EVS in new health care environments

There are more than 40,000 outpatient clinics providing medical procedures, tests and services of all kinds across the country, according to a 2018 study on U.S. medical office buildings by real estate firm CBRE, Los Angeles. 

Many are affiliated with large health care systems that run multiple hospitals and sometimes dozens of off-site clinics. 

In some cases, a single environmental services (EVS) director is responsible for the cleanliness and disinfection of many new care facilities. The task can be monumental. 

“I was director of environmental services for a system that owned a 750-bed hospital, six acute care campuses, and 200 ancillary properties that included doctor’s offices, clinics and medical buildings,” says Mike Bailey, CHESP, MT-CHEST, MT-CSCT, now an EVS consultant based in Simpsonville, S.C. “At one time, I was either directly or indirectly responsible for dozens of janitorial vendors and the work of more than 500 people, not to mention the safety of thousands of patients and staff.” 

That sort of workload is not uncommon in EVS. The continuing transition to outpatient facilities often adds layers of responsibility to already stretched EVS professionals, so the ability to manage the workload becomes an essential part of the job. Looking at the issue practically can help EVS professionals organize and simplify the task. 

An evolution 

Why are health care systems dispersing care to satellite clinics rather than taking those services in house, as they used to? The reasons are both patient- and finance-driven. 

Patient wellness and satisfaction are critical success metrics for health care and hospital administrators. Everyone appreciates timely, high-quality health care that can be accomplished close to home. Not only are outpatient clinics typically more convenient for patients and accessible to doctors, the cost of the procedure is often less. 

Acute care hospitals are around-the-clock facilities with large staffs and many overhead expenses. Outpatient clinics in suburban locations require smaller staffs, less upkeep and have fewer related expenses. Plus, most of the procedures do not require an overnight stay, which significantly reduces patient costs. 

“The trend in health care is to move more services out of the hospital,” says Mike Lamoreaux, CHESP, T-CHEST, the environmental support services director for Intermountain Healthcare, which owns more than 20 hospitals and 170 clinics across several western states. “One of the benefits of outpatient clinics is they help lower the cost of health care but allow us to maintain a high level of infection prevention and patient care,” he says. 

Such an approach is common with health care systems across the country. Minimally invasive procedures and modern medical technologies such as laparoscopy and robotic surgery help make this possible. 

Further good news: New care facilities help lower costs for both patients and providers. They also enhance the patient experience through newer, more modern facilities and easier, more convenient access to surgeries and procedures. Health care providers also are responding to pressure from the Centers for Medicare & Medicaid Services (CMS), which has incentivized health care systems to achieve higher levels of patient satisfaction. 

Multiple challenges 

The growth in new care facilities, it seems, is occurring from multiple directions and providing multiple challenges for EVS professionals. Following are discussions of some of these challenges: 

Bandwidth. Reducing patient costs while enhancing care is a worthy goal, but what about the stress this puts on EVS? Building or acquiring new facilities 

often adds significant layers of responsibilities for EVS professionals. That’s true whether or not the hospital system increases the EVS budget or adds more staff. And sometimes they don’t. 

One EVS director contacted for this article related that in a previous job his employer added properties without consulting the EVS department. He recalled that when they purchased an existing facility, it created tons of work even before his company took possession of the building. 

First, there was research to do: square footage, types of surfaces, accessibility, assessing the existing cleaning contractor and so forth. 

If an organization chooses to change the cleaning contractor, that necessitates creating a scope-of-service plan, a request for proposals and initiating a bid process, which always includes tours by competing vendors. If it is determined the facility will be cleaned by the EVS team, then staffing, transportation and scheduling are issues that must be addressed. 

There are multiplication factors, too. EVS professionals are responsible for infection control at the facilities they already manage, plus regulation compliance, personnel issues, training, reporting and a dozen other duties. Additional facilities — perhaps many thousands of additional square feet and hundreds of new patients — multiply those duties. 

So, EVS professionals are left to figure out how to stretch their resources further — resources such as time, money and manpower — without sacrificing the mission of optimum patient outcomes. 

Training. When managing multiple new care facilities, diminishing quality is not an option; outpatient facilities must have the same level of environmental care as hospitals. 

“The challenge is to live within your means and not cut services,” according to Brad Winnie, MBA, CHESP, a director of operations and the current Association for the Health Care Environment (AHE) board president. 

Asked what advice he would have for EVS professionals faced with oversight of multiple facilities, he recommended one thing above all else: knowledge. 

“Infection prevention is the core professional work we do,” Winnie says. “You have to know the environmental services business; you have to know how to prevent infection. Patient safety is always the priority and the foundation of every decision, whether you manage one facility or many.” 

That’s simple advice but perhaps difficult to execute when faced with so many responsibilities. 

One would expect that most EVS professionals are knowledgeable about infection prevention, but when faced with cleaning multiple facilities, it’s essential to have great management and teaching skills, too. 

Teaching managers and technicians the “how and why” of infection prevention will allow them to work more effectively and independently. Likewise, good organizational structure and communication allow everyone to consistently do their best work. 

