Mark Heller is the president of Hygiene Performance Solutions, a consulting and coaching firm. He works with hospitals, long-term care facilities, and other organizations to help them improve their cleaning and disinfecting processes.
His experience as a healthcare executive — and advising other organizations — gives him incredible insight into the forces affecting healthcare housekeeping and environmental services teams today.
We talked with Mark to hear his thoughts on why healthcare cleaning is unique, how to create a successful quality control program, and the forces he sees shaping the healthcare industry’s future.
From 50-story hotels to 500+ healthcare facilities
First, some background on Mark. He started in the housekeeping industry about 35 years ago, right out of college, as a hotel room inspector for a large hotel chain in Toronto.
“I quickly discovered I had a passion, or an obsessiveness, when it came to being meticulous about cleaning, about order, and about cleanliness,” he says.
Mark spent years inspecting hotel rooms. He honed his skills in 50-story hotels, where worked his way to a senior level and ran housekeeping and laundry departments. Then, someone suggested a switch to healthcare.
Healthcare appealed to Mark as a way to use his passion for cleanliness to help others.
“In the hotel industry, if we messed up on cleaning and disinfection, we had an unhappy guest . . . In the healthcare field, if you mess up, you can contribute to their death. It raised the game of responsibility in a dramatic way,” he said, adding that those stakes were “a very powerful force of motivation to really develop best practices.”
For about 25 years, Mark worked in progressively larger healthcare organizations. Eventually, he was a senior executive running North America’s largest publicly operated environmental services department. He oversaw 176+ hospitals and 330 long-term care facilities.
Eventually, he went for his MBA and decided to begin work as a consultant. Today, he works with hospitals, long-term care facilities, and other organizations to help them improve cleaning and disinfecting. He also works on market development for products and services related to cleaning and disinfection.
“I think I have a really unique position, because I know what it means to inspect a room,” Mark told us. “To inspect a hotel room, to inspect an office, to inspect a plant, to inspect a patient room, an operating room . . . I understand how to translate standards of cleaning and cleanliness outcomes and turn them into a grading of whether something is acceptable.”
Why healthcare is different from other industries
Mark says he sees a lot of cleaning service providers try to make the leap into healthcare, only to find that the strategies that worked well for different types of cleaning don’t cut it with healthcare.
“In a healthcare facility, you can be brilliant at what you do Monday to Friday from 8 to 4. But if you fall down on the job Sunday at 8 p.m., a germ or virus doesn’t care,” Mark says. “That can be your weakest link.”
“Sometimes, people who look at healthcare [from the outside] don’t appreciate that just doing basic audits on visual cleanliness is probably the least critical thing that we do in healthcare.” Instead, he says it’s about how effectively the team eliminates pathogens on surfaces.
Creating a “menu of audits” for quality control success
Mark defines auditing as a management tool that helps track behaviors and quality outcomes, giving leaders data to make decisions about how to use resources, evaluate employees, and get the right management in place.
“One of the things that we look for at an effectively run quality process is that they are doing multiple types of audits,” he says. Rather than just using visual cleanliness audits, he recommends using a whole “menu of audits.” This is actually how we met Mark, who began using OrangeQC as a way to help teams manage multiple types of audits in one place.
So what should be on the menu for healthcare facilities? Here are a few of Mark’s must-haves:
- Fluorescent marking audits: During these audits, supervisors pre-mark a surface with glow gel or fluorescent markers, then let the cleaners do their job as they normally would. Afterwards, they go back with a UV light to find out if the area was cleaned sufficiently.
Mark says these audits are a “great cleaning and teaching tool for front-line workers.” Make sure to include the cleaners in the process so they can see the results for themselves. - ATP monitoring: ATP, or adenosine triphosphate, is an enzyme whose presence marks the likeliness that a surface is contaminated.
“[ATP] is not a contaminant itself, but it’s a marker of likely behavior,” Mark says. Measuring ATP levels regularly gives healthcare teams a leading indicator that warns when surfaces aren’t being cleaned well enough to eliminate contaminants. - Process compliance audits: “What makes healthcare unique is that it’s not just about getting a great outcome, it’s about making sure the cleaning process is done in the right way,” Mark says.
For example, Mark recommends audits for the cleanliness of carts, the way equipment is organized, and the staff’s understanding of protocols such as isolation cleaning.
In addition to these audits, teams should also perform visual cleanliness audits, microbial simulation audits, and safety audits, Mark says.
How to set the QC process up for success
There are three crucial parts of the quality control process that Mark says need to be done correctly:
- The protocol must be set up correctly.
- Audits need to actually be performed regularly. Making time to get audits done is often a major barrier.
- Audit findings need to be shared with the right people and used to guide improvement. It’s critical to communicate results in a manner appropriate to the audience (for example, front-line cleaning staff have different needs than clinical staff.)
If there’s a failure at any step of the process, it ends up being ineffective — which can have disastrous consequences for the patients healthcare teams serve, so it’s crucial to get each part right. Mark broke down what it looks like to tackle each stage successfully.
Using the right audits in the right places
Healthcare quality control processes should cover all parts of the building, as well as the process of cleaning. Additionally, everything needs to be organized by risk.
“In a healthcare facility, making sure that the CEO’s office is clean and shiny might be a politically wise thing to do, but it doesn’t affect patient or resident care,” Mark says. That means it needs to be a lower priority than an operating room, for example.
