Can an Internal Housekeeping Department Compete with ... · Can an Internal Housekeeping Department Compete with Outsourcing Companies? ... services expenses / Outsourcing ... –

Can an Internal Housekeeping Department Compete with Outsourcing

Companies?

Christy FingerManagement EngineerPhone: 801-357-8141

Email: [email protected]

David D. Clark, FACHERegional Chief Operating Officer

Phone: 801-357-7692Email: [email protected]

2/12/2005 2005 Annual SHS Conference 2

Presentation Outline

1. Project background1. Project background

2. Environmental Services focus2. Environmental Services focus

3. Financial goals3. Financial goals

4. Subcommittees4. Subcommittees

5. Financial results5. Financial results

6. Lessons learned6. Lessons learned


Project Background

UNR

UCRUSR

Intermountain Health Care

– 21 hospitals throughout Utah and Southern Idaho

– Integrated health system

– Recognized as #1 health system in the United State for 4 of the past 5 years

– Clusters of facilities broken into regions


Project Background

• January 2004: Operational Best Practice teams formed by corporate leaders based on top 11 company initiatives– Regional COO as Team Leader– Corporate V.P.s as Corporate Support– Management Engineering Support– Public Relations Support– Human Resources Support

Our team’s initiative: Reduce non-clinical services expenses / Outsourcing analysis


Project Background

• Non-Clinical Best Practices / Outsourcing Analysis Team– Where to focus efforts?

• Review of national benchmarking data– Housekeeping depts throughout the system showed a

$875,000+ opportunity for improvement• IHC internal benchmarking data

– Housekeeping depts showed a $1.1 million opportunity for improvement

• National research– Healthcare Advisory Board, Outsourcing remains on the

rise as hospitals seek to cut costs, improve patient experience


Project Background

• Environmental Services Task Force Created– Addition of:

• EVS corporate director• Regional Operations Officers responsible for EVS• Directors/Managers of EVS

– Key success factors:• Representation from corporate office & various

regions• Up-front commitment & buy-in• Clear expectations, accountability reporting, &

reasonable timelines for project implementation


Environmental Services Focus

• Current situation assessment– Survey conducted

• Identify cost effective &/or service excellence processes– Existing best practices to share– Best practices currently developing– Future areas for improvement


Financial Goals

• Task force members asked to set financial goals for 2005

3.6%$642,898$18,072,832Total0.9%$6,900$727,275Logan1.3%$25,000$1,939,068Dixie1.4%$37,370$2,644,971Primary2.6%$75,000$2,839,519UNR2.6%$158,628$6,057,023UCR8.8%$340,000$3,864,976USR

ExpenseReduction (%)

ExpenseReduction ($)

Current Budgeted Sub-Total Exp

Region/Hospital


Subcommittees

1. Financial/Quality/Staffing2. Supplies3. Budget Standardization4. H.R. Organization & Policies5. Employee Engagement


Subcommittees

1. Financial/Quality/Staffing Subcommittee• Outcomes

– Handheld quality inspection program– I.S. request and tracking system (EMMA)– Daily activity report (DAR)– Area staffing analysis


Financial/Quality/Staffing Subcommittee

• Handheld quality inspection programMANUAL PROCESS (Original)

Document Inspection on Paper

Manually Calculate Score

Enter Summary Results into Excel

File Inspection Paper

Pull Files for Annual Review

PDA PROCESS (After)

Enter Inspection into PDA

Upload into Excel

Access Results, as needed



• Handheld quality inspection program– Results:

• Web Access, Standardization throughout IHC• Standardized and Comparable Reports

– Overall score by hospital– Score by employee– Room type score by hospital

• Productivity Increase– Original Process = 1 hour per inspection– New (PDA) Process = 10-15 minutes per inspection

» 4-6 times productivity increase



• Electronic request & tracking system (EMMA)



• Electronic request & tracking system (EMMA)

Green = call has not been acknowledged 0-5 minutesRed = call has not been acknowledged 10+ minutesTurquoise = housekeeper is off schedule, need to reallocateOrange = suspended call, waiting for something



