When Eva L. North talks about how the environmental services (ES) staff and the patients at the Department of Veterans Affairs Tennessee Valley Healthcare System (VA TVHS) are like family, she speaks with authority. That comes from a unique loyalty that exists among U.S. military veterans that she knows from personal experience.
North's philosophy of "veterans serving veterans" is more than a slogan to encourage hard work. Empathy for fellow vets plus teamwork, continual training and employee recognition are what make the ES staff at the hospital stand out. North's leadership as chief, environmental management service, has a lot to do with that too.
Those factors are key among how and why the ES at VA TVHS is regularly recognized by its management and why its ES team has been awarded the 2009 Environmental Services Department of the Year. The award, now in its third year, was created by Health Facilities Management and the American Society for Healthcare Environmental Services (ASHES) and is sponsored by Cintas Corp. The award recognizes outstanding achievements in 13 critical areas of ES performance.
North is understandably proud of her full-time staff of 183 veterans, including some who were homeless or rebounding from substance abuse.
"We've got a great team; that's how we get everything done. It is a really close-knit team," North says. Indeed, it takes a great team and strong leadership to keep an estimated 1.8 million square feet of cleanable space at two major medical centers—one in Nashville, Tenn., and a second in Murfreesboro, Tenn.—in top shape, in addition to a host of other tasks.
But that's fine with North. She's a competitive type who not only loves a challenge but also has both the military and the VA in her blood. She retired in March from the U.S. Army Reserve after 32 years— finishing her career as a Sgt. Major E9— and has 35 years of service with the VA under her belt, including the last 22 in ES.
"I'm really proud of the fact that we are veterans serving veterans; it's almost like you're family," North says about her ES staff. "We take care of each other. I think there is a willingness to work harder because the ES staff is made up of vets and the patients are vets."
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Sean Stephens, site manager, and Eva North, chief of environmental services. |
Patti Costello, executive director of ASHES, says VA TVHS' winning entry speaks to the quality and range of work they do. The VA staff exemplifies ES departments everywhere as the "unsung heroes of every hospital who grind it out day in and day out with limited resources and help," she adds.
"This entry really demonstrated the diversity of activities within ES," Costello says. "ES is everything from soup to nuts. People tend to think it's just about housecleaning. [But] they are immersed in hand hygiene. They are immersed in the time it takes to turn a patient room. They are immersed in reduction of medical waste," she says. In addition, VA TVHS' ES department joined the VA's effort to help veterans re-engage in civilian life.
VA TVHS is an integrated health care system composed of two medical centers—the Alvin C. York campus in Murfreesboro and the Nashville campus—and several community-based outpatient clinics throughout the state. North splits her time between the two medical centers. (While the outpatient clinics are part of North's responsibility, the ES work there is contracted out by the building owners, she says.)
VA TVHS provides ambulatory care, primary care and secondary care in acute medicine and surgery, specialized tertiary care, transplant services, spinal cord injury, outpatient care and a full range of extended care and mental health services. The Nashville campus is the only VA facility that supports all solid-organ transplant programs, including total in-house kidney and bone marrow transplants. The York campus is a network referral center for mental health services, geriatrics and extended care. VA TVHS also provides a full range of specialized medical services.
While the esprit de corps among staff is critical in maintaining high employee and customer job satisfaction, North knows that at the end of the day it's all about achieving results in their primary duties of providing a clean and safe environment for patients, visitors and staff. That's where North's emphasis on continuous training, especially for customer service, effective communication and skilled, efficient work make a big difference. She includes herself in that regimen, too.
Joining the MRSA fight
For example, when the national VA department instituted a zero methicillin-resistant Staphylococcus aureus (MRSA) initiative for all its U.S. medical centers about five years ago, North attended training from national MRSA teams and served on the MRSA task force at VA TVHS along with the infection control practitioners. The task force developed protocols utilized by hospital staff and ES that resulted in a significant decrease in the MRSA infection rate—from 0.82 per 1,000 bed days in FY06 to 0.19 per 1,000 bed days in FY08, North says.
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Melvin Caruthers, housekeeping aid, cleans a surgical intensive care room using a microfiber cleaning system. |
Key prevention measures developed by the MRSA task force include the use of intensified hand hygiene practices by ES and all staff. More thorough monitoring of hand hygiene resulted in an increase from 75 percent to 100 percent compliance by ES staff over a three-month period. Use of protective gowns, gloves and, when necessary, masks and foot covers by the ES staff is part of the new zero-MRSA protocol.