Mark advises facilities to set up their system so that high-priority spaces get audited for both leading and lagging indicators. That means if there’s a problem, it should be caught early (as with ATP monitoring); but if a problem gets missed once, it should definitely be caught down the road (such as through a visual inspection or when the cleaning process is audited).
Actually performing the audits
Once a quality control process is in place, follow-through is key.
“We frequently see wonderful binders or wonderful programs that are put on the software and the system, but then we dig into the data and say, how many audits are you actually getting done?” Often, they’re not.
Engaging the staff in the process is key. Audits should be used as a moment for training, education, and communication, Mark says. Making sure your team engages the front-line staff as they do inspections and audits. That’s an excellent way to get on the same page about quality standards and to help the team rally together to provide better service.
Using audit results
Mark’s experience as a senior executive has made the value of data plain as day to him.
“Data drives decisions,” he says. “The cost of cleaning services is always under scrutiny, and increasingly, we have to measure our performance. In healthcare, we have to measure our effectiveness not just by the dirt we can see, but by the dirt we can’t.”
However, Mark decries “auditing for auditing’s sake.” Instead, auditing should be used to make better decisions about how to budget staff labor, make sure critical training gets done, and continuously improving.
“We’ve seen many examples of facilities that actually do audits, generate reports and data, and that data is never shared with the actual front-line workers, or there’s no evidence that that data was actually followed up on. That’s a tragic waste of that important information.”
Mark recommends a few practical steps teams can take to find success:
- Realistic audit quota. “We see time and time again, a facility will put in place an unrealistic quota of audits to be performed,” he says. “The might get them done once, maybe twice, but it’s just not sustainable given the other priorities that a healthcare facility has.” Instead, set the quotas and measure compliance to encourage follow-through.
- Make sure that staff are part of the process. “A big red flag for me is when I find out audits are being done after-hours, or all in one afternoon,” Mark says. Audits should be done regularly, throughout the month, and with active staff participation.
- Communicate the results with staff in an easy-to-understand way. Rather than loading your hourly employees up on the same charts and graphs you use, Mark says to try curating photos of what a great clean looks like (and what’s clearly unacceptable). Share them with your staff. Great work should be celebrated publicly; on the flip side, “be discreet about situations where employees need training and coaching.”
Three trends shaping the healthcare facilities industry today
Finally, Mark shared three trends he sees shaping how healthcare organizations and their housekeeping teams operate. Staying on top of these forces can help teams stay current.
1. Real-time data sharing
Mark sees an “ever-greater push on real-time, transparent sharing of information.” People want real-time access to the data, he says. For example, infection control professionals want to be able to log into a system and look at quality control data as it comes in.
Some hospitals are even moving towards live-streaming dashboards of their cleanliness performance and how they measure up on their KPIs (key performance indicators).
So what does Mark think of this trend?
“Overall, transparency and speeding up the communication process is a good thing and I generally support it,” he says. “You have to be careful, though. Quality data and KPIs, while they can be very helpful . . . they can also be a weapon if they’re misused and the data is not understood.”
That’s why the data needs to be presented with the right context. Additionally, the audience is key. Some KPIs may be appropriate to share with the public, others with staff. “Not every KPI is suitable for all eyes,” Mark says. “You’ve got multiple stakeholders that want to know about the performance of the cleaning department and they want to know this for different reasons.”
That means that teams need to present their findings to each audience with an understanding of why they want to know it.
2. More pressure on housekeeping teams.
Another trend Mark’s team sees? “As hospitals are getting squeezed tighter and tighter and tighter, occupancy levels are going up. In Canada, for example, we’re seeing hospital occupancy rates in excess of 100%.”
That can mean medical care is administered in hallways, or that people are admitted to the hospital but not admitted to a room for days. Mark calls that a “huge burden on Environmental Services to deliver a higher level of cleaning.”
Those occupancy levels also put tremendous pressure on turnaround time, which is now measured in minutes. And the resources aren’t always there to keep up.
“Staffing levels are tight, budgets are tight, and they’re getting tighter,” Mark says. That means teams need to make choices about their priorities.
“In healthcare facilities, we have to accept that lower-risk areas of the building are going to look to be cleaned less often as resources are focused on higher-risk, high-priority areas.” That might mean there are multiple levels of quality outcomes considered acceptable.
But in the midst of the squeeze on housekeeping teams, their value is becoming more and more apparent.
“What I’m excited about is that we now have a lot of great scientific evidence connecting the hygiene of the clinical environment to the risk of a patient or a resident getting a healthcare-related infection,” Mark says. “We always believed it was true, but we’ve got now good-quality evidence to support that.”
That recognition is helping to fuel a push to define acceptable standards for protecting patients and residents, what Mark calls the “holy grail” of the healthcare industry.
“I’m excited about that because we’ve got some amazing microbiologists and infection control specialists in the industry working on this.”
3. The globalization of infectious disease
As global travel becomes the norm, organisms spread at faster and faster rates. That presents new challenges in the healthcare industry. Now, teams need to know what’s happening around the world.
“When we see an outbreak happening elsewhere in the world, we need to be aware of that,” Mark says. “It’s only one plane ride away from being in our city or community.”
Protocols are changing quickly for Environmental Service professionals, he adds. “They really have to stay on top of their education and be well-connected to the professionals as knowledge of pathogens and how to deal with them changes quickly.”
Thanks so much to Mark Heller for sharing these tips and insights! We hope they help your team develop and maintain a rigorous quality control program. To learn more about Mark’s team, visit Hygiene Performance Solutions online.
