Providing Excellent Patient Care Through Environmental Services

A lot of the talk around providing excellent patient care revolves around soft skills. Mechanisms like AIDET^Ⓡ (Acknowledge, Introduce, Duration, Explanation, Thank) serve as helpful guides for communicating with patients, but the quality of care goes far beyond that.

Patient experience should also guide your operational systems and processes.

We’ve taken this approach with our environmental services (EVS) teams and have seen some incredible results. At a facility in Tennessee, we’ve seen a 10 point increase in HCAHPS cleanliness scores over a two-year span.

We implemented three steps that focused on process improvement that led to those results:

• Educating for comprehension

• High-quality patient rounding

• Incentivizing the process

Educating for Comprehension

A mistake many hospital administrators make is assuming that their managers are experts in all the right systems and processes.

Unfortunately, this isn’t always the case, and assuming it is can damage the quality of patient care you’re providing.

This isn’t necessarily your manager’s fault either. Even if they sit through a training, there’s usually not a follow up or verification process in place to ensure that their comprehension and implementation of the training meets the expectation.

Across 13 hospitals in Tennessee, we found that our efforts at training initially fell short because we weren’t verifying a certain level of comprehension. So we got more intentional about our training programs.

Rather than a video call or webinar, we held large group trainings in person with our managers. This allowed us to apply teach-back methods to verify our managers not only had the correct knowledge but also had the tools necessary to teach their own teams. We began this program at the beginning of 2018 and saw immediate results that we’ve been able to sustain.

Here’s what happened to our cleanliness scores division-wide.

Part of what carried our consistent performance here was our implementation of the 5 zone and 2 zone cleaning process. This is the order in which we clean patient rooms, using a different microfiber cloth for the five zones and a different mop head for the two floor zones.

We made sure every manager and hourly team member not only knew the system but knew how to communicate it to the patient so that the patient’s perception was consistent with the level of cleaning we were providing.

If your patient satisfaction scores aren’t where you want them to be, don’t assume what the problem is or that your managers are adequately equipped to handle the challenge.

Get intentional about your training methods. Review everything with your managers and make sure they have the knowledge, ability, and resources needed to coach their team.

High-Quality Patient Rounding

Patient rounding allows you to get real-time feedback about how well your team is carrying out the processes they’ve been trained on.

Asking deliberate, open-ended questions to patients is the best way to find out how your team is performing. This is akin to getting a patient’s verbatim response on your HCAHPS but in a face-to-face interaction.

At the hospital division in Tennessee, we noticed that the questions we were asking when conducting patient rounds weren’t giving us real insight into our performance.

We were asking general questions like, “How has the housekeeping been?”, and the patient, more often than not, let us know that housekeeping was “good” and then we thanked them and moved on.

So we trained our leaders to get more specific. They started asking things like, “What did you observe the housekeeper doing when they were in the room?” If the patient said the housekeeper took out the trash, we knew it was likely that the housekeeper didn’t approach the bedside, wipe down the high-touch areas, or discuss with the patient what they were doing and why they were doing it.

Asking the right questions when rounding will give you a better picture of what the patient experience is like at your facility and help keep your team focused on the processes they’ve been trained on.

The results of this can be dramatic. We began these patient rounding techniques at the beginning of 2018 at one of the facilities in the Tennessee hospital division. Here are the facility’s cleanliness and overall hospital scores beginning in 2017—the year before we started the program—through July 2020.The average HCAHPS score in 2017 was 69.6. Through July 2020, the score was 79.4. That’s nearly a 10 point increase over two and a half years. The EVS team is now consistently delivering excellent patient care because their leaders are asking better questions and are tapped into the daily patient experience.

Incentivizing the Process

When you set out to improve your patient satisfaction scores, you have to remember that ultimately what you’re doing is changing behavior. And that takes time.

To speed up the process, you can incentivize it. We offered some results-based awards for improvements in scores, but the most effective thing we did was give out process-based awards and recognition.

We came up with four quarterly awards for hourly team members that were directly related to the operational improvements we were making.

The awards were:

• Communication quality

• Cleaning quality

• Support (for floor techs and other support staff)

• Overall experience

Each quarter, the four team members would receive a trophy and then get taken out to dinner at any restaurant they wanted. Their spouse or significant other was also invited and the director, vice president, and executive vice president over their facility also attended the dinner.

Word got around fast that HHS was doing this for their hourly team members. People started working hard to win these awards. And because they were tied to the types of operational changes we were making, we started seeing widespread improvements across all of our processes and initiatives.

All we did was put some more thought into our incentives and got more specific. We wanted our housekeepers to do a better job of communicating with patients and educating them on what they were doing in the room to keep them safe. So we created a communication quality award that was given to housekeepers who did that well.

Giving awards out for results is powerful, but tying them to your processes helps your team start doing the things you want to change operationally.

Behavior change is hard and takes time. By putting a little more thought into the incentives and awards you’re offering can give you the extra boost you need to start providing excellent patient care.

These three steps—educating for comprehension, high-quality patient rounding, and incentivizing process improvement—requires a hard shift in taking your focus off of results and onto your processes. But by getting into the nitty gritty details of each department and improving your systems, you’ll deliver a better overall patient experience.