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Quality and Environmental Services

What does Quality look like in an Environmental Service (ES) program today? The ES program is the backbone of the facility and impacts overall patient, visitor, and staff satisfaction. The ES department touches every aspect of the hospital flow from the time someone parks the car and enters the facility to the time they leave the parking lot. Unlike 95% of the other departments in a hospital, ES touches all the square footage of the facility, every day. Add the impact of Covid-19 related to new cleaning procedures and protocols, ensuring that your ES department is working to standards is imperative to continue to slow the spread.

environmental services

The best housekeeping program needs to consist of the following items:

  1. The right employees engaging with patients
  2. An overall engaged workforce
  3. A fully implemented 7 step cleaning process
  4. A management team that is visible on the patient floors

Healthcare Cleaning Management Team


The Right Employee

Currently, many ES departments hire individuals into the hospital based solely due to an open position in the department. The Director does not focus on matching a new hire skillset to the opening, potentially resulting in placing an employee in a spot where they don’t want to/can’t clean. Resulting in the possibility that the employee does not do their best work or positively interact with the patients, directly impacting HCAHPS scores.

ES Directors should use behavioral based interviewing when looking for new employees. Behavioral questions ask a deeper probing into an applicant’s work history and ask specific examples they were involved with. This allows the Directors to get an understanding of how a person acts in different situations to predict how they will act in the future. Once we have a better understanding of how the new employees will act, we can find the best suited hires to work in the patient rooms to have the best impact to the program. Not everyone that we interview wants to be in the patient rooms, so during our interviews, we can determine the best fit for them. The mantra that we use is “We want to hire for the right attitude, and train for skill.” This means that we can hire the best fit for the job, and then we can train anyone to clean.

An Engaged Workforce

Once we have the right person hired, we need to make sure they stay part of your engaged workforce. The best way to ensure employees stay engaged is to round or visit them in their work area. The supervision team must have a visible presence on the patient floors and in the areas that our employees are in. The managers should schedule time in their pattern of management to visit each employee in their work area regularly, just as they are rounding on the patients. The important step is to do something with the information that you get from your employees. When you talk with your employees you ask them if they have the tools that they need to do their job. It is a good time to make a personal connection with them and ask them about their interests outside of work. The employee will be happy that you are showing interest with them and will be honest with you and let you know what they need. The key is to listen and let the employee know you heard them. Another aspect to help with engagement is recognition. All employees want to be recognized for a job well done. It is our responsibility as managers to make sure we treat them well. An easy part of any program is rewarding attendance. Monthly, quarterly and yearly attendance awards are an easy way to boost attendance for work as well as rewarding your employees. A happy workforce is an engaged workforce.

7 Step Cleaning

With a happy and engaged workforce, the following 7 steps are critical to solid program:

  1. Pull waste and soiled linen. After entering the patient room, pull the trash from both the restroom and inside the patient room, then collect the soiled linen
  2. High Dust – with the high dusting tool, start at the door and work around the room clockwise to dust all ledges. Make sure to not dust directly over the patient
  3. Damp Wipe – Using your approved disinfectant, wipe all surfaces in the patient room to include all high touch surfaces
  4. Bathroom -Using a new cloth, clean the bathroom
  5. Dust Mop – sweep the floor to get all of the physical debris off of the floor
  6. Damp mop floor– Using an “S” pattern, start in the furthest corner of the room and mop toward the door
  7. Inspect room – before the employee leaves the room, they should inspect their work to make sure they didn’t miss anything

The importance of each one of these steps helps drive satisfaction. The ES management team must train new employees on these steps to make sure they are following them each time. The other part of cleaning the room also starts with “AIDET.”

AIDET stands for:
A – Ask the patient if it is ok to enter the room and clean
I – Introduce themselves to the patient and tell them who they are
D– Duration. The employee should tell the patient how long to expect the cleaning will take
E – Explain. The employee should explain to the patient what they are cleaning when they do it
T – Thank. Thank the patient when they leave and ask if there is anything else, they need before they leave

When training employees, include the importance and timing of patient interactions when in the rooms, the employee needs communicate each step to the patient as perform them. Especially when they are cleaning the bathroom, bottom line, they should make the patient comfortable and feel informed. The final step is to inspect their work and ask the patients if there is anything else, they can do for them before they leave.

Proper training of the cleaning team

Visible Management Team

The final step in a solid Quality program is having the management team visible on the floor. The management team cannot run the facility from their offices, instead they must be on the patient floors, in clinics and in the ancillary areas to make sure the work is getting done. Soriant first develops a “Pattern of Management” (POM) for each member of the supervisory team and implements. The POM is like a daily schedule that the team follows when they are on the floors completing quality inspections, it includes office time, to check emails and complete other administrative duties. The rounds are not a way to “catch” employees doing something wrong, but it is a way to conduct “on the spot train” on things that doesn’t meet standard or could use improving. Completing the QA inspections and documenting the rounds are crucial in keeping and growing a better program. The results can show if there is a pattern of items/duties that “fails inspection” and show what refresher training the ES management team needs to complete with the staff.

When all the above steps are in place, the result will be a facility with a strong program that will result in stronger/higher HCAHPS scores as well. If you feel that your program needs evaluating or patients are not fully satisfied, Soriant welcomes a call to explore how our hospital ES consultants can partner with you to ensure your program is top notch.


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