About this series

This series of tutorial articles is a joint project of the Association for the Healthcare Environment and Health Facilities Management.

Today's health care environment is rapidly changing and requires leadership that is highly competent, extremely agile and well-connected to trending clinical practices, infection prevention research, labor-saving technology and effective influence techniques for staff engagement.


To help fulfill those requirements, hospital administrators are seeking a variety of knowledge, skills and abilities (KSAs) from their environmental services (ES) leaders. Reviewing these KSAs and exploring how they apply to the ES department can provide valuable insight to ES professionals.

Developing knowledge

Knowledge is a body of information typically obtained through classroom instruction, research or on-the-job training. For example, an ES director may possess the body of knowledge related to medical waste management technology that can be particularly valuable to the health care organization.

The knowledge typically required for a successful ES leader includes:

Human resources. ES leaders should have knowledge of human resource concepts, practices, policies and procedures, including interviewing, hiring, onboarding, training, competencies, payroll and timecard processing, performance management, employee relations, staff development and workplace safety.

Regulations. Knowledge of environment of care regulations and compliance requirements of various agencies and organizations also are important. These include, but are not limited to, the Centers for Disease Control and Prevention, the Environmental Protection Agency, the Joint Commission, the Food and Drug Administration, the Occupational Safety & Health Administration, the National Fire Protection Association (NFPA) and state departments of health. They also must understand the tools to monitor departmental activities to ensure consistent compliance with regulatory guidelines of these organizations. Knowledge of regulatory survey processes, periodic reporting procedures and records management requirements are particularly necessary.

Technology. This includes knowledge of ES processes and procedures that will result in a clean, safe and attractive medical campus; and knowledge of basic microbiology and chemistry, including the ability to understand infection prevention, product labeling, pH values and the effectiveness of chemical products to reduce health care-associated infections. Also important are knowledge of ES machinery and basic mechanical functions related to machines, including revolutions per minute, cubic feet per minute, utility consumption calculations and the ability to evaluate maintenance cost opportunities; and knowledge of medical waste management, including cradle-to-grave processes and sustainability solutions.

Design. ES leaders must possess knowledge of building products, including the materials, surfaces and equipment that meet regulatory standards for health care. They also should have the ability to discuss best options, return on investment (ROI) and maintenance costs of alternative options for new construction or remodeling. Knowledge of fabrics and textiles is important, including textile construction, NFPA fabric requirements for health care, and the equipment and techniques to process textiles to prevent infection and reduce skin damage to patients. Knowing how to read blueprints and understanding manufacturers' specifications for interior building surfaces and materials also are important.

Finance. It is key for ES leaders to know general accounting and budgeting principles as well as automated information systems for financial applications, quality improvement and records management.

Acquiring skills

Skills are measurable competencies that usually can be assessed or observed to determine the level of learning. For example, an ES director may have the skill to utilize Excel spreadsheets for accounting reports.

Instructional. ES leaders should demonstrate teaching skills as measured by the ability to relay new information to adult learners in a way that it makes a difference in their behavior. This includes learning assessments, lesson plan preparation, education calendars and presentation skills in the classroom environment. Demonstrating skills in developing others toward future success is important.

Information technology. Demonstrated personal computer skills and an intermediate skill level of Microsoft Office software applications should be exhibited. Database management skills and statistical reporting for quality measures, regulatory survey response and staff records also are valuable.

Accounting. ES leaders should demonstrate basic accounting skills: knowing how to prepare budgets and analyze variance reports so that labor, supply and equipment cost calculations can be made quickly and accurately to facilitate executive decisions and least-cost outcomes.

Communication. Communication skills required for ES leaders include the ability to create effective written correspondence and emails; articulate key ideas in verbal presentations; and create and respond to electronic documents effectively.

Organization. ES leaders should possess organizational skills, including the ability to triage service requests in sync with patient priorities and facility resources. The ability to encounter chaotic order in the current state, visualize a future state of order and cast an inspiring and compelling vision of that order to those under their supervision are key.

