Writing about my experiences in Healthcare Environmental Services
Productivity
Labor Cost
Recycling
Absenteeism
Turnover
Safety
Productivity – Floor Care
Factors that influence the choice of disinfection procedure for Environmental Surfaces:
-Nature of item to be disinfected
-Number of organisms present
-Innate resistance of organisms
-Amount of organic soil present
-Type & concentration of germicide contact
-Specific indications & directions for use.
Consider efficacy, spectrum, versatility, ease of use, safety profile and cost.
It is cheaper and more effective to prevent environmental & health damage than to attempt to manage or cure it. Prevention requires examining the entire life cycle of products. It encourages the exploration of safer alternatives and the development of cleaner workplaces.
It doesn’t take much skill to spot a problem. The majority of us in Environmental Services can see the obstacles in front of us, yet only a select few see the opportunities. We need to understand the need to stop focusing on problems and look for opportunities to improve our operations.
I have learned to be analytical and persistent in dealing with problems. Defining the issue and seeking out other peoples’ opinions. Many times, I have not understood a situation at first, then while trying to explain my problem to another colleague, some ideas come to mind. Through this process I have come to understand a few simple truths:
Problems are a matter of perspective. Through many difficulties others will often give up. A confident manager will show team members and stakeholders how easy it is to prevail when they try.
Obstacles, setbacks and failures are simply parts of our daily operation. You can’t avoid them, but don’t give in to them either. Focus on possibilities rather than liabilities and push the limits of what you can do. Take what you have and find a way to make it work.
Problems either stop us or stretch us. When it comes to approaching problems, you really have only four choices: flee them, fight them, forget them or face them. Which do you usually do?
Here are a few suggestions to help you become a leader focused on solutions:
Refuse to give up. No problem can withstand sustained troubleshooting. Work with your key team members on the issues and don’t wait until you are too tired or distracted to start.
Rethink your strategy. Albert Einstein once said, “The significant problems we face cannot be solved at the same level of thinking we were at when we created them.” Think outside the box, break a few rules. Redefine the problem.
Repeat. If at first you don’t succeed, keep at it. Remember your goal is to cultivate a solution oriented attitude within your department.
ICE STORM TESTS KY HOSPITALS’ METTLE
by John Commins, HealthLeaders Media, March 11, 2009
If you weren’t living in Kentucky in the last week of January, the ice storm that crippled the Bluegrass State wasn’t much more than a lead item on CNN – something regrettable that happened to somebody else. You watched the coverage. You felt bad for them, but you probably forgot about it when CNN moves to the sports segment. After all, there is nothing more local than weather.
The news that wasn’t reported, however, was the widespread closure of rural hospitals, and hospitals running out of supplies and food, and leaving desperate, freezing patients to fend for themselves. That wasn’t reported because it didn’t happen. And that didn’t happen because of the remarkable efforts by some of those small, isolated community hospitals in the path of the storm.
Methodist Hospital, a 205-licensed bed community hospital in Henderson, on the Ohio River about 15 miles south of Evansville, Indiana, not only kept the lights on when a lot of the region was in the dark, but seved as a shelter for townspeople who’d lost power, needed a warm place to sleep and a hot meal, and had nowhere else to turn. The hospital lost land-line and most of its cellular telephone services and the icy roads cluttered with downed tree limbs limited access, but Methodist continued to provide care because of dedicated employees, a solid emergency management plan, and the help of suppliers.
Don Nauser, director of materials management at Methodist, says the hospital was ready when the storm hit due to disaster preparedness training that several dozen employees at the hospital had taken at the Emergency Management Institute in Anniston, Al. The hospital set up its command center that spelled out each operational task and the personnel assigned to that task.
“One of the things they teach you at Anniston is the first 72 hours you are on your own,” Nauser says. “The National Guard didn’t show up with MREs and cots until the Monday or Tuesday of the next week. They were affected as much as anybody.”
In the initial hours after the storm hit, when electric power for much of the area was cut by falling tree limbs and temperatures plunged, “everybody knew the place to go was the hospital because everyday assumed the hospital would have power,” he ways.
The biggest obstacles for Methodist were the ones they didn’t foresee. For example, when the land line went down, the local cellular telephone service that almost everyone at Methodist used also experienced weather-related problems and was all but inoperable. Nauser says they had to rely heavily on his personal cell phone, which was based in southeastern Missouri.