Also, ES utilizes high-touch wipe- down procedures in daily cleaning, and terminal cleaning includes removal and cleaning of cubicle curtains, North says. Isolation door signs used in rooms with MRSA patients remain on the door until ES takes the sign to the charge nurse or nurse manager so they know to inspect the room upon patient discharge.
The two medical centers also have a rapid deployment team that responds to calls of Clostridium difficile (C. diff). The infection control practitioner notifies North when there is a case of C. diff and she deploys a supervisor and staff to clean the room immediately. Wipe downs of high-touch areas are intensified and bleach is utilized in a 1:10 ratio with water, which allows the staff to reduce the use of chlorine as much as possible, North says. There have been no C. diff outbreaks in her five-year tenure at VA TVHS.
She is a strong proponent of the use of microfiber cleaning products (one mop and cleaning cloth per room is the rule she introduced).
As for productivity, the ES staff has made dramatic improvements in bed flow. A computerized room-tracking system developed by the national VA, a team effort involving other hospital staff and the use of digital pagers by ES have led to quicker room turnaround times compared with a few years ago.
North says when ES started collecting data about a year ago, the average bed flow was typically anywhere from 90 minutes to two hours from the time of notification that a patient was discharged to when the room was cleaned and prepped for a new patient. Today, it's about 60 minutes on average. The reduced time puts the ES staff near the national average best practice standard, she says.
The improved turnaround time is largely the result of improved communication using the VA's computerized bed tracking system, or "bed board." The system allows bed-flow team members—ward clerks, nurse coordinators and others—to update patient room status on the bed board.
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Kathy Brewster, patient flow coordinator, and Sean Stephens, site manager, check the bed-flow tracking system. |
The information can be accessed by ES supervisors at their site stations and by ES staff who can check computer monitors located throughout the hospital wards. Computer training offered by the VA has contributed greatly to ES understanding of the system, North says.
She credits the ward clerks, nurse coordinators and her site manager, Sean Stephens, for making the system work smoothly and for training staff. The staff turns over about 1,000 beds a month, sometimes 30 to 40 simultaneously.
The ES staff also has achieved dramatic reduction in medical waste and other materials over the past few years due in large part to North's leadership and the start of the Green Environmental Management System (GEMS) program. Working closely with program coordinators, North trained staff to step up the recycling of cardboard, paper, medical waste, and metal and construction materials, with impressive results and savings.
Increased recycling including construction materials reduced waste costs from about $150,000 in FY05 to $93,000 in FY08, North says. Implementation of a sharps recycling program and greater segregation of medical waste has decreased medical waste costs from $87,000 in FY05 to $77,000 in FY08. VA TVHS recycled/shredded 619,000 pounds of regular and confidential paper, further diverting costs and weight from solid waste disposal. Cardboard recycling netted $10,000 in revenue over the past several years. North's green efforts did not go unnoticed. Last year she received the Environmental Stewardship Award from ASHES for expanding the recycling program.
North knows that recognition is not a one-way street, especially if you want to boost staff morale and job satisfaction. She instituted an employee recognition program in which staff recommends fellow staff members. Top management honors employees with "Star" awards and North gives bonuses to those in ES who have been singled out by management.
The recognition program had the intended impact. An employee survey showed that the ES staff rank at or above the Veterans Health Administration's national average in overall job satisfaction and in other work-related categories. The fact that 96 percent of patients surveyed rate overall cleanliness of their rooms and the hospital in general as good or excellent, which is up more than 10 points from five years ago, has a positive impact, too. North shares that information with the staff so they know that their hard work is appreciated.
North tries to promote from within her department as much as possible, which serves as another source of motivation for staff.
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Tom Phillips, housekeeping aid, at work in the sharps container truck at the Veterans Affairs Tennessee Valley Healthcare System. |
It's no surprise that ASHES gave North the Employee Recognition Award last year for her role in the program, making her a double award winner along with the launch of the environmental program.
She enjoys the recognition, but seeing the ES staff succeed and improve their lives gives her deep satisfaction. The VA's Compensative Work Therapy Program is particularly close to her heart. In the program North hires veterans who are homeless or have a substance abuse or alcohol problem for which they have been in rehab. They are hired on a temporary basis with the chance to become a full-time permanent employee of the staff.
"It's my favorite program of all. When someone who's been here 12 years comes up to me and says, Miss North, I just bought a house,' I'm in tears. That's the best part when someone gets hired and gets their life together and they're not homeless anymore and they say they bought a new home. It makes me happy," she says as she chokes up.
North points out that none of what ES accomplishes is possible without supportive management. She is quick to praise Juan Morales, director of the medical center, for his ongoing financial and moral support of ES and their efforts.
