Author: John Weir

With over 27 years in Healthcare Environmental Services (ES), I lead with a belief that attitude drives outcomes. As a Regional Director at MultiCare Health System, I oversee multi-site ES operations with a focus on people-first leadership, infection control, and operational excellence. I champion a Positive Mental Attitude (PMA) not as a slogan, but as a leadership principle. I believe positivity is contagious, and as a leader, I set the tone. Through consistent, uplifting communication, I create environments where ES teams feel empowered to be helpful, proactive, and proud of their impact. For me, development is a choice, and I invest in training, huddles, and coaching that energize teams, helping them thrive in their current roles and grow toward what’s next. My approach to high standards isn't theoretical, it's practical. Just like we notice when a hotel room is clean and fresh, patients and families immediately sense a space that’s been cared for. Through standardized protocols, team accountability, and a shared mission, I help create clean, safe, and healing environments that directly enhance patient experience and staff well-being. It's a privilege to lead teams that play such a vital role in the patient journey, and to help elevate the perception and performance of ES professionals across our system.

quality

I’m closing your hallway door, Mrs. Smith. We always want your room to be as quiet as possible.

We always strive to clean your bathroom twice a day.

It’s really second nature for us to always make sure you understand your medications.

It’s customary for our team to always answer call lights within five minutes.

It’s routine for us to always inquire about how well we’re managing your pain.

We make it a practice to always answer your questions without delay.

Service “all the time” is routine for us… We want your experience with us to always be excellent

objectives

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…

Our profession is so immensely diverse because of the level of talent and professionalism our members bring to the table. Many years ago, various housekeeping departments were just that–housekeeping–but due to the evolution of health care environmental services managers, we have become multifaceted department managers with responsibilities encompassing a wider array of functions.

With the increased complexity of the job, such as emerging pathogens and potential worldwide outbreaks like avian bird flu, there is demand for professionals who are both experienced and have Certified Healthcare Environmental Services Professional (CHESP) certifications in health care systems throughout the world. We all need to be ready to step up and take the extra challenge on, view it as an opportunity and allow it to shape us as professionals.

Another impacting grand approach is to ensure you have an active succession-planning program in place for your future environmental champions. This profession has provided a lifelong career to many individuals and provides a clean, safe, healthy and healing environment to the patients we serve every day.

Lose the weight. I’m not talking about physical weight but dead weight from your department. Deal with staff who negatively affect the department. They “weigh” on time, energy and morale and are preventing the team from achieving excellence.

Exercise your role and lead by example. Now that you can move about freely because you cut away the dead weight, use the time and energy wisely to walk and talk to your staff on a daily basis. Share in their world; hear their suggestions, concerns and ideas. They are the people who make it happen daily. Demonstrate that you value the staff members who make the department and institution look good every single day.

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.

Download the Environmental-Cleaning-Checklist-10-6-2010 from this link or go directly to the CDC site.

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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.

Health Care Reform

As part of the proposed changes to healthcare, reimbursement for hospital care and post-acute care will be bundled; patient readmission’s will be at a lower rate in some cases; hospital reimbursement and performance will be directly linked; and physician self-referral will be more closely regulated. Out of those four important items, environmental services has a direct impact on two—readmission rates and performance-based reimbursements. A sufficiently staffed environmental services department plays a major role in minimizing patient readmission’s. The proliferation of microorganisms affecting our communities and the patient population demands a properly cleaned and disinfected care environment. It is my belief that investing in the environmental services department and assuring proper funding, staffing, training, and consistent cleaning procedures and protocols will have a positive impact on lowering the infection rates, lowering the rate of “never” events like patient falls and improving patient satisfaction rates. Each of these examples provides a direct link between our departments and performance-based reimbursements.

So what does this all mean to the environmental services department? This is an opportunity to position the department as the front-line quality assurance and infection control team able to facilitate cost containment for the health care facility and ensure a proper setting for care delivery throughout the continuum of care. Speak up and make sure your senior leaders know the value you and the departmental staff bring to the health care facility. Make the business case for what you do and the big-picture impact on finances, patient readmission and performance-based reimbursement.

