Jim Rohn Quote

“Don’t join an easy crowd. Go where the challenge is great and the emotions are high. Go where the expectations are so strong that they provoke you, push you, and urgently insist that you not remain in one place. That way, you will grow and change.” -Jim Rohn

Environmental Services departments are constantly being challenged to “do more with less,” to provide quality services with fewer resources, especially labor resources. Cleaning is a very labor intensive function and our largest costs relate to labor. A ES manager must constantly be looking for ways to improve labor productivity, either through improved tools or automated equipment, or investigating new methods for cleaning. Waiting until reductions are mandated will not give you enough time to investigate options and evaluate if they will work in your facility. I recommend you become active in professional associations like IEHA and AHE. Network with ES colleagues in other facilities is also an excellent way to learn about new techniques and systems that improve productivity.

Measuring productivity
The way we track and measure productivity often is the biggest barrier to achieving improvement. Many cleaning managers have a vague and incomplete view of what to realistically expect from their staff, so there is no way to know what areas are unproductive and certainly no way to measure the full impact of any changes.

To begin with, determine the exact amount of square feet the cleaning staff is working with. Of that total, how much is actually cleanable? Exactly what does it take in terms of labor, chemicals and equipment to clean that area? What steps do workers take to clean that area and how long does each of those tasks take to complete?

Managers need an accurate benchmark before they can make changes or comparisons. “Guesstimates” aren’t good enough.

One way to determine these benchmarks is to evaluate the different areas of a cleaning operation. Once managers know what goes into a task, how much time it should take and what the results should be, they can determine a range of areas where improvement should occur. Some employees may need more training while some tasks might warrant altering or elimination.

Change management
A common stumbling block for many ES managers is that, once they’ve determined what needs improvement, they simply do not understand how to work with staff to make any changes.

Many times managers attempt to test a new, potentially time-saving tool or technique in their operations, but when employees resist, the managers give up. Managers either dismiss something because it takes too much effort to institute, or simply decide their staff is too stubborn to learn anything new.

Instead, explain the benefits of change in terms employees understand. Managers also need to distinguish between “different” and “wrong” when communicating changes to their staff. Many employees tend to view new ideas as wrong, unless proven otherwise, and subtleties such as this can make or break new procedures.

For instance, a new tool could help an employee work faster, possibly with less fatigue, and with better quality results. But the employee’s priority is to get through that shift, and a new tool means taking time to learn and adapt. Meanwhile, failure to use this new tool properly can add even more effort and time, making the change counterproductive.

A manager sensitive to the nuances of change knows it is essential to explain how this new method, though time-consuming at first, would eventually save the employee more time and create less fatigue. Taking the time to provide a thorough explanation, and to listen to employee feedback, can produce favorable results much faster.

Follow-up also is a must. If managers don’t ensure that workers are using new tools or methods properly, they could be erecting more barriers to change.

Often, employees create their own version of a task, mixing and matching what they prefer, or they revert back to the old way. Without constant tracking and retraining, managers might assume bad results mean the new method isn’t working or employees aren’t capable of adapting. In actual fact, the change they’ve implemented may not be in practice at all. This leads to false data that can skew benchmarking, making it harder to track a department’s inefficiencies.

This is a brief overview of productivity, measuring and implementing change. In the future I share some thoughts on capturing and reporting the savings.

Feel free to ask any questions in the comments below.

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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The process of physical cleaning of environmental surfaces using detergent (soap), water, and friction is the critical step required prior to surface disinfection. The combination of the cleaning and disinfection processes is designed to remove and kill vegetative microorganisms on surfaces. Disinfection will not be effective in the presence of dirt, blood, or other bio burden. The  goal of the cleaning step is to remove bio burden and with it, the majority of pathogens. Disinfection is designed to be a synergistic and somewhat redundant step to ensure comprehensive removal/kill of pathogens on surfaces.

The CDC’s Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, states that, “noncritical surfaces (e.g., dialysis bed or chair, countertops, external surfaces of dialysis machines) should be disinfected with an EPA-registered disinfectant unless the item is visibly contaminated with blood. In that case, an EPA registered tuberculocidal agent with specific label claims for HBV and HIV should be used.”1 the commonly used disinfectant for blood contaminated environmental surfaces is a 1:100 dilution of bleach (500–600 parts per million [ppm] free chlorine).

