Five steps for boosting patient experience through zone maintenance
And how it can make a positive impact on patient safety as well
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 that’s circulating in the operating room?
These issues matter because they all contribute to the patient experience, and are as crucial to patient satisfaction and outcomes as clinical care. Effectively managing these factors may even help drive HCAHPS scores up and hospital acquired infections (HAIs) down.
While leaders should be aware, they shouldn’t have to worry. They should be able to trust that there is a system in place to ensure that these issues, and many more, are addressed efficiently and reliably. Zone maintenance is a proven, effective way of doing so.
In the simplest terms zone maintenance means assigning a space within a hospital to one general maintenance mechanic. In a good program that’s generally 100,000 square feet per zone mechanic for general acute care space; 85,000 square feet for intensive care and other critical care space; 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 a single, dedicated mechanic, 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.
In fact, 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. Approximately 80% 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 simply assigning space to a mechanic is relatively simple. But without the proper structure and management in place, it’s easy to lose focus. Old habits are hard to break and new ones 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 onto the care team
Effective zone maintenance is possible only when the mechanic is fully integrated into the clinical care community. That includes participating in the clinical team huddle every morning, interacting with patients and receiving recognition as a real team member who is as integral to the patient experience as the clinicians.
I have seen firsthand how 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, over 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 the ventilation or managing temperature in the room, he made sure that “his” patients were safe within the work environment for which he was responsible.
2. Education that goes beyond machines and tools
Successfully launching a zone maintenance program requires educating mechanics and the clinical care team on why things are changing. Everyone needs to leave behind the “we’ve always done it this way” mindset and embrace the new program.
Mechanics will also need to sharpen new skills, such as interpersonal communication, and adjust to new procedures. This 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 developing a checklist of critical areas to be monitored every day in each zone. For our facility management teams, that’s 16 items, ranging from air flow to managing barriers. The mechanic assigned to each zone then inspects those items first thing in the morning, every day, evaluating 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 the patient and ask for permission to do a quick inspection. They’ll also ask the patient if he or she is too warm or cold, if the television is working to their satisfaction, or if there’s anything that would make their stay more comfortable.
The encounter can take less than two minutes, but in that short time issues are noted, the patient feels heard, and repairs or adjustments are made 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 program mechanics go through a semi-annual peer review, with supervisors walking through the zones, talking with nurses and patients. Checks and balances are in place to ensure that systems run as they should and that minor issues don’t become major ones.
On a daily basis, mechanics are hyper aware of safety issues around their own actions. Hand hygiene is stressed time and again and, knowing that ventilation and air quality are among the top causes of HAIs, they become vigilant about working within enclosures in critical care areas. As owners of their environment they become meticulous. They make sure that 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% of his job was crisis management and 20% 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. More than that, though, are improved experiences for the most important stakeholders of all — the patients.