We are currently experiencing economic situations not seen in many years. The times are extreme and uncertain. What does this mean for us in support services departments? Given the current economic environment, we need to develop extreme leadership skills, which means being more, doing more and accepting more. Not only must we be conservative with budgetary issues, but we must utilize the resources we are responsible for in a way that gets the job done and accomplishes what is expected.

Be an extreme leader in these extreme times. Get out of the office, share your knowledge and include your staff and peers in the solutions. In doing this, you will be part of the solution and will show how invaluable your knowledge and skills are to your organization. True leaders rise to the occasion during the most extreme times, so be a positive force in making necessary changes.

Accomplishing the difficult in a positive, optimistic process is a true example of extreme leadership. As part of my practicing extreme leadership I have taken over the safety and security department, the hospital safety officer responsibility and am chair of the environment of care and emergency preparedness committees. I also serve as vice chair of our service excellence council. I do these things because as a leader and advocate for environmental services I am responsible for providing guidance, resources and knowledge. What better way to gain more knowledge and resources to share and to learn as much as I can about the hospitals business beyond the ES department.

Today there is more to environmental services than keeping the environment safe and clean. Success is achieved through a strong commitment to professional development and extreme leadership

There are thousands of health care facilities in the United States. I imagine there are mock surveys and actual surveys everyday somewhere. And during each one, many regulations and requirements are checked for compliance. An increasing focus is being paid to regulated medical waste or RMW.

Most health care facility professionals understand the need to be familiar with the regulatory complexities of managing waste. In Environmental Services we deal with a lot of waste, including RMW.

There are many regulations and standards, including the Joint Commission’s Leadership (LD), Environment of Care (EC) and Emergency Management (EM) standards, as well as the federal Department of Transportation, Environmental Protection Agency and many state and local rules and regulations.

Quite a few of the standards related to regulated medical waste can be found in these standards:

  • LD.04.01.01
  • EC.01.01.01 (EP 5)
  • EC.02.02.01 (EP 11, 12)
  • EC.04.01.01 (EP.01, 8, 15)
  • EM.02.02.05 (EP 4)

An organization can be fined thousands of dollars per day per violation by local, state and federal authorities if it is found noncompliant with waste regulations. Many of these fines vary by state. It is very important to be familiar and understand your own state’s current and emerging regulations to avoid these costly fines and remain a compliant leader within the health care industry and their community

Do have your 2011 yearly goals written down yet? I sure hope you do. If not, while no one is looking, get busy and do it already. Do you have your 90-day goals written down? Your weekly goals? How about your daily goals?

Unfortunately, the vast majority would have to admit that they do not have these written goals and that is a gigantic blunder.

Did you know that upwards of eighty five percent of all written goals come to pass. With that being the case, why don’t more people use this incredibly powerful tactic? First, most probably had no idea that was true and secondly most are living in a situation called the tyranny of the urgent. They are dealing with day to day situations all day long and never get to thinking about or planning for the future.

If you are one of the few, great job. You are achieving more than most. If not, get some paper and a pen, and start with long range goals. What do you want to be in ten years? If that is too far out, try for five. Work backwards from those long term goals and build smaller goals, steps really, to help you achieve them.

So now you have these goals all written out. What next?

First of all, unless someone is critical to helping you achieve your goal(s), do not freely share your goals with others. The negative attitude from friends, family and neighbors can drag you down quickly. It’s very important that your self-talk (the thoughts in your head) are positive.

Reviewing your goals daily is a crucial part of your success and must become part of your routine. Each morning when you wake up read your list of goals that are written in the positive. Visualize the completed goal, see the new home, smell the leather seats in your new car, feel the cold hard cash in your hands. Then each night, right before you go to bed, repeat the process. This process will start both your subconscious and conscious mind on working towards the goal. This will also begin to replace any of the negative self-talk you may have and replace it with positive self-talk.

Every time you make a decision during the day, ask yourself this question, "Does it take me closer to, or further from my goal." If the answer is "closer to," then you’ve made the right decision. If the answer is "further from," well, you know what to do.

If you follow this process everyday you will be on your way to achieving unlimited success in every aspect of your life.

What? You are housekeeping, not plant operations! Why should you care about life safety you ask?

For 2011, all hospitals, including critical access hospitals, will have a life safety surveyor for at least two days of a Joint Commission survey. Those hospitals with more than 1.5 million square feet will have a third day. Yet an additional day will be added for every three buildings classified as health care occupancy. This is considerably more than we are used to and it is not enough to be focused on cleaning. We in environmental services are the only department in a hospital to service every patient room daily, and all other areas at least periodically. We are the eyes for every facility service department.