Enhancing abilities

Abilities are the behavioral competencies to apply both knowledge and skills to achieve a particular outcome. For example, an ES director could demonstrate ability by using his or her knowledge of medical waste equipment and his or her skill at accounting and Excel to create an ROI document to evaluate three options for a new medical waste treatment program at his or her hospital.

Perseverance. ES leaders should be able to demonstrate perseverance and patience in the face of criticism, accusations, diminished resources and increasing demands for service. The ability to analyze and solve problems, manage projects to desired outcomes, make administrative and procedural decisions and the ability to be patient with facility leaders, vendors and staff through learning opportunities and process transitions are important.

Collaboration. ES leaders must demonstrate teamwork and collaboration by working with other health care professionals to resolve regulatory compliance concerns, space utilization challenges, construction projects and service enhancement opportunities in a way that supports team-building among direct care and service departments.

Influence. The ability to inspire and influence is important for ES leaders. This includes leading a staff to perform repetitive service functions with consistent quality to achieve excellent patient care. The ability to inspire all facility employees, visitors and patients to care for the facility as if it were their home, including consideration for fellow staff and environmental resources, is key.

Compassion. ES leaders should be able to demonstrate compassion and caring for people who are ill and contribute to the healing environment with a servant heart. The ability to work in an environment around hazardous materials like blood, bodily fluids and medical waste products is important.

Ethics and character. The ability to demonstrate strong ethics and high moral character, to earn credibility by following policies and procedures at all times, to model professional behaviors and to inspire others to do the same even when nobody else is watching are extremely important.

Experience and education

For the developing health care ES leader, knowledge will come with service years in the field combined with classroom or virtual education provided by a professional organization such as the Association for the Healthcare Environment or a local college or university.

Skills such as those related to accounting or computing usually can be obtained at a local community college. Sometimes communication skills or teaching skills can be learned in speech classes or participation in professional organizations.

Key abilities typically are earned in leadership practice in both work and volunteer environments. Most of these abilities are tied to personal values, which are developed by health care ES leaders as they grow, learn and mature throughout their careers.

Cindy Paget, SPHR, CHESP, is human resource manager for St. Luke's Health System. She is based in McCall, Idaho, and can be contacted at pagetc@slhs.org.

Sidebar - Acquiring ES leadership training

Few people are born leaders. However, anyone can become one by developing and practicing leadership skills. That is why the Association for the Healthcare Environment (AHE) is so critical to the success of environmental services (ES) leaders. AHE offers resources to further develop and enhance the knowledge, skills and abilities of ES professionals.

A sampling of AHE's offerings includes:

• "Think Like a CFO: A Justification for Staffing" — an on-demand, 60-minute, pre-recorded program. Today's successful ES leaders must understand C-suite language. They should know how to land their plane on their chief financial officer's (CFO's) runway by demonstrating value and calculating return on investment. How can they accomplish this? This eye-opening presentation is filled with hard facts to help today's ES leaders communicate effectively with CFOs.

• "The EVS Leader: Surprising Truths about What the C-Suite Requires" — an on-demand, 60-minute, pre-recorded program. Leaders today want to influence strategic decisions in their organizations. They want to gain support for key capital and other expenditures. Yet, surprisingly, some ES leaders are not always able to secure an audience with members of the C-suite. This program explores strategies articulated by a panel of top health care executives and officers outlining how ES leaders can position themselves and their departments to get an audience with executive leadership and demonstrate their value to the organization.

• "Foundations for Success for Environmental Services Management" — a 10-week, online education program. To win in today's challenging job market, ES leaders must distinguish themselves from the competition. This program is particularly valuable for new ES managers or supervisors seeking to build their professional knowledge and develop critical skills.

The AHE has a comprehensive educational and developmental program targeting all levels of experience. For more information, visit www.ahe.org.