There is a poem by Robert Fulghum called "All I Really Need to Know I Learned in Kindergarten" that we would do well to remember in days like these. We all learned things like:
Share everything.
Play fair.
Don't hit people.
Put things back where you found them.
Clean up your own mess.
Don't take things that aren't yours.
Say you're sorry when you hurt somebody.
As Fulghum stated so simply, yet so elegantly, "Everything you need to know is in there somewhere."
Think what a better world it would be if
all - the whole world - had cookies and milk about
three o'clock every afternoon and then lay down with
our blankies for a nap. Or if all governments
had a basic policy to always put things back where
they found them and to clean up their own mess.
It's pretty amazing when you think about it. Some of the basic principles of getting along with one another could be taught to all of us adults by a 5 year-old kindergartener. And I am not just talking about our government leaders (though, I would argue that our government leaders would do very well to learn those lessons too). We could take some of these lessons to heart in our own organizations.
I am reading a book by the author Leah Weiss right now called, "How We Work: Live Your Purpose, Reclaim Your Sanity, and Embrace the Daily Grind". Dr. Weiss mentions a fairly recent study conducted by Jane Dutton, Gelaye Debebe, and Amy Wrzesniewski entitled ""Being Valued and Devalued At Work: A Social Valuing Perspective" that we would all do well to read and carefully consider. As a matter of fact, it probably should be required reading for all of us in the health care industry. It's really that powerful.
These investigators wanted to answer a simple question - "How do people doing hospital cleaning work feel about doing this kind of work, and how do other people at work affect the experience of this job?" They conducted a series of focus groups and personal interviews with close to 30 members of one hospital's environmental services department. What they found may surprise you, and it certainly should catch your attention.
First, and perhaps most importantly, every single hospital cleaner that they interviewed felt like their job was important to the overall mission of the hospital (I can't help but think of the story I referred to in "Back to that vision thing...NASA, Cathedrals, and an Automobile Executive" involving President John F. Kennedy and a janitor at NASA). There is no question that environmental services are critical to daily operations in a hospital. As the investigators in this study emphasize, "A hospital's effectiveness depends on the work of the cleaning staff. The delivery of quality care to patients in a hospital rests on the effective care for the physical infrastructure of the hospital. Those who clean hospitals ensure a safe and sanitary environment for the execution of routine and complicated medical procedures."
Consider for a moment the impact on environmental services on infection prevention and control. Just think of how crucial environmental services is when either operating rooms or inpatient rooms need to turn over quickly between patients. Finally, think of how important environmental services workers are to the overall patient experience. Again, these investigators point out, "In a time of extreme distress for patients and their visitors, the cleaner is often seen as someone who is willing to listen, spend time, and be sympathetic."
So, you would think that members of the environmental services department are considered part of the health care team, right? Think again. Dutton, Debeb, and Wrzesniewski heard close to 200 different stories during their interviews with hospital cleaners that described the various interactions with physicians, nurses, patients, and visitors. Unfortunately, some of the most commonly experienced interactions were negative in nature, causing the workers to feel devalued, unimportant, and not part of the team.
Negative interactions were broadly classified into several different categories. For example, lack of acknowledgement was the most common negative interaction experienced. Cleaners shared stories of groups of physicians (in most, but not all cases) walking by them without acknowledging them in any manner:
"The doctors have a tendency to look at us like we're not even there, like, you know, we'll be working in the hallway, and you know, no recognition what you are doing whatsoever."
"In the S unit, I've been working there almost a year now and they used to not speak to me. They would see every weekend and not say hello, just hello. Or they order out for lunch a lot and they never ask me to order out to lunch."
"And the doctors stand in the way. And what I mean by 'doctors that stand in the way.' I mean literally, stand in the way. Like you're going down the hallway to sweep it. Doctors will stand in the way. You have to ask them to move, every day, the same doctors every day."
Hospital cleaners struggled with one particular issue fairly frequently. "Cleaners fight against an occupational stereotype that suggests that they steal, lie, and generally cannot be trusted." Hospital cleaners struggled a lot, for example, when cleaning patient rooms. In order to clean a patient's room, they would invariably have to move personal articles out of the way. They felt quite reluctant to move personal articles out of the way for fear of being accused of trying to steal them.
Finally, physicians and nurses often made the cleaners' jobs more difficult by not picking up their own messes.
"I don't think the doctors and nurses value our jobs more or like they should. They take advantage of, you know, our jobs as being housekeepers and picking up after them...they are too lazy to pick up after themselves or they leave trash all over the place."
There's a lot to unpack in this study. Fortunately, not all of the interactions were negative in nature. There were, in fact, some very positive interactions as well. So, other than remembering the Golden Rule and all the lessons that we learned in kindergarten, how can we make non-clinicians feel like that they are an important part of our health care team?
1. Recognize the cleaner's presence. Say "hello" or "good morning" for sure, but try to get to know the environmental services staff. Always be friendly, courteous, and respectful. But try to make a deeper connection than just "hello." Get to know them!
2. Make the cleaners' jobs easier by cleaning up after yourself!
3. If you are ordering lunch as a team, invite the environmental services staff to participate!
4. Get out of the cleaners' way when they are sweeping or mopping the floor!
It's all very simple. As Robert Fulghum says, "Everything you need to know is in there somewhere. The Golden Rule and love and basic sanitation...And it is still true, no matter how old you are - when you go out into the world, it is best to hold hands and stick together."
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