The goal of any Environmental Services Department within a healthcare facility should be to prevent the spread of infectious agents among patients and healthcare workers by meticulous cleaning and appropriate disinfection of environmental surfaces. To reach this goal, the EVS department will need to have a comprehensive training program, the objective of which should be to provide department staff with the information they need to accomplish their jobs safely. The training program should be a part of the big picture of “How to Protect Yourself.” At a minimum the training program should include the following:

1. Identification of occupational risks and hazards associated with handling infectious waste.
2. Sharps safety.
3. Blood borne pathogens.
4. Infection control training – (a) Microbiology and (b) Transmission.
5. Hand hygiene.
6. Personal Protective Equipment (PPE) including donning and doffing.
7. MSDS and hazards associated with using chemicals (cleaning agents, disinfectants, etc.)
8. Product usage training including proper cleaning and disinfection techniques.

The benefit behind breaking the training into sections is two-fold. First, it allows the person responsible for training to involve other departments such as Infection Control or Occupational Health & Safety where specific knowledge and expertise can be called upon. Second, by segmenting the areas into shorter pieces the trainee is not overwhelmed. The individual sections also allow for developing unique methods of delivery. Education should be tailored to the size, topic and needs of the group. Not all programs must be instructor-led in classroom setting. They can also consist of CD programs and/or video-based programs or a series of self-study modules. For example, the product usage training may be better suited to a traditional classroom setting where employees can observe someone performing the task while other sections such as Blood Borne Pathogens can use video-based training. Switching up the method of delivery helps keep the trainee engaged.

A basic understanding of these eight topics doesn’t require a stethoscope or coke-bottle glasses, or even the ability to squint. It takes knowledge, imagination and responsibility. Knowledge… to know basic microbiology, where pathogenic microbes are found, and how they cause disease; to know how cleaning and disinfectant products should be used; to know how to be protected from exposure to blood borne pathogens and sharps injuries; about the proper use of PPE. Imagination… to be able to actually picture the microbes all around us. Responsibility… to take reasonable action to prevent disease.

One person dies every six minutes from hospital-acquired infection. It’s tragic that this is allowed to continue and that an Environmental Services department can be allowed to operate without ongoing, targeted and evolving education.

Time spent properly training staff is an investment that pays dividends for a long time. Training should be a constant process, not just something you do for new employees or to meet the annual requirement. Whenever new products, equipment or procedures are introduced into your department, all staff should be trained on their safe and proper use. Research has shown that adults learn differently than children do, they generally learn more and retain more if they are involved in the training process. Adults learn best by doing, not by listening to lectures or by viewing videos. Lectures and videos have a place in the training process, but trainee involvement needs to be included.

Feel free to share your thoughts and comments.

You need to develop and improve your managerial skills on an ongoing basis as your career develops and as you meet new managerial challenges.

Whether you manage a department or a project team, it’s important to know how to get the work done right. When you’re asked to achieve something with the help of others, it’s complex – and you spend much of your time managing relationships instead of doing the actual work. So, you must develop not only your technical skills, but your management skills as well.

Delegating, motivating, communicating, and understanding team dynamics are some of the key skills needed. With those skills, along with patience and a strong sense of balance, you can become a very effective manager.

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Sometimes, despite your best efforts, there are problems with individual performance. As a manager, you have to deal with these promptly. If you don’t discipline, you risk negative impacts on the rest of the team as well as your customers, as poor performance typically impacts customer service, and it hurts the team and everything that the team has accomplished. It’s very demotivating to work beside someone who consistently fails to meet expectations, so if you tolerate it, the rest of the team will likely suffer. In our article on team management skills, we explore this issue in further detail and give you some examples.

Team performance will also suffer when differences between individual team members turn into outright conflict, and it’s your job as team manager to facilitate a resolution. Read our article on Resolving Team Conflict for a three-step process for doing this. However, conflict can be positive when it highlights underlying structural problems – make sure that you recognize conflict and deal with its causes, rather than just suppressing its symptoms or avoiding it.

Good management means understanding how teams operate. It’s worth remembering that teams usually follow a certain pattern of development. It’s important to encourage and support people through this process, so that you can help your team become fully effective as quickly as possible.

When forming teams, managers must create a balance so that there’s a diverse set of skills, personalities, and perspectives. You may think it’s easier to manage a group of people who are likely to get along, but truly effective teams invite many viewpoints and use their differences to be creative and innovative.

Here, your task is to develop the skills needed to steer those differences in a positive direction. This is why introducing a team charter and knowing how to resolve team conflict are so useful for managing your team effectively. Finding great new team members, and developing the skills needed for your team’s success is another important part of team formation.

