Can an Internal Housekeeping Department Compete with Outsourcing Companies?

Can an Internal Housekeeping Department Compete with Outsourcing Companies? David D. Clark, FACHE Regional Chief Operating Officer Phone: 801-357-7692 Email: david.clark@ihc.com Christy Finger Management Engineer Phone: 801-357-8141 Email: christy.finger@ihc.com

Presentation Outline 1. 1. Project background 2. 2. Environmental Services focus 3. 3. Financial goals 4. 4. Subcommittees 5. 5. Financial results 6. 6. Lessons learned 2/12/2005 2005 Annual SHS Conference 2

Project Background Intermountain Health Care 21 hospitals throughout Utah and Southern Idaho Integrated health system UNR UCR USR Recognized as #1 health system in the United State for 4 of the past 5 years Clusters of facilities broken into regions 2/12/2005 2005 Annual SHS Conference 3

Project Background January 2004: Operational Best Practice teams formed by corporate leaders based on top 11 company initiatives Regional COO as Team Leader Corporate V.P.s as Corporate Support Management Engineering Support Public Relations Support Human Resources Support Our team s initiative: Reduce non-clinical services expenses / Outsourcing analysis 2/12/2005 2005 Annual SHS Conference 4

Project Background Non-Clinical Best Practices / Outsourcing Analysis Team Where to focus efforts? Review of national benchmarking data Housekeeping depts throughout the system showed a $875,000+ opportunity for improvement IHC internal benchmarking data Housekeeping depts showed a $1.1 million opportunity for improvement National research Healthcare Advisory Board, Outsourcing remains on the rise as hospitals seek to cut costs, improve patient experience 2/12/2005 2005 Annual SHS Conference 5

Project Background Environmental Services Task Force Created Addition of: EVS corporate director Regional Operations Officers responsible for EVS Directors/Managers of EVS Key success factors: Representation from corporate office & various regions Up-front commitment & buy-in Clear expectations, accountability reporting, & reasonable timelines for project implementation 2/12/2005 2005 Annual SHS Conference 6

Environmental Services Focus Current situation assessment Survey conducted Identify cost effective &/or service excellence processes Existing best practices to share Best practices currently developing Future areas for improvement 2/12/2005 2005 Annual SHS Conference 7

Financial Goals Task force members asked to set financial goals for 2005 Region/ Hospital Current Budgeted Sub-Total Exp Expense Reduction ($) Expense Reduction (%) USR $3,864,976 $340,000 8.8% UCR $6,057,023 $158,628 2.6% UNR $2,839,519 $75,000 2.6% Primary $2,644,971 $37,370 1.4% Dixie $1,939,068 $25,000 1.3% Logan $727,275 $6,900 0.9% Total $18,072,832 $642,898 3.6% 2/12/2005 2005 Annual SHS Conference 8

Subcommittees 1. Financial/Quality/Staffing 2. Supplies 3. Budget Standardization 4. H.R. Organization & Policies 5. Employee Engagement 2/12/2005 2005 Annual SHS Conference 9

Subcommittees 1. Financial/Quality/Staffing Subcommittee Outcomes Handheld quality inspection program I.S. request and tracking system (EMMA) Daily activity report (DAR) Area staffing analysis 2/12/2005 2005 Annual SHS Conference 10

Financial/Quality/Staffing Subcommittee Handheld quality inspection program MANUAL PROCESS (Original) PDA PROCESS (After) Document Inspection on Paper Enter Inspection into PDA Manually Calculate Score Enter Summary Results into Excel Upload into Excel File Inspection Paper Access Results, as needed Pull Files for Annual Review 2/12/2005 2005 Annual SHS Conference 11

Financial/Quality/Staffing Subcommittee Handheld quality inspection program Results: Web Access, Standardization throughout IHC Standardized and Comparable Reports Overall score by hospital Score by employee Room type score by hospital Productivity Increase Original Process = 1 hour per inspection New (PDA) Process = 10-15 minutes per inspection» 4-6 times productivity increase 2/12/2005 2005 Annual SHS Conference 12

Financial/Quality/Staffing Subcommittee Electronic request & tracking system (EMMA) 2/12/2005 2005 Annual SHS Conference 13

Financial/Quality/Staffing Subcommittee Electronic request & tracking system (EMMA) Green = call has not been acknowledged 0-5 minutes Red = call has not been acknowledged 10+ minutes Turquoise = housekeeper is off schedule, need to reallocate Orange = suspended call, waiting for something 2/12/2005 2005 Annual SHS Conference 14

