Housekeeping Management

Navaz Clement
Manager Housekeeping
Aravind Eye care system

Organizing a Housekeeping Department:
The Housekeeping Department serves all areas and departments of a hospital. Hence the Housekeeping Department needs to be centrally located and close to the vertical transport system to facilitate easy movement of housekeeping materials and equipment.

Facilities and space requirement:

Office for the housekeeping manager
Clerical work area
Chief housekeepers desk and bulletin board to put up daily duty charts and other housekeeping information
Store room for the housekeeping equipment and materials
Housekeeping closets on all floors of the hospital with space and shelves for housekeeping equipment and materials, and trolleys. As a matter of routine, supplies for daily use should be delivered to their respective closets directly.

Housekeeping control desk:
The housekeeping desk is the nerve centre of the entire department and its efficiency determines the smooth operation and effectiveness of housekeeping. It is the focal point for the dissemination of information and communication to various points in the Housekeeping Department as well as to other departments for co-ordination. The area of the control desk must have:

Information board:

Duty chart for housekeepers and sweepers
Cleaning schedules
Hospital staff room accommodation details
Other general information and important announcements

Key board:

Patients room keys
Office room keys
Entrance key
Others

Registers, files, forms:

Housekeeping equipment and supplies list
Attendance register for sweepers
Request form for supplies and equipments from stores
Request form for repairs to be carried out in other departments
Inventories of supplies and equipment
Checklist for patients rooms
Year planning calendar
Inventories of furniture and furnishings
Inventory of linen

Organization chart:

The Housekeeping Department has multiple functions to perform. Housekeeping services may be requested any time of the day or night, hence the staff structure must be so arranged as to provide the necessary services. Personalized services remains very much an important part of quality health care and this too is largely provided by the housekeeping department.

The Housekeeping Manager, as Head of the Department, must coordinate the performance of these functions for the most efficient operation possible. Since the housekeeper cannot single-handedly discharge all the functions of supervision, requisition, scheduling, budgeting and so forth, the Department must be organized in such a way that each of these jobs is capably done. Delegation of authority through a clear chain of command will accomplish this objective. It must however be remembered that although authority is delegated, the Manager retains full responsibility for the department.

Job Descriptions:

Job Title: Housekeeping Manager
Reports to: Administrator
This is an important position in a hospital as it carries the responsibilities for the cleanliness, maintenance and aesthetic appeal of the hospital. An efficient housekeeping manager must possess a high degree of tact as well as good organizing ability, because of the need to work with other departments and with so many different people.

Work performed:

Collaborate with other departments to ensure delivery of quality services
Interview, select, train, evaluate and counsel staff in the hospital Housekeeping Department
Instruct and advise staff on changes in policies, procedures or working standards
Listen to the problems if any, of the housekeepers and sweepers and try to resolve them
Conduct meetings with the housekeepers and sweepers separately to exchange ideas and solve problems
Attend to the complaints and queries, if any, from other departments, or patients regarding the housekeeping functions and take necessary action.
Go on rounds every morning to inspect the floors of the hospital and to correct any mistakes on the part of the housekeepers
Prepare a report as required by the management
Train all staff to efficiently perform the standard procedures as applicable to their job positions
Work closely with the administrator on day to day housekeeping requirements
Monitor departmental activities to ensure that maximum efficiency is maintained in the services being provided
Assist in developing, delegating and monitoring departmental goals, objectives and programs to ensure timely completion
Monitor the use of supplies and equipment and prepare a monthly request list including purchase of cleaning supplies

Job Title: Housekeeper
Reports to: Housekeeping Manager

Work performed:

Co-operate with the staff of other departments
Deployment, supervision, control and training of staff
Check the standard of cleanliness of all areas of the hospital
Keep inventories and records of equipment and supplies
Supervise and instruct the sweepers on the day to day activities
Enhance the dcor of different areas of the hospital with floral arrangements
Control and supervision of the work in the linen room
Train new recruits
Check all the safety items on allotted floors
Record all lost and found items on as per laid down norms
Report to the Housekeeping Manager on sweepers performance

Job Title: Sweeper
Reports to: Housekeeper

Work performed:

Receive the allocation of floor and area of cleaning
Clean the rooms twice a day
Clean the common toilets and bathrooms twice a day
Follow instructions and cleaning procedures given by housekeepers
Take care of cleaning materials and ensure economical use of supplies given from the department
Remove and dispose off refuse and rubbish at the assigned area
Report missing or broken hospital property to the housekeeper
Maintain a polite, dignified and helpful attitude toward the patient
Hand over the lost and found articles to the supervisor
Attend over daily briefings and give attendance