“Don’t assume that one vendor, in terms of cellular service, is going to be reliable,” Nauser says. “I would recommend having a backup. Ours here was completely off line.” He said his cellular service was one of the few links that Methodist had to a smaller, remote sister critical-access hospital in Morganfield, 30 miles away. Methodist also relied on sporadic Internet service, so employees could update the hospital on their availability, and the hospital could update employees about heir staffing needs.
Methodist was also able to use the Internet, satellite phones (“they work a lot better when there isn’t ice on the antenna,” Nauser says), and cellular phones to communicate with vendors who kept the hospital well-stocked, despite the nearly impassible roads. The main supply point in Paducah, KY had been hit hard by the ice storm. So, Methodist’s vendors which include U.S. Foods, Cardinal Health, and Premier Inc., went north of the storm’s wake and routed supplies through Indianapolis. “We did not miss a deliver,” he says. “It may have meant bringing trucks in at 10 at night or later, but the basic supplies that you need was almost uninterrupted.”
There was a huge – and unanticipated – demand for oxygen canisters for home-bound patients nearby. Methodist found itself cast into the role of chief oxygen supplier for the area after local durable medical equipment suppliers and retail pharmacies that normally sell oxygen told their patients they’d either run out of oxygen or couldn’t get the product to patients.
“They were telling people ‘go to the hospital because we can’t take care of you’,” Nauser says. “Every other problem paled in comparison to the demand for home oxygen. Smaller hospitals, know where your DME is coming from.” The ice storm and its fallout prompted Methodist to reconsider whether it will expand its role as oxygen supplier for the area in the future.
As they struggled during the week-long emergency to provide care and shelter, Methodist officials didn’t have much time to reflect on their reaction to the weather disaster. “You get to the point where you’re running on adrenaline,” Nauser says. But during that frenetic week, no patients were denied care or shelter and services continued in an orderly way. “When it was over I wandered back to the apartment and started to reflect that this worked smoothly,” Nauser says. “It wasn’t perfect. We learned lessons for the next time. But our level of preparedness helped prevent a whole lot of problems. It was as close to business as usual as we could get under the circumstances.”
I hope there is some relief in the activity at your institution now that we have made it through another heavy viral season. Not that there really is a slow season in health care anymore, just a less busy one. So, welcome to the less busy season, when there is time to think and plan.
Environmental services departments are pivotal in the “flow” process, but it must be balanced with proper infection control practices. The challenge is timely, thorough communication—getting and giving good information.
Let’s imagine the emergency room waiting area is filled to capacity and census is at 99 percent. The health care institution has a patient throughput initiative and, hopefully, all of you have been involved in this initiative.
Here is the scenario:
The emergency room has just informed Patient A that he will be admitted. Bed management then scurries to see where the patient can be placed. For purposes of this scenario, we will assume Patient A is a cardiac patient and will need to be admitted into the cardiac intensive care unit, which is currently full. This means the patient shuffle will now occur.
This pending admittance is happening after 7 p.m., when staffing is at a lower level. The most stable patient, Patient S in the cardiac intensive care unit, will move to the step-down unit. But Patient O, who is currently in the step-down unit, needs to be relocated since there is now no need for monitoring this patient, but he is still not ready for discharge. We will now have to move multiple patients to get emergency room Patient A into a necessary room, but the only data that will be looked at is the time it takes to get Patient A to his room, although this is not the only process that is occurring.
The race is on to get Patient A into an intensive care unit room within a certain time frame. Patient S, who is in an intensive care unit room, has to move to the step-down unit room occupied by Patient C. Patient C is stable enough to move to Patient H’s room, which was discharged earlier in the day during the shift change.
This means either there was a lack of communication or miscommunication both from human beings and/or from the “fail-safe” electronic system to notify the incoming environmental services shift of the discharge. The room now resides in “neitherland”; hopefully, it will be discovered and cleaning completed within the required amount of time of the patient flow initiative. If not, we just encountered our first “dam” in the flow.
The current status for environmental services is one critical patient in the emergency room, two patients needing relocating, four rooms counting the ER exam room needing to be cleaned, with the emergency room waiting area overflowing and the health care institution on the verge of going into divert. Contact time to properly disinfect surfaces is 10 minutes, and two of the three rooms are in the same cleaning zone of one person. Patient C needs to go into Patient H’s room, which is the empty discharge room that is lost in the communication process. Patient A, who will move when Patient O moves, can go into Patient S’s room. What does all this mean for the hospital’s environmental services department?
