Why does perception of cleanliness matter so much from an organizational standpoint?

Transcription

1

2 Jaynelle F. Stichler, DNS, RN, EDAC, NEA-BC, FACHE, FAAN Jaynelle Stichler is Professor Emerita of Nursing at San Diego State University and a Fellow in both the American Academy of Nursing and the American College of Healthcare Executives. She has extensive experience in the healthcare design industry as a healthcare executive and nurse consultant, working with hospitals both nationally and internationally. A founding member of the Nursing Institute for Healthcare Design, she is also Co-Founding Co-Editor of Health Environments Research & Design (HERD) journal. Nearly 200 of her articles have appeared in peerreviewed journals, and she is a frequent presenter at national and international conferences. People have more options than ever before when it comes to medical care. When consumers are asked how they select a healthcare facility, some cite the facility s quality of care. But since quality is hard to judge, their decision often comes down to the setting s cleanliness, which is easier to see. So what is it that patients are actually evaluating when it comes to rating cleanliness? An article in Health Facilities Management journal says that patients define hospital cleanliness by the age and attractiveness of the facility, and by the quality of the interactions between patients and staff. This means that if communication is poor between the patient and the clinical staff, then the patient s perception of cleanliness will be affected. On the other hand, if a patient thinks the room is dirty, that will also negatively affect his or her communication with nurses and other staff. Beyond this, some of the specific environmental factors that patients notice and that impact their perception of cleanliness include: dingy walls; tiny, crowded bathrooms; equipment stored in hallways; and clutter. In fact, I did a research study with a colleague and found a strong correlation between clutter and patients perceptions of cleanliness. If the hallway or room is cluttered with equipment, then the patient feels that the room isn t clean. In addition, dingy or scarred walls, as well as dark lighting, can give patients the impression that the environment is dirty. This makes it important for every hospital to be diligent about regular maintenance. In addition, when the budget gets tight during the design process, storage areas tend to get smaller than what is needed. It is a big mistake for hospitals to use hallways to make up for the space shortage. Why does perception of cleanliness matter so much from an organizational standpoint? Patients perceptions of cleanliness are directly related to how they view the overall quality of care. Patients do not necessarily have the knowledge to adequately evaluate how well the hospital is equipped, or the experience level of the providers but they are able to evaluate cleanliness. Therefore, they will 2 Copyright 2016 The Center for Health Design. All Rights Reserved.

3 use their assessment of the cleanliness factor to judge the quality of the hospital as a whole. Patients perceptions of cleanliness are directly related to how they view the overall quality of care. Perception of cleanliness is directly related to a patient s view of safety, too. In fact, there is a Gallup survey report indicating that if patients believe a hospital can t maintain cleanliness, then it can t be trusted to provide quality care. This means that if the room isn t clean, patients won t be satisfied with their doctors, nurses, or any other part of their care. One of the questions on the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is: During your hospital stay, how often were your room and bathroom kept clean? Patients ratings on this survey are directly related to a hospital s Medicare payments from CMS and, in some states, Medicaid payments, too. Cleanliness is also directly related to cross-contamination in the hospital setting. If a patient gets a hospital-acquired infection, CMS won t pay the bill for the patient s stay, regardless of how long the patient stayed. This can be very costly, so trust me, hospital and nurse leaders are motivated to make sure patients get the best care to prevent hospital-acquired infections. There are also financial penalties for hospitals with high rates of hospital-acquired infections. What are some ways that nurses and environmental services (ES) staff can help to influence patient cleanliness ratings? One approach is to have ES staff leave a business card behind when they clean, including a checklist of cleaning tasks they completed. This small action can provide patients with peace of mind if they missed the cleaning visit because they were out of the room when the cleaning took place. Some hospitals also do quality checks and evaluations after cleaning to ensure a thorough job was performed. If any areas were missed in the cleaning, the ES workers receive feedback and are taught to improve their cleaning processes. Hospital leaders can also display charts and graphs to grade the environmental staff members on their performance and encourage them to constantly improve. In addition, environmental staff should have constant training and staff development on effective cleaning methods, since their efforts have such a huge 3 Copyright 2016 The Center for Health Design. All Rights Reserved.

