INTEGRITY: An Old-Fashioned Value Rekindled
by Patricia Ann Jones, CRCST

The following is a 2006 Fellowship Paper.

As I experience the decades of my life, it appears the days of absolutes, issues of black and white, and decisions of right and wrong are heading for the sunset as I am. American culture seems to be embracing a new age of "gray days"; thought processes based on one's own truth. I am greatly concerned that the gradual loss of old-fashioned standards and morals will negatively impact the American work arena, especially the
hospital setting of Central Service Processing. Accordingly, the intent of this article is to rekindle one's desire for workplace integrity and personal gratification, in hopes to never enter into the "gray days".

Understanding Integrity
The word integrity means "an uncompromising adherence to a code of moral, artistic, or other values: utter sincerity, honesty, and candor....1" The Central Service Technical Manual states, "Moral behavior relates to the basic principles of what is right and wrong."2 A definition of sincerity ascribes to the adjective sincere which means "... marked by genuineness: ... real, true, honest..."3 Research of the word honesty reveals "a fairness and straightforwardness of conduct: integrity... ."4 And lastly, candor means "... freedom from bias, prejudice, and malice: fairness ... ."5

With the aforesaid perception of integrity, how does one operate in the workplace to exhibit these qualities? The Central Service Technical Manual states, "Staff are accountable and must carry out duties assigned in accordance with each detail and procedural step. Accept responsibility to follow work schedules, to maintain good attendance and to always abide by established policies and principles in the best interests of patient care."6 Integrity should be applied to every task in Central Service no matter how great or small. For example, an employee could view the job of delinting linen as a very simple, mundane, unimportant assignment. With this viewpoint, he may assume a careless attitude; thereby, performing a sloppy job. The linen may have threads, fuzz or particles remaining on the fabric. The end product is not a quality product. This is not an act of integrity. If an employee allows his thought processes to be trained in integrity and in the importance of delinting linen in relationship with satisfactory patient outcomes, he will most likely reprogram his attitude. This change should lead to better job performance, yielding a quality product of lint-free linen. This is an act of integrity. An integrity test is featured in Figure 1.

In the above example, imparting knowledge through training plays a role in rekindling integrity. Jack Ninemeier, Ph.D., states, "trained employees become more productive, are better able to meet quality requirements, feel better about the work they do, and are more likely to remain with the facility... ."7 With training and quality results, the employee should experience increased job satisfaction for a job well-done.

Overcoming Ignorance
The opposite of knowledge is ignorance. Ignorance can lead to employee dishonesty. Often an employee may not know how to perform a certain function or may have forgotten the procedure over time. Fear of failure or appearing foolish may enter into the situation. The temptation to fake or omit the task may overwhelm the person. Training and retraining cannot be overemphasized. Everyone learns at an individual pace. One person may need repeated directions for a procedure while another person may "catch on" from one demonstration. Patience and understanding are necessary traits of a training supervisor in order to provide an environment conducive to learning. The freedom to ask questions without reprimand encourages an employee to dispel feelings of inadequacy. A Central Service position is not a job that can be learned overnight. Much repetition is necessary to insure satisfactory patient outcomes. Once an employee learns and recognizes the right procedures and processes, integrity should blossom as temptations and doubts perish.

My beginning experience in the Sterile Processing Department of a 229-bed acute care facility was stressful and scary. I was returning to the workforce after a twenty year hiatus from direct patient care. Upon returning to the workforce as a Sterile Processing aide, I entered a whole new world of knowledge. From decontamination to assembly to sterilization to storage, every procedure and instrument had to be incorporated into my brain for long-term use. I appreciated the calm direction and leadership of the lead technician in the department. I believe the favorable training I received helped to develop my workplace integrity along with the moral values I had been taught as a child.

If All Else Fails
There will still be events where mistakes or omissions occur. People are imperfect human beings. The work environment is often fast-paced and stressful. When an adverse event occurs, integrity prompts one to admit the mistake, fix the problem if possible, and move ahead. If an
employee chooses to ignore integrity and allows a wrongful act to stand, integrity suffers. The employee will most likely suffer with feelings of guilt and anxiety. Unknowingly to the employee, patient care may also suffer. The example of delinting linen that was cited earlier will be revisited. A careless employee may not have considered the possible ramifications of lint left behind on a towel that is to be sterilized for OR use. During a surgical procedure, the towel is used and lint is transferred to the patient's incision. The patient's immune system detects the lint as a foreign body. An inflammation develops which delays healing, increases hospitalization days, prolongs emotional and physical pain, and increases the amount of scar tissue. Even at this point, an employee, after much remorse for one's wrongful conduct, can decide to regroup and try again. Learning from bad choices can be an experience one never forgets. Hopefully, over time less failures occur and more peace abounds in one's inner consciousness. Learning to forgive oneself aids in the healing process to regain integrity.

