Caring for the Healthcare Environment: EVS Leading Implementation Science

By Patti Costello

There has been a lot of chatter about standards of practice for cleaning and surface disinfection or the perceived lack thereof. Evidence- based best practices in environmental services do in fact exist. However, willingness outside of environmental services to accept them has been less than stellar. Environmental services (EVS) professionals are not scientists nor trained researchers, but they can tell you whether your data can be practically implemented. The bottom line is there are so many conflicting views on everything from disinfecting floors to whether or not infection can be traced back to environmental surfaces, that we are just short of turf wars.

Unfortunately, current research, and the manner in which it has and is being presented, has diminished the credibility of and poorly positioned EVS professionals in taking the lead role in facilitating evidence-based implementation science. Published findings have made statements such as: sub optimal cleaning, improper cleaning, not being cleaned according to policy, etc. While probably not meant to be derogatory, these statements have minimized the credibility of the professionals running the department. There are basic principles of cleaning for health and their impact on positive outcomes; they are battle-tested and evidence-based. Most of the EVS managers and directors know what they doing and why they are doing it. So the question is, why are we still doing the same research when there are already a multitude of repetitive studies on cleaning and surface disinfection that seem to be reaching the same outcome? Why not try a different approach and work to implement the best of the research science to promote change?

As the reform landscape continues to change and the demands on improved outcomes and higher satisfaction scores increase; job requirements and how employees demonstrate working knowledge of their profession should be changing as well. This is the first step toward implementation science. Lets use the plethora of data collected over 20-plus years to invoke meaningful change by employing a multidisciplinary team. We need to stop analyzing and start doing. At what point will we have enough data to tell us what we already know? It takes a village to properly maintain a healthy care environment and protect patients. EVS is perfectly positioned and they have the skill set to take the lead.

The first step to getting implementation science right is to avoid painting such an unflattering picture of EVS teams in published studies, presentations and discussions. Negative data presentation will not motivate teams to do a better job. The more you hear you are ugly, the more you will believe it even when you know its not true. EVS deserves the same respect as the rest of the healthcare team. Their knowledge base is not the same as other professionals; it is different, it is battle-tested and it is sorely needed if we are going to achieve quality outcomes.

A second step is to form institutional cross functional, multidisciplinary teams of healthcare professionals. Meet and review the latest research together to determine which studies have the best data and information that can be used to develop  the most efficient, effective and economical plan that suits the needs of individual facilities. One size does not fit all. We also need to embrace the competencies and the evidence-based recommended practices and processes of our EVS peers. We need to listen to the practical side of what can be done with the data and how to do it. We need to get to the core of the problems potentially affecting cleaning quality and outcomes. However, there are so many competing priorities that we are missing sightlines to other disciplines critical to success and its making meaningful progress seem like pushing a rope uphill.

A third step to getting it right is to recognize the professional membership organizations outside of the research and clinical communities and their most important assets the members! Everything membership organizations do revolves around the wants, needs and professional development of its members. The tools and resources are geared to assist with the delivery of services to facilities and patients. The core missions of professional membership organizations are very similar, regardless of the discipline of practice. They all promote professional excellence, develop best practice, they collaborate with others, are advocates for their specific discipline, they add value to their healthcare organizations and they exchange critical but practical information.  However, the way information is exchanged is beginning to blur the lines of where one discipline ends and the other begins and it is inadvertently minimizing the credibility of professionals. EVS is in particular.

Professional organizations that are the most recognized, respected and valued have developed certification programs with minimum competency requirements. Credentialed professionals demonstrated they have met the basic requirements of a specific discipline or profession. The requisite knowledge is typically based on role delineation studies and job analysis, formulation of core content domains in support of the data from job analysis. The end result is a certification exam that has met the rigors of psychometric testing and further analysis. Certification programs that meet and/or exceed national competency assessment standards have been developed to enable professionals and to master a body of knowledge central to the discipline. Typically, eligibility to sit for an exam is based on a combination of education and management experience in the field.  Most recognized in this arena are professionals certified in infection control (CIC) for infection preventionists and certified nurse operating room (CNOR) for perioperative nurses. These credentials are accepted, expected and respected.

Environmental services professionals also have a program that meets the same standards --  the certified healthcare environmental services professional (CHESP). The fourth change agent is to accept, expect and respect CHESP in similar fashion as other credentials. The core knowledge base is not the same; it is different but no less critical to positive outcomes.

The point in even discussing competencies and credentialing is to drive the fifth step  homeEVS professionals possess a knowledge base as compelling and powerful as the infection preventionist or the perioperative professional. They are not housekeeping managers, custodians or janitorial supervisors. Housekeepers work in hotels, janitors and custodians in schools, office buildings and sports arenas. They are cleaning for health but not in an environment for the infirmed. Environmental services professionals however, are hygiene specialists. They work in healthcare and their role affects patient or resident outcomes and the quality of the care environment.

Willingness to move over and allow EVS the opportunity to lead implementation science is critical. Research conducted by daVinci Consulting Group shows that 50 percent of the variance in the performance of a healthcare organization comes from measurable and improvable leadership and organizational climate. As the saying goes, attitude is everything.

As EVS moves forward in leading implementation science, rest assured the methods employed will be rigorous and evidence based to withstand the test of time. Acceptance, recognition and respect for the EVS knowledge base and their ability to lead implementation science will allow all the professionals contribute to the desired outcomes.

Patti Costello is executive director of the Association for the Healthcare Environment (AHE).