Job Title: Gardener
Reports to: Housekeeper

Work performed:

Clean and maintain the garden
Take good care of newly cultivated plants
Take an interest in adopting new technology in the development of the garden
Water and prune the plants
Be creative in arranging the plants in a garden
Attend work regularly

Responsibilities of the Housekeeping Department

Direct responsibilities:

Daily cleaning
Periodic cleaning
Trash and garbage removal including proper hospital waste disposal
Exterminating bugs and pests
Preventing spread of infection
Ensuring clean linen
Safety and security of the hospital
Creating an aesthetically pleasing environment
Gardening
Making the necessary arrangements for meetings, workshops and conferences

Indirect responsibilities:

Saving electricity by switching off lights and fans when not in use
Ensuring an economical use of supplies
Developing goodwill by a courteous, helpful and caring attitude towards patients and visitors
Promoting safety rules and measures by observing them and reporting dangerous conditions
Maintaining a harmonious working relationship with the staff of other departments
Arranging accommodation facilities for visitors and providing food during their stay at the hospital

Qualities required in a housekeeper:

Basic knowledge of health care and sanitation, including principles of bacteriology, chemistry and related sciences, applicable to the prevention and control of infections and communicable diseases. The housekeeper should also have the ability to convey this knowledge in a non-technical way to subordinate supervisors and workers so that it can be applied in their daily work.
Ability to plan, administer and develop all phases of a comprehensive housekeeping program that will provide a suitable environment for the hospitals medical and administrative activities
General working knowledge of sanitation, laundry operations, linen service and interior decoration
Ability to assign, supervise and evaluate the work of subordinate supervisors and their personnel
An interest in people and tact in handling them
A pleasant personality and the ability to converse with all types of people
An ability to hide personal likes and dislikes and to be conscientious, fair and just
Be strict with respect to punctuality and observance of rules and regulations of the hospital
Loyalty to the hospital and to her staff
A sense of humour
A cool head to deal with emergencies
Adaptability and willingness to experiment with new ideas
Powers of critical observation

Recruitment, selection and training of manpower::
Having decided on the layout and facilities in the Housekeeping Department, the next task is to decide how many people are needed for the department. The number of people would depend on the structure of the hospital (block construction or cluster of rooms), number of floors and rooms per floor, number of public areas, size of landscape, the flow of patients and the time required for each task.

Recruitment and selection:
The Administrator of the hospital and Housekeeping Manager make the final decision regarding the selection of housekeepers. The process involved in recruitment and selection is:

Planning the selection schedule:

Print application form
Inform public and staff through bulletin boards, advertisements and by word of mouth
Issue application forms
Collect application forms
Shortlist and file applications
Arrange interviews
Conduct written exam and interview
Shortlist the selected candidates
Send employment letters
Conduct an orientation program for the selected candidates
Conduct a basic training program
Give an on-the-job training

Selection criteria for housekeeping staff:

Educational Qualifications	12th(HSC) passed with 500-700marks
Age	18-20 years
Experience	Fresh candidate with no prior experience in hospitals.
Skills	Ability to talk clearly and politely. Ability to listen well. Ability to influence others. Knowledge of knitting, drawing, stitching. Understand and speak the local language
Personality	Independent, responsible, open, bold, bright and pleasant disposition
Background	A low /middle income family
Health and appearance	Smart, clean, tidy, simple in dress. Good health should pass the medical test criteria

Basic training program for housekeepers:
The basic training schedule for the recruited housekeepers should be planned for a specific period and should cover all aspects of housekeeping. The Housekeeping Manager should appoint appropriate well-trained staff from the Housekeeping Department and other resource persons to conduct the training in the related field. The students can then be put on an on-the-job training.