• Electronic request & tracking system (EMMA)– Reports: Call Volume Report

Utah Valley Regional Medical Center: Call Volume Report10/4/04 - 11/5/04

020406080

100120140

12:0

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• Electronic request & tracking system (EMMA)– Reports: Event Report by type & by housekeeper

HousekeeperNamesHere



• Daily Activity ReportName Ancillary Time 196.3 3 Hours 16 MinutesDate 12/1/04 12.5 Patient Rooms 13 162.5 2 Hours 42 MinutesArea 6a 25 Discharge 4 100 1 Hour 40 Minutes

25 Transfers 0 0 0 MinutesOther 0 0 0 Minutes

Total time 458.8 7 Hours 38 Minutes

Room #Discharge

timeTime

Started Time

Completed Hig

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Ancillary Detail ListE660 x x x x x x x x Vacuum maintenanceE661 xx Behind computersE662 x x x x x x x xx Water fountainsE663 x x x x x x x Picture framesE664 xx Defrost FridgeE665 x Elevator TracksE667 x x x x x x x x Elevator TracksE668 x x x x x x x Other:E669 x x x x x x xE670 x x x x x xE671E672 x x x x x x xE673 x x x x x xE674 x x x x x xE675 xx xx xx xx xx xxE676E677

Day Shift Daily Activity Report

Housekeeper

Pt Room Detail List



• Daily Activity Report– Results at Utah Valley Regional Medical Center

FTE VarianceActual FTE Usage - Volume Adjusted Budget

-12

-10

-8

-6

-4

-2

0

Aug

-03

Sep

-03

Oct

-03

Nov

-03

Dec

-03

Jan-

04

Feb-

04

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-04

Apr

-04

May

-04

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04

Jul-0

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Aug

-04

Sep

-04

Month

FTE

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e (N

egat

ive

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ette

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dget

)

DAR implemented



• Area Staffing Analysis– Staffing model comparison across IHC system

• Example: ER staffingSorted by Cost per ER Visit

2003Total ER Visits

2003 ER Sq Ft

Weekly Labor Hours

Labor Expense per Year ER Rooms

ER Cost per Visit

1 Logan 26,313 8,416 46 $22,981.14 13 $0.872 Cottonwood 46,601 10,119 112 $64,355.20 18 $1.383 American Fork 22,330 7,178 67 $32,176.17 9 $1.444 UV (EVS Model) 43,309 7,800 133 $67,776.80 18 $1.565 Alta View 32,510 8,479 112 $62,433.28 11 $1.926 McKay 57,222 19,313 211 $114,218.52 27 $2.007 Primary 40,505 8,131 168 $88,932.48 24 $2.208 LDS 37,950 8,600 168 $94,872.96 14 $2.509 Dixie 31,561 18,159 168 $85,438.08 32 $2.71

10 UV (ER Current Model)** 43,309 7,800 254 $130,862.16 18 $3.02



• Area Staffing Analysis– Staffing model comparison across IHC system

• Example: ER staffing -- Results

Note: The FTEs reduced during the change were transferred into open positions already existing in the Environmental Services department.

Table

$39,037$10,121$28,9161.4Comparison(reduction)

$156,147$40,482$115,6655.6New Model

$195,184$50,603$144,5817.0Old Model

Salary + Benefits

Benefits,PTO, etc.Salary $FTEs


Subcommittees

2. Supplies Subcommittee• Outcomes

– Mop analysis– Floor wax analysis (work in process)


Supplies Subcommittee

• Mop Analysis– Wet-loop mop vs. Microfiber mop Cost/Benefit Analysis

Wet-Loop Microfiber

Versus



• Mop Analysis

Increased Expenses

Start-up Costs

Replacement Costs

Dec

reas

ed E

xpen

ses

Chemical Costs

Water Costs

Labor Costs

Worker’s Compensation

Overall estimated savings for large IHC hospitals = $521,000

Existing opportunity (facilities using wet-loop mops) = $334,000 with$28,000 start-up cost