Good EVS professionals can spot potential in their employees. They should encourage managers and technicians to seek professional certifications. Programs like the Certification of Mastery in Infection Prevention for Environmental Services Professionals (CMIP) equip technicians to take leadership roles and greater responsibilities. It also will help them grow in their EVS careers. 

Finding and cultivating talent on an existing team can greatly relieve some of the stress EVS professionals may face when taking on new care facilities. 

Recruiting. If EVS professionals don’t have suitable candidates on their existing team, it may be necessary to recruit them. Finding great employees is not always easy, but there are resources that can help. 

“The AHE has an employment board, and we sometimes get new employees there,” Winnie says. “They already have an infection-prevention background, and they usually come in with a good level of knowledge.” 

Prequalified employees are not always available in a given area, but that does not mean the talent pool is dry. The recent COVID-19 pandemic spiked unemployment numbers across the country, making many intelligent, hardworking people available. Skillful employment screening can help EVS professionals locate them. 

When EVS professionals advertise openings on their teams, it’s very helpful to promote the upward mobility opportunities in EVS. What begins as a janitorial job can often lead to a high-paying, professional career. There are many examples of entry-level employees who, through training and certifications, have worked their way up the EVS ladder. 

Pam Toppel, CHEST, CHESP, T-CHEST, CMIP, TCSCT, is the eastern regional director for OSF Health Care in Bloomington, Ill. She began her career cleaning doctor’s offices. “EVS is not just a job; it can be a career for anyone who is capable and motivated,” Toppel says. 

The talent pool may not be as deep in a few months as the economy begins to recover from the coronavirus. Now is a great time to seek qualified new team members, if EVS professionals have the budget to do so. 

Outsourcing. Often, the simplest solution when taking on new care facilities is to hire a cleaning service to handle the new square footage. 

In some cases, a facility is purchased that already has a cleaning vendor doing excellent work. Careful examination of their protocol and interviews with their team will soon reveal if they are competent or not. 

If an EVS professional inherits a vendor that does not meet their standards and they can’t take on the new facility with their own staff, the EVS professional must find a capable new vendor. 

“It is extremely important to hire vendors that represent your values and your mission,” Lamoreaux says. “Patients typically don’t know that a cleaning company is not part of the clinic or hospital staff. When you hire vendors, you have to know that they are well-trained and very capable.” 

Lamoreaux mentioned several questions he would ask any company seeking his business: 

• Knowledge. Do they fully understand the regulations governing health care facilities including those of the CMS, Centers for Disease Control and Prevention, Occupational Safety and Health Administration and other regulatory bodies? 
• Training. Does their training resemble the training the EVS department provides its own staff? Do they fully understand and teach infection control? 
• Communication and reporting. What process do they have for internal quality control, and how well do they communicate with management? 
• Staffing. How do they fill staff openings? Where do they typically find employees? 
• Turnover rate. High turnover rates are not uncommon, but a very high rate is a red flag. 
• Compensation. What is the pay rate? What incentives and benefits do they provide? 

Reasonable answers to these questions will help EVS professionals find cleaning companies that are qualified to provide the quality of service to keep patients safe and satisfied. 

Budgeting. Much of the stress caused by adding new care facilities to the EVS agenda can be alleviated by adequate funding. With a bigger budget, EVS directors can staff up, hire new managers and supervisors, or bring in a qualified cleaning company to handle the new facilities. Sometimes these new care facilities come with additional budgets, but sometimes they do not. 

EVS budgeting shortfalls often occur when management does not consult EVS on expansion or acquisition decisions. 

“It’s a struggle when you are not involved in the purchase discussions,” Winnie says. “The decision-makers sometimes don’t consider all of the support functions like environmental services, operations, maintenance and so forth.” If EVS has a seat at the table, it’s more likely for the decision to include the needs of the support services. 

The prime objective of health care is healing, and that must be the North Star that guides decisions made by all providers, including EVS. Better planning, more training, greater efficiency and outsourcing when possible can help EVS professionals achieve their goal of infection prevention and a clean, safe and healthy facility. 

In general, EVS departments in many cases lack the funding and personnel to maintain appropriate levels of cleanliness. Therefore, it is imperative that EVS professionals seek the necessary funding to appropriately maintain the environment of care. 

Added pressure 

The growth of outpatient clinics is not likely to end anytime soon. Market pressures encourage new care facilities and acquisitions. The added pressure on EVS will be there every time a system buys or builds a new care facility. 

Failure to address the additional needs of EVS departments can have a negative effect on performance, and diminished EVS capability may impact patient outcomes and satisfaction. Most hospital administrators know this and adjust budgets accordingly. 

In health care organizations, the bottom line is never financial; it is always patient safety and wellness. If this is considered at the outset of expansion talks, EVS will likely have the resources it needs to do the job. 

---

Steve Zimmerman, CHESP, T-CSCT, is the director of health care services for ServiceMaster Clean. He has experience as an EVS director and consultant in health care facilities across the country. He also co-chaired the AHE’s advisory council, and was a member of the conference planning and industry advisory team. He can be reached at szimmerman@smclean.com.