Well if you played along with my little word game, the answer is “chaos”! Most hospitals spend from November to April in this type of scenario. Though the patient flow initiative may not have been accomplished, patients are treated in a timely, effective and safe manner with positive outcomes.
Now, when things are calmer, evaluate your turnaround times, your communication methods and your systems and start to develop process improvement initiatives. Use this time to document, evaluate your data and present this information to your administrator with improvement suggestions. This will assist you and your staff to develop, acquire or change initiatives that will lessen the burden next viral season.
On the road to excellence!
Tina L. Cermignano, CHESP
Operations Manager
Children’s Hospital of Philadelphia
Philadelphia
This article first appeared in the June 2008 issue of HFM Magazine.
There has been a lot of media attention about the Institute of Medicine’s (IOM) report “To Err is Human,” especially over outbreaks of community-based Methicillin-resistant Staphylococcus aureus (MRSA). However, we should concentrate on the second report from the IOM, “Crossing the Quality Chasm,” which provides a road map for quality.
In this report, the IOM describes “Six Aims” to ensure health care quality. The Six Aims are identified as: safe, timely, effective, efficient, equitable and patient-centered health care. So what does this mean for ASHES members?
There is no other service in the health care environment that more intimately and consistently touches patients than environmental services. The patient comes in constant contact with our products, from the textiles that they wear and sleep on to the furniture, fixtures and various pieces of equipment they touch on a daily basis.
Taking this into consideration, our base of operations must be in complete balance with the Six Aims. A health care institution may employ the best in clinical care and purchase the finest technology available, yet little of it will matter if the institution is not properly cleaned and disinfected where appropriate. At its very core, environmental services’ reason for being is patient-centered. If we do not perform our roles in a safe, effective, efficient, equitable and timely manner we compromise the quality and health of our patients.
Environmental services staff and the roles they play are often the forgotten heroes in the quest for quality. As the rest of the institution works to achieve and improve upon the Six Aims, our services are often viewed as a way to improve timeliness and the core purpose is defeated. It is our job and obligation to make sure that everyone in the institution and within the industry is aware of how vital our services are to the safety and the healing environment of the patient.
There is no substitute for a clean environment that is free from potentially harmful organisms. The quality initiatives of environmental, waste, linen and transport services cannot be minimized or overlooked as insignificant in the quest for quality improvement.
What can you do? Get involved! In the IOM report, quality is defined as, “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Professional knowledge is not limited to our profession. Be knowledgeable about other professions and their roles in quality as well. Be knowledgeable about what is going on in your institution. Make sure when the rest of your institution is working on the Six Aims, that you and your staff are involved and that you have allies in the infection control, safety and quality departments so you are included in the discussions and decisions when initiatives are being developed.
It is common for improvement initiatives that seem simple in the planning phase to turn into a problem for another department further down the continuum of care. This is not done intentionally; it usually occurs from lack of awareness about the rest of the cycle. Do not let this happen to you. Keep your eyes and ears open to what improvements are being discussed in your institution and play an active role.
Quality should be a topic when you meet with your boss, your peers across the institution and your staff. They tend to know more than we do at times, because they are on the units every day.
What steps have you taken in order to be consistent with professional knowledge? Let’s talk about it.
On the road to excellence!
Tina L. Cermignano, CHESP
Operations Manager
Children’s Hospital of Philadelphia
Philadelphia
A new study has concluded the U.S. hospitals are beginning to embrace Lean and Six Sigma business management strategies to cut costs and boost productivity, despite there currently being little evidence as of yet that these strategies are effective. Lean management focuses on removing waste from companies and processes, while delivering added value to customers. Six Sigma, meanwhile, is to reduce variations in processes, products and services.
The study, from the American Society for Quality, included 77 hospitals. Researchers concluded that 53 percent of hospitals reported some level of Lean deployment, while 42 percent reported some level of Six Sigma deployment. Not surprisingly, given the gradual evolution of these practices in hospitals, only 4 percent reported “full deployment” of Lean, and only 8 percent full deployment of Six Sigma.
Where hospitals had not deployed either method, reasons included a need for more resources (59 percent), lack of information (41 percent) and lack of leadership buy-in (30 percent). Another 11 percent of hospitals surveyed weren’t familiar with either strategy.
Get more information on the survey:
- read this Healthcare Finance News Article Here
Chasing the numbers
I spent a good part of the day writing performance evaluations. I find it somewhat refreshing to think about a staff member and write wonderful words that reflect their performance during the last year. Of course not every word is, glowing, but for the most part all my staff are good, hard workers and each one has positive qualities that work together for the department, and the hospitals good.
