Monday, April 3, 2017

Make It a Clean Sweep: Freedom to Clean

I was on my way to return a rental car. My travel companion asked me if I was going to wash the car before I returned it, and I said, “I don’t think so!”, and she said “Why not?”, and I said “Well, I don’t own it.” 

Consider This

No one’s going to financially own a hospital, but we want you to psychologically own the concept of a quiet, restful environment, and the concept of freedom to clean. 

Best Practices for HCAHPS Improvement Success
Do your managers and staff know what to do to raise HCAHPS scores? Is your staff engaged? Do they have a desire to improve your HCAHPS outcomes?

Let’s discuss the role of Staff Skills and Behaviors we need in this process.

Make It Personal:
While conducting a focus group in a hospital in Oklahoma, I met Loretta, a 98-pound housekeeper, who decided that in addition to cleaning patient rooms she would visit each patient three times a day and be their friend.  She said:

“As a matter of fact, when we get our HCAHPS scores we can break them down by unit, and my HCAHPS scores in last three months have gone from the 13th percentile to 63rd!”

Did you catch that?

My HCAHPS scores.

This is the ultimate that we aspire to: individual, personal commitment and ownership.

Make It a Team Effort:
We need to empower everyone to keep the entire hospital environment clean and tidy – it’s everybody’s job.

1.       Increase staff awareness about cleanliness.
2.       Take personal action if anything about the hospital environment is unclean.
3.       Report to housekeeping any cleanliness concerns (excessive dust, spoiled food, dried spills, or unsightly stains on the walls, floors, and ceiling).
4.       If housekeeping is not available, get a mop and clean it yourself!
5.       We are all housekeepers. Adopt the same philosophy as Johnson Medical Center: “Housekeepers are Life-Savers!”

Everyone is a “Clean Team” Member.

All change begins with awareness; awareness by all staff that preventing potential for HAI’s requires constant vigilance and action toward cleanliness. No doubt your housekeepers have a high level of awareness, but you’ll never solve your cleanliness problems until your frontline owns them, all of them. This is where it all starts. The actions and words of your staff matter.

Words Are Medicine:
We’ve raised a generation or two that don’t know how to speak because of watching too much television. They’re stuck for language. It is vital that we work, train, and drill “sentence starters” into the vocabulary of our frontline that can be used to start a conversation – always on the tips of their tongues. If you’re going to manage a patient’s expectations around cleanliness (and consequently increase your HCAHPS score), you start the moment your patient walks through the door.

Here are a few examples of sentence starters:
1.       “Our goal is to always provide you with a clean, safe, comfortable environment in which to heal.”
2.       “Please tell us if you have any concerns about cleanliness.”
3.       “Our team is always going to keep your room and bathroom clean. Please let me know if you have any concerns about the cleanliness of your room and bathroom.”
4.       “Do you mind if I check your room and bathroom to make sure that we are always keeping everything clean for you?”

In addition, you use this idea of “Behavior Labeling.” It’s okay to let your patients know what we’ve done to keep them safe and comfortable.
1.          “Mrs. Smith, I always wipe down your door handles to make sure they’re nice and clean…”
2.       “Mr. Tilson, I noticed that Housekeeping was just here to clean and disinfect your bathroom for your comfort…”

Manage expectations for cleanliness by telling people what you’re doing. For example:
1.       “Let me scrub your tray table, Ms. Hill, just to be sure it’s nice and clean…”
2.       “We always want to make sure your room and bathroom are clean for your protection…”

Help your staff become comfortable using these “sentence starters” by:
1.       Initiating a classroom workshop and teach them how to use “sentence starters.”
2.       Letting them adapt the wording to fit their own style of communicating.
3.       Taking the time to role-play; it’s not good enough just to talk about it. Have people pair-off, and role-play using the “sentence starters” or “words that work.”
4.       Practice, practice, practice! Model the use of “sentence starters” every chance you have, you yourselves, managers and SEAs, if you use them, the staff is going to use them.

Infection-control awareness means you need to remind staff that “words are medicine.”  Words matter. Words cause emotional reactions. Words are how we link to our patients and their family members. So choosing them well is important.

One final thought:

If you surveyed your staff today, what would be their level of awareness; their level of ownership?
You’ll never solve your cleanliness problems until everyone owns them.

The Take Away
In the spirit of creating ownership, we challenge you to request your CEO issue a “Freedom to Clean” Empowerment Card. This card means that everybody is “licensed” to do whatever is needed to keep the hospital clean. Remember, all change begins with awareness.

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