One opportunity for EVS professionals to excel is by leading the standardization of consumables, such as textiles, across care settings.

Photo from Getty Images by Antonio Diaz

Change and innovation have been at the top of health care’s “pay attention” list for quite a while.

Mergers and acquisitions; partnerships and nontraditional players; non-acute care players with thousands of retail locations and loyalty programs partnering with insurance companies; and growing consumer demand for price transparency are changing how health care operates.

Couple that activity with major e-commerce players with a wealth of knowledge in product delivery and customer experience, and it is a recipe for unprecedented changes related to value, cost, experience and convenience.

It was only a matter of time before the services that support care delivery would be dramatically altered. And it doesn’t appear to be letting up any time soon.

Embracing change

In the early 1990s, health care professionals thought consolidations and changes due to managed care and capitation were painful. An Association for the Health Care Environment (AHE) survey back then received a response from one AHE member who said, “Just make the pain stop!” That phase and comment pales in comparison to the speed and nature of the change and pain now.


There are many questions facility professionals can ask themselves: Are they ahead of and anticipating the changes? Are they scaling and adjusting their departmental business models for the shift from acute care to outpatient care? What does it look like? Are they competitive with current service offerings for non-acute settings, and are the competencies in alignment with needs? Have they been thinking about the role they will play as outpatient surgeries increase, or are they leaving that to contractors without expert oversight? What are they doing to facilitate a proper care environment for home care? Are they riding the waves and allowing change to happen versus influencing change?

When asking professionals from various health care disciplines about how they are adjusting to shifts to outpatient care and how they are reinventing themselves and the department to remain valuable to their organizations, the responses are usually very similar: “Our census is actually up,” “We have been on diversion for weeks,” “We aren’t seeing that kind of change in our area,” “The only changes are more requests to decrease staff while maintaining the service standard” and “I’m busier than I have ever been filling gaps.”

It sounds encouraging until one sees another article about change, the need for faster innovation, artificial intelligence, robotics, telehealth or consolidation and one realizes that many of these professionals are busy filling gaps yet losing sight of the pressing need to embrace and lead meaningful change.

That needs to be corrected. Management skills can be taught and, in time and with the proper coaching, a protégé can manage a department, people, budget and environmental services (EVS) program. What the profession needs right now are bold, courageous leaders with a vision and a passion for taking the profession to the next level.

Managers vs. leaders

Confusion remains about management versus leadership. Not long ago, AHE distributed a division-level survey to gather input on topic preferences for leadership education. Surprisingly, there was a marked absence of actual leadership topics. Responses were all about running the business, staffing models, budgets, understanding chemicals and managing a multigenerational workforce.

So, if a vast array of professionals across multiple disciplines are unsure of the difference between management and leadership, how are professionals to survive what lies ahead? How can they influence executives to make strategic decisions that make sense if they aren’t at the table or demonstrating they can lead change in their corner of the continuum?

Health care needs both managers and leaders, and, yes, there is a bit of overlap between the two. But if professionals are spending more time managing and not analyzing the current business model to explore what can be done to expand the level of services across all care settings at the lowest cost, someone else will take on that task, and the manager will become irrelevant.

If professionals are managing more than leading, being blindsided is just around the corner. They must ensure someone on the team can oversee operations so they have time to be strategic, innovative thinkers. Professionals all move between leading and managing for various reasons, but usually it’s because managing is more comfortable. Solutions are easier to find when professionals are managing the familiar. When they’re leading, they are taking calculated risks and being proactive.

In August 2013, Harvard Business Review made a very clear distinction, stating, “Management consists of controlling a group or a set of entities to accomplish a goal. Leadership refers to an individual’s ability to influence, motivate and enable others to contribute toward organizational success. Influence and inspiration separate leaders from managers, not power and control.” The nuggets from that article centered on contributing toward organizational success and motivating others.

The health care field needs great leaders to prepare, influence and motivate good managers to change the way an organization is run. The traditional model of running a department for one acute care facility is over, and organizations need coaching and leadership. System directors are looking for regional leaders to help make tough decisions on product standardization, people and service lines for acute and ambulatory care as well as ambulatory surgery, physician offices and home care. They also need professionals who can lead a team to being more operationally efficient.

