By Dan Hounsell, Senior Editor

Environmental safety rounds in healthcare facilities are among the highest priorities for healthcare facilities managers and their safety teams. The inspections identify environmental deficiencies, hazards and unsafe practices by examining the physical aspects of the building and equipment and randomly assessing staff knowledge of critical environment of care (EC) functions. They also help organizations comply with The Joint Commission’s EC standards for achieving hospital accreditation. 

The conditions of participation of the Centers for Medicare and Medicaid Services (CMS) do not directly provide a requirement for the frequency or scheduling of recurring inspections, but they do state that “the condition of the physical plant and overall hospital environment must be developed and maintained in such a manner that the safety and well-being of patients are assured.” 

Unfortunately, managers and others involved in EC safety and environmental rounds tend to rely on outdated or ineffective processes that result in repeated requests for improvement (RFI) from the Joint Commission and, ultimately, less-than-effective efforts to improve patient safety and care. 

Robert Neil, a principal consultant with Joint Commission Resources specializing in EC issues, offered an updated approach to environmental tours during ASHE’s recent Health Care Facilities Innovations Conference in Anaheim. 

Looking for trouble 

Among the issues undermining hospitals’ efforts to conduct effective EC rounds is a lack of understanding among managers about key requirements for the process. Neil says 65 percent of hospitals’ overall policies exceed the Joint Commission’s requirements, which too often sets up facilities to receive RFIs in areas not required for compliance. 

For example, Neil says that while CMS does not specifically require environmental tours, healthcare organizations often have their own policies stating that the inspections must occur says twice annually for clinical areas and once annually everywhere else. 

To avoid such issues, Neil says managers must ask themselves and their teams. “Where have we exceeded the Joint Commission’s requirements?” 

Environmental tours typically feature these key elements, Neil says: 

• Hazard identification, including identifying potential risks, such as tripping hazards, faulty equipment and inadequate lighting 
• Compliance checks to ensure compliance with safety standards, protocols and regulations. 
• Maintenance and housekeeping surveys to assess the condition of a facility’s infrastructure, cleanliness and maintenance needs 
• Staff engagement to involve frontline staff in recognizing and reporting safety issues and gathering their input on potential improvements 
• Documentation and follow-up on tour findings, including creating action plans and ensuring timely follow-up and resolution. 

The problem is that typical tours do not produce the results managers intend, Neil says. For example, 70 percent of the top 10 cited standards in 2023 consisted of EC and life safety (LS) deficiencies. But 90 percent of the cited standards involved compliance issues are routinely evaluated and often noted during environmental tours. 

Neil says healthcare organizations and managers need to take a new approach: “What we’re doing isn’t working.” 

A new approach   

One major reason that healthcare organizations struggle to maximize the effectiveness of environmental rounds and EC safety in general is a lack of knowledge among front-line workers, Neil says, adding that too much time between tours and ineffective focus of the tours also contribute to the problem. 

With the goal of creating and maintaining a safe, secure environment free of hazards and deficiencies, Neil recommends a three-pronged approach designed to: increase staff knowledge and awareness of hazards and deficiencies; increase the frequency of tours and the number of trained personnel; and develop effective solutions for frequent, repeated and hard-to-resolve hazards and deficiencies. 

The first step is developing and training frontline staff to be experts in their environment. Neil recommends these tactics: 

• Develop a detailed checklist of the most common and serious deficiencies. This tactic will make staff aware of potential hazards and deficiencies in their departments. 
• Assign and train a frontline staff member on the checklist, and task that person with conducting daily rounds. The result? The department develops a local expert who can monitor and audit for compliance. 
• Have an assigned frontline staff member recruit a different team member each day to participate in daily rounds. This enables specific knowledge of potential hazards and deficiencies to become hardwired through repetition. 
• Communicate rounds findings to the manager, display them on a communication board, and review them daily at department safety meetings. In this way, departments can create and maintain a safe, secure environment free of hazards and deficiencies. 

Next, managers can focus on increasing the number of trained experts and the frequency of rounds. Neil recommends these steps: 

• Develop an accompanying reference guide for the deficiencies checklist with pictures and applicable regulatory and policy references. The guide helps staff gain more information and ensures a uniform understanding of the requirements. 
• Recruit and train representatives from clinical, administrative and support services to be experts. This tactic helps the hospital develop a large team of experts who can monitor and audit for compliance. 
• Assign survey teams of two people to conduct tours monthly in an area other than their own. Using this approach, environmental tours are conducted more often, with the goal of conducting monthly audits. 
• Communicate findings to the safety officer or EC committee, and display them on the communication board. In this way, the hospital can evaluate the effectiveness of previously implemented activities. 

Managers who are able incorporate these strategies into their environmental rounds, compare their organizations’ requirements with those of the CMS and expand their list of staff EC experts are more likely to produce inspections that create environments that result in improved patient safety and care. 

Says Neil, “The result is a safe, sustained environment of care.” 

Dan Hounsell is senior editor for the facilities market. He has more than 30 years of experience writing about facilities maintenance, engineering and management.