Environmental Services

Tech talk

New tools and devices for ES operations
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In any environmental services (ES) department, a critical component to achieving consistent service excellence is the department's quality assurance program, which will dictate the department's specific standards of cleanliness.

Today, ES managers have many new tools and devices that can be used to improve the quality of services delivered to patients. To remain competitive and provide excellent service, ES managers must take advantage of these new developments.

Today's technology

There are many instances of ES managers using today's technology to maintain excellent and consistent quality of services within their departments. Some examples include:

Simulation training. The ES department must provide new employees with skills and competencies required to perform tasks efficiently, safely and competently. It also is critically important to keep all ES staff up to date on current issues and areas of concern. Additionally, specialized training often is required to respond to changing patient and customer requirements.

The ES department at the University of Wisconsin Hospital and Clinics, Madison, has partnered with the UW Health Clinical Simulation Center to use this technology to better train new and existing ES staff. The department now conducts monthly sessions during which ES staff complete simulated patient room discharges and daily patient room exercises that review the cleaning of high-touch surfaces, discharge cleaning and patient interaction and communication.

Following an invitation letter from the ES department's training supervisors, staff complete the assigned simulation in the simulation center. Prior to the simulation exercise, both the facilitator and the trainee are given copies of the simulation exercise to be completed. Exercises have included such areas as patient discharge cleaning, the importance of cleaning highly touched surfaces and communications with the patient. The ES department also uses the simulation center to review new employees' retention of what they have learned during their first 12 weeks of employment.

The entire simulation is filmed by a member of the simulation center team and these videos are made available on their Web page for review by the employee, the trainer and the supervisor. As soon as filming is completed, the employee discusses the process with the training supervisor. Employees are encouraged to ask questions and provide suggestions. A debriefing also is conducted with each employee to garner suggestions and improve the process.

Within a week of filming, the employee's immediate supervisor will review the film and compare the employee's cleaning against the ES department's discharge cleaning standards. The supervisor will review the film with the employee and determine what areas still need review or practice. When the employee has demonstrated competence in all areas of discharge cleaning, he or she is presented a certificate of competency by the supervisor at a formal staff meeting.

Pulsed UV light technology. All ES departments are charged with providing a clean and safe healing environment for patients. This is now being brought even more to the forefront with new Medicare Guidelines in which health care-associated infections will reduce a hospital's Medicare reimbursements.

In 2011, UW Hospital and Clinics' ES department began testing the effectiveness of pulsed ultraviolet (UV) light technology as a means of reducing health care-associated infections and the incidence of Clostridium difficile infections. The physician leader for infection control and the ES director worked collaboratively to develop the testing and usage protocols for the new technology.

The basis of this new technology is that it produces UV-C light, which fuses the DNA of organisms, causing them to die instantly or become unable to reproduce. The technology is effective for all organisms and can be used safely by ES staff.

The UW ES staff now are using the UV light technology after every discharge on four patient units identified with high rates of C. difficile. The technology is being used on average in 750 discharges each month. The use of the technology is shared with patients so they know they are getting the most up-to-date care from the ES department. The ES staff also feel empowered because they have a powerful tool they can use to combat health care-associated infections.

About this series

This series of tutorial articles is a joint project of the American Society for Healthcare Engineering and Health Facilities Management.

The ES director provides the hospital's infection control committee with a monthly update on the use and results of the technology. Early results have demonstrated decreases in C. difficile rates on the four patient units where it is used. Suggestions already have been made to make this new technology part of all patient room redesign plans.

PC and Web-based inspection systems. Inspection reports are designed to document the quality of cleaning in areas under the supervisor's authority. This forms a basis for problem-solving with the employees who are working in the area. The front-line supervisor's main purpose is to provide direction and support to the staff to assure that all job responsibilities are carried out as planned. For an ES supervisor, this direction and support includes making frequent tours to ensure that work is completed correctly.

The supervisory staff in UW Hospital and Clinics' ES department use iPads or iPod Touches as part of their room inspection process. The devices allow supervisors to input and review data from a computer-based room inspection system. Upon completion, inspection results are uploaded to a central website that can be accessed 24/7 by any member of the management or supervisory team. Moreover, the department director can download all inspection results and review trends and problem areas.

Reports are generated by area, supervisor, employee, type of room and shift. This allows the ES department to analyze critical results and focus resources as dictated by the results. Immediate feedback and response are now readily available and utilized. All supervisory staff receive specific goals for completing inspections. Employee inspections are a key element of the department's quality assurance program and part of each employee's performance evaluation.

The cost of this technology is slight when compared with the department's total budget, but the payback has been tremendous. The department can provide staff with instant feedback on the quality of their work and track performance by the individual and by the department. This has allowed UW's ES department to better focus its resources in areas of need or concern.