The training schedule can cover the following areas:

Introduction to housekeeping
General rules and regulations
Hospital work culture and values
Housekeeping and patient relationship interaction with patients to ensure patient satisfaction
Housekeeping and other departments
Microbiology
Ward management
Bed making
General cleaning procedures
Dusting
Cleaning of picture-frames and windows
Sweeping
Mopping
Cleaning the surroundings
Cleaning the room
Cleaning toilets and bathrooms
Stain removal and polishing
Cleaning walls
Cleaning brass items
Cleaning the lift
Cleaning the water filter and cooler
Maintenance and cleaning of drinking water tank. Chlorination
Importance of checklists
Indenting
Maintenance and use of various equipment
Other housekeeping activities like making articles for interior decoration
Linen management and supply
Waste Management
Furniture care and maintenance
Arrangement of meeting and conference hall
Flower arrangement
Problem solving
Manpower planning and management
Sweepers job description
Effective communication

Orientation schedule for cleaners:

Day	Particulars
1	General orientation about the hospital Visit to all departments and wards of the hospital Dress code General cleaning demonstration and sweeping under the guidance of a housekeeper
2	Sweepers role in the organization Introduction to cleaning materials, equipment and supplies Demonstration on the use of these equipment and materials General cleaning demonstration and mopping under the guidance of a housekeeper
3	Teaching the significance of cleanliness and personal hygiene Orientation on the different types of rooms Demonstration on gardening, and cleaning the surroundings General cleaning-sweeping and mopping under the supervision of a housekeeper
4	Carrying out sweeping, mopping, cleaning the surroundings and gardening Discussions with senior housekeeper regarding days off, leave, shifts, night duty, Sunday duty, welfare schemes, discipline and attitude expected of the cleaner Demonstration of cleaning wash basins, walls, doors, windows, and stain removal
5-10	Cleaning wash basin, walls, doors, windows, and removing stains under the supervision of a housekeeper
11	Observation and cleaning of bathroom under the guidance of a housekeeper

Refresher training:
This should be conducted periodically to upgrade the standards of cleanliness, or whenever the standards are not being met adequately. This can also be conducted whenever there is a change in policy, procedure or equipment.

Welfare of the staff:
To keep up the morale of the staff and to motivate them, it is important to provide a good working atmosphere at the hospital. This can be done by providing:

Good working conditions
Good working relationship and accessibility
Incentive bonus
Best employee award
Statutory wages (provident fund, gratuity etc)
Medical facilities
Sick leave and maternity leave
Meals when on duty
Proper work methods

Good employees are hard to come by and once they are found, it is important to consider their welfare. Discipline should be maintained. Rules that are made should always be followed. Managerial policies should be consistent and every member of the staff should participate in the efficient and economic running of the department.

Supervision:
Supervising the workers and getting quality work done is an important role of the housekeeping supervisor.

The functions of the supervisor are:

Organize the work assigned to him
Plan the task to be performed
Direct the work of those responsible to him
Co-ordinate the resources under his direction
Control workers and resources
Evaluate the total job performance and the individual

Guidelines for effective supervision:

Workers should understand clearly what is expected of them
Workers should get guidance in performing work
Good work should always be recognized
Poor work should be corrected by adopting remedial methods
Unwanted action and behaviour towards workers should be avoided.

Routine inspection work is required to

Ensure that correct procedures and methods are being followed, and to make any improvements
Ensure that standards are met and maintained
Allow action to be taken to correct defective work
Identify responsibility for defective work
Enable complaints to be dealt with effectively

The supervisor should check each employees work on each area at least twice during a work period. The first check should be at the beginning of the work to ensure that it has been started on time, and that it is being carried out satisfactorily. The second check should be made before the work in each area is completed to ensure that the work is satisfactory and to inform the worker to correct any faults, if necessary. It is also important to check that the work is being achieved in the stipulated time.

Checks should not be carried out at the same time each day, as the staff would be alert and responsive. Spot checks in the course of the work period are useful. More frequent checks are necessary for new recruits who are under training.

Handling the difficult worker:

Find out the reasons for the problem health, personal problem, or problem with the work procedures
Arrange refresher training if required
Frequently monitor and supervise the work
Ask them to repeat the work if found unsatisfactory
Motivate him to adopt new procedures and techniques adopted by the department (inculcate positive thinking)
Encourage the worker through incentives, and bonus for festivals.

Evaluation of workers:
In order to ensure continuing efficiency, it is important that the staff is evaluated from time to time. This exercise will be effective, if the following points are kept in mind

Pay individual attention to each worker and supervise his work
Observe if he completes his work in the stipulated time
Help him if he has a problem related to his work
Plan additional training for the worker, if you think he requires it.
Observe his attitude to other workers in the department

Organization of work
A well managed housekeeping department relies on the ability of its housekeepers to organize work efficiently and manage the use of equipment, space and human labour with minimum effort. It is also important that she concerns herself with the staffing requirements and modern cleaning equipments, agents, and methods. She should study their advantages and disadvantages and bring into use those that make cleaning easier for her staff, spare time and ultimately cut down costs.