A good portion of the rest of the day was spent chasing numbers. You know, the NRC Picker, or Press Ganey satisfaction survey results that go along with the HCAHPS survey results. I find I’m more and more often aligning strategies, scripting, and work teams to push these numbers up. It can become an obsession… the daily logging into Press Ganey, running the queries, reading the reports.
Hurray! +.5 % on the mean score for courtesy, oh sad, -.6 on cleanliness, but wait, the emergency room waiting area jumped up 7%. Lets go clean the furniture again, did we make enough patient room rounds today? It is not enough to manage by walking around (MBWA), we need to fill out some quality assurance checks and speak to a dozen patients as well, hold staff huddles, post the numbers, give more praise and recognition, re-train on high dusting, pass out more putty knives to scrape those corners, look into 55 gallon drums of floor finish, as we go through gallon jugs too fast and so on, so forth.
I find it rather exciting to push the numbers. Of course it is not smoke and mirrors. Behind those gains are many staff members and other hospital employees working hard, doing things right, taking care of the patients, guests and each other. That is why I am in this business, but we measure, measure and measure again to make sure we keep on doing those right things.
Chasing the numbers? Yes, it can seem that way. And those are moving targets, what with the hospitals we compete with doing everything they can to improve just as we are. I might achieve an increase in my cleanliness mean score but if other hospitals also increase, and higher than I do my percentile will go down. So we compete against ourselves, and against other hospitals. Makes it all just a little more complicated.
Employees may be more prone these days to blame others for problems they have caused themselves, said Paul Harvey, assistant professor of management at the University of New Hampshire in Durham.
Harvey, who studies behavior in the workplace, said it is “a natural human tendency to want to deflect blame for negative outcomes (especially at work where your competency is always being evaluated), and so people often subconsciously look for other people to blame when problems arise.”
If the finger-pointer is the boss, the situation becomes even more complicated, he explained. “When that happens, people usually have to stand their ground and hope that, over time, the facts help to vindicate them.”
This version of blaming is a form of “abusive supervision” and includes “spreading rumors about employees, insulting them, withholding information, and pretty much everything short of actual physical abuse.”
Reference:
Watch for ‘Employee Scapegoating’ as Economic Troubles Continue. (2009, March). HR Focus, 86(3), 8-9. Retrieved March 29, 2009, from Alumni – ABI/INFORM Global database. (Document ID: 1654950911).
Housekeeping management is often viewed as a straightforward position and can be an overlooked area for training. While everyone thinks they know how to clean, the management of housekeeping is more complex than people realize and has critical impact on guest satisfaction. To help tackle your job, cover these 10 areas:
Recently I’ve started using workers that have restrictions to the point where I can not work them, but they can walk, talk and write come in for ES Ambassador duty. I give them some scripting, a clipboard and the rounding questions and have them spend hours going to talk with patients. We talk about our goal of having their room always clean, how the survey works, and so on. I’ve had very positive feedback on this and it helps get the staff back to work with a better attitude.
I’ve increased our cross training and we all know how that helps. I’ve also moved staff more frequently to play to their strengths more than I have done in the past.
I put a large communication board in our common room. This happens to be our laundry and storeroom area where we check in and out the keys and pagers. During our standup meetings I share Press Ganey positive comments and other good comments and post them on our communication board. The increased focus on the score has helped I believe.
So far my HCAHPS score for the first quarter of 2009 is running 81%. This is a 10 point improvement over last years average, and higher over just November and December of last year.
What things have you all been doing to raise your scores and your staff satisfaction?
Even so, I feel we are coming up to the critical mass point in our operations where we are going to see a massive change in this business. Up to now, we have all been learning to adapt to doing more with less, different cleaning chemicals and processes, competition between the in-house and out-sources operations just to mention a few of the “hard” process aspects. In the “soft” or the human, labor side we have seen many laws to benefit employees, different types of time off opportunities, repetitive stress injuries and a multitude of generational issues that are present in our labor intensive business.
With hospital reimbursements shrinking, expenses expanding, and the probable change in the way health care is delivered coming with the new elected leaders, don’t be satisfied with the status quo. While the daily work must go on, take the time to consider and evaluate new ways to deliver your service. I’m open to sharing and helping anyone to brainstorm and think outside the box.
John Michael Weir – BBA, CHESP, REH is Stephen Fry proof thanks to caching by WP Super Cache