We had our “long awaited” Joint Commission Survey the beginning of this week. It seemed like forever, waiting for them to arrive… not really. While it might have seemed like a long time, it really was just another week for a hospital that prides itself on being the best possible caregiver to meet the physical, and spiritual needs of the community.

Environmental Services is the department that cleans, disinfects, and fights infection in every hospital. ES for short, is a department that touches every aspect of a healthcare facility, every patient, every staff member and every visitor. My team is no different, but we try to be different in one aspect; we don’t “get ready” for survey’s like The Joint Commission, or CMS, we practice survey readiness everyday.

A quick tip regarding recognition.

Successful leadership in healthcare environmental services requires constant vigilance, ongoing education, willingness to identify opportunities for improvement in ourselves first, and staff second. In that spirit I share 11 principles and 14 traits for leading in this ever changing environment.

The principles are:

1. Know yourself and seek self-improvement.
2. Be technically and tactically proficient.
3. Develop a sense of responsibility among your subordinates.
4. Make sound and timely decisions.
5. Set the example.
6. Know your Staff and look out for their welfare.
7. Keep your Staff informed.
8. Seek responsibility and take responsibility for your actions.
9. Ensure assigned tasks are understood, supervised, and ac­complished.
10. Train your Staff as a team.
11. Employ your team in accordance with their capabilities.

The traits are:

1. Dependability. The certainty of proper performance of duty.
2. Bearing. Creating a favorable impression in carriage, appearance, and personal conduct at all times.
3. Courage. The mental quality that recognizes fear of danger or criticism, but enables a man to proceed in the face of it with calmness and firmness.
4. Decisiveness. Ability to make decisions promptly and to announce them in a clear forceful manner.
5. Endurance. The mental and physical stamina measured by the ability to withstand fatigue, stress, and hardship.
6. Enthusiasm. The display of sincere interest and exuberance in the performance of duty
7. Initiative. Taking action in the absence of concerns, complaints or direction from above.
8. Integrity. Uprightness of character and soundness of moral principles; includes the qualities of truthfulness and honesty.
9. Judgment. The ability to weigh facts and possible solutions on which to base sound judgments.
10. Justice. Giving reward and punishment according to the merits of the case. The ability to administer a system of rewards and punishments impartially and consistently.
11. Knowledge. Understanding of a science or an art. The range of one’s information, including professional knowledge and an understanding of your staff members.
12. Tact. The ability to deal with others without creating offense.
13. Unselfishness. Avoidance of providing for one’s own comfort and personal advancement at the expense of others.
14. Loyalty. The quality of faithfulness to your community, hospital, to one’s seniors, subordinates, and peers.

Adapted from Leading the Charge: Leadership Lessons From the Battlefield to the Boardroom by Palgrave Macmillan, a division of Macmillan Publishers Ltd.

Resonant Leaders engage us. They evoke positive emotions and inspire us through their positive thoughts and clear vision. Leaders develop their resonance through compassion, hope, mindfulness and they maintain their resonance. Is it any wonder this leads to increased revenue in an organization?

Leaders of all kinds possess these abilities. However, their level of emotional intelligence determines their ability to manage the feeling and emotions that motivate groups to meet its goals. Resonance, in terms of brain function, means that people’s emotional centers are in synch in a positive way. We have to do everything we can to promote resonant leadership skills.

Sure it seems like a never ending cycle of cutbacks, reductions and expectations to do more with less. Some hospitals reach the breaking point sooner because they have been more efficient to begin with. Eventually even the over-staffed facilities will feel the challenge to keep up.

Patient satisfaction scores are one measure of performance. While it is important to listen to the customer we must first measure our staff performance ourselves. When rounding do you take the time to observe how your staff are cleaning, and offer tips, suggestions and training on the spot?

First understand the mistakes, errors and near misses will happen. Never give an excuse to a patient, nurse or your staff. Face the complaint head on and apologize and make it right immediately. Patients will appreciate that a lot more then hearing some excuse. Then work with your staff so it won’t likely happen again.

Even our Stars have bad days, sometimes weeks and we first have to understand that. Scores go up and down and you can’t let short term dips sabotage your team. Work with them, not against them, and you will have better results.

My efforts to improve scores includes personal one-on-one recognition and development, team training and development, consistent and regular communication of my vision that every patient, everyday will be happy with their room cleaning. We hold weekly huddles to reinforce service excellence. We have Do-It projects to improve key metrics and most of all; we build a team by caring about each person.