Work organization involves the preparation of:

Work specification
Work schedule
Job procedure
Work study
Work simplification

Work Specification This is a detailed description of the work to be carried out in a specific area. There should be work specifications for every area covered by the Housekeeping Department.

Eg. Work specification for cleaning corridors:
1. Collect the required equipment and materials
2. Store the equipment and materials neatly in the corridor to be cleaned.
3. Empty the waste bins and collect any other waste that may be on the ground
4. Remove the dust from the walls, windows, curtains and picture frames
5. Spot clean areas such as door handles, window sills and shaft
6. Frequency of corridor cleaning to be decided based on the patient flow
Work schedule This is a list of actual work to be carried out by an individual staff member during a particular period of the day. It would also include meal breaks and allow time for cleaning and tidying up of equipments. The number of schedules necessary indicates the number of staff required to clean an area once a day.
Job procedure This specifies the way a job is done and is to be prepared for each job individually.

Eg. Procedure for cleaning a telephone:
Materials: Damp cloth, dusters, disinfectant
Method: Dust the telephone completely with the damp cloth. Wipe down with a disinfectant solution paying attention to the dial, mouthpiece, phone. Wash, rinse and dry the dusters, and put them back in their place.
Work study A work study involves work measurements that are required to determine the work involved in a particular job, the time taken to carry out a job under normal; circumstances by an average worker. This helps in determining the number of staff required and in standardizing labour costs.

Eg. A work study on bed making showed that the distance covered by the staff during bed-making can be reduced if she were to strip the bed more systematically and did not tuck in the sheets and the covers till the end of bed-making.

A work study must be carried out whenever there is a waste of time, labour or material. When there is a delay in carrying out the work, or when the complaints made by patients increase, it is a sure indication that one worker is overburdened with work, and another is not fully occupied. This is an indication that a work study needs to be carried out.

A work study involves the following procedure:
1. Select the job procedure and identify the problem
2. Observe and record the present work method
3. Develop an improved method
4. Conduct periodic checks to ensure that the improved method is working satisfactorily
A work study cannot be carried out unless it gets the full co-operation of the staff involved throughout the investigation. It is possible to get a clear picture of the old working method, and implement the new method only with the full support of the staff.
Work simplification While a worker is busy and on the job, the muscles of his body need moments of rest between motions. Tensed muscles produce neither high quality nor great quantity of work. The worker finds the work easy or difficult depending on the way he uses his body. New methods need to be developed to make the work easier and to reduce the stress factor for the worker.

A few methods of work are listed below:
- Movement of the worker should be limited to the minimum necessary.
- The work should be in a pattern of curved line motion
- Both hands should begin and complete a motion at the same time
- Arms should move in opposite and symmetrical directions to give the worker proper balance
- Daily activity should be restricted to normal reach level. Objects out of reach can be cleaned periodically
- Use of different parts of the body should be restricted to a minimum
- Before starting work the equipment and materials should be arranged conveniently to avoid unnecessary movement
- Wherever possible, adjust work heights to make the work easier.

Planning the cleaning procedure in a hospital:
Cleaning requires a systematic and planned approach, both, towards the individual tasks involved and towards the hospitals cleaning operations as a whole. This involves two areas:

The cleaning process
The work schedule

The cleaning process:
The objective of the process of cleaning is to remove as much dirt as possible without damaging the surface, and to prevent dirt from resettling. To do this effectively and safely, we need to identify the different types of dust and stains involved, along with ways in which they are introduced into the building. This information helps to decide which cleaning method, equipment and materials are most appropriate. The Housekeeping Department should establish methods of cleaning and work schedules.

The work schedule:
Before any cleaning program can be carried out, a suitable work plan must be drawn up. The work schedule gives the actual work to be undertaken by a particular staff member during a particular period of the day. This should take into account several factors, which affect the way in which the work is carried out. These factors include:

Standard of cleanliness: Cleaning standards vary in different parts of the hospital. In every hospital, the area of work can be classified as high risk and low risk areas. The standard of housekeeping services depends on the level of risk.