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For any healthcare administrator to discount quality results – with documented evidence – and revert to justification based on square footage borders on the unconscionable and very possibly unethical.  To ignore your results and measures and revert to staffing levels and budget levels based only on square feet of floor surface will certainly have a detrimental effect on overall patient health, outcomes, and survival.  Just as proper staffing and proper processes in place by nursing saves lives, proper staffing and proper processes used by Environmental Services saves lives.  Environmental Services should be viewed by everyone in healthcare as an investment in patients and quality outcomes, not an expense to the bottom line.

1. Take time to set your mind. A little time in prayer, meditation or just reflecting on all the amazing blessings you have does *marvelous* things for setting your mind and spirit in a great state to start the week.

2. Stretch! Stretching does *great* stuff for body. It promotes blood flow, it works out kinks and aches and it makes you feel more flexible. And really, when we’re more flexible and we feel good our minds are more flexible too!

3. Do a bit of exercise. You bet. Strong bodies help build strong minds. Get those endorphins flowing, build muscle, feel buff.

4. Picture your week. Create the image of the week that you’re starting – and see it all going GREAT! See it just the way it should be. Don’t worry, even if things come up, you’d be amazed at how easily you can adapt those surprises in and help make them part of how great the week is!

5. Make today’s to do list. If you haven’t already done it the night before, do one now. Don’t make it exhaustive and don’t make it for the rest of the month. Today’s list is fine. Then find one thing you can get done straight away and get your first check mark!

6. Smile and say hello to everyone (yes, even "them") that you work with on the way into your desk/office/cube/work station. You’d be surprised at how much starting with a smile will make both their week and yours better!

7. Be *positive*! For real! This is pithy, but true. Look at things with a glass half full – heck – even go 3/4 full! – mentality. Sure, stuff happens, but look at it as an opportunity! Yes, I hear some of you thinking that you’re a "realist" or " too pragmatic" for that. Well, guess what! The most pragmatic thing you can do is to change the reality by going after those opportunities by unleashing your creative mind with a positive outlook for creative solutions with enthusiasm!

I wrote about goals a few days ago and one question I received was “what are your department goals for this year? That is a great question because I make it a practice to write out what I call major objectives for the new year each December. These are sort of mid-range goals, not short term, and not long term. That is why they are objectives. Sometimes they continue for more than one year. No serious rules here, just get some things down on paper you so you can plan the necessary action steps to achieve them.

Here are my four major objectives in 2011

1. To improve Infection control within the medical center

2. To improve environmental services staff knowledge of their role in infection control

3. To monitor the cleanliness of the facility with data driven results

4. Better patient outcomes

There you go. Those are the foundational objectives that I have used to develop a number of goals and an even greater number of action items to achieve them.

Enjoy…

In the great work presented in Options for Evaluating Environmental Cleaning, December 2010 by Alice Guh, MD, MPH and Philip Carling, MD, objective monitoring of environmental surfaces was studied and presented as a necessary component of training. In view of the evidence that transmission of many healthcare acquired pathogens (HAPs) is related to contamination of near-patient surfaces and equipment, all hospitals are encouraged to develop programs to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients. A two level approach to this is presented and quite well discussed.

For now please draw your attention to the 8 locations above. The importance of targeted cleaning to these surfaces must be taught to your staff and reinforced on a regular basis. While many of our staff have an excellent understanding of the basic policies and procedures involved in terminal room cleaning, most will benefit from focused educational interventions related to our evolving understanding of the role of the environment in healthcare-associated pathogen (HAP) transmission. Specific targeted cleaning will not only reduce HAI’s it will greatly increase the awareness level of your staff.

At our hospital we are in year three of a Service Excellence Initiative. Partnering with Custom Learning Systems we have been been teaching all our staff hard and soft skills to improve customer service through service excellence. Being on the Service Excellence council has given me many opportunities to directly and indirectly influence the process and see first hand the cause and effect results of the program.

Here on my website I try to focus on Environmental Services related topics and the all important “room and restroom always clean” question.

Here are some initial steps for improving your HCAHPS scores:

Train and implement patient visits and staff rounding, utilizing HCAHPS scripting

Have regular, (daily or weekly) 15 minute stand up huddle with each shift to share HCAHPS scores, patient satisfaction and tips to continuously improve the patients experience

Create a regular report to share with your staff and direct reports recapping your scores, efforts and results

Pick one thing to focus on each month to increase your performance. Preferably something you can tie back into your HCAHPS questions.

As a result, I haven’t been focused like I should have been and realized that maybe I need to double up with my self improvement. When I’m feeling unfocused and unproductive I am AWARE of it and do whatever I can at that moment to work on it and am constantly improving myself.

Recently I saw a gentleman named Benny Morris speak on self improvement and how to break past the barriers in our lives.

Dr. Benny Morris:

ALL of you have heard the whole “break past your beliefs” thing and probably have heard it many times. This seminar was NOT just another self-help “thing,” I originally wasn’t going to talk about this for that reason, but I decided what I learned was too valuable to share and would really improve your business ten fold!

