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May 4, 2022

How to Improve HCAHPS Cleanliness Scores

Writers: Katelyn Hyatt and Hamlin Ghee

Before we dive into some strategies you can implement to improve HCAHPS cleanliness scores, it’s worth taking a moment to understand what, exactly, these scores are and how they can be useful.

HCAHPS cleanliness scores highlight honest feedback from patients and help to reveal trends and opportunities for facilities — especially environmental services teams. 

In other words, they tell us how patients perceive the cleanliness of their experience at the hospital. 

Why is it important to make this distinction?

Well, first of all, it helps us remember that HCAHPS scores don’t tell the whole story. Budget and materials management, infection prevention measures such as hand hygiene and proper chemical dilution and application — these are things the patient never sees or thinks about and, at best, indirectly impact the patient experience.

Nonetheless, HCAHPS are critical to understanding the relationship between EVS and the patient and can help you identify areas you need to improve from that perspective. 

So, if you’re looking to improve your HCAHPS cleanliness scores, here are some areas you can begin to investigate and address to begin to move the needle.


Staffing is a constant struggle in the workforce right now, especially for hospitals and, even more specifically, for EVS teams. This challenge isn’t just about having enough people but is more about finding the right people.

While staffing may seem to be an impossible problem to solve, the impact of your personnel shouldn’t be overlooked and can be a good place to start.

There will always be ups and downs in terms of turnover and, yes, there is no perfect solution (if there was, there wouldn’t be such a big staffing problem). Instead, when it comes to personnel, it’s better to focus your attention on who’s already there and identify ways to empower the team you currently have.

Generally, areas for improvement can be addressed with focused training and a commitment to continued education.

  • The keyword there is “focused.” EVS leadership should evaluate each team member to identify specific strengths and weaknesses. Then they can work on making improvements in the areas of weakness while putting them in positions to succeed with their strengths.

For example, a housekeeper may be an excellent cleaner but doesn’t interact with or explain their processes to a patient, which can make a patient feel uncomfortable and affect their perception of cleanliness. 

In this case, the team member doesn’t need training on cleaning techniques but rather on patient engagement skills, such as communication using the AIDET method.

When you’re able to understand a team member’s strengths and weaknesses, you spend less time on the things they already excel at and more time on training areas that will make the greatest impact on your cleanliness scores.


One of the best ways to improve cleanliness scores is to implement a thorough quality assurance system.

In a healthcare facility, a key component of quality assurance and validation is rounding. 

There are a few types of rounding that can help improve your scores:

  • Performance indicator (PI) rounding
  • Collaborative rounding
  • Patient rounding

Performance indicator (PI) rounding takes place when a manager or supervisor rounds with a specific team member to validate that their performance is up to standard. 

The manager gets the opportunity to see the team member’s interaction with patients first-hand and provide one-on-one coaching and feedback. 

This approach is impactful in two ways. First — it develops the team member. Investing time into one-on-one coaching will reap rewards in the EVS team's performance.

Second — it makes housekeepers feel valued and improves morale. This can’t be overstated. When leadership commits to PI rounding, housekeepers feel like their job really matters and begin to really care about doing a good job.

As a bonus,  this type of rounding gives quick validation of cleanliness using tools such as ATP testing, fluorescent marking, or visual spot checks. While patients don’t see that and it doesn’t directly impact HCAHPS scores, doing the behind-the-scenes work of infection prevention makes patients safer and reduces HAIs.

Patient rounding takes place when an EVS manager visits with patients and talks with them about what the patients see housekeepers clean and the level of interaction that the patient, family members, or friends have had with the housekeeper.

Collaborative rounding is when EVS leaders round with leaders from different departments, like nursing, infection prevention, or plant operations. The goal of this type of rounding is to improve transparency and strengthen relationships between EVS and other teams.

Collaboration helps everyone understand their role in keeping the hospital clean. Yes, cleanliness is the housekeeper’s main priority. But the responsibility of keeping things tidy falls on everyone at the hospital, and collaborative rounding can help each department understand what their role is in improving cleanliness.

Using these rounding methods as validation and quality assurance systems, managers can better identify areas for improvement and provide accountability, helping to maintain a quality standard of performance and improve cleanliness scores.

Nursing partnerships

While housekeepers may only spend 10-20 minutes in a patient’s room per day, nursing staff spend significantly more time at the bedside. In addition to their roles, they also play a part in keeping the room clean and ensuring the patient feels comfortable, happy, and safe.

This is why the relationship between EVS and nursing teams is so important. It helps to ensure that everyone is on the same page and creates open communication between departments.

Nursing staff also help to provide feedback to EVS leadership on areas of improvement for housekeepers, creating opportunities for continued learning and development and an improved patient experience.

Team member engagement

It’s not always easy to keep EVS teams motivated, as the job can often be tedious. To boost team morale, try implementing a team member engagement program.

For example, incentivize based on HCAHPS performance. You can use boards to track and display HCAHPS scores or to announce a reward or celebration if a certain HCAHPS goal is met. 

If throwing a celebration is not a possibility, consider an incentive like a free day of PTO or a gift card — something to recognize the team or team members for real achievements in cleanliness scores and metrics. 

When team members enjoy their jobs and are motivated to be better, their performance improves, affecting interactions and experiences with patients.


Finally, if you’re struggling with cleanliness scores, it may make sense to consider outsourcing your EVS team to a company whose sole focus is housekeeping, with proven systems and processes in place. 

Outsourcing is only successful, however, when you select a vendor that fits within your culture and is financially and operationally transparent. 

When done well, switching from in-house to a trusted vendor won’t feel like you’re losing control. It will actually give you better insight and visibility into the department’s performance. You get to focus on your core capabilities and purpose as a healthcare provider while the vendor is able to focus on theirs.

Tag(s): Healthcare

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