4 Some hospitals also do quality checks and evaluations after cleaning to ensure a thorough job was performed. impact on the outcomes for the patients and the organization as a whole. Staff members can even interview patients and family members at random to get their real-time feedback on the cleanliness of their room and the overall hospital environment. Some of the specific tasks to focus on are removing clutter and trash from rooms and bathrooms, cleaning up spills promptly, and removing unnecessary supplies and equipment from rooms and hallways. The environmental services staff should also come back after cleaning to do another round of decontamination of high-touch areas like door handles, push plates, and sink faucets. Finally, the cleaning staff can leave a card on the over-bed table with a phone number for patients to call if they need something or have any concerns about the cleanliness of their room. When designing a healthcare facility, what are some of the key elements in the physical environment that can support cleanliness? Having adequate space for storage is essential, as is creating a bathroom big enough for patients to use safely. Copper finishes on faucets and other hightouch surfaces can also make a difference, since copper is antimicrobial. Research results indicate that if you clean a stainless steel arm rail on a chair, in four hours the bacterial level is the same as it was pre-cleaning. But if the rail is made from copper or a copper alloy, the bacterial growth continues to diminish over time. In my opinion, this one research finding will change the face of how we design the physical environment for healthcare facilities in the future. I recently published an article explaining that even after a room has been cleaned, if the previous patient had SARS, MRSA, or Clostridium difficile (C. Diff), there is a higher risk for the next person assigned to that room to contract the illness. Typical terminal cleaning is inadequate to prevent the transmission of some communicable illnesses. Using methods such as bleach-based cleaning products, UV lights, or hydrogen peroxide mist is necessary to remove the risk for transmission of communicable illness to subsequent patients assigned to the room. Hand sinks must also be designed so that water does not pool at the bottom of the sink, around the faucet, or on the surrounding counter space. In addition, 4 Copyright 2016 The Center for Health Design. All Rights Reserved.

5 water faucets should be offset from the drain so the stream of water does not go directly in the drain. Water delivered straight into the drain can cause a splash-back of contaminated water in the drain to the sink area or on care providers hands. In high-risk areas, designers should not propose electronic faucets, because they are more likely to become contaminated with bacteria. Many designers forget that patient come with their toothbrush and grooming products and do not provide space for patients to store these items. The Gallup poll reported that staff members should think like patients. Since patients spend their time in bed, the staff and design experts should view the room from that perspective. Look at the ceiling, the bedside and over-bed tables, and the bathroom. Many designers forget that patients come with their toothbrush and grooming products and do not provide space for patients to store these items. A simple stainless steel shelf above the sink is not adequate and often cannot be reached by a patient in a wheelchair. Such design details are important and affect how patients perceive their surroundings. How can an organization s leadership help to support a culture of cleanliness? Safety has to be one of the primary goals of the hospital. The CEO of St. Joseph s Hospital in Florida talks about the importance of environmental awareness. If a staff member sees a piece of paper on the floor, the person should pick it up. It s everyone s job not just environmental services to keep the environment clean. I ll give you another example: I am a professor on-site at Sharp Memorial Hospital, and we have seven pillars of excellence (safety, quality, people, finance, growth, service, and community) that are a critical part of everything we do there. The leadership sets the direction of the organization, and they seek constant feedback to measure the performance on each of the pillars of excellence. I believe that if something is worth doing, it s worth measuring. And if it is worth measuring, it s worth disseminating the findings. There are benchmarks, scorecards, and constant feedback at Sharp HealthCare on how we are performing from the patient s perspective and on specific organizational goals. The results are reported back to managers, and everyone at the front-line level knows the results and evaluates what is working and what needs to be 5 Copyright 2016 The Center for Health Design. All Rights Reserved.

6 improved. Frontline leaders share the findings with staff and engage them in creating changes as needed. When the vision and direction come from the top down, everyone, at all levels, is involved and accountable and can work together toward achieving optimal patient outcomes and organizational goals. The Center for Health Design advances best practices and empowers healthcare leaders with quality research that demonstrates the value of design to improve health outcomes, patient experience of care, and provider/staff satisfaction and performance. Learn more at Copyright 2016 The Center for Health Design. All Rights Reserved. 6 While The Copyright Center 2016 believes The that Center the information Health in this Design. interview All Rights is valid, Reserved. it has not fact-checked the information or tested any findings. The Center disclaims any warranties, expressed or implied, regarding this content.