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From meeting HCAHPS standards for room cleanliness and noise to lowering operating expenses as part of a Lean initiative, environmental services (ES) professionals are facing significant challenges.

All ES professionals should have access to data related to their departments and the facilities they help to maintain. These data can help them provide the best outcomes for the patients they serve.

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Data collection may seem daunting, but the long-term rewards can be significant if the data are put to use.

Cleaning measures

The following measures will be useful in achieving high patient satisfaction scores on a consistent basis. ES professionals should remember to keep it simple. They should not allow the data collection process to be cumbersome.

Room cleanliness. An ES professional’s primary objective is to provide patients with a clean and safe healing environment and there are a number of tools that can be used to measure performance outcomes.

Overall success or failure often is measured by the HCAHPS room cleanliness score. This aggregate score indicates the department’s overall performance, but also can be broken down by unit or medical specialty.

ES professionals should drill down to analyze departmental performance at the supervisor and employee level. This not only helps to improve performance, but also instills a sense of ownership at the employee level. It also allows ES professionals to pinpoint areas of success or concern.

Lower cleanliness scores may indicate a need for further training of employees or more frequent inspections. Monthly training and educational meetings can be tailored to address any cleaning issues that are discovered.

Public recognition of a job well done rewards and motivates staff. Employees or units with high scores should be celebrated. Moreover, employees with high scores often have success tips they can share with their peers.

At the employee level, other tools also are available to measure performance success. All employee performances should be formally inspected at least twice a month to obtain quantifiable results.

These results then can be used to help coach the employee to improved performance. In addition, documented inspection results are critical if ES professionals are to provide each employee with a fair and accurate annual review.

There are a number of quantifiable performance measurement tools:

• Visual room inspections. Using a handheld iPad or iPhone checklist that can be downloaded to a personal computer provides an easy means of collecting, storing and collating data. The same checklist should be used for every room and employee to ensure the best measurable results. Typical checklists include dusting and a visual inspection of the patient bed, floors, highly touched surfaces, bathroom fixtures and windows.

The best grading scale is pass or fail. From the patient’s view, there is no in-between. The surface or fixture was or wasn’t clean. The results should be downloaded for further review, comparisons and tracking over time. By using a computer-based inspection system, ES professionals are able to track employee performance, develop improvement plans in areas with low performance scores and have a fair and accurate means of completing employee performance reviews.

• Surface testing results. Technical tools allow ES professionals to accurately measure the cleanliness of surfaces to ensure that they are free of any infection-inducing agent.  

Each month, ES professionals should test the most highly touched surfaces in patient rooms to determine the effectiveness of cleaning techniques and staff adherence to cleaning procedures. The number of rooms to test each month will depend on the number of patient rooms in the facility.

Enough room inspections should be completed to ensure that results are statistically significant. The Centers for Disease Control and Prevention has tools that can assist with the number of rooms and surfaces that should be tested each month. The results of these tests can be used for staff education and to help direct resources.

The goal is to ensure that all staff members effectively clean all the high-touch surfaces in all patient rooms. Successful cleaning procedures play a key role in minimizing health care-associated infections. Their importance cannot be minimized. Failure also can directly affect hospital Medicare reimbursements.

• Customer service. The patient is the ES department’s customer. If possible, ES professionals can develop and administer a hospitalwide customer service survey to determine how accessible, timely, accurate, friendly and efficient ES service is perceived by the patient.

Based on the initial survey, ES professionals can develop measurable improvement goals. Each supervisory staff member should complete at least five patient surveys each month to measure progress.

Room turnaround. Making sure that incoming patients have quick access to a clean patient room is essential. If the patient’s room is not ready when he or she arrives, it can create a poor first impression.

In cooperation with nursing and ES staff, ES professionals should develop specific turnaround times for staff to respond to STAT rooms, which are needed immediately. These times should include the ES department’s response time and overall cleaning time.

If ES professionals have access to discharge data, they can easily monitor and track each employee’s response times. This will ensure that every incoming patient has a clean room upon arrival. ES professionals should review staffing levels to ensure that they mesh with each medical unit’s discharge pattern. ES staff members play a key role in the patient’s hospital admission process and it is imperative that they are available when needed.

Supervisory performance. A key to a department’s success is the overall performance of managerial and front-line supervisory staff. Each month, every supervisor should have specific expectations and goals.

