“Clean and Quiet”
In a recent conversation with a nursing manager it was discussed how HCAHPS survey scores are affecting our departments. What is HCAHPS? It stands for Hospital Care Quality Information from the Consumer Perspective. As a consumer you know it as a survey. The surveys are taken after a short or long stay in a hospital. They can be in written form or by telephone. As an Environmental Services Consultant I train and coach franchise owners to address these subjective questions related to our department.
- During this hospital stay, how often was the area around your room quiet at night?
- During this hospital stay, how often were your room and bathroom clean?
Here is the problem…the questions are designed to “grade” services provided by the Environmental Service Department only, but we are not solely in control of the results. Noise is a hospital staff-wide concern and responsibility. Cleanliness scores can vary greatly based on the condition of the physical plant’s age and upkeep. So how do we keep our scores up? Read on…
What is HCAHPS?
The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care. While many hospitals have collected information on patient satisfaction, prior to HCAHPS there was no national standard for collecting or publicly reporting patients’ perspectives of care information that would enable valid comparisons to be made across all hospitals. In order to make “apples to apples” comparisons to support consumer choice, it was necessary to introduce a standard measurement approach… for more data visit the HCAHPS website.
What Experiences are Surveyed?
The (8) dimensions specifically surveyed are:
- Nurse Communication
- Doctor Communication
- Hospital Staff Responsiveness
- Pain Management
- Medicine Communication
- Hospital Cleanliness and Quietness
- Discharge Information
- Overall Hospital Rating
Although item (6) is “ours” we have found success in affecting item(3) because a patient often requests us to:
- Call a nurse
- Turn off a light
- Open or shut a blind or curtain
- Hand them the remote for the television
All the Noise, Noise, Noise
Somehow, the specific question on noise has been interpreted as all noise… all of the time. In reality, the specific time frame can be narrowed down to normal sleeping hours of 9pm to 7am. Several factors can contribute to noise pollution in the hospital environment including:
- Nursing staff communicating with Doctors, colleagues and patients.
- Consults and meetings being held in the hallways/corridors.
- Hospitalists, Social workers and case managers working on the floor.
- Medical and service equipment being moved or operated down corridors.
- Service staff on the floor performing work functions.
- Families of the patient congregating outside patient rooms.
- Location of the room in relationship to other ancillary areas such as the cafeteria, patios and workstations.
To combat the negative scores related to noise all hospital staff must buy in to a “mandate for quiet”. A well developed plan for a quiet hospital starts with the belief that quiet promotes healing. Check out the article/study by the Minnesota Medical Association. When the belief is true and the staff “buy-in” the rest will fall into place.
Here are some proactive ways to reduce noise in the environment:
- Lubricate hinges and grease bearings on carts and equipment.
- Replace cart wheels with softer rubber wheels
- Reduce volume of elevator bells, ringtones and alarms
- Use earpieces for two-way radios, keep cell phones/pagers on vibrate.
- Schedule noisier cleaning, such as floor work, at patient friendly times.
Squeaky Clean and Disinfected
Most Environmental Services Departments clean each patient room thoroughly once per day and then recheck or police the room and restroom three to four additional times during the same (24) hour period. Proper work loading, consistent training, coaching and supervision ensure the patient rooms are well maintained and safe for both patient and family. Some proactive measures to help with cleanliness are:
- Train and educate staff in correct cleaning procedures. Provide the staff with picture flip cards to assist in procedures effectiveness.
- Maintain open communication with staff to address changes in the environment which may include:
- High census.
- Long-term stays of patients.
- Storage of medical equipment.
- Train and educate your staff in the use of equipment and chemicals. Stay up to date on the ever changing requirements for disinfectant use in OR, ICU and ER environments.
- Conduct daily quality checks of cleaned areas for compliance and opportunity for improvement.
- Get facility buy-in that it is everyone’s responsibility to maintain a clean environment (ex. if you see trash on the floor pick it up).
“Friendliness” of EVS Staff
The most important measure the EVS Staff can take is scripting for interaction with patients. The friendliness of the EVS technician can and will affect the scores overall…positively. We have found that by engaging with patients in a polite and considerate manner our scores have increased dramatically. Every facility has policies and procedures that guard patients from unneeded bother so check with adminstration before initiating a patient “respect” program. Here is a process we have initiated with great success:
- Ask permission to enter the room.
- Introduce yourself by name.
- Tell the patient what you will be doing in the room and ask permission to do so.
- As you clean the room tell the patient what you are doing and why.
- Ask for the patients permission to move personal items so that you may clean the area.
- Before you leave thank the patient for their patience and inform them of how and why they would contact you.
The Road to HCAHPS Success
All departments are connected…..let’s start working together and shhh…