• Mop Analysis– Opportunity by IHC hospital

Wet Loop vs. Flat Mop Cost ComparisonPotential Savings Adjusted by Existing Implementation

$30,379 $33,186

$18,860 $8,810$7,988

$37,463

$98,805

$64,368

$20,335

$14,110

$-

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

Wet

Loo

p

Mic

rofib

er

Wet

Loo

p

Mic

rofib

er

Wet

Loo

p

Mic

rofib

er

Wet

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p

Mic

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er

Wet

Loo

p

Mic

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Wet

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Mic

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Wet

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Mic

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Wet

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Alta View AmericanFork

Cottonwood Dixie LDS Logan McKay-Dee OremCommunity

PrimaryChildren's

Utah Valley

Facility, Mop Type

Annu

al E

xpen

se

$-

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

Ann

ual P

oten

tial S

avin

gs

Non-EVS Cost

EVS Cost

Potential Savings


Subcommittees

3. Budget Standardization Subcommittee• Outcomes

– Standardized cleanable square footage calculations

– Consistent budgeting methodology for all facilities (work in process)


Budget Standardization Subcommittee

• Standardized Cleanable Sq. Ft. CalculationsReport Date: 2003

Building Name Interior Gross AreaVertical Penetrable

Area

Usable Area (Interior - Vertical) Comments

American Fork Hospital 229,256.91 15,227.82 214,029.09Facility Total 229,256.91 15,227.82 214,029.09

Report Total Cleanable Square Footage 214,029

Areas not Cleaned by EVS that are included in the "Space Allocation Analysis"Description of Area not cleaned by EVS Square Footage Date UpdatedVacant Space 9,508.21 Oct-04Telecom 720118 1,198.60 Oct-04 Equipment Rooms not cleaned by EVS

Plant Operations 654118 7,893.40 Nov-04

Maintenance & Repairs 630118 6,727.81 Nov-04Not Cleaned by EVS Total Cleanable Sq Footage 25,328

Additions to "Space Allocation Analysis"Other Areas not Included in Report & cleaned by EVS Square Footage Date UpdatedDaycare 1,870.00 Oct-04Patio 4,469.00 Nov-04ER overhang 1,626.00 Oct-04Gift Shop overhang 272.00 Oct-04Admitting overhang 169.00 Oct-04Rehab overhang 191.00 Oct-04SDS overhang 386.50 Oct-04

Additions Total Cleanable Square Footage 8,984 Total Sq Ft = 773; half maintained by grounds

Comments

Completed by Karen Jackson

All space removed then back offices added back because cleaned by EVS; Completed by Karen Jackson

Data from "Space Allocation Analysis" conducted by IHC corporate office

Comments

All space removed then back offices added back because cleaned by EVS; Completed by Karen Jackson


Budget Standardization Subcommittee

• Standardized Cleanable Sq. Ft. CalculationsAddition of Vertical Penetration AreasVertical Penetration Areas (Stairways & Elevators) cleaned by EVS Square Footage Date UpdatedAFH Stairways 3,034.00 Nov-04AFH Elevators 336.00 Nov-04Transcription in Southeast Medical Building 2,994.00 Nov-04

Additions Total Cleanable Square Footage 6,364

New Construction not included in "Space Allocation Analysis"

Description of Area Square Footage Budgeted Date UpdatedSquare Footage Comments

Medical Office BuildingFirst Floor Common Area (Stairs, Restrooms, Lobby, Entry) 0.00 Nov-04 2,092.00

Negotiation in progress. If cleaned, budget when cleaning begins.

Pharmacy (Physician Division) 0.00 Nov-04 1,023.00 Negotiation in progress. If cleaned, budget when cleaning begins.

Internal Med (Physician Division) 0.00 Nov-04 4,300.00 Negotiation in progress. If cleaned, budget when cleaning begins.

