Many EVS directors have well-defined training programs in place for new technicians.

Photo courtesy of ServiceMaster Clean

The person who is cleaning the hospital restroom and patient room, polishing the floor or collecting the trash has a far greater responsibility than most people realize.

“We deal with life and death. What we don’t do could cost someone their life,” says Pam Toppel, CHESP, MT-CHEST, T-CSCT, regional manager for environmental services (EVS) at OSF HealthCare, based in Peoria, Ill., and president of the Association for the Health Care Environment (AHE).

EVS technicians are the first line of defense in a health care facility’s battle against infection. Failure to eliminate pathogens can lead to infectious outbreaks among patients, staff and guests. For people with compromised immune systems, a relatively minor illness can become a life-or-death matter, not to mention a significant liability issue for the hospital.

In recent years, the importance and reputation of the EVS profession has been elevated across most of the health care field. Administrators and clinical staff in particular have acknowledged that EVS plays a pivotal role in successful patient outcomes.

EVS managers have a seat at the leadership table in many health care organizations, and they should have a seat in the remaining organizations. Health care organizations also realize the important role the EVS team plays in patient experience, satisfaction scores, infection rates, safety and, ultimately, clinical outcomes.

Recruiting and developing

Despite the emerging role of EVS, some people within health care still view hospital cleaning as janitorial work. This inhibits many talented people from pursuing a career in health care EVS and denies them an opportunity for financial success and personal fulfillment.

To help combat this misperception among potential recruits, EVS leaders should stress the advantages of a hospital EVS position. Then, once a recruit is hired, they should be taught their important roles with thorough training. This recruiting and onboarding process centers on the following areas:

Career opportunities. Recruits need positive examples of their career opportunities to show them how far they may progress in the field. Toppel’s story provides one such example.

In high school, she considered careers in health care but felt she was too sensitive to work on the clinical side. “The thought of a patient possibly dying gave me great anxiety, but I wanted to help people and be involved in health care in some way.” She eventually took a job cleaning doctors’ offices. This was her foothold in health care.

After a short time, she transitioned to a new job, processing linen at a health care facility. She soon moved on to a full-time EVS position. Smart and conscientious, she was elevated to supervisor within six months. Later came a director’s job, then regional director for the Eastern Region of OSF Health Care in Bloomington, Ill.

Along the way, she accumulated accreditations, including Certified Health Care Environmental Services Professional (CHESP), Certified Health Care Environmental Services Technician Master Trainer (MT-CHEST) and Certified Surgical Cleaning Technician Trainer (T-CSCT).

Toppel’s accomplishments and leadership ability led her to being nominated to the AHE board and, ultimately, to a two-year term as president by her board peers.

“EVS is not just a job; it can be a career for anyone who is capable and motivated,” Toppel says. “We are an integral part of the health care field. I’ve worked hard, and I’ve had an amazing career.”

Aptitude and attitude. One of the challenges faced by EVS management is finding and onboarding entry-level staff. Some health care organizations face high turnover rates in their EVS departments, sometimes greater than 50% annually. Couple that with a historically low unemployment rate and there is a difficult staffing challenge.

Unless EVS is outsourced, the hospital’s human resources department must explore the usual channels for potential employees: online job sites and local job fairs. EVS leaders also may promote part-time staffers or rely on referrals from current staff. The educational qualifications for an entry-level technician are typically a high school diploma or GED certificate, and work experience is a plus. Far more important are the applicant’s character attributes.

“We do behavioral-based interviews,” Toppel explains. “We present situations and ask the candidate how they would react. We are looking for people who want to help others, people with honesty and integrity. People who have the desire and ability to learn. Plus, they must be patient-focused. A lot of potential candidates don’t realize how patient-focused the job is.”

Faye Washington is an EVS supervisor at a large children’s hospital. “It’s about caring,” she says when asked what she looks for in a technician. “Most of our patients are children, and your heart goes out to them,” she says. “We want to show them love. Keeping their room clean to promote a healing environment is what we do, and it’s part of their healing process.”

Aptitude is a requirement for EVS technicians, but attitude and service orientation are equally important. It is a service profession position with important health care responsibilities. Finding employees who understand the duality of the job is essential for building a competent staff.

Training ground. The training of new EVS technicians is not standardized across the health care field, but many EVS directors have well-defined training programs in place for new technicians.

It is important that technicians be taught both the “what” and the “why” of hospital cleaning. The “what” (approved cleaning methods) is important, but the “why” (infection prevention) is essential. The objective is not just a clean room but a pathogen-free room. This requires specialized tools and techniques. Trainees must be taught that their work can be lifesaving.

Paying meticulous attention to detail, and learning how to use products, equipment and protective gear are all vitally important. Likewise, trainees must learn how to communicate thoroughly and accurately with clinical staff.

