Impact of Leadership Structures on Sterile Processing Performance and Patient Safety.

Background: Sterile processing departments (SPDs) are foundational to perioperative safety and play a critical role in preventing surgical-site infections and ensuring procedural reliability. Despite this essential function, SPD professionals often report limited organizational visibility and constrained decision-making authority. Many also experience insufficient integration into formal governance structures. Empirical literature examining the relationship among reporting structures, professional autonomy, and patient safety outcomes in SPDs remains limited. Methods: A convergent mixed-methods design was used in this study. A structured survey of 89 SPD professionals was conducted to quantify perceptions of reporting relationships, leadership support, and adherence to sterilization protocols. Open-ended responses were also collected to capture qualitative insights. Quantitative data were analyzed using descriptive statistics. Qualitative responses were examined through inductive thematic coding to identify recurring organizational and cultural factors influencing professional autonomy and operational performance. Results: Most respondents reported administratively reporting to nursing or supply chain leadership. Participants generally expressed low to moderate confidence in leadership's understanding of SPD workflows. In addition, 43% of respondents reported experiencing pressure to circumvent established sterilization protocols. Qualitative analysis identified 13 dominant themes. Key themes included the need for greater professional autonomy, formal leadership development, stronger interdisciplinary alignment, standardized credentialing, and improved professional recognition. Conclusion: The findings suggested that current governance structures may limit SPD operational authority and introduce potential risks to patient safety. Organizational restructuring may help strengthen SPD leadership and decision-making capacity. Establishing formal credentialing standards and leadership development pathways may also be beneficial. Greater integration of SPD leadership into executive decision-making processes could improve compliance with sterilization standards and support higher-quality perioperative outcomes.