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Outsourcing Environmental Services—A Fast Track Means of Boosting HCAHPS Results

Better management of EVS departments yields greatly improved patient satisfaction with the hospital experience

Date: 12/01/2006

The following release was created by Power PR, a business to business marketing public relations firm based in Torrance, California.

Cleanliness may be next to Godliness, but it's also turning out to be a Godsend to hospital administrative staff who seek to strengthen the position of their hospitals for the upcoming publication of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers & Systems) survey results in 2007. Through an increased reliance on management companies who provide environmental services (EVS) to help enhance the patient experience, hospitals can improve survey responses. Such high-percentile marks can help increase census counts and ultimately the financial position of the hospital as patients patronize those facilities that they perceive to provide the best care.

"Everyone has struggled with patient satisfaction and the surveys in general, but we see HCAHPS as an opportunity," says Laura Fortin, Chief Nursing Officer and Chief Operating Officer at the 1.2 million square-foot St. Joseph Medical Center in Houston, Texas. "There are studies out there that show a definite correlation between patient satisfaction and your bottom line, and EVS plays a key role in patient satisfaction."

No time to lose
Composed of 27 items that encompass critical aspects of the hospital experience—such as the responsiveness of hospital staff, quietness, and cleanliness of the hospital—the HCAHPS survey provides a standardized instrument and data collection methodology for measuring patients' perspectives on hospital care.

Starting in 2007, the results of these surveys will be made public via a government-sponsored website. At that point, an increasingly astute patient population will be able to make direct comparisons between competing acute care facilities and subsequently exercise their influence in selecting the facility that will render services to them. Any hospital that wishes to remain in the running must act now to position itself as a leader among survey respondents.

Given such a short timeline, many administrators and operating officers are opting for quick solutions, and upping the "cleanliness" factor is an effective means of enhancing the perception of competency.

"Patients can definitely assess how clean their room is, and how nice the person was who cleaned their room—these are things they can easily quantify on a survey, so housekeeping definitely has a role," states St. Joseph's Fortin.

"EVS is an important part of the patient's experience in the hospital," agrees Marilyn Schock, Assistant Administrator at McKee Medical Center in Loveland, Colorado. Celebrating its 30th birthday, McKee is part of the Phoenix, Arizona-based Banner Health organization, which encompasses 20 hospitals and other facilities that offer an array of medical services.

"Cleanliness is an important part of the healing and caring environment," continues Schock. "Clean areas invoke a sense of confidence and a positive feeling about the people and services. Dirty places tend to trigger a sense of doubt, uncertainty and a feeling of skepticism about the people and services being provided. EVS plays a crucial role in meeting the patient’s expectations of excellent patient care."

The challenge of improving EVS
Coupled with the typically low retention rate of EVS employees and hospitals traditionally lacking systematized processes for this department, accomplishing gains in EVS often proves elusive.

In response, administrators at some hospitals are increasingly turning to management companies and consultants who, by virtue of the fact that they specialize only in healthcare EVS, can transform that facet of hospital operations into a high-scoring asset when surveys get filled out. St. Joseph was one hospital who chose this route.

"I believe each facility is unique, and management has to seek out what is best for their operation," comments Fortin. "It made sense for us to go with Medi-Dyn because we share a similar vision and value system with them, so we work really well together."

Founded in 1979 and based in Englewood, Colorado, Medi-Dyn is a privately held corporation providing environmental and laundry management services exclusively to the healthcare industry.

Typically, a contract management firm like Medi-Dyn will offer a range of services so that administrators can tailor the available services to fit the needs of their particular facility. In a management-only structure, the contractor provides the on-site management needed to effectively lead daily operations. In other situations, both managers and all direct labor staff are employed by the contractor under a full-service option. Intermediate levels of integration also exist.

"We only utilize Medi-Dyn for its management services—the employees are our own but they report directly to the Medi-Dyn manager," notes Schock. "Typically, EVS staff represents a tough population for retention. Medi-Dyn’s expertise combined with our culture of excellence ensures a seamless teamwork approach. The outcome for Mckee Medical Center has been achieving and sustaining breakthrough outcomes. If you were to visit our facility in person, you would understand."

"In the selection of any vendor, the key is to get the right management person," Fortin reiterates. "The Medi-Dyn director here, Bill Walles, is phenomenal. He is very involved in patient satisfaction, exposing new hires to our goal of improving the patient experience. He really believes in this and understands what we are trying to accomplish within our EVS department. When you have that, you can't fail."

At the same time, it is the EVS worker who frequently comes into direct contact with patients, so effective training in meeting patients' expectations must extend to all levels of the department. This allows hospital administration to concentrate on other facets of patient care and improving the facility's ratings.

When EVS "shines," so do HCAHPS surveys
Early positive returns on patient surveys from hospitals that rely on EVS management experts prove hard to ignore.

At the McKee Medical Center, for example, Press Ganey scores in third quarter of 2006 for "courtesy" and "cleanliness" were in the 99th percentile, maintaining EVS as the hospital's top-scoring department. That was up from the 70th percentile on courtesy and the 65th percentile on cleanliness when Medi-Dyn began the contract in June 2003.

The attainment of such successes hinges on proven quality control systems. Through such feedback mechanisms as: patient interviews, department head inspections, physician questionnaires, administrative reporting procedures and financial accountability, the level of quality can consistently improve over time.

"We started a competition between departments: nursing competes against each other on scores each month, as well as ancillary departments," says Fortin, "and housekeeping has blown all other departments off the map, so they are doing something right."

Other hospitals that chose the same option as St. Joseph and McKee include Memorial Hermann Hospital in The Woodlands, Texas, where patient satisfaction scores for EVS are consistently above the 95th percentile; and, Natchez Community Hospital in Mississippi, where more than 99% of patient responses have ranked EVS services as good or excellent since 2001.

The ultimate payoff
One of the lesser-know benefits of turning to an EVS management expert to help enhance HCAHPS results, is the fact that it can yield a return on investment that is often superior to managing the department from within. Under the guidance of Medi-Dyn, one particular hospital reduced its full-time-equivalent EVS staff from 72 to 46, and its managerial staff from 8 to 4, saving over $350,000 per year while improving quality of service.

Gains in EVS management can even possibly influence capital outcomes.

"When our hospital was up for sale, every person that came in that was interested in buying the hospital could not believe how clean it was," recalls Fortin. "The cleanliness definitely affected their overall impression of our facility."

As of August 2006, St. Joseph's became a part of Hospital Partners of America, a Charlotte, North Carolina-based healthcare services company that owns and operates general acute care hospitals in partnership with leading physicians throughout the US.

"Perception is everything, and the 'face' that you want to put out there is one of cleanliness," agrees Schock. "EVS plays a key roll in how your hospital is rated, but the customer-service gains you achieve, does not end with just good 'H-caps' scores, it improves the possibility a patient will return or recommend your services."

For more information, contact Medi-Dyn, Inc. at 13111 E. Briarwood Avenue, Suite 225; Englewood, Colorado 80112-3926; 303.662.0602 or 800.776.6441; fax 303.662.0626;; or

For additional information about the client, the release or for photography please contact Power PR. Power PR is a business to business marketing publicity firm. Additional client articles can be found at


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