EVS leadership areas

Speaking strictly for EVS, there are a few key leadership areas to immediately consider, some of which are applicable across multiple disciplines:

Taking a programmatic approach. There are nearly 80 current studies in support of a strong EVS/hygiene and quality monitoring program. An organization’s infection preventionist or epidemiologist can run a literature search to help build a strong business case for standardized training, education, processes and products across all care settings. A strong, consistent, evidence-based program facilitates all wheels spinning in the same direction. This drives efficiency, efficacy and cost savings over the long haul. EVS leaders should make the time to read the studies and build the case.

Leading the standardization of consumables across settings. Fewer product lines bought in volume drives pricing down. This includes trash liners, paper products, disinfectants, floor care products, hand-hygiene products, microfiber cloths, textiles, equipment and rentals. Sounds logical, right? But who is leading the exploratory committee and the investigative work on annual savings while leading the efforts to get everyone on board to give up their preferred products? Who is leading the frontline staff buy-in and final rollout of product changes? If EVS professionals are busy managing, they can’t lead these efforts.

Branding across facilities in the network or system. What’s the EVS mission and brand, and is it known across the network or system by patients and staff, including clinicians? Trusted, recognized brands perform better even if the cost is a bit higher. Brand ambassadors are the backbone of a successful program and partners in something bigger. As systems grow larger, serving more diverse populations over wider geographies, the brand recognition for EVS as a partner is paramount. EVS professionals must lead the branding efforts away from housekeeping and to a mission with systemic outcomes.

Engaging staff members. Happy, engaged partners equals improved retention. A well-trained, empowered staff provided with tools for success perform better and have little incentive to leave. Pay increases alone will not retain employees. Gallup Inc.’s State of the American Workplace reports that establishing, modeling and expecting a standard partner behavior is a culture. An organization’s culture fosters a loyalty to the departmental and organizational mission. Positive culture is the first step to creating brand ambassadors. 

The glue that holds the strategic objectives of the employee and the business together is frequent, effective communication that reaches and informs the employee at their level and where they perform their work. 

According to a 2018 Deloitte study, the cost to replace an employee is over $7,000. The average annual EVS turnover currently sits at 18 percent; the highest rate noted since 2005, according to AHE trend data. So, depending on the size of the department, that is considerable lost productivity, loss of brand equity, resources and consistency of service.

Bringing high standards to alternative care sites. Outpatient facilities, physician offices, clinics and surgery centers need the same programmatic EVS response to quality infection prevention and patient experience as acute care, and that demand is growing exponentially. The staff or contractors performing the cleaning, disinfecting, waste removal and supply movement need to be as qualified as the acute care team. The competencies for contracting must be written by an EVS leader consistent with the same standard as acute care.

Improving supply movement efficiencies. Supply movement throughout the hospital, the network and the system is very costly. Awareness of the inefficiencies is the first step to discovering what needs to be done to wring the costs out of movement. Professionals should study the people-hours expended to move products from point of delivery to end users and how many times the same materials are touched and moved by the EVS team and others. Paying attention to the inefficiencies in internal supply distribution will provide numerous opportunities to innovate solutions to move what is needed to the bedside or the point of service. The upfront costs to implement a more labor-saving solution will help redistribute people where the greatest needs are.

Planning for home health care. Is there an EVS leader on the discharge team or one that has developed an environmental hygiene checklist for patients discharged after surgery for continued home care? That checklist can make the difference in preventing a post-discharge infection and prevent a readmission. 

Readily available

While this is not an exhaustive list of EVS leadership opportunities in a rapidly changing health care environment, it is a list of opportunities that are readily available for EVS leaders to be the extraordinary, recognized authorities for establishing a systemic, programmatic response that drives excellence for the organization and the EVS brand. 

Patti Costello is executive director of the Association for the Health Care Environment and contributing editor to Health Facilities Management. She can be reached at