So what are the areas we should be looking at during our daily cleaning and rounding.

  1. Penetrations: Holes in walls, ceiling tiles, and around fire sprinklers. These tend to happen and often get overlooked. Make a point of looking around and putting work orders in.
  2. Doors: The majority of fire, smoke and corridor doors will be checked. Make sure they positively latch. My staff close each patient door on a regular basis and makes sure they latch. We tell the patients that we are checking the door for proper operation for their safety. It is appreciated. This is a good time to check the hardware and look for missing screws. Yes, missing screws in the hinge have been found on many survey’s.
  3. Look up: Sure holes in ceiling tiles are important to correct, and so are stained or broken tiles. Get those reported and changed. Also ceiling grilles and diffusers are being checked for dust accumulation. Same goes for fire sprinklers. Dust and dust bunnies are just not appreciated anymore.
  4. Corridor Clutter: Recent inspectors are coming down hard on hospital clutter. The only items allowed to keep in corridors are code and isolation carts and equipment in use, E.G. not stationary for more than 30 minutes. Other than those you need to maintain either the 4’ or 8’ clear corridor width.

There certainly can be more things our staff can find that need to be corrected. If you are not already on board start with one area and build on it.

Wondering when your HCAHPS scores will be on the public reporting site? Here is the list for HCAHPS Public Reporting April 2011 through April 2012.

Presented here are the calendar quarters of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey results that will be publicly reported on Hospital Compare (www.hospitalcompare.hhs.gov) from April 2011 through April 2012.

Please note: The dates of preview and public reporting are estimates based on current timetables and thus are subject to change.

APRIL 2011 HCAHPS Public Reporting
QUARTERS INCLUDED: 3Q09, 4Q09, 1Q10, 2Q10
DATE RANGE: 7/1/2009 to 6/30/2010
DATE OF PREVIEW: January 2011
DATE OF PUBLIC REPORTING: April 2011

JULY 2011 HCAHPS Public Reporting
QUARTERS INCLUDED: 4Q09, 1Q10, 2Q10, 3Q10
DATE RANGE: 10/1/2009 to 9/30/2010
DATE OF PREVIEW: April 2011
DATE OF PUBLIC REPORTING: July 2011

OCTOBER 2011 HCAHPS Public Reporting
QUARTERS INCLUDED: 1Q10, 2Q10, 3Q10, 4Q10
DATE RANGE: 1/1/2010 to 12/31/2010
DATE OF PREVIEW: July 2011
DATE OF PUBLIC REPORTING: October 2011

JANUARY 2012 HCAHPS Public Reporting
QUARTERS INCLUDED: 2Q10, 3Q10, 4Q10, 1Q11
DATE RANGE: 4/1/2010 to 3/31/2011
DATE OF PREVIEW: October 2011
DATE OF PUBLIC REPORTING: January 2012

APRIL 2012 HCAHPS Public Reporting
QUARTERS INCLUDED: 3Q10, 4Q10, 1Q11, 2Q11
DATE RANGE: 7/1/2010 to 6/30/2011
DATE OF PREVIEW: January2012
DATE OF PUBLIC REPORTING: April 2012

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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.

On April 29, 2011 The Centers for Medicare & Medicaid Services today issued a final rule (42 CFR Parts 422 and 480) that sets forth its policies for the hospital value-based purchasing program. Under the Patient Protection and Affordable Care Act, the VBP program will pay hospitals based on their actual performance on quality measures, rather than just the reporting of those measures, beginning in fiscal year 2013. In the first year, the VBP program will include 12 clinical quality measures as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experiences with care survey.

The clinical measures will account for 70% of a hospital’s VBP score and the HCAHPS survey for 30%. For FY 2014, CMS will add the heart attack, heart failure and pneumonia mortality measures to the VBP program, as well as eight measures of hospital-acquired conditions and two composite patient safety and inpatient quality indicators developed by the Agency for Healthcare Research and Quality. The VBP program will apply to all acute-care prospective payment system hospitals with certain exceptions. For example, for the clinical process measures, CMS will exclude from hospitals’ scores any measures for which they report fewer than 10 cases and will exclude from the VBP program any hospitals for which fewer than four of the 12 proposed clinical process measures apply. CMS will also exclude from the VBP program any hospital that reports fewer than 100 HCAHPS surveys during the performance period.

