Photo by Scott Miller

For the environmental services (ES) department at Bartlesville, Okla.-based Jane Phillips Medical Center/St. John Health System, part of Ascension, earning a well-deserved reputation for cleanliness has been a team effort.

The highly effective team-cleaning approach, fortified by a rigorous infection-control protocol, has resulted in steadily climbing HCAHPS scores and declining health care-associated infection rates. In 2017, the ES department’s HCAHPS score for cleanliness was 86.4 compared with the national average of 75 percent and the state average of 76. The department’s Clostridium difficile rate decreased from 5.19 in 2015 to 2.31 in 2017.

“Visitors from other states have commented on the cleanliness of our facility as well as the friendliness of our staff and their willingness to assist,” says Mike Hubler, director of the ES department, which has 49 employees from Touchpoint Support Services, Sandy Springs, Ga. “Our accrediting surveyors mention how well-kept our facility is and the great job we do here.”

Hubler attributes success not only to a commitment to cleaning, but also to an ongoing dedication to change. ES leaders continually strive to improve staff training, streamline cleaning processes and find better technology and cleaning products to raise the bar for cleanliness and patient satisfaction. ES staff work closely with other departments, including infection prevention (IP) and nursing, and leaders continually look for new opportunities to collaborate.

For these and a number of other accomplishments, Jane Phillips Medical Center has earned the Association for the Health Care Environment’s (AHE’s) 2018 ES Department of the Year Award in the 1-249 bed category. This award recognizes outstanding ES performance in a number of critical categories.

A team approach

Two years ago, Hubler, who has been at Jane Phillips for 22 years, implemented a new, two-person team-cleaning approach for the three main patient care floors with 57 patient rooms. The team enters each room three times daily, doing a full-room clean in the morning, returning for touch-ups in the afternoon and evening. When the staff member leaves, he or she tells the patient when to expect the next cleaning, engaging the patient in the process.

“Each shift talks about the next shift,” Hubler says. “They build each other up. They will say, ‘We are done here for today, but you will see a team member in the morning for a full-room clean.’”

Because the team dynamic is critical, Hubler works to find the right combination of personalities, along with the required cleaning expertise. “We identify key players with outgoing personalities who are very good with patients and who have a strong work ethic,” he says. “It’s very important to find the right people with the right personalities for the team to succeed.”

To keep things fresh, the two team members occasionally switch their cleaning duties. “Flipping the roles keeps the staff engaged in their jobs,” Hubler says.

While the model would be harder to implement in a larger facility, Hubler says it’s been highly effective in a smaller hospital like Jane Phillips.

“Team training has benefited our department and facility by helping to increase our HCAHPS scores,” Hubler says.

On-site learning lab

Along with a successful cleaning model, ES leaders have worked diligently to improve the cleaning process. In 2016, ES leaders created an on-site learning lab to train housekeepers in cleaning standards and processes in a mock patient-room setting.

After talking with administration, Hubler secured five patient rooms for the learning lab — each one with a different focus (e.g., picture-perfect room, isolation room, etc.). ES leaders take small groups of staff through each room, teaching the 10-step cleaning process and discussing standards, safety, value and goals. Staff are shown how to identify isolation rooms and use isolation personnel equipment. Supervisors use foam-back boards to illustrate various goals, standards and values, and discuss each process with employees.

“The sessions are highly interactive,” Hubler says. “For example, I will throw a value out and then ask someone to tell me in their own words what that value means to them and how that carries over to achieving our goals.”

Last is the “dot room,” a patient room that is the exact opposite of picture-perfect. The room is decorated with paper dots representing things that are wrong (e.g., bugs in the sink, trash on the floor, etc.), and two housekeepers are allowed 10 minutes to identify as many problems as possible, while the rest of the team watches. In the final part of the lab training, housekeepers perform a patient-room dismissal, concluding with a critique by their co-workers.

New employees are trained in the lab and current employees go through the process annually, Hubler says. Another benefit is that other departments, including nursing, are invited to view the lab training and offer input.

Safety culture

Along with being devoted to patients, ES leaders also look out for their own staff. The department has created what Hubler describes as a culture of safety, which is taught from Day 1.

“On the first day, we tell every employee that we want them to go home the same way they came in — injury-free,” Hubler says. In fact, that happened in 2017, when there were no recordable safety claims in the ES department for the entire year.

Safety is emphasized on a daily basis, beginning with a team huddle during both the morning and afternoon shifts. Hubler begins with a safety tip that offers helpful reminders. For example, he might discuss lifting techniques and the importance of lifting with the legs vs. the back. In addition, a safety committee meets once a month to discuss relevant issues and suggest improvements. ES encourages other employees to point out unsafe behavior and suggest new ideas for safety.

ES leaders also offer incentives for days without injury claims, including coupons for meals and drinks, and pizza parties to observe milestones without injuries. Another activity — safety Bingo — is extremely popular with employees. The game is played like regular Bingo, with the winner getting a $15 gift card. But when someone gets injured, the game is over. “We have been playing for two years, and the staff love it,” Hubler says.

Staying competitive

Along with rising HCAHPS scores, the ES department also reports healthy employee retention rates. In 2017, the department’s turnover rate was 21 percent, down from 34 percent in 2016.

While taking pride in having a successful year on a number of fronts, ES leaders don’t rest on their laurels. Staying competitive, creative and focused on the hospital’s core mission is critical to continued success, especially in a field that is changing as quickly as health care. HFM

Beth Burmahl is a freelance writer specializing in health care topics and based in Lisle, Ill.