The environmental surfaces in HD settings at highest risk of transmitting germs are described using different terms. From the perspective of the patient, the term “patient zone” is used to refer to the surfaces which the patient can touch, or can touch the patient, including the chair, armrests, bedside table top/counter, and drawer/cupboard handles. From the HCW or dialysis staff perspective, the term “high touch surfaces” is used to describe surfaces which are frequently touched by HCWs. These include the same surfaces in the patient zone in addition to others such as the exterior surfaces of the HD machine, computer screens, and keyboards. Cleaning and disinfection of these surfaces (patient zone/high touch surfaces) should be performed between all patient treatments, no matter what the patient diagnosis is, in order to prevent spread of environmentally transmitted pathogens including MDROs (e.g., MRSA, VRE, C. difficile) and bloodborne pathogens (e.g., HBV, HCV). Of note, microorganisms can live for varying periods of time in the environment. MRSA has been documented as viable at 38 weeks on external sterile packaging and VRE at 6 months on a wheelchair. HBV can survive for 7 days in dried blood.

There are certain products and principles which are recommended in order to optimize environmental cleaning in healthcare settings, including HD facilities. These include the following tasks which are typically performed by the dialysis nurse or technician.

• Store cleaner/disinfectant separately from skin antiseptics/patient supplies (separate shelves and below patient supplies to avoid potential contamination).

• Perform hand hygiene before and after cleaning the patient station.

• Don gloves when using cleaner/disinfectants.

• Use one set of cleaning cloths or disposable germicidal wipes for each patient station.

• Use microfiber cloths and mops if possible (more effective cleaning products than regular cotton cleaning cloths).

• Clean all frequently touched or “high touch” surfaces in the “patient zone” between patient treatments (chair, armrests, counters, drawer/cupboard handles, exterior surface of the HD machine)—please note that some of these high touch surfaces may be right outside the patient zone (e.g., computer stations), and must also be cleaned between patient treatments.

• Clean the top of an object first and work down to avoid soiling surfaces just cleaned.

• If using cleaning cloths instead of disposable germicidal wipes:

• When using a disinfectant cleaner, wet the surface, use friction to clean, and allow to air dry.

• Fold the cleaning cloth in a series of squares to provide a number of potential cleaning surfaces. A wadded cloth does not clean efficiently.

• Replace cloth as needed. More than one cloth may be required for a patient station.

• Never use the same cleaning cloth for more than one patient unit.

• Never re-dip used cloth into clean disinfectant solution.

Additional cleaning functions, typically performed by housekeeping staff in HD facilities, should include:

• At the end of the day:

• Wet mop the floor

• Clean patient/staff bathrooms and restock paper products/hand hygiene supplies

• Check and refill all hand hygiene product dispensers in nursing stations and at patient stations (soap, paper towels, lotion, alcohol-based hand sanitizer)

• On a routine basis, walls and high dusting should be performed.

Multi Drug Resistant Organisms Cleaning and Disinfection

Many healthcare workers believe the environment of patients with MDROs require special cleaning. Healthcare workers in HD facilities should clean the environment of the MDRO patient as they would for any patient, as many more patients than are known are colonized/infected with an MDRO. Cleaning involves the use of friction on environmental surfaces to physically remove the soil and germs. The wet contact time of the germicide on the surface helps kill or inactivate any remaining microorganisms. The exception is C. difficile, which requires removal by friction and is not inactivated by any surface disinfectant except bleach.

EVS is a proud and honorable profession and as such it must always insist on doing the best and taking the extra steps to ensure that everyone and everything associated with it is held to the highest standards and goals.  If our professionals do not do so, we will see other disciplines encroaching upon and annexing what is currently EVS. 

I would suggest that you look for the following on-line: State Operations Manual, Appendix A – Survey Protocol, Regulations, and Interpretive Guidelines for Hospitals or go to this link to download a PDF document that you may find invaluable:

www.hcmarketplace.com/supplemental/8987_browse.pdf

For assistance in reasoning out the excluding of the rooms in question, I refer everyone to the following.  They are two typical CMS Guidelines cited.  I’ve also provided an OSHA Website that might interest you.

