The performance of your environmental services department is a critical step in your hospital’s patient flow. The ability of patients to enter your hospital as direct admissions or through the emergency department relies heavily on bed availability. Many institutions focus on clinical decision making and patient care when examining patient flow. However, focusing on the performance of your environmental services department is also important. All of the work your hospital puts into patient flow can be lost if your ES department is not being monitored and performance is not optimized. So how is it done?
Whether you chose to employ your own staff or contract with an outside company to provide your environmental services, there are quite a number of key metrics you should be tracking. It may seem difficult to locate a benchmark for ES, but there are some areas of assistance. A good example of what you can measure comes from Health Facilities Management 28(1):41-43, January 2015. In this article, Rock Jensen does an excellent job summarizing the key portions of the certification as a Healthcare Environmental Services Professional (CHESP).
The content of this certification includes several categories detailed in the candidate handbook from the American Hospital Association Certificaiton Center (AHA-CC CHESP Handbook). These categories include:
- Regulatory Compliance
- Planning, Design, and Construction
- Operations Related to Environmental Sanitation
- Operations Related to Waste Management
- Operations Related to Textile Management
- Financial Stewardship
As is pointed out in the Health Facilities Management Article, the key elements of the certification related to process flow center around correctly measuring workload. Although we are not environmental services administrators, the approach will seem strikingly similar to processes we have discussed before. It bears many similarities to a Lean approach. The key elements are:
- Square footage – actual space requiring cleaning, not total building square footage.
- Frequency of cleaning – patient rooms, operating rooms, commons areas like lobbies, and offices all have different needs.
- Locked-in areas – spaces where ES personnel are staffed for an entire shift. The emergency department is a perfect example where a minimum staff of ES workers is needed regardless of square footage.
- Space classification – this is a factor of the level of cleaning required. Terminal cleaning a patient room requires more time than a simple clean of an office. The type of cleaning dictates how long the same square footage will take.
Once these requirements are identified, an appropriate staffing schedule is created. Note that frequency of cleaning is a moving target. Although the exact time a room will be vacated by a discharged patient may not be known, a look back at the past month’s bed tracking data will easily supply sufficient information for future projections. Variability is identified day to day and the vast majority of discharges can be predicted on an hourly basis as the cycle repeats weekly. All of us in the ED are accustomed to the variability of peaks and troughs but your environmental services department may not be taking that factor into account. Staffing must match demand. In addition, a knowledge of seasonal fluctuations and unplanned surges from the prior year is helpful. This adds to the ability of the ES department to match the needs of the institution and provide an initial staffing schedule.
Then comes the accountability for performance. Tracking individual ES staff performance requires technology and a knowledge of performance benchmarks. Here are some of the standards listed in the 2015 article from Health Facilities Management.
- Surgical suites: 425
- Restrooms: 480
- Patient rooms: 1,000
- Nurses stations: 1,800
- Lobbies and offices: 2,500
- Conference rooms: 3,000
- Corridors: 15,000
- Ride-on scrubbing or burnishing: 17,860
- 2.5 minutes per patient room that needs the trash pulled
- 15 minutes per trash holding room
- 1 floor care position / 10.5 general housekeeping staff
- 15 minutes each
It is difficult work to obtain all the necessary information to build a staffing schedule based on the 4 key elements – square footage, frequency of cleaning, locked-in areas, and space classification. However, the resulting ability to match demand and monitor performance is extremely valuable. Since the the majority of the environmental services departmental budget will be devoted to staffing, a structured and objective approach is critical.