Why should the temperature of a patient’s room matter to a healthcare executive? Or whether the television works, the faucet drips or the toilet makes a funny noise? How about the air circulating in the operating room?
These issues matter because they all contribute to the patient experience, and they are as crucial to patient satisfaction and outcomes as clinical care. Effectively managing these factors might even help drive down hospital acquired infections (HAIs) and drive up Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
While leaders should be aware, they should not have to worry. They should be able to trust that a system is in place to ensure that these issues and many more are addressed efficiently and reliably.
In the zone
Zone maintenance is a proven, effective way of achieving this goal. In the simplest terms, zone maintenance means assigning a space within a hospital to one general maintenance mechanic. In an effective program, that space is generally: 100,000 square feet per mechanic for general acute care space; 85,000 square feet for intensive care and other critical care spaces; and up to 125,000 square feet for common areas, such as lobbies and the cafeteria.
Upkeep, repairs and general maintenance in that zone are the responsibility of one dedicated mechanic who is supported by a team of engineering specialists. The zone mechanic is limited to two hours for any task. If the job requires more time, they request support from another team member.
Many hospitals try zone maintenance, but few keep the effort up. At a recent conference, I asked an audience of approximately 150 engineers how many of them had tried zone maintenance. About 80 percent of them raised their hands. When I asked how many were still practicing it, not one hand went up.
Why? Because starting a zone maintenance program sounds easy, and assigning space to a mechanic is relatively simple. But without the proper structure and management in place, it is easy to lose focus. Old habits are hard to break, and new ones are hard to start and maintain, but it can be done.
Our experience shows that when accountability and teamwork become systematic, zone maintenance enhances the patient experience and improves safety, making it well worth the effort. Here are five keys to a successful zone maintenance program.
1. Integrating the mechanic into the care team
Effective zone maintenance succeeds only when the mechanic is fully integrated into the clinical care community. That process includes participating in the clinical team huddle every morning, interacting with patients and receiving recognition as a team member who is as integral to the patient experience as the clinicians.
I have seen firsthand that integrating mechanics into the care team empowers them to take ownership of creating safer care environments. In one of the first zone maintenance programs I rolled out more than 20 years ago, I gave the mechanics business cards. I’ll never forget how one of the guys, a man in his early 50s who had been there for more than two decades, looked at me with tears in his eyes and with genuine emotion, said, “George, I’ve never had a business card.”
That unmistakable pride came through in his work, especially in protecting patients from potential harm. Whether it was maintaining ventilation or managing temperatures in patient rooms, he made sure his patients were safe within his zone.
2. Education that goes beyond machines and tools
Successfully launching a zone maintenance program requires educating mechanics and the clinical care team on the reasons things are changing. Everyone needs to leave behind the “We’ve always done it this way” mindset and embrace the new program.
Mechanics also will need to sharpen new skills, such as interpersonal communication, and adjust to new procedures. This process will likely include education and reinforcement on hand hygiene, one of the leading causes of HAIs.
3. A daily 16-point inspection
A well-organized zone maintenance program starts with implementing a checklist of critical areas to be monitored every day in each zone. For our facility management teams, that is 16 items ranging from air flow to managing barriers.
The mechanic assigned to each zone then inspects those items first thing every morning and evaluates them for compliance. The rest of the day is spent repairing the issues uncovered and addressing other issues identified by nurses in that space.
4. Elevating the mechanic as patient advocate
Another differentiator of effective zone maintenance is one-on-one interaction between the mechanic and patient. On their daily rounds, mechanics introduce themselves to patients and ask for permission to do a quick inspection. They also ask the patient if he or she is too warm or cold, if the television works to their satisfaction and if anything would make their stay more comfortable.
The encounter can take less than two minutes, but in that time, the patient feels heard, and the mechanic notes issues and makes repairs or adjustments on the spot, if possible. If not, the mechanic asks the nurse when the patient will be out of the room and schedules the repair accordingly.
5. Accountability for patient safety
In a well-run zone maintenance program, mechanics go through a semiannual peer review, with supervisors walking through the zones and talking with nurses and patients. Checks and balances are in place to ensure systems run as they should and that minor issues do not become major.
Mechanics need to be hyperaware of safety issues around their own actions. Hand hygiene is stressed repeatedly, and knowing that ventilation and air quality are among the top causes of HAIs, they are vigilant about working within enclosures in critical-care areas. As owners of their environment, they become meticulous. They make sure other members of the team and outside contractors follow the same safety rules and avoid risk to patients.
One hospital leader told me once that 80 percent of his job was crisis management and 20 percent was dealing with organized chaos. In such an environment, zone maintenance can mean one less thing for executives to worry about, and in a properly structured program, it is.
A zone maintenance program that nurtures collaboration and responsibility for common objectives helps that environment run smoothly and safely. Beyond that, though, are improved experiences for the most important stakeholders of all — the patients.
George Mills is director of healthcare technical operations with JLL.