Financial/Quality/Staffing Subcommittee Electronic request & tracking system (EMMA) Reports: Call Volume Report Utah Valley Regional Medical Center: Call Volume Report 10/4/04-11/5/04 140 120 100 80 60 40 20 0 12:00 AM 1:00 AM 2:00 AM 3:00 AM 4:00 AM 5:00 AM 6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 11:00 PM # of Requests Time of Day 2/12/2005 2005 Annual SHS Conference 15

Financial/Quality/Staffing Subcommittee Electronic request & tracking system (EMMA) Reports: Event Report by type & by housekeeper Housekeeper Names Here 2/12/2005 2005 Annual SHS Conference 16

Financial/Quality/Staffing Subcommittee Daily Activity Report Day Shift Daily Activity Report Name Housekeeper Ancillary Time 196.3 3 Hours 16 Minutes Date 12/1/04 12.5 Patient Rooms 13 162.5 2 Hours 42 Minutes Area 6a 25 Discharge 4 100 1 Hour 40 Minutes 25 Transfers 0 0 0 Minutes Other 0 0 0 Minutes Total time 458.8 7 Hours 38 Minutes Pt Room Detail List High Dust Sink Fixtures Drains Room # Discharge time Time Started Time Completed Ancillary Detail List E660 x x x x x x x x Vacuum maintenance E661 xx Behind computers E662 x x x x x x x xx Water fountains E663 x x x x x x x Picture frames E664 xx Defrost Fridge E665 x Elevator Tracks E667 x x x x x x x x Elevator Tracks E668 x x x x x x x Other: E669 x x x x x x x E670 x x x x x x E671 E672 x x x x x x x E673 x x x x x x E674 x x x x x x E675 xx xx xx xx xx xx E676 E677 Showers: Soap scum 2/12/2005 2005 Annual SHS Conference 17 Shower heads Windows, sills, frames Privacy Curtains Walls - complete

Financial/Quality/Staffing Subcommittee Daily Activity Report Results at Utah Valley Regional Medical Center FTE Variance Actual FTE Usage - Volume Adjusted Budget 0-2 -4-6 -8-10 -12 DAR implemented Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 FTE Variance (Negative is better than budget) Month 2/12/2005 2005 Annual SHS Conference 18

Financial/Quality/Staffing Subcommittee Area Staffing Analysis Staffing model comparison across IHC system Example: ER staffing Sorted by Cost per ER Visit 2003 Total ER Visits Labor Expense per Year 2003 ER Sq Weekly ER Cost per Ft Labor Hours ER Rooms Visit 1 Logan 26,313 8,416 46 $22,981.14 13 $0.87 2 Cottonwood 46,601 10,119 112 $64,355.20 18 $1.38 3 American Fork 22,330 7,178 67 $32,176.17 9 $1.44 4 UV (EVS Model) 43,309 7,800 133 $67,776.80 18 $1.56 5 Alta View 32,510 8,479 112 $62,433.28 11 $1.92 6 McKay 57,222 19,313 211 $114,218.52 27 $2.00 7 Primary 40,505 8,131 168 $88,932.48 24 $2.20 8 LDS 37,950 8,600 168 $94,872.96 14 $2.50 9 Dixie 31,561 18,159 168 $85,438.08 32 $2.71 10 UV (ER Current Model)** 43,309 7,800 254 $130,862.16 18 $3.02 2/12/2005 2005 Annual SHS Conference 19

Financial/Quality/Staffing Subcommittee Area Staffing Analysis Staffing model comparison across IHC system Example: ER staffing -- Results FTEs Table Salary $ Benefits, PTO, etc. Salary + Benefits Old Model 7.0 $144,581 $50,603 $195,184 New Model 5.6 $115,665 $40,482 $156,147 Comparison (reduction) 1.4 $28,916 $10,121 $39,037 Note: The FTEs reduced during the change were transferred into open positions already existing in the Environmental Services department. 2/12/2005 2005 Annual SHS Conference 20

Subcommittees 2. Supplies Subcommittee Outcomes Mop analysis Floor wax analysis (work in process) 2/12/2005 2005 Annual SHS Conference 21

Supplies Subcommittee Mop Analysis Wet-loop mop vs. Microfiber mop Cost/Benefit Analysis Wet-Loop Microfiber Versus 2/12/2005 2005 Annual SHS Conference 22