EVS directors and outsourcing companies typically recommend a four- to six-week training period for new technicians. The first week will be a get-acquainted period where they learn the facility, meet the people they will interact with and get a general idea of what the job entails. They also should receive online and classroom training during the first several days.

For the next three to four weeks, they are placed under an experienced mentor who they will shadow, gradually taking on more cleaning responsibilities as they learn proper cleaning and disinfecting methods — the “what” of EVS. Through classroom and online sessions, they also will learn the science of infection control, which helps answer the “why” question. In weeks five to six, they are evaluated based on their work, and often there are written and oral exams to test the trainee’s knowledge retention.

As part of their training, new technicians should be taught how to properly interact with both patients and clinical staff. EVS staff interact with patients every day, so the department can have a real impact on patient experience and satisfaction. A technician should be able to succinctly and cordially explain why they are in the room and the importance of their task.

Furthermore, technicians must be able to interact with clinical staff to exchange important information that can affect outcomes. Communications skills can be almost as important for the technician as the physical skills of the job.

Career ladder. Infection prevention, knowledge of specialized cleaning techniques, service orientation, communications ability and learning the work culture are all necessary for the modern EVS technician. These skills are frequently being improved or modified through innovation in the field, which is why continuing education is essential for an organization to remain competitive, compliant, safe and healthy.

AHE plays an important role in ongoing training by promoting accreditations for various levels of learning in EVS. The first certification typically acquired is the CHEST. The program was developed by EVS subject matter experts and covers the EVS technicians’ usual tasks and accountabilities. Other designations include the CSCT program for surgical cleaning, the CHESP program for management and leadership, a Certificate of Mastery program for Infection Prevention (CMIP), and designations for training trainers and EVS strategic leadership.

“If someone wants to advance in this career, they need to demonstrate competency,” Toppel says. “AHE is committed to promoting across the profession. Accreditations provide an opportunity for employees to demonstrate competency, provide advancement and promote professionalism. They also help promote employee retention because accreditations give them a career pathway. Professional accreditation is good for the individual employee, the EVS department and the organization.”

Moving up the career ladder in EVS has financial benefits. Although salaries range widely depending on location, the average EVS technician will earn an annual salary of approximately $22,000 to $25,000, and supervisors will be in the $35,000-plus range, while managers can make $50,000 to $75,000. Moving further up the ladder, a director can earn six figures, depending on the level of responsibility. “Certification can add $10,000 to $20,000 to your salary,” Toppel adds.

Colleges are just beginning to provide programs for education in health care EVS. The Ohio State University recently began a three-year EVS certificate program. Toppel expects other universities to begin offering similar programs, as EVS careers are now available in many health care settings, including outpatient surgery centers, minor medical clinics, senior living facilities and even community centers.

Leadership. The performance and success of a health care EVS department cannot occur in a vacuum. There must be support and direction from EVS leadership and health care administrators. The leadership must provide a clear vision that creates a culture of service, safety and professionalism at every level. There also must be cooperation and respect among administration, clinical and EVS staff. The benefit of such a relationship goes far beyond a clean facility and is an essential step toward higher satisfaction scores, improved patient experience and profitability.

Some organizations choose to outsource EVS leadership to professional service providers. This is often due to a lack of competency or expertise. In any case, whether the EVS team is fully in-house or outsourced, organizational leadership must embrace EVS as an equal partner in its long-term success.

A savvy, dedicated EVS director sets the tone for the EVS staff. It’s important for the director to create upward mobility opportunities for those with ambition and leadership skills. This will help boost department morale and enhance professionalism.

Perhaps most importantly, leaders must emphasize the “why” in EVS and align it to the organization’s mission.

“I tell the younger technicians that the EVS department is absolutely essential to the success of the organization and its mission to heal our patients,” says Washington, who has spent three decades in EVS and has 30 people on her team. 

Washington is a role model for EVS leadership. She is a highly motivated professional who cares about the work and the patients, and she conveys her passion to those who work with her. She has the characteristics of the person managers look for when hiring for any EVS position at every level.

“I am always looking to hire potential leaders,” Toppel says. “A leader is accountable, someone who can take constructive comments and leverage them to improve; a person with integrity, passion and a strong work ethic.”

Making a difference

The importance of EVS is directly related to its responsibility: to eliminate pathogens and create a clean, safe and healing care environment. 

A new generation of EVS leaders may come through universities or other schools that teach EVS as a career. The financial and emotional rewards abound.

“Environmental services provides an amazing career opportunity,” Toppel says. “I love what I do. I love teaching, and I know that I have a positive impact on patient outcomes. Every day, I know we are making a difference.”