envision? So if you work in sterile processing, you're struggling with a difficult environment or lack of resources, that's just part of the game. You know, our profession is changing so rapidly that there's always something shinier, newer, and better. Or, you know, you've also always got that one person or two people that spread disillusionment like a male on a hoagie, I mean, let's put it out there. But a few things I would pass along, that I've learned over my thirty, forty, almost forty years in nursing is disengaged people are very hard to work with and they're even harder to manage. When I first began working in sterile processing, as I said before, I oriented to all the areas, partly from my own knowledge and partly to develop relationships with staff and help them re engage in their mission of sterile processing. It's hard to be disengaged when the person you're working for is working with you side by side and shows you that they care about your success, as it relates to the department's success. Number two would be to recognize achievement constantly. Little, big, whatever, recognize achievement and not just your own staff. I can't tell you how many staff in other services will bend over backwards to help our service because I've sent kudos about them to their boss or given them an on the spot award. I've even nominated people in other departments for employee of the month. And they'll do anything for me because they know I care about them too and not just about what they can do for me. Don't ever go to leadership without data to back up what you want. Learn how to use the reports features in your instrument tracking system and if you don't know how to do it, the help desk is a phone call away. They'll show you how to extract the data that you need to get what you need. Also, don't ever go to leadership without a problem unless you have a solution, at least something and possibly even an implementation plan. Okay, leaders and so I used to think that to be a boss would be to sit in an office and just tell people what to do all day. It's so hard, guys. Being at this level, and I'm just kind of a mid level, I'm not up there in the Pentad realm, there are so many moving parts and so many competing priorities and so many disasters going on at any one moment in time that you need to tell them what they need to know, the evidence to back up what you're asking for and what you think a good solution would be. Because you're their subject matter expert, right. Just like your SPS techs are your subject matter expert, you are your leadership's subject matter expert. My other favorite thing to say is I'm going to be a rock in your shoe until you take care of this. That's a good analogy. With all of those multiple competing priorities, what you're asking for might fall off the radar. So be a rock in their shoe. Top leadership has multiple competing priorities. If you don't get an answer, try again and again and again and again because if it's important, you gotta keep bringing it up. After a while, they're gonna be tired of hearing it and they'll act on it. This lady's crazy and she doesn't leave us alone. Let's just give her what she wants. Yes. She's just like a big old rock in my shoe. And that's I think I think you you dropped some fantastic words of wisdom and some great stories. And I love personally, I love hearing about the journey that your team has been on over the years to just really be their best selves, as it relates to their their patient care, their veteran care, and and how they're supporting the community. It's fantastic what you guys are doing. Well, we could not do it without every single member of our team. From the newest tech all the way up to our associate director that has oversight for our sterile processing service. I gotta tell you, I've worked in places where I didn't have leadership support and it's miserable. At our facility SPS truly has a place at the table. And it's been an honor and a privilege, to get to serve veterans in this way, for the last fifteen years and gosh, twenty five years total working for the Department of Veterans Affairs and then another fifteen in the private sector. But, it's just been the most exciting job I've ever had. Thank you again, Cheryl, for taking the time today to talk to us. For those of you listening, thank you for joining us for another episode of Consensus podcast. If you want to hear more from Census, go to census dot com, YouTube, or wherever you get your podcasts and make sure you hit the subscribe button to keep up to date on everything that we're bringing to you. Thank you again for joining us, and we'll see you next time.