Supplies Subcommittee Mop Analysis Increased Expenses Start-up Costs Replacement Costs Decreased Expenses Chemical Costs Water Costs Labor Costs Worker s Compensation Overall estimated savings for large IHC hospitals = $521,000 Existing opportunity (facilities using wet-loop mops) = $334,000 with $28,000 start-up cost 2/12/2005 2005 Annual SHS Conference 23

Supplies Subcommittee Mop Analysis Opportunity by IHC hospital Wet Loop vs. Flat Mop Cost Comparison Potential Savings Adjusted by Existing Implementation Annual Expense $700,000 $600,000 $500,000 $400,000 $300,000 $200,000 $100,000 $7,988 $30,379 $33,186 $37,463 $98,805 $64,368 $18,860 $8,810 Non-EVS Cost EVS Cost Potential Savings $14,110 $20,335 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $- Wet Loop Microfiber Wet Loop Microfiber Wet Loop Microfiber Wet Loop Microfiber Wet Loop Microfiber Wet Loop Microfiber Wet Loop Microfiber Wet Loop Microfiber Wet Loop Microfiber Wet Loop Microfiber Annual Potential Savings $- Alta View American Fork Cottonwood Dixie LDS Logan McKay-Dee Orem Community Primary Children's Utah Valley Facility, Mop Type 2/12/2005 2005 Annual SHS Conference 24

Subcommittees 3. Budget Standardization Subcommittee Outcomes Standardized cleanable square footage calculations Consistent budgeting methodology for all facilities (work in process) 2/12/2005 2005 Annual SHS Conference 25

Budget Standardization Subcommittee Standardized Cleanable Sq. Ft. Calculations Report Date: 2003 Data from "Space Allocation Analysis" conducted by IHC corporate office Usable Area Building Name Interior Gross Area Vertical Penetrable Area (Interior - Vertical) Comments American Fork Hospital 229,256.91 15,227.82 214,029.09 Facility Total 229,256.91 15,227.82 214,029.09 Report Total Cleanable Square Footage 214,029 Areas not Cleaned by EVS that are included in the "Space Allocation Analysis" Description of Area not cleaned by EVS Square Footage Date Updated Comments Vacant Space 9,508.21 Oct-04 Telecom 720118 1,198.60 Oct-04 Equipment Rooms not cleaned by EVS Plant Operations 654118 7,893.40 Nov-04 Maintenance & Repairs 630118 6,727.81 Nov-04 Not Cleaned by EVS Total Cleanable Sq Footage 25,328 All space removed then back offices added back because cleaned by EVS; Completed by Karen Jackson All space removed then back offices added back because cleaned by EVS; Completed by Karen Jackson Additions to "Space Allocation Analysis" Other Areas not Included in Report & cleaned by EVS Square Footage Date Updated Daycare 1,870.00 Oct-04 Patio 4,469.00 Nov-04 ER overhang 1,626.00 Oct-04 Gift Shop overhang 272.00 Oct-04 Admitting overhang 169.00 Oct-04 Rehab overhang 191.00 Oct-04 SDS overhang 386.50 Oct-04 Additions Total Cleanable Square Footage 8,984 Comments Completed by Karen Jackson Total Sq Ft = 773; half maintained by grounds 2/12/2005 2005 Annual SHS Conference 26

