There is one specific question in the HCAHPS survey dealing with cleanliness: "During your hospital stay, how often were your room and bathroom kept clean?" While this might seem like a straightforward issue that's easy to manage, in fact, patients' perception of the cleanliness of their environment is more complicated than you might think. There are several reasons for this. For one, psychological issues play into perceptions of cleanliness. Your patients view cleanliness as a marker of safety and quality. They're in an unfamiliar and scary place, and often, suffering physical pain. Patients need an environment that is emotionally soothing and promotes healing; if they see (or smell) something in the environment that makes them uneasy, they feel stressed and more negative about their experience. And let's face it, because of media attention to hospital-acquired infections and surgical/medication errors, many people come into your hospital worrying about whether it's unsafe and unclean.
It's also true that patients expect everyone involved in their care to help keep their space clean, not just the environmental service staff. The bottom line? Cleanliness must be an organization-wide priority, and not something that only housekeepers/environment of care (EOC) staff are concerned about.
6 suggestions for improving HCAHPS cleanliness scores:
Think broadly about cleanliness
Studies show that perceptions of cleanliness are impacted by sights of visible clutter, areas that need maintenance, smells, sounds, and touch. This applies to areas other than the patient's room; in fact, the outpatient and waiting areas also factor into whether patients think your hospital is clean, and therefore, safe and a place that provides excellent care.
Make cleanliness everyone's responsibility
The interaction between non-housekeeping staff and patients factors into perceptions about overall cleanliness. Organizations that are the most effective at dealing with cleanliness expect that if nursing or other staff see something that needs addressing, such as a dirty patient tray, they address it then and there. On the other hand, if a nurse or even physician in your organization leaves the patient's room without noticing and doing something about a dirty towel left on the floor, that seemingly small oversight just might factor significantly in that patient's cleanliness rating.
Develop goals around this HCAHPS metric
According to the StuderGroup, cleanliness reflects organizational attention to detail, staff attitudes and pride, and the overall culture of excellence and safety. Senior leadership needs to emphasize the importance of cleanliness to perceptions of the entire organization by developing measurable goals and regularly monitoring whether those goals are being reached.
Use rounding as a tool to assess and improve cleanliness perceptions
Of course, your organization should be doing regular patient rounding to ensure that you're delivering top quality care. Routine rounding is a known method for improving quality, safety and overall patient satisfaction scores, and it's fast becoming a best practice for hospitals and other healthcare organizations. Mobile rounding solutions can help you assess cleanliness by providing a simple platform to record, aggregate, analyze and act on problems in real-time. Centralized rounding tools help you see the connection between patient satisfaction and the environment of care. Rounding platforms that have issue management tools help you standardize how your staff respond to concerns raised, and enable them to close the loop so that patients see that their concerns about cleanliness are in fact addressed.
Develop and role-play cleanliness assessment scripts
During rounding, simple conversation starters help staff address cleanliness. For example, here are some good intro sentences: "Our team will always keep your room and bathroom clean, so please tell me if you feel that they are clean." Or, "I have cleaned your room and sanitized your bathroom; is there anything you think I've missed?"
If your staff seems uncomfortable with a scripted conversation, have them role-play with someone else and practice until it feels comfortable and natural. Scripting facilitates desired patient-centered behavior, and it eliminates variation among employees.
Engage with the patient to reinforce your cleaning procedures
It's a good idea to make sure patients know your staff is regularly cleaning their room. Some hospitals provide printed cards to the EOC staff which they leave in patient rooms after cleaning is completed. Another useful approach is to tell patients what has been done to keep them safe and comfortable. Staff might say, for example, "I always wipe down your door handles so they're clean and safe"; or, "I wanted to let you know that I scrubbed and disinfected your bathroom while you were out."