She also notes the support of Emma Metcalf and Gary Trende, chief operating officers; Janice Cobb, associate director of nursing; and Joyce Jones, interim chief of staff. "Without them I can't do what I do to make this place excellent," she says.
Morales has similar admiration for North. "She is always looking at ways to improve services, looking at new products and new ways of making the job easier for her employees," he says.
| Sidebar - All Children's builds strength through diversity | ||
Sometimes a little creativity makes all the difference in solving problems. When All Children's Hospital's environmental services (ES) department purchased two riding floor scrubber machines a couple of years ago, they didn't get much use at first. Because their noise and size at times frightened some of the younger patients, nurses would discourage ES staff from using the machines. Michael Dansberger, the director of ES at All Children's, had an idea. Why not paint the machines in a kid-friendly way? So a local artist came in, donated her time and materials, and turned two menacing-looking pieces of machinery into "cars" patterned after the cartoon characters from the children's movie of the same name. Problem solved. Instead of being afraid of the floor cleaning equipment, children now clamor to ride the machines and tell their parents about it, Dansberger says. Innovative solutions like the one cited above and plenty of hard work by a diverse staff enabled All Children's ES department to exceed every goal it set in productivity, customer satisfaction and infection control in 2008. It also earned them the title of runner-up in the 2009 Environmental Services Department of the Year competition. The hospital hired Sodexo Worldwide Inc., a Gaithersburg, Md.-based facility management company, about four years ago to provide ES at the 219-bed pediatric facility, which is located in St. Petersburg, Fla. Patients range in age from newborn to 18 years old. The Sodexo-employed Dansberger, who came on board at All Children's about two and half years ago, says that while the 83-member ES department had an excellent year in 2008, a couple of achievements in particular stand out. One was a reduction in bed turnaround times, which Dansberger says was a major iniÂtiative identified by All Children's through a collaboration with the Child Health Corp. of America (CHCA), a group of children's hospitals across the United States. Over a 14-month period from August 2007 through December 2008, the ES team reduced the average turnaround time from about 90 minutes to 43 minutes, Dansberger says. Several steps were taken to achieve the reduction. Increased communication among the different disciplines, including case management, the clinical staff, ES and others, contributed to the drastically reduced turnaround time. Another key step involved predicting patient discharge 48 hours out so that staffing levels could be adjusted to handle the workload. Customer satisfaction also has risen dramatically. For two years in a row, the key user satisfaction survey done by each department head in the hospital has resulted in 100 percent satisfaction with ES services. That's a jump of 24 percent over the three prior years, Dansberger says. Recognition of excellent work has paid dividends too. Two years ago Dansberger and the ES department launched a Shining Star of the Month program to honor special effort by employees in ES. Dansberger's team also contributed to impressive infection prevention efforts over the past couple years. An intensified cleaning regimen by staff coupled with the use of microfiber products was critical in reducing the number of infections, including mostly rotavirus but also Clostridium difficile and vancomycin-resistant enterococcus (VRE). The number dropped from 500 in 2006 to only 20 last year. Dansberger is also proud of the fact that the retention rate of employees in ES has improved over the past couple years. Three weeks of comprehensive on-the-job training with a manager coupled with a thorough understanding of what is expected of ES staff before they are hired have reduced turnover, he says. "We believe that every candidate is fully informed of our process and what we do here," Dansberger says. "It seems to create a very good buzz among the newly hired employees." In addition, Dansberger uses an employee software program called Trakkar to keep tabs on employee progress, successes and areas for improvement as they occur. The possible need for additional training or retraining for an employee is viewed as an opportunity to solve a problem before it grows, he says. Finding qualified employees is always a challenge but his decision to seek candidates through local churches and service organizations that work with refugees from other countries has been a blessing, Dansberger says. "I would say that the diversity that we find in our staff is reflective of the diversity we find in this area," he says. The ES department includes Hispanics, Eastern Europeans, Haitians and Filipinos among its ranks. Asked how everyone gets along in a group that varied, he notes that they put any racial or political differences aside and unite in the common cause of providing excellent service to the patients and customers at All Children's. And the proof is in the results. |
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RUNNER UP JUDGES John Scherberger, CHESP, director of environmental services, Spartanburg Hospital for Restorative Care, Spartanburg, S.C. Joan Blanchard, R.N., M.S.S., C.I.C, perioperative nursing specialist, Center for Nursing Practice, AORN, Denver Bob Paine, consultant, Casey Management Services, Marlborough, Mass. SPONSORS |
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Jeff Ferenc is a freelance health care writer based in Lombard, Ill. |
This article first appeared in the September 2009 issue of HFM.
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