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    iM Med ran a fascinating study day on 16 May, aimed at staff with lead and management responsibility for endoscope decontamination. CSJ reviews some of the highlights.

    The Leadership in Endoscopy Decontamination took place at The Thinktank, Birmingham Science Museum, one of the region’s premier centres for business events and the one day event focused on the management skills required to lead teams to deliver excellence in endoscope decontamination.

    Expert speakers provided an essential overview from legislative requirements, microbiological facts, to practical advice to ensure departments are effective and compliant.

    Following a welcome and overview of the day’s proceedings by Dr Helen Griffiths, decontamination advisor at BSG and Gillian Hill, clinical director at iM Med, Dan Simmons from Metris Leadership took to the lectern. Dan provided a unique and fascinating insight into leadership under high pressured environments.

    Dan founded Metris in 2011, after a 16 year military career, including eight years’ service as an Officer with the Special Air Service. With a breadth of operational experience at both command and staff, he is an expert at developing high performing teams that deliver under the most demanding conditions. He held appointments teaching, coaching and mentoring at the Royal Military Academy Sandurst and the Army Staff College, where he was responsible for leadership development and planning processes. He also served in the MOD working in operations and crisis management.

    Relating his experience to Trusts, Dan noted that a key problem is conflict and lack of communication. “In a situation of conflict, it’s important to sit down with, for example, a director,” he noted.

    Citing Steve Peters’ book The Chimp Paradox, Dan said that this kind of approach isn’t a new psychoanalytical theory, but it explains the neuroscience behind the complex working of the human brain that determines action and behaviour.

    “The Chimp also resembles the automatic negative thoughts described in Beck’s Cognitive Behaviour Therapy,” he added. “It’s about adopting an attitude of rational against emotional.” Highlighting honesty and the importance of an honest culture, Dan explained the importance of perceiving ‘truth’ within a Trust and warned that this may be perceived by some as not being a team player.

    “Middle management leaders have to learn leadership in three directions,” he continued. “They must address their own leadership, as well as those people above and below. So, rather than using phrases such as ‘We want this to happen’, try rephrasing as ‘If you do X or Y then this will happen…’

    “In the military, you are taught to think two levels up. You need to ask ‘what are the objectives of my boss?’ and ‘what are the objectives of his/her boss? Transferring that into a Trust context helps to identify the critical path.”

    In a demonstration, Dan invited a delegate to join him on the stage and hooked him to a heart rate variance monitor. The delegate’s heart rate was displayed on the screen as Dan talked him through stressful conditions. The audience was able to watch the rate between heart beats, either slowing down or speeding up. He then gave the delegate some breathing exercises to create a more calming atmosphere and the heart rate became more regular.

    “This performance tool helps to demonstrate the ability to think and act clearly under pressure,” said Dan. “It’s something you can learn – the dialogue between the heart and the brain, influenced by emotional states.”

    An irregular sine wave demonstrated an ‘incoherent state’ – representative of anxiety or anger. A regular sine wave demonstrated a ‘coherent states’ – representative of gratitude or love. “Slow breathing creates more regular sine waves and a more coherent state, thus improving your ability to think under pressure,” Dan explained.


    Empowering through training

    Dr Helen Griffiths, decontamination advisor at BSG, provided examples of how to empower teams through training.

    Dr Griffiths first highlighted the critical need for specialist trained staff, which can often be overlooked due to time constraints and staff availability. “Their specialist skills reduce the risk of errors and cross contamination, and they have a specialist knowledge of health and safety issues relating to reprocessing flexible endoscopes,” said Dr Griffiths.

    “Your critical role is to ensure the availability of clean instruments, but also to ensure endoscopy patients can have a timely diagnosis. Under times of pressure teams revert back to what they had been trained to do. Specialist skills are important and it’s part of our guidance to train them accordingly. Without training, we are less likely to admit when we don’t know something, and will fail to learn lessons from the mistakes. Indeed, we will instead perpetuate them.  Similarly, we fail to grow and find new and more efficient ways of working and doing things. It’s important to empower those you train in case you haven’t been trained properly.”

    Dr Griffiths advised that for team leaders, what is needed is a good knowledge of the staff. “You must know your team,” she noted. “You must know their knowledge, their skills and their attitude. This creates a culture that promotes active questioning, where staff are not afraid to discuss errors, where they are engaged in experimentation and reflection, and where they actively seek feedback.

    “This creates a ‘safe environment’, protected time and a schedule. Above all, leadership is about attitude paths and pinpointing the emotional state of your team – ie: to know who they are and to respect their ‘protected time’ – such as coffee breaks.”

    “On another practical level, by empowering your team to learn you enable them to run Trusts efficiently if you’re away.”


    Endoscope decontamination management

    During lunch, delegates were given an opportunity to network and discuss the morning’s talks. This was followed by authorised engineer, decontamination (AED), Wayne Spencer, taking to the stage to discuss why endoscope decontamination needs management.

    First addressing the risks of the decontamination processes, Wayne noted: “There are many factors that create risk: failure to clean and disinfect properly; incorrect connectors; failure to irrigate channels; no leak testing; rinsing with poor quality water – and so on. ERCP scopes are a particular problem. Traditionally, we take the cap off a duodenoscope – but now the newer designs are fixed. Some of these new designs are hampering our ability to decontaminate.

    Citing an Advisory Committee meeting, Wayne focused on the broad range of infection mitigation strategies it suggested, noting that several specific supplemental measures have been implemented in individual healthcare facilities. He explained: “Combined with strict adherence to the duodenoscope manufacturer’s reprocessing instructions, the following supplemental measures may further help reduce the risk of infection transmission associated with the use of duodenoscopes: Microbiological culturing; Ethylene Oxide sterilisation; Use of a liquid chemical sterilant processing system; and reeat high level disinfection.”

    “Ultimately, the user has the following responsibilities: to certify that the decontamination equipment is fit for use; to hold all documentation relating to the decontamination equipment, including the names of other key personnel; and to ensure that decontamination equipment is subject to periodic testing and maintenance.

    “The user must also appoint operators where required and ensure that they are adequately trained – as well as to maintain production records. Additionally, the user needs to have documented training records demonstrating that they are competent to undertake responsibilities; to establish procedures for product release in line with the quality management system; and to ensure that procedures for production, quality control and safe working are documented and adhered to.

    “Ultimately, the responsibility for management lies with the user, so get yourself trained!”

    In a packed theatre, delegates were treated to further talks, including Andrew Bent, senior medical device specialist at MHRA, who shared his expertise on Leading compliance, and Isopharm Laboratories’ Iain Mein, who elucidated on managing rinse water sampling, providing information on the essentials and sharing insight into the latest advancements.

    Following a lively panel session Q&A with all the day’s speakers, and a summary from Dr Helen Griffiths, delegates concluded the day with a tour of the Science Museum.

    Due to the success of iM Med’s Study Day’s, the next event has already been announced, The Study Day will take place on Tuesday 9th October 2018 at The Queen’s Hotel, Leeds. Once again, the day will be headed by Dan Simmons with Dr Helen Griffiths and Wayne Spencer.

    To book a place, email [email protected] with your full name, title, Hospital Trust, department, telephone number and email address. Attendance is free of charge.