Budget Standardization Subcommittee Standardized Cleanable Sq. Ft. Calculations Addition of Vertical Penetration Areas Vertical Penetration Areas (Stairways & Elevators) cleaned by EVS Square Footage Date Updated AFH Stairways 3,034.00 Nov-04 AFH Elevators 336.00 Nov-04 Transcription in Southeast Medical Building 2,994.00 Nov-04 Additions Total Cleanable Square Footage 6,364 New Construction not included in "Space Allocation Analysis" Description of Area Square Footage Budgeted Date Updated Square Footage Comments Medical Office Building First Floor Common Area (Stairs, Restrooms, Negotiation in progress. If cleaned, budget when cleaning Lobby, Entry) 0.00 Nov-04 2,092.00 begins. Pharmacy (Physician Division) 0.00 Nov-04 1,023.00 Negotiation in progress. If cleaned, budget when cleaning begins. Internal Med (Physician Division) 0.00 Nov-04 4,300.00 Negotiation in progress. If cleaned, budget when cleaning begins. Lab-phlebotomy (USR Space) 0.00 Nov-04 287.00 Budget when cleaning begins. Physical Therapy (USR Space) 0.00 Nov-04 5,210.00 Budget when cleaning begins. Second Floor Lawrence & Jones (Physician Division) 0.00 Nov-04 Negotiation in progress. If cleaned, budget when cleaning 5,222.00 begins. New Construction Total Cleanable Square Footage - SUMMARY Comments Completed by Karen Jackson Completed by Karen Jackson Completed by Karen Jackson Description of Square Footage Square Footage Comments 1. Total Sq Ft from "Space Allocation Analysis" 214,029 Orange Section 2. Total Not Cleaned by EVS 25,328 Yellow Section. This number is removed from EVS cl sq ft grand total. 3. Total Additions 8,984 Green Section 4. Total Vertical Penetration Space Cleaned 6,364 Blue Section 5. Total New Construction 0 Purple Section Grand Total EVS Cleanable Sq Ft (1-2+3+4+5) 204,049 For Budget and Internal Benchmarking Grand Total Cleanable Sq Ft (1+3+4+5) 229,377 For External Benchmarking 2/12/2005 2005 Annual SHS Conference 27

Subcommittees 4. H.R. Organization & Policies Subcommittee Work in process Organizational structure standardization Policy standardization Pre-screening questions 2/12/2005 2005 Annual SHS Conference 28

Subcommittees 5. Employee Engagement Subcommittee Work in process Employee incentive program Employee safety program 2/12/2005 2005 Annual SHS Conference 29

Financial Results 2005 Budget Goals & Results Region/ Hosptial Current Budgeted Sub-Total Exp Projected Expense Reduction (%) 2005 Expense Reduction Goal ($) Actual Expense Reduction (%) 2005 Actual Budgeted Reduction ($) USR $ 3,864,976 8.8% $ 340,000 8.8% $340,800 USR EVS ER Staffing 0.0% $ - 20.0% $40,000 UCR $ 6,057,023 2.6% $ 158,628 2.6% $158,628 UNR $ 2,839,519 2.6% $ 75,000 3.0% $83,936 Primary $ 2,644,971 1.4% $ 37,370 1.4% $37,370 Dixie $ 1,939,068 1.3% $ 25,000 2.8% $54,611 Logan $ 727,275 0.9% $ 6,900 1.3% $9,310 Total $ 18,072,832 3.6% $ 642,898 4.0% $724,655 2/12/2005 2005 Annual SHS Conference 30

YTD Financial Results Orem AFH UVRMC LDS CWH Subtotal Expenses YTD Nov $5,622 $22,259 $210,880 $107,526 $72,921 Dixie Logan Primary McKay Subtotal Expenses YTD Nov $80,246 $35,402 $13,252 $54,139 Alta View $46,091 2/12/2005 2005 Annual SHS Conference 31

Lessons Learned Improvements can be identified when we pull our experiences and knowledge together Technology can assist housekeeping departments in increasing productivity, in both staffing and supplies If managers and staff are given the opportunity and support to implement their ideas, they will surpass your expectations 2/12/2005 2005 Annual SHS Conference 32

Summary IHC s Environmental Services (housekeeping) Depts reduced their expenses by $725,000 by adopting Best Practices, mostly achieved through: I.S. request & tracking system (EMMA) Daily Activity Report (DAR) Area Staffing Analysis Microfiber mops The EVS Depts will continue to identify & implement best practices Outsourcing possible in the future? Not if the teams keep their momentum. 2/12/2005 2005 Annual SHS Conference 33

Team Members Task Force, Subcommittees, and Work-teams: Calvin Allen, Brian Bentley, Greg Parrott, Ron Jones, Paulette Thomason, Mary Ann Washington, Phyllis Loos, Craig Fitt, Laura Thurston, Ryan Eggleston, Allen Anderson Council, Task Force, and Subcommittees: David D. Clark, Bill Prows, Bruce Clark, Christy Finger, Jami Perrett, Bryant Larsen Task Force: Jeff Sanders, Tim Bricker, Marie Prothero/Mike Olson, Dale Green, Sherman Curtis, John Worley 2/12/2005 2005 Annual SHS Conference 34

Interesting Thought 2/12/2005 2005 Annual SHS Conference 35

Questions 2/12/2005 2005 Annual SHS Conference 36