It is not easy, but I have seen a steady increase in patient scores and that in itself is a good motivator for my team. They understand the value in being appreciated and when they see the trends posted in their closets and in our supply room.

Today I went in, wished them a happy Fourth of July and gave cookies and candy bars. Not very healthy but the appreciation shown both ways helps us all.

Housekeeping schedules should be planned, written and closely followed. Cleaning schedules should be developed according to the needs of each area. Without written routines and schedules your productivity and customer satisfaction are going to go up and down more often then a roller coaster.

A properly stocked cleaning cart will help prevent wasted trips to supply closets and should be equipped with any of the following items which are necessary for your work:

Equipment

Goggles or safety glasses

Microfiber dust mop and wet mop handle with pad holders and buddy jug

Microfiber dust and wet mop heads

Microfiber cleaning towels

Nylon broom and dustpan

Scotch Brite blue power pad scrubbing pads

Toilet bowl mop and caddy

Putty knife

Small detail brush

Assignment checklist and pen

Personalized environmental services calling card “Clean as a whistle”

Wet floor signs

Vacuum cleaner

Chemicals

EPA registered hospital grade cleaner disinfectant: Virex II 256 (#5)

Oxivir TB, ready to use EPA registered hospital grade cleaner disinfectant

Glance glass and multi surface cleaner (#1)

Emerel multi surface crème cleanser

Misty lemon oil furniture and stainless steel polish

Stride neutral cleaner (#18)

Consumables

Toilet seat covers

Paper towels

Hand soap

Alcohol based hand sanitizer

Large and small trash liners

Disposable non latex gloves (on the cart)

The major difference between cleaning a medical facility and any other building is the focus on the un-seen enemy, bacteria. Environmental Service’s job is to not only provide good visible results, but to reduce the number of surface bacteria to a safe level in order to control cross infection. This is an extremely important responsibility because it keeps harmful bacteria from infecting the person next door or across the hall. Persons whose bodies are recuperating from surgery, injury or a primary infection are in a weakened condition and therefore, cannot put p their normal fight against harmful bacteria. A secondary infection in these cases can cause very serious illness.

Cleaning procedures are performed with a germicidal detergent which is designed to kill the most common kinds of harmful bacteria. This solution does not kill all of the bacteria, but reduces them to a safe level. The only way to kill all bacteria is to apply a very high temperature for long periods of time such as done in an autoclave.

Since many bacteria ride from place to place on dust particles, cleaning procedures are designed to prevent scattering of dust; therefore, damp-dusting and treated dust-mops are effective. Straw brooms for sweeping or feather dusters would scatter bacteria and are not used in healthcare facilities.

There are certain kinds of harmful bacteria that the germicide does not kill, but these are reduced to a safe level if proper procedures are used. The cleaning process is mainly a transfer of bacteria from one place to another. Bacteria are transferred from the surface being cleaned to your mop-head or micro fiber towel.

It is important to use solutions properly. Too much soap will leave a sticky residue or film, while too little will not clean properly. Always use your chemical dispenser and never mix chemicals yourself.

Always pick up trash inside the room to prevent bacteria from spreading to other areas. Covers should always be kept on trash barrels of cleaning carts.

Here I continue to list cleaning standards. We use these as a guide to understanding our responsibilities in general cleaning. This is not meant to be a complete list, rather a broad overview. Enjoy your reading:

6. Mattresses: Clean, free of stains and lint; should be germicidal cleaned on both sides.

7. Bedside Tables: Tabletop shelves, inside door facings and hinges clean, free of dust and lint. Legs and wheels free of dust, dirt, lint, hair or other debris.

8. Overbed Tables: Clean, free of dust. Tabletop is free of stains, streaks, spots, dirt and liquid residue. The mirrors are clean, free of streaks and spots. Wheels free of dust, hair or other debris.

9. Closets: Clean and free of dust and lint. All drawers in bedside shelf units free of dust, dirt, and lint. All handles on drawers germicidal damp wiped.

10. Chairs: Germicidal damp wiped. Free of lint, dust, and spots. Legs free of mop splatters.

11. Television Sets: Clean, free of dust and lint on screen, top, and sides.

12. Blinds: Clean, free of lint, dust, and dirt on both sides of blind slats. Blind adjusters germicidal damp wiped daily.

13. Overbed Light & Cord: Completely free of dust, dirt, and lint. Light pull cord germicidal damp wiped daily.

14. Telephones: Clean, free of dust and lint; total receiver germicidal damp wiped daily. Cord is wiped daily, and free of dust and dirt accumulations.

