I had an interesting revelation recently that I wanted to share. In my consulting work, I am frequently asked to help clients understand the patient experience behind the HCAHPS scores. One area that many organizations struggle with is cleanliness. When the cleanliness score goes down, all eyes are on housekeeping, right? Conventional wisdom suggests that, if the scores are bad, it must mean an environmental service is doing a poor job. Well, before you start harping on the housekeeping crew, you might want to take a closer look around and make sure you understand how the patient defines cleanliness. Next, you’ll want to examine some habits that are giving you a bad rap.
We recently sent a number of mystery shoppers along with patients through their admission and fist days in a hospital to help a client gain a deeper understanding of the patient experience. These mystery shoppers went along as family members and had no idea about patient satisfaction scores or which categories of the HCAHPS survey were giving the leaders headaches. But their observations and documentation showed it wasn’t necessarily what the housekeepers did that caused patients to feel the hospital was unclean. It was the rest of the staff that contributed to making and ignoring clutter, which caused issues.
The patients’ comments and concerns about cleanliness in this case had more to do with clutter and staff habits than how housekeeping performed. In three of the four in-patient visits, patients were turned off by the clutter left on their bedside tables and the dirty linens left on the floor. In both examples, it was staff who dropped things on the floor, ignored empty containers on the bedside table, or left clutter behind.
In one situation it was the nursing assistant who helped a patient change his gown and then left the soiled one on the floor next to the bed. It was still there, along with another soiled one left on the bathroom floor, twelve hours later.
In two other situations, patients told the mystery shopper that they were bothered by empty juice containers, melted ice chips, and coffee cups left on their tables. They also noticed that, even though a number of staff members came in and out of the room for other reasons, they looked right past the mess and never straightened things up or offered to get rid of empty drink containers. Patients asked their family members to clean up.
Of course, meticulous housekeeping is essential for infection control and positive patient experiences. But in this assessment, our “AHA!” moment was in realizing that much of the patient perception about cleanliness was not about housekeeping, but rather staff habits and lack of attention to detail.