Before I get into everything I’ve learned, I want to give you a brief history on Dr. Morris, to show you his credibility. Benny owned the FIRST Tony Robins Franchise and went on to tour with Tony across the country. In addition, he’s created a 5 step method (Valeo Method) on how to achieve your goals and dreams and his book is fantastic! He truly practices what he preaches and that is SO important when you’re listening to ANY leader!

What I Learned That Changed My Business and Life Forever:

During the seminar, thinking about why I still feel like I have things holding me back, yet I’m successful and really feel somehow at the same time that I give my business my all! I was confused and frustrated with myself.

Then Benny asked, “How many of you are living up to 50% of your potential,” NO ONE raised their hand, then he asked how many were living up to 10% of their potential, NO ONE raised their hand!!

This was it! I was NOT using all of my potential and I KNEW it! How crazy is that?? Most of us know that we’re not using our full potential, and still continue to do a half ass job day in and day out. We sit back and make excuses for not doing something and justify it with our EGO, then it never gets done!

What I learned at that seminar was to really push yourself to make a positive, disciplined, productive routine into a habit. There is no excuse for lack of discipline, and really no excuse for ultimate failure. Sure we might fail here and there, but that’s part of success!! However if you let that failure defeat you I HIGHLY suggest you figure out why and fix the problem within.

We’ve all been told this, but how many of us actually follow it?

So Here’s My Action Step For You TODAY:

Here’s what I want you to do every day, for the rest of your life ! Whenever a thought comes into your head like “oh you can’t do that,” “You’re too young, You’re too old” blah blah blah, imagine it leaving your mind, grabbing that thought, throwing it into a trash bin tied to a helium balloon and floating away into space…

Your Ego is NOT your friend! It will say anything to you to keep you from your goals, and this is why you have to make these little mental pictures and tricks to keep it from taking you over.

Finally I want to tell you that Affirmations are so important. Admittedly I had stopped writing them, but from today on I am going to write them every single day, they condition our subconscious to allow us to be successful and free from mental barriers. Let’s write them together, after all repetition and routine will turn into habit .

To Your Success!

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.

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.

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.

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)

Then there is the type of task which produces a backlog if it is not attended to. Dealing with paper is the classic example of this type of task. Have you ever noticed how paper has the strange tendency to breed if given the chance? Leave two bits of paper together overnight and miraculously when you come down in the morning you have a six-inch pile of papers in various stages of inaction. Leave the pile on its own for another 24 hours and you have an office full of piles of paper.

The modern age has produced an even worse backlog producer — the email. Leave your inbox for 24 hours and you will have hundreds of these little monsters clamoring for your attention. I have had clients who complain that they have literally thousands of emails they haven’t even got round to reading.

Other well-known backlog producers are phone calls, filing, and updating client records. There may be others that are peculiar to your life.
The real problem with backlogs is that they take you out of the present. Instead of dealing with today’s work, you are constantly trying to catch up. It’s the difference between walking along a well-defined path and walking across a muddy field. On the path you can walk freely, but in the field your boots get caked in mud and you have to put out more and more effort while going slower and slower.

Backlogs can make people feel hopeless. It may seem impossible to catch up. And even if you do catch up you may only find yourself almost immediately slipping back again.
So how can you deal with them once and for all?

STEP ONE — DRAW A LINE. Say to yourself “Everything that comes in from now on I will deal with immediately. And I will tackle the backlog bit by bit.” Ring fence the backlogs so that they don’t get any bigger.

STEP TWO — CLEAR INCOMING MATERIAL DAILY. The best way to deal with incoming paper, emails, phone calls, etc. is to have a check list which you go through several times a day. So I have a list which comprises about five items and I go through it checking each one off. I do this three times a day — first thing, after lunch and early evening. Because this keeps me right on top of all incoming material, I can sometimes get through the list in as little as ten minutes. More often it takes me an hour or more — but I don’t have any backlogs. The rest of my time is free to get on with creative work.

STEP THREE — REDUCE THE INCOMING VOLUME. One of the reasons backlogs build up in the first place is because we attract far too much inessential stuff. Chuck junk mail in the trash without even opening it. Cancel subscriptions for newsletters you don’t read (you DO read this one!). Don’t write off for things you don’t need. Keep asking yourself “Why am I receiving this?”.

STEP FOUR — GET RID OF THE BACKLOGS BIT BY BIT. If you do steps one and two correctly, your backlogs can now only get smaller. Don’t try to get rid of the lot in one go. Keep chipping away at them. With emails, try clearing one day at a time, starting with the oldest. With paper, try clearing it one subject at a time — such as all bank statements, then all bills, then all client letters and so forth.

Copyright Mark Forster 2002. Thanks Mark!