15. A/C Units: Vents clean, free of dust and lint. Sill area germicidal damp wiped daily; corners free of soil accumulations.

16. Windows: Completely clean, free of any streaks, spots, adhesive, or lint. Windows free of smears or haziness.

17. Paper Towel Soap Dispensers: Free of dust, lint, spots, and streaks on top and sides. Supplies properly replenished so as not to cause waste.

18. Walls & Partitions: Clean, free of dust, dirt, and soil residue; no spots or stains left on walls. Free of finger marks around light switches. No dust on top of partitions. Spot clean daily.

19. Doors: Clean, free of spots, marks, and stains. Kick plates are clean and free of wax splatters or scuff marks. Top of door is free of dust and dirt. Door handle, push plate, or doorknob clean and germicidal damp wiped daily. Door frame and hinge areas clean of dust and dirt.

20. Floors: Clean completely free of dust, lint, and stains; no wax build-up or accumulation of dirt in corners or between edge of flooring and bottom of base coving. Completely free of all scuffs and heel marks. Free of spots, spills, and tracking. Free of discolored or old floor finish. Carpet is free of spots and vacuumed thoroughly.

21. Base Covings: Clean, free of dust, dirt, and soil residue. No mop water splatters; no soil accumulation in corners. No wax build-up on coving.

22. Cubicle Curtains: Clean and free of stains, spots, or any type of residue. Curtains should pull freely around bed and hanging properly.

23. Water Fountains: Stainless steel free of water spots and streaks. Lime residue removed from basin and mouthpiece daily, rinsed thoroughly. Handles germicidal cleaned and rinsed daily.

24. Desks: Clean, free of accumulated dust. No furniture polish build-up on desktops. Sides of desks and legs of desks wiped daily.

25. Bookcases: Clean, free of dust accumulation; no furniture polish build-up on bookcase tops. Sides of bookcases wiped down weekly.

The above stated quality standards are guidelines to give the employee a reference for understanding what level of cleanliness is expected. Employees will be held responsible only for those items that are within their specified areas of assignment or job responsibility.

For example, the technician will not be held responsible for yellowed or discolored floor finish or wax build-up in the room, but would be held responsible for any spots or spills on the floor, the types of things that are removable normal cleaning procedures.

During quality control room inspections, consideration will be made concerning things that the employee has the ability to clean or improve, and those things that can not be cleaned or improved by the technician will not be held against them. We do expect that you will submit a work order if the floor needs to be refinished or the carpet cleaned.

Environmental Services (ES) is important to any business because the visible cleaning results create the first impression of a visitor or customer. You’ve probably heard that “the first impression is a lasting one” and there is a great deal of truth in that. Our job is to make that first impression a good one.

In addition to visible cleaning results, impressions are formed by the appearance of you, personally. Some important points to creating a good impression are:

(a) Proper uniform, including name badge

(b) Good grooming and personal hygiene

(c) Neatness and cleanliness of supplies and equipment

(d) A cheerful and positive attitude

(e) As you are moving about the building, learn to “walk with a purpose.”

I have developed these quality standards to ensure that each employee knows the level of cleanliness that is expected for each item cleaned. These standards ensure that quality assurance can be attained in the Environmental Services Department in our effort to provide a clean, safe, and attractive environment.

These Quality standards define the acceptable levels of cleanliness of each item cleaned. If each Environmental Services employee cleans the items at the acceptable levels on a continuous basis, the employee will be performing satisfactory work according to department quality standards.

The following are acceptable quality standards for the areas or items listed.

1 Sinks: Clean inside, outside, and underneath, and free of streaks and stains. Plumbing fixtures on top and underneath free of dirt, spots, and streaks; base of plumbing fixtures free of lime build-up and green residue.

2. Mirrors: Clean, free of spots and streaks; mirror top and edges free of dust and lint; mirror shelf clean and free of spots and streaks or stains.

3. Toilets/Urinals: Toilet bowl clean inside and outside, no stains, streaks or residue; toilet seat clean, free of spots, stains or streaks; plumbing pipe connections to toilet free of lime deposits or green residue and dirt; base of toilet free of dirt, residue and build-up or stains.

4. Showers: Walls clean, free of soil build-up on grout. No soap residue on walls; shower fixtures free of spots and streaks; safety bars free of dust, lint, spots, and streaks.

5. Beds: Headboard, footboard, bed frame, motor control and light cord clean, free of dust, lint, and soil. Wheels and bumpers free of dust and dirt.