These expectations and goals can include:

• Employee inspections. ES professionals should complete at least two formal inspections of every employee's performance. This ties directly to room and facility cleanliness and is perhaps the most critical piece of data collected. Ignoring this step ultimately will be detrimental to any ES department. It is critical that inspections are done fairly and with buy-in from staff. This also encourages staff ownership of the quality of work they perform.

• Meetings with clinical staff. ES professionals may conduct a formal meeting with each medical unit nurse manager in the area covered by the supervisor. Each meeting should include the cleaner responsible for the area. The results of these monthly meetings then should be summarized and shared with all interested parties.

• Patient surveys. If possible, ES professionals should complete at least six customer service or patient surveys. Patient perceptions are a key component of any quality program. If patients don’t believe their rooms are being cleaned to their satisfaction, the department’s practices need to be evaluated. ES professionals should always take time to respond to patients’ concerns. There always is room for improvement.

• Staff meetings. Monthly formal staff meetings with all ES employees also may be conducted. It is an excellent idea to develop a departmental template for each supervisor so staff members are receiving the same information in a consistent manner.

• Effectiveness testing. It is important to complete all assigned testing of high-touch surfaces to assess staff effectiveness. While a visual inspection may be a good initial review, a thorough and scientific analysis of the surfaces being cleaned will reduce the chance of cross-infection.

• Restroom inspections. ES professionals should complete at least five formal and documented public restroom inspections each month. For many visitors and outpatients, their first impression of a facility may be the condition of the public restrooms. ES professionals should ensure that all public restrooms meet the highest standards.

• Turnaround goals. It’s important for ES professionals to meet or exceed all patient room discharge turnaround times. This should be a hospitalwide goal. Monitoring discharge turnaround times will help to ensure that no patient has to wait for a room. ES staff must be cognizant of the department’s cleaning time standards and understand that their timely response allows the hospital to admit all incoming patients.

• HCAHPS goals. Achieving or exceeding HCAHPS room cleanliness goals is a top priority. ES supervisors invariably will meet this goal if all other performance standards are met. HCAHPS scores customarily will be used to grade the ES department’s overall performance and will be a key component of the ES professional’s own performance.

Expenses. Every department has a finite budget. It is the ES professional’s responsibility to operate within these budgetary constraints. Each month, ES professionals should review all of their expenses.

ES professionals also should develop a simple spreadsheet that outlines their major expenses. If possible, they can join a peer group that allows them to compare expenses with other similar facilities. A common measure is total expense per 1,000 square feet cleaned.

Key expense indicators include:

• Overtime expense. This should be monitored because it is costly and often can be minimized through changes in the ES staffing model. Each month, ES professionals should review their overtime expenses and pinpoint where, when and why the overtime is occurring. For example, if an ES professional discovers that there is a high occurrence of overtime at shift change, this may indicate a need to alter staffing hours at that time of day.

• Overall labor expense. Labor costs typically exceed 90 percent of the department's total budget. It is imperative that total hours paid each month match budgeted hours. If total paid hours are under budget, it may indicate that vacant positions are not being filled in an efficient manner. This may require consultation with the hospital’s human resources department.

If labor expenses are high, ES professionals should review their paid hours by budgeted position. If certain positions are consistently working more than the hours for which that position is budgeted, it may indicate that staffing levels are incorrect. This type of information can be helpful when preparing the following year’s budget.

• Peer review. Peer group expense comparisons can be useful when validating annual budget requests. ES professionals will have a powerful persuasion tool by demonstrating that their budget requests are lower than the majority of their peers while still delivering high patient satisfaction scores.

Ownership in the process

It is critical that ES staff have ownership in the improvement process. Each month, supervisors should be provided with a breakdown of patient satisfaction scores and performance inspection results by patient unit along with scores from the previous months.

ES staff should develop and implement corrective action plans for each patient unit with an overall score lower than the goal. These corrective action plans should incorporate input from front-line ES staff, nursing unit managers and supervisory staff. Each month, the effectiveness of these plans should be reviewed.

Based on the follow-up patient satisfaction scores, these plans can be redefined, strengthened or dropped. Sharing and celebrating success stories will help achieve patient satisfaction goals.

Thomas A. Peck is an environmental services consultant based in Madison, Wis. He can be reached at