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.

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.

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)

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.

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.

Cleanliness is a prime concern to every member of our team because a clean environment successfully keeps bacteria and other germs from multiplying on facility surfaces, and this helps prevent a sick person from being at a greater risk from other diseases and conditions.

Yet as important as it is to remove soil and germs from the physical environment, it is also important to keep all areas neat and organized and in good repair. After all, surroundings with a pleasant appearance help to cheer up patients and send the message that their caregivers are concerned about every detail of service. A clean and attractive facility can actually enhance a patient’s ability to receive care and get well again.

Since 1930, the International Executive Housekeepers Association (IEHA) has been a non-profit organization committed to raising professionalism in the cleaning industry and providing a cleaner, safer, healthier environment.

IEHA members are Executive Housekeepers—managers who direct housekeeping programs in commercial, industrial or institutional facilities. IEHA provides members with an array of channels through which they can achieve personal and professional growth. Some are: leadership opportunities; resource materials; education program designation; employment referral service; a Technical Question Hotline (1-800-200-6342); networking; an annual convention and trade show, including several educational sessions; and a monthly trade publication, Executive Housekeeping Today.

Take a moment and learn more about our professional organization:

ACTION STEPS:

1. Organize the Approach for Training

a. Decide the amount of skill you expect the trainee to acquire and by what dates.
b. Prepare a schedule to follow

1. Have the employee ready for training.
2. Decide what area will be used for training.
3. Decide items to be covered in each training session.

2. Organize the Work

a. Decide how the area to be covered will be separated into segments that can be learned.
b. Arrange for the proper supplies.
c. Be sure the necessary equipment is available and in good condition.

3. Orient the Employee

a. Put the person at ease.  Make them feel comfortable with you.
b. Explain the task to be learned and find out how much the employee knows about it.
c. Stress the importance of the task, the reason it must be done, and the results of doing it well.  The employee must become interested in learning the work.
d. Explain and show the employee each step of the task, one step at a time.  Don’t go too fast, look for understanding.
e. Stress each step clearly, completely, and with patience to make sure the employee understands.

4. Hands on Training

a. Have the employee attempt the task, and correct any errors while he or she does the task.
b. Have the employee do the task again, and explain each step as the employee does the tasks.
c. Repeat the procedure until you are certain that the task is being done properly and the employee fully understands.

5. Follow Up

a. Allow the employee to perform the task on their own.  Be sure they know that they should contact their supervisor if assistance is needed.
b. Check on the employee frequently until they are thoroughly comfortable in the performance of their duties.  Always encourage the employee to ask questions.

6. Evaluation Employee Performance

a. What are the areas of poor performance?
b. Should they be retrained?
c. If retraining is required, when should it be started, and how long should it last?
d. Is the schedule being met?  If not, why?

Any Questions?

We know that our primary purpose is cleaning. We train our staff to recognize dirt and soil in so many forms and to remove it. We educate, coach and celebrate our successes. We also know that good strategies for combating infection and cross contamination include things such as hand washing and personal protective equipment. In fact recent studies point more often to poor hand washing practices then the environment as the primary cause of hospital acquired infections.

We in Environmental Services understand the importance of hand washing as well as the importance of a clean environment. No matter how well hospital employees adhere to hand washing policies we simply cannot keep pathogens out. Without a top quality training program focused on cleaning and disinfecting the environment, infections will continue to be a problem; germs must be killed wherever they exist within the hospital environment.

I teach my staff to focus on cleaning. Our primary purpose is cleaning, and we never stop and say good enough. We clean and disinfect so that our surfaces not only look clean, they are free of contamination also. I work closely with our infection control department to track results and the partnership has helped to develop best practices that have proven very successful.

When you think about your role in healthcare, remember that without a healthy environment, patients will get sicker, and ultimately, go somewhere else for their healthcare. Support you facility with excellent cleaning, a team relationship with your infection control department as well as your staff. And don’t ever lose focus on cleaning for success.

1. Guest experience
2. Multicultural understanding
3. Staff training
4. Efficiency
5. Inspections
6. Deep cleaning
7. Preventive maintenance
8. Safety and security
9. Inventory
10. Standard operating procedures