John Weir – Healthcare Cleaning Professional

A little late, here are some suggested training topics for October:

1. Customer satisfaction surveys; HCAHPS, Press Ganey, Picker or your favorite. Don’t forget to add internal surveys and patient rounding results.
2. Department team building. Always very important.
3. Hazardous waste; transportation, handling and storage.

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.

By now, everyone should know that patient satisfaction data is no longer public. The Centers for Medicare & Medicaid Services (CMS) developed the Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS for short, to increase accountability and transparency of healthcare delivery practices. It is the first public, and nationwide standardized survey that provides direct comparisons of hospital services.

Survey results are posted on the web at www.hospitalcompare.hhs.gov along with other clinical measures to give patients a fairly complete view of the quality any given hospital is providing. One idea behind this is that consumers will “shop around” for their healthcare, something like one would shop around for a restaurant or a new car.

At my, like most hospitals we use in addition to HCAHPS, another survey tool that measures many more aspects of patient care and performance. A drawback to HCAHPS is that it measures only the basic elements of patients care, excluding a lot of factors important to patients in their overall experience.

For my area of responsibility HCAHPS includes only one question: “During this stay, how often were your room and restroom kept clean?” -Never, Sometimes, Usually or Always. This can be misleading because it does not measure the level of cleanliness, only the frequency. If the housekeeper makes several visits to your room does that mean “Usually” or “Always”. If the housekeeper makes several visits to tidy or straighten up but does not clean would that influence the response”.

Regardless of the answer to that we take definite and clear steps to improve our scores and raise the patient awareness that we are cleaning, and we want their room and restroom to always be clean, really clean. Our staff are trained with scripting and hospitality programs that include greeting the patient and letting them know what we will be doing in their room. We use leave behind cards when the patient is asleep or away for a test letting them know their room was cleaned and a phone extension to call if they would like any further service.

I have no doubt that HCAHPS, in the present form or revised will remain. I work hard to help my staff be successful at delivering a quality service to our patients and guests worthy of the “Always” score. We will continue to do so regardless of this survey though. Our greatest satisfaction comes from the patient who really feels their room is very clean and safe for them.

We have been doing patient rounding where we go see the patients and ask a few questions like, was your housekeeper friendly, was your room cleaned satisfactorily, is there anything we can do for you? We get good feedback and has helped our HCAHPS and Press Ganey scores.

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?