Often only the employee knows where he has overstepped his conscience. It may not be obvious to others. There are other integrity breaches that have disciplinary consequences. An employee may face a verbal warning, a written warning, or an immediate dismissal. At my place of employment, an employee who would allow someone else to clock in or out for him would be subject to discharge according to the hospital's timecard policy. Supervisors must be willing to take corrective action to insure the corruptive behavior of one employee does not infect the rest of the staff.

Most workers do not intentionally seek to do wrong. The healthcare industry is constantly changing. My place of employment "downsized" last summer and the Sterile Processing Department lost an employee. Increased workloads, threatened job security, and frustration with change are several events which may lead employees to react negatively to the workplace. Ms. Claudio-Pascua, consultant with SGV-DDI, states, "There is growing cynicism among today's workers. In the eighties, globalization and its effects started to hit the Philippines. The nineties saw the explosion of the Asian economic crisis. This series of events led to the rampant downsizing of companies, which, in turn, damaged employees' perceptions of and feelings towards their employers. The notion of job security became a thing of the past. The more recent and widely broadcasted Enron and Worldcom scandals raised even more questions about the credibility of organizations and trustworthiness of senior leaders. The corrupt behaviors of political leaders, as well as respected professionals such as doctors and lawyers, only add to the rising level of distrust.... People don't give their best to someone they don't trust. According to [DDI's Robert] Rogers, trust is the most important element in any business relationship. Without trust in the workplace, people waste energy protecting their own standing instead of promoting continuous improvement and growth."8 Trust is a very integral component of integrity. Open communication within the hospital from the highest level to the lowest level builds trust and helps employees adjust to the changing nature of healthcare.

"Gray Days"
I am concerned about the encroaching "gray days" mentality where truth is relative. In Central Service, many of the tasks are very detailed and exact protocol must be followed to insure accurate results. Harmony and consistency of quality customer service and products depend on following standard procedures. These standards are in place to equip the employees in performing their jobs. Deviations in procedures due to employees inserting their own view of truth would herald in confusion and a lower level of workmanship. Central Service employees must remember that the ultimate goal of indirect patient care, a quality product or service, directly affects human life. There is a living, breathing person on the opposite end who is expecting to be treated with respect and dignity. Our daily choices will either aid or hinder the healing process.

In Conclusion
Integrity is an act of listening to one's conscience. The conscience guides a person to behave honestly and morally with basic principles of right and wrong. All of the training and understanding in the world will not guarantee integrity, but hopefully integrity will prevail when situations arise. Figure 2 summarizes positive and negative factors affecting workplace integrity that were mentioned in this article. My hope is that each
reader's passion for integrity has been rekindled, and the threat of "gray days" has been banished into the sunset.

Endnotes

1. "Integrity." Webster's Third New International Dictionary, 1174.
2. Jack Ninemeier, "Human Relations Skills and Professional Development," Chapter Nineteen in Central Service Technical Manual 6th ed, ed. Jack D. Ninemeier (Chicago: International Association of Healthcare Central Service Materiel Management, 2003), 357.
3. Webster's Dictionary. 2122.
4. Ibid., 1086.
5. Ibid., 326.
6. Ninemeier, 357.
7. Jack Ninemeier, Supervision Principles: Leadership Strategies for Healthcare Facilities.2nd ed. (Chicago: International Association of Healthcare Central Service Material Management, 1997), 88.
8. Ma. Valerie Vanessa Claudio-Pascua, "Integrity and Trust in the Workplace," Personnel Management Association of the Philippines Newsletter (June 2004). 24 June 2005 http://www.ddiworld.com/pdf/ddi_go_ sgv-ddi_IntegrityandTrustintheWorkplace _ar.pdf.
   

References

Gove,P. (Ed.). (1993). Webster's third new international dictionary. Springfield, Massachusetts: Merriam-Webster, Incorporated.
Ninemeier,J. (2003). Human relations skills and professional development. In J. D. Ninemeier (Ed.), Central service technical manual (6th ed.). (p. 357). Chicago: International Association of Healthcare Central Service Materiel Management.

Ninemeier, J. (1997). Supervision principles: Leadership strategies for healthcare facilities (2nd ed.). Chicago: International Association of Healthcare Central Service Materiel Management.

Claudio-Pascua, Ma. V. (2004). Integrity and trust in the workplace. Personnel Management Association of the Philippines Newsletter (June). 24 June 2005

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