Interpretive Guidelines §482.41(c)(2) – Facilities, supplies, and equipment must be maintained to ensure an acceptable level of safety and quality. Interpretive Guidelines §482.42 Condition of Participation: Infection Control.

http://www.osha.gov/SLTC/etools/hospital/housekeeping/housekeeping.html#ContaminatedWorkEnvironments

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.

I consider myself a very progressive person who stays current with the latest technology and methods for cleaning and disinfecting healthcare facilities.  I learn and share best practices. I communicate with my peers all over the country and I have more than a few years experience in healthcare cleaning.  That said, I am getting more than a little tired of so called “experts” who think they know better how we should run our business.

It is my firm conviction that the EVS profession has allowed itself to be corralled, hobbled, hoodwinked, and kidnapped by so many experts doing time studies specifying cleanable square feet.  It’s time for EVS professionals to take back our profession and present the facts of life to the number crunchers, statisticians, human resources, CFOs and the like by doing their own time studies based on their own individual facilities.  No one knows, or can know, their facility and what it takes – people, time, equipment, and supplies -  to clean and disinfect their facility better than EVS.  The problem is that many EVS directors and managers have not taken the initiative to know what it takes to produce a quality outcome for their facility.  Too many want someone else to give them a formula, a policy, a procedure, practice, numbers, metrics, guidelines or whatever to get the job done then they complain when their Administration brings in an "expert" who tells them they should execute a terminal cleaning of a patient room in 12 minutes!  The experts bring in their BRIM, their ISSA, Premier, or other "studies" and handcuff the EVS department and who suffers?  Patients!  We are here for the patients, to give to them a clean and disinfected, and safe patient care environment.  No one can do it better.  But when EVS professionals abdicate their position and authority to others who many be experts in their field but don’t know EVS from shine-ola, well we asked for it and what else would we expect?

As far as these “benchmarks” are concerned, I have one question for everyone who is being asked to follow those guidelines (as good as they may be for non-healthcare) and others like them:  "What is their definition of ‘cleanable square feet?’  If it’s just the floor surface, I would ask what about the number of square feet of wall space that needs to be dusted down and cleaned?  Ceilings?  What about the square feet of windows that need cleaning?  How many square feet are they allowing for the surfaces of a patient bed – six sides plus the bed frame? A barbaric bed?  An over-the-bed table? Chair surfaces?  Bathtubs and showers?  A toilet?  How many square feet are granted in time allowance to remove and replace a cubicle/privacy curtain? You get the picture.  A cookie cutter "standard" cannot address all of the variables found in a patient room.  But EVS professionals can and should. 

Do your own time study; you clean a discharged room and an occupied room.  Then have a similar room cleaned by your "slowest" and "fastest" staff members (be sure you inspect the rooms afterward to ensure completeness).  Take the average and you have then done a very basic time study.  Be sure you do rooms at different times of the day to take into account the energy levels of the staff because as the day progresses their energy level decreases.  Cleaning patient rooms has so many variables its not an assembly line.

The truth is that you must set your own time standards and be prepared to defend them against all comers!

Here are some of the steps I said would be important in reviewing their existing housekeeping operations or developing new outsourcing initiatives.

Two key phases of review include:

Analysis

• Interviews with administration/housekeeping/staff
• Facility inspection
• FTE analysis
• Existing support contracts
• Departmental policies & procedures
• Review of housekeeping requirements
• Budget review
• Review of supplies & equipment

Scope

• Physical auditing process
• FTE determination
• Training requirements
• Contractor performance expectations
• Quantifiable & measurable performance requirements
• Quality control processes
• Benchmarking
• Selection of qualified contractors and contract type
• Work loading

These are first steps, and make a great start. Contact me if you want to discuss this further.

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!

But there is no limit to the intangible rewards you can give them. These "psychological paychecks" require little effort and cost the company nothing. They represent an excellent way for you to compensate your people during times of transition and change.

Don’t underestimate the value employees place on simple things such as a word of encouragement or a compliment from you. Give them a listening ear and show empathy. Ask their opinions about things. Call them by name, ask about their family, say thank you when they have the right attitude and effort. Write a short note to the employee expressing appreciation for quality work, initiative, etc. When you hold staff meetings, single out individuals and give them a word of praise or commendation for good job performance.

If you take the time to be nicer, you will energize, and encourage your staff. This has many far reaching benefits, particularly during periods of organizational change. There is a real payoff for you, the employee, and your company.