Lab-phlebotomy (USR Space) 0.00 Nov-04 287.00 Budget when cleaning begins.Physical Therapy (USR Space) 0.00 Nov-04 5,210.00 Budget when cleaning begins.Second Floor Lawrence & Jones (Physician Division) 0.00 Nov-04 5,222.00

Negotiation in progress. If cleaned, budget when cleaning begins.

New Construction Total Cleanable Square Footage -

SUMMARYDescription of Square Footage Square Footage1. Total Sq Ft from "Space Allocation Analysis" 214,0292. Total Not Cleaned by EVS 25,3283. Total Additions 8,9844. Total Vertical Penetration Space Cleaned 6,3645. Total New Construction 0

Grand Total EVS Cleanable Sq Ft (1-2+3+4+5) 204,049Grand Total Cleanable Sq Ft (1+3+4+5) 229,377

Completed by Karen JacksonCompleted by Karen Jackson

Comments

Blue Section

Yellow Section. This number is removed from EVS cl sq ft grand total.Green Section

CommentsOrange Section

For Budget and Internal BenchmarkingFor External Benchmarking

Purple Section

Completed by Karen Jackson


Subcommittees

4. H.R. Organization & Policies Subcommittee• Work in process

– Organizational structure standardization– Policy standardization– Pre-screening questions


Subcommittees

5. Employee Engagement Subcommittee• Work in process

– Employee incentive program– Employee safety program


Financial Results

• 2005 Budget Goals & Results

Region/ Hosptial

Current Budgeted Sub-Total Exp

Projected Expense

Reduction (%)

2005Expense

Reduction Goal ($)

Actual Expense

Reduction (%)

2005 Actual Budgeted

Reduction ($)

USR 3,864,976$ 8.8% 340,000$ 8.8% $340,800

USR EVS ER Staffing 0.0% -$ 20.0% $40,000

UCR 6,057,023$ 2.6% 158,628$ 2.6% $158,628

UNR 2,839,519$ 2.6% 75,000$ 3.0% $83,936

Primary 2,644,971$ 1.4% 37,370$ 1.4% $37,370

Dixie 1,939,068$ 1.3% 25,000$ 2.8% $54,611

Logan 727,275$ 0.9% 6,900$ 1.3% $9,310

Total 18,072,832$ 3.6% 642,898$ 4.0% $724,655


YTD Financial Results

$46,091Alta View

$107,526LDS

$210,880UVRMC

$72,921CWH

$22,259AFH

$5,622Orem

SubtotalExpensesYTD Nov

$54,139McKay

$13,252Primary

$35,402Logan

$80,246Dixie

SubtotalExpensesYTD Nov


Lessons Learned

Improvements can be identified when we pull our experiences and knowledge togetherTechnology can assist housekeeping departments in increasing productivity, in both staffing and suppliesIf managers and staff are given the opportunity and support to implement their ideas, they will surpass your expectations


Summary

• IHC’s Environmental Services (housekeeping) Depts reduced their expenses by $725,000 by adopting Best Practices, mostly achieved through:– I.S. request & tracking system (EMMA)– Daily Activity Report (DAR)– Area Staffing Analysis– Microfiber mops

• The EVS Depts will continue to identify & implement best practices

• Outsourcing possible in the future? Not if the teams keep their momentum.


Team Members

Task Force, Subcommittees, and Work-teams:• Calvin Allen, Brian Bentley, Greg Parrott, Ron Jones,

Paulette Thomason, Mary Ann Washington, Phyllis Loos, Craig Fitt, Laura Thurston, Ryan Eggleston, Allen Anderson

Council, Task Force, and Subcommittees:• David D. Clark, Bill Prows, Bruce Clark, Christy Finger,

Jami Perrett, Bryant Larsen

Task Force:• Jeff Sanders, Tim Bricker, Marie Prothero/Mike Olson,

Dale Green, Sherman Curtis, John Worley


Interesting Thought…


Questions

Can an Internal Housekeeping Department Compete with ... · Can an Internal Housekeeping Department Compete with Outsourcing Companies? ... services expenses / Outsourcing ... –

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