Surface testing. There are a number of products on the market that allow ES leaders to accurately test and monitor the effectiveness of their staff's cleaning. UW Hospital and Clinics' ES department uses a fluorescent marking gel process to test staff effectiveness in cleaning the top 17 highly touched surfaces in the patient room and the patient bathroom. Each month, at least four patient rooms and four patient bathrooms are tested on 13 different patient units, for a total of 52 rooms. Each quarter, all patient units at the main hospital as well as the children's hospital are tested. The number of rooms far exceeds the Centers for Disease Control and Prevention's recommendations.

The test results are shared immediately with the area cleaner and used as a teaching tool. Results can be compiled and reported in a number of ways. Some reporting examples include summaries by employee, room type, floor, supervisor, surface type and time periods. Since implementing this testing system, staff improvement has been very impressive, with scores averaging in the mid-90s.

Immediate and visual feedback has been very beneficial to staff. The results also are shared with the infection control department to find correlations between ES staff cleaning effectiveness and rates of health care-associated infections.

Staffing software. The days of determining staffing needs solely based on square footage are long gone. With today's sophisticated software, ES departments now can easily take into account other factors critical to developing an accurate staffing model and budget.

To be useful and precise, a staffing model not only must account for the size of the areas but also floor types, expected frequency of cleaning, patient acuity, hours of service, periodic policing of trash removal needs during the day, discharge activity and the timing of discharges, number and type of items in the room to be cleaned, time of day the area is to be terminally cleaned, and special considerations or requests from the area's staff. Staffing software that can be purchased or developed in house makes the introduction of these many factors easier to manage and manipulate.

Staffing software also allows ES managers to react quickly and accurately to changes in staff budgets. If a department experiences budget reductions, staffing software allows managers to easily develop and present "what if" scenarios to document and communicate how staff reductions will affect service levels. Thus, it also allows the end users to visualize how the budget reductions will directly affect their areas.

Other PC tools. ES managers should use the tools available to them on their PCs to manage their departments and, more importantly, their time. They should learn how to use and take advantage of their organization's database software, such as Redmond, Wash.-based Microsoft Corp.'s Access, and spreadsheet software, such as Microsoft's Excel.

If an ES manager's organization uses Epic Systems Corp. (Verona, Wis.) software or similar health care management software, they should take advantage of all the features related to ES and bed management.

UW Hospital and Clinics' ES department uses its database to maintain thousands of different records including, but not limited to, employee records, floor care and project work completion, space management data, Joint Commission findings, daily overtime data and recycling by type and room.

The department uses spreadsheets on a daily basis for monitoring discharge activity and responses, STAT delays, overtime by shift (linked to the database), supervisory performance and UV light disinfection usage compliance, to name a few. This allows the ES manager to monitor quality indices closely and react quickly to problems or changes in the patient and work environment.

ES departments might consider providing supervisory staff with handheld PCs. With organized data at their fingertips, supervisory staff will be able to respond quickly to any informational requests. Management reporting and retention of information is a valuable and appreciated managerial trait.

Achieving the goal

The goal of the ES department is to ensure that patients, visitors and staff receive consistently excellent service. Using today's technology allows ES departments to be proactive in responding to constant changes in the health care environment.

Thomas A. Peck is director of environmental services at the University of Wisconsin Hospital and Clinics, Madison. He can be reached at ta.peck@hosp.wisc.edu.

Training program pays HCAHPS dividends

The Hospital Consumer Assessment of Healthcare Providers and Systems question that directly concerns environmental services (ES) is: "During your hospital stay, how often were your room and bathroom kept clean?"

The question facing the University of Wisconsin (Madison) Hospital and Clinics' ES department was how they could maximize their impact on this score when staff only spend about 15 minutes per day cleaning an occupied room. To achieve and retain the best scores possible in these circumstances, ES staff needed to quickly establish a relationship with the patient and family and to let them know they are doing their part by performing a thorough daily cleaning of the room and the restroom.

The ES department decided that daily patient interaction needed to include a formal script that was uniform and meaningful. The department's trainers devised an entrance and an exit script, and developed a calling card with a contact number to be left every time a room is cleaned. Expectations also were developed for when the patient was gone during cleaning.

The revised program was introduced in stages — rolled out at general meetings, discussed often at daily crew meetings, then in one-on-one supervisory time with each employee to review the script and expectations.

Next, the trainers utilized the UW Health Clinical Simulation Center to check and increase the communication competence of each cleaner, with a talking manikin serving as the patient. Each person entered the 'occupied' room, using the entrance script, 'cleaned' a couple of items and used the exit script while leaving the calling card.

Trainers immediately reviewed performances with staff members and discussed what they did if the patient were gone during cleaning. If they missed required elements, they went through the exercise again for practice. The supervisors followed up with reminders during meetings and daily interactions.

Since starting this program, the ES department has received many comments and compliments about the courtesy and engagement of its people.

By Peg Adamowicz, environmental services trainer, University of Wisconsin Hospital and Clinics, Madison.

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