The method used to determine costs and expenses in environmental services (EVS) in hospitals is often flawed because many times the individuals creating the standards have never worked in EVS. AHE is addressing this problem.
Keeping costs down in a hospital is a monumental task, and determining what the environmental services (EVS) productivity benchmarks for hospitals should be is not as easy as one size fits all. In order to get the most accurate and effective operational standards and benchmarks, the hospitals’ EVS department should be involved in the determination. Typically, however, third-party consulting financial benchmark companies are brought in to determine what the standards should be, and there are issues with that solution.
Infection Control Today® (ICT®) asked Rock Jensen, Association for Health Care Environment (AHE) advisory board president, and the administrative director of support services for Yuma Regional Medical Center, what to do about EVS operational standards and the tool AHE has developed to address this issue. He spoke in a panel discussion, “Environmental Serives Operational Standards and Benchmarks” at The Association for Health Care Environment (AHE) annual conference: AHE Exchange, AHE Conference & Solution Center, held on October 3-5, 2022, in Orlando, Florida.
ICT®: Please give ICT®’s readers an overview of your presentation.
Rock Jenson: The presentation I am engaged with discusses industry standards and benchmarks as identified by a third-party consulting organization. The organization has looked at EVS departments around the country and developed standards and benchmarks based upon their experience. It is unknown if these benchmarks were developed from hospitals before or after the consulting organization’s involvement. There are organizations across the spectrum that are trying to identify opportunities to reduce costs and expenses for hospital departments. That is just par for the course in health care today. There is nothing inherently wrong with driving efficiencies and expense improvements. It sounds like something we would all want to be a part of.
However, every organization has a bias as they create their benchmarks. By referring to it as a bias doesn’t mean it is wrong; it means you need to understand what the driving force is behind its creation. For example, most consulting organizations' business model is to go into hospitals and find waste, inefficiency, and cost savings. That’s how they make their money. To do that, they lean on benchmarks that they view as a tool to challenge what is being done inside the hospitals so that they can be invited in to implement processes to drive cost savings and take a share of those savings. Again, there is nothing specifically wrong with that, and it can be a very helpful and useful process for certain hospitals.
Where the “miss” comes in is in the way they measure and analyze data and establish goals for a department to meet. For example, they will present a cost per square foot that the department should be running at. Operating room worked hours per square foot. Unfortunately, every single hospital is different from another. The type of square footage inside is different (clinical vs non-clinical). Patient volumes are often ignored in these benchmarks, and square footage is the magic bullet to drive efficiency. The error [consulting organizations] make is that for EVS, [EVS] clean both space associated with patient volumes, as well as space mostly affected by square footage. It takes a blend of data analysis to get an accurate result. These companies don’t have the ability to do a hybrid analysis of both measurements.
The other challenge is that often the people doing the analysis have never worked in or run an EVS Department. There is more often than not a commonality of them coming from the finance world, not operations.
Fortunately, AHE has developed a Staffing Calculator that is based on multiple analysis of volumes, square footage, and formulas that calculate worked hours from time studies and space size. Additionally, these standards were not driven by any specific bias. It was based upon time studies and data provided by AHE members from their own experiences. The focus was to identify time required to clean any particular space appropriately. Not how fast it could be done.
Multiple surveys were done by members to gather data from the best workers and slower worker alike so that a realistic result could be obtained. The standards are based upon following work tasks identified by the AHE Practice Guidance for Room Cleaning. Again, time was not the driving factor.
Administrators and infection preventionists alike can be assured that if their EVS staff are following the AHE Practice Guidance and adhering to the AHE staffing standards, they are doing work and performing tasks at efficiencies which will not require the staff to skip steps and become the weak link in the chain of infection.
ICT®: What do you want both EVS and infection preventionists to take away from your presentation? How can what they learn impact and improve their performance at their own facilities?
RJ: I would encourage IPs at their facilities to become familiar with AHE’s certification programs for EVS staff and managers. That they complete the education, training, and understanding necessary to ensure they are providing a safe and healing environment for staff and patients. AHE is the only national organization to offer these certifications. Their Certificate of Mastery in Infection Prevention (CMIP) is a high-level certification program for EVS leaders that allows them to better interact and communicate with hospital IPs regarding infection-related issues.
ICT®: Do you have anything else you would like to add?
RJ: The [COVID-19] pandemic we are coming out of today helped to show the value EVS leaders can provide to their organizations. So many of the tools AHE had spent years developing and putting in place were key in responding to many aspects of the pandemic. AHE coordinated with the Centers for Disease Control and Prevention in developing protocols and policies to be able to effectively respond to the industry needs in providing clean and safe environments for everyone who had a need to be at the hospital.