By Karen Thomas
Since COVID-19 emerged in the United States in early 2020, preventing the spread of infection in health care settings has been a top priority for health care leaders. Amid concerns about the risk of transmitting the virus in hospitals and other care settings, there is at least one piece of good news: Although this coronavirus is new, the techniques for cleaning and disinfecting environmental surfaces are not. And environmental services (EVS) professionals were well equipped to take on the challenge of COVID-19.
They have long served as the first line of defense against health care-associated infections and they count infection prevention among their core competencies.
In addition to understanding the role of microorganisms in disease and how they are transmitted in health care settings, EVS technicians are expected to problem-solve and apply their knowledge to recognize, contain and prevent infection transmission. These and other skills are set forth in Core Competencies for Health Care Environmental Services Professionals (Core Competencies), the first comprehensive treatment of this topic for health care EVS. Core Competencies was recently published by the Association for the Health Care Environment (AHE), a professional membership group of the American Hospital Association.
Breaking the chain of infection
To prevent and control infection, health care professionals such as EVS staff must draw on their understanding of how infections spread, according to Doe Kley, R.N., CIC, MPH, T-CHEST. "EVS staff play a very important role in the prevention of disease transmission, and this virus is no exception," Kley writes in Health Facilities Management. "When carrying out their daily duties, EVS staff have many opportunities to break the chain of infection."1
Infection prevention begins with knowing and practicing proper hand hygiene and accurately donning and doffing personal protective equipment on a routine basis, skills that are enumerated in Core Competencies.
The infection prevention expertise of EVS staff was reflected in clinical outcomes for health care-associated infections long before COVID-19 became a household word. Research conducted by AHE found that after EVS staff received training based on the Core Competencies, infection rates for surgical site and other health care-associated infections dropped by up to 75%.2
Infection prevention and related core competencies, such as cleaning and disinfection, are an integral part of what EVS professionals do. However, there is much more to EVS roles at all levels, including technicians, supervisors, managers and directors. AHE’s Core Competencies identifies a wide array of EVS skills in areas ranging from textile management to financial stewardship.
Contributing to a positive patient experience
EVS team members also play an important role in creating a positive experience for patients.
The cleanliness of patient rooms is one of the first things that patients and family members notice about the hospital environment. It takes extra effort to keep patient rooms clean while avoiding disturbing patients’ sleep with noisy floor buffers or interrupting bedside care with daily cleaning routines. That’s why promoting positive public engagements with patients, staff and visitors is included in EVS core competencies. At the managerial level, this extends to interviewing patients to evaluate service and quality and collaborating with other departments to resolve patient care delivery issues.
Efforts to put patients first translate to higher levels of patient satisfaction. In organizations where EVS professionals received training based on the Core Competencies, scores improved on HCAHPS metrics related to cleanliness of patient rooms and quiet nighttime environments.3
Using EVS core competencies in HR
With the publication of Core Competencies, EVS joins other health care professions, including nursing and clinical specialties, in codifying skills that are considered to be absolute requirements for a specific job. Although the EVS core competencies were developed for acute care hospitals, they may be used in a variety of health care settings, as most have broad applicability.
The core competencies were used to create job descriptions (which are included in the report). They may also be used to assess performance, identify training needs and guide professional development. By specifying the expected progression of skills in various core competency areas at technician and supervisory/managerial levels, Core Competencies brings EVS career paths into clear view. "Drawing on these specific and concrete core competencies for the various environmental services roles makes it easier to visualize the career ladder and make it actionable," says AHE Executive Director Patti Costello. "Environmental services offers many opportunities for advancement at all levels. A resource like Core Competencies can serve as a catalyst."
In its report, AHE notes that core competencies — not titles — should drive decision making about compensation and appropriate pay bands. Leadership titles vary by organizational size, system level, structure and other unique characteristics, so it’s important to assess which title is most applicable to a particular management structure.
As the United States moves through the COVID-19 pandemic, hospitals and outpatient clinics are being challenged to help patients who have deferred care for other conditions feel confident about returning to their health care providers. The pandemic has raised public awareness of the importance of cleaning, disinfection and environmental infection prevention, which may result in a higher profile for EVS careers. Regardless, the development of core competencies for EVS professionals highlights not only their expertise in creating a clean, safe health care environment but also the multifaceted nature of their roles.
How core competencies change at various EVS career levels
As individuals move from a technician role to the supervisor level and beyond, they are expected to demonstrate progressively more complex levels of skill, as shown in this example for the core competency area of waste management.
- Technicians must demonstrate proper segregation and storage of various waste streams according to federal, state and local regulations.
- Supervisors must train hospital staff and environmental services personnel in the proper handling, segregation, disposal, reduction and treatment of all waste streams.
- Managers must develop processes for monitoring and evaluating chemotherapeutic waste, hazardous waste, radioactive waste and various other waste streams.
- Directors must develop a waste management program, including goals, operation requirements, reporting procedures, manifests and documentation.
AHE Executive Director Patti Costello sums it up: "Health care environmental services professionals care for a highly complex, regulated environment where sick people want and need a care environment conducive to safety, recovery and wellness. That very environment plays a key role in patient experience and quality outcomes throughout a patient’s continuum of care. Simply put, health care environmental services contributes to saving lives every day."
Interested in learning more?
Download Core Competencies for Health Care Environmental Services Professionals and Training Insights 2020: Improving Value Through Evidence-Based Training at www.ahe.org.
How the EVS core competencies were developed
The AHE Action Team charged with developing the core competencies used two job task analyses as a starting point. One analysis examined the universal job tasks associated with the EVS technician job role (excluding facility-specific and certain other specialized tasks). This analysis was based on qualitative research, consisting of in-depth interviews and focus groups conducted with subject matter experts, followed by a survey that was fielded to more than 7,000 EVS professionals, yielding 418 completed surveys.
A second job task analysis for EVS leadership positions was performed by the AHA Certification Center. This analysis, which informs AHE’s Certified Health Care Environmental Services Professional (CHESP) certification, includes more than 100 competencies. Through an individual assessment process, an AHE Action Team first identified the knowledge, skills and abilities in the job task analysis that warranted designation as potential core competencies.
An AHE advisory council and the 2019 AHE board participated in the development of leadership core competencies. Another AHE Action Team subsequently determined which competencies should be elevated to the core level.
Karen Thomas has written about a wide array of health care topics for associations, including the American Hospital Association and the Healthcare Financial Management Association, for more than 25 years. She holds a master’s degree in health care management from Northwestern University’s Kellogg School of Management.
1. Kley, D. "Waging the battle against COVID-19," Health Facilities Management. May 14, 2020. Available from: https://www.hfmmagazine.com/articles/3902-waging-the-battle-against-covid-19
2. Association for the Health Care Environment. Training Insights 2020: Improving Value Through Evidence-Based Training. Available from: www.ahe.org
3. Association for the Health Care Environment. Training Insights 2020: Improving Value Through Evidence-Based Training. Available from: www.ahe.org.
Originally published in the Fall 2020 issue of HR Pulse magazine.