For the FY 2013 incentive payments, CMS proposes that it will use data associated with hospital discharges from the third and fourth quarters of 2011 and the first quarter of FY 2012, as the “performance period” for the proposed clinical process of care and HCAHPS measures. So starting July 1, 2011 and running to March 31, 2012, our scores for “Room and restroom always clean” will be very, very important. All your hard work improving your scores will now be validated.

A hospital’s performance on each measure during the performance period will be compared with a “baseline period” from July 1, 2009 to March 31, 2010. Whether the hospital receives a value-based incentive payment, and the amount of such payment, will be based on either how well the hospital performs on the specified quality measures during the performance period or how much the hospital’s performance improves on the quality measures from its performance during the baseline period. The higher a hospital’s achievement or improvement during the performance period, the higher the hospital’s value-based incentive payment.

Do you know what your HCAHPS scores were July 1, 2009 to March 31, 2010? If you have been tracking and working on your performance good for you. If not, well, I’m sure you will be now. You should already have a spreadsheet setup for doing your own comparison and tracking.

In upcoming posts I will be writing about steps you can take to improve your scores and staff performance. Go HCAHPS!

What is Clostridium difficile?

Clostridium difficile is a spore-forming, gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15-25% of all episodes of AAD.

Clostridium difficile is a bacterium that may develop due to the prolonged use of antibiotics during healthcare treatment. Clostridium difficile infections cause diarrhea and more serious intestinal conditions such as colitis. The CDC provides guidelines and tools to the healthcare community to help end clostridium difficile infections and resources to help the public understand these infections and take measures to safeguard their own health when possible.

C. difficile is an anaerobic, gram-positive bacterium. Normally fastidious in its vegetative state, it is capable of sporulating when environmental conditions no longer support its continued growth. The capacity to form spores enables the organism to persist in the environment (e.g., in soil and on dry surfaces) for extended periods of time. Environmental contamination by this microorganism is well known, especially in places where fecal contamination may occur. The environment (especially housekeeping surfaces) rarely serves as a direct source of infection for patients. However, direct exposure to contaminated patient-care items (e.g., rectal thermometers) and high-touch surfaces in patients’ bathrooms (e.g., light switches) have been implicated as sources of infection.

How is Clostridium difficile transmitted?

Clostridium difficile is shed in feces. Any surface, device, or material (e.g., commodes, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the Clostridium difficile spores. Clostridium difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item.

Transfer of the pathogen to the patient via the hands of health-care workers is thought to be the most likely mechanism of exposure. Standard isolation techniques intended to minimize enteric contamination of patients, health-care–workers’ hands, patient-care items, and environmental surfaces have been published. Hand washing remains the most effective means of reducing hand contamination. Proper use of gloves is an ancillary measure that helps to further minimize transfer of these pathogens from one surface to another.

What can I use to clean and disinfect surfaces and devices to help control Clostridium difficile?

Surfaces should be kept clean, and body substance spills should be managed promptly as outlined in CDC’s "Guidelines for Environmental Infection Control in Health-Care Facilities." Adobe PDF file [PDF 1.4 MB] Routine cleaning should be performed prior to disinfection. EPA-registered disinfectants with a sporicidal claim have been used with success for environmental surface disinfection in those patient-care areas where surveillance and epidemiology indicate ongoing transmission of Clostridium difficile. It is important to distinguish the need for a disinfectant with a sporicidal claim. Currently only specific bleach containing products have this registration. Bleach harms surfaces and is hazardous to the user. Normally, HAI’s can often be controlled with good cleaning practices and a non bleach disinfectant.

The recommended approach to environmental infection control with respect to C. difficile is meticulous cleaning followed by disinfection using hypochlorite-based germicides as appropriate. I recommend using microfiber towels and an accelerated hydrogen peroxide based disinfectant. There are now a few products with a C.difficile claim. One I have tried is Dispatch wipes. I found the odor to be acceptable for most of my staff but the film left after using is a significant and required a second cleaning to remove it for an acceptable appearance.