Housekeeping cleaning standard has been defined as:
Housekeeping cleaning standard = method x frequency

When cleaning methods are correctly selected, correct equipment and agents are used for each surface and cleaning tasks are carried out methodically, the housekeeping standards are said to be efficiently met. The following table shows the standard of cleanliness required in different areas of the hospital:

Area	Standard	Requirement
High risk areas (operation theatres, special units)	Prestige standard	Highest possible standard of cleaning, dust and infection control
Medium risk areas Kitchen, toilets	Special standard	High standard of cleaning, and infection control
Low risk areas Corridors, offices, waiting areas, patient rooms	Normal standard	Good standard of cleaning, absence of soil, dust and stains

The activity in the area and the time of day: Consideration should be given to the level of activity and amount of traffic in the areas to be cleaned. Where possible, cleaning will be undertaken when these levels are at their lowest. Each part of the hospital has a primary function which should be disrupted as little as possible. Cleaning should fit in as modestly as possible with the main activity of that area. Administration areas and most departments have a standard working day. Hence cleaning in these areas can be programmed to take place either before or after working hours.
The planning schedule: The Housekeeping Department should plan and apply a systematic cleaning procedure. This includes:
- Daily and weekly cleaning schedule
- Periodic cleaning schedule
Daily and weekly schedule: This includes all tasks that are to be carried out regularly in a specific functional area on a predetermined basis set by management according to area usage and the need for cleanliness. (dusting, sweeping, mopping)

Periodic schedule: This includes tasks, those additional to, but in combination with routine tasks, which have a frequency of once every 15 days or once every month. (changing curtains, removing stains, polishing, cleaning water tanks, cleaning septic tanks) records should be maintained to show when and where a particular task is started and completed.

Frequency of cleaning: Frequencies are to be based on sound quality cleaning, especially as they relate to routine cleaning. A set time schedule is not considered appropriate for routine cleaning. If an area requires cleaning, it should be cleaned, if it does not require cleaning, it should not be cleaned. Cleaning on the basis of it has to be cleaned everyday even when it does not need it is not applicable.

Even though waiting area, patient examination area, refraction area and pathways are considered low risk areas in the hospital, frequency of routine cleaning is to be followed to keep the area clean all the time. The area supervisor should check now and then and instruct the sweepers to go for special cleaning.

The following table may be used to plan the frequency of cleaning:

Area	Frequency of cleaning	Special attention	Special care
OPD
Registration Waiting area Corridors	Continuous	Patient flow is high; rainy season	Provide doormats at the entrances and clean them frequently
Common toilets	4-6 times a day	Patient flow is high
WARDS
Patient room	Twice a day	Emergency, spillage, vomiting	Take immediate action to clean
Corridors	4 times a day	Emergency; spillage	Take action immediately
Room toilets	Twice a day	More usage
Common toilets	Four times a day	More usage
OFFICE AREA
Camp office Finance Department Personnel Department	Once a day
LABORATORY
Biochemistry lab	Twice a day
Lab. toilet	4 - 6 times a day	Patient flow is high	Use odonil, a good disinfectant
OUTSIDE AREA	Twice a day		Sprinkle water to settle dust

Use of appropriate cleaning agents

Usage area	Cleaning agent	Dilution	Time for cleaning agent to act	Frequency of use
Floor, tiles, wash basin, outside of w/c closet, flush tank	LOC, Vim or any other good detergent	20ml: 5litre, 8gm/washbasin/toilet	Direct	Twice a day
Floor, glass mirror	LOC, seespray/colin	20ml:5Llitre 18ml/litre	Direct	Weekly
Toilet closet and all stain removal	Harpic	No dilution	Direct	Once a day
Mopping the floor. Cleaning the toilet	Pursue	18ml/litre	Direct	Twice a day
Septic tank- 1kg/wash Water tank-500gms/wash	Bleaching powder	No dilution	2 mins	Septic tank-weekly Water tank-monthly
Brass items	Brasso	Direct		Special cleaning
Drawers, wardrobes, sinks	Naphthalene balls		Direct	Weekly
Toilet odour control	Odonil		Direct	Weekly
Disinfections	Dettol	100ml/5litres	Direct	Daily

Communication:
Effective communication between housekeepers and workers is very important. Generally the cleaners are illiterate and recruited from the rural areas. Hence they understand only very simple language. Thus, it is necessary for the housekeeper to use very simple language when explaining the work procedures, so that the workers are not mislead into using incorrect procedures. This will lead to poor quality work.

Factors to be considered:

Workers should understand clearly what is expected of them
Unwanted actions should be avoided
Use simple and clear language
Adopt demonstration methods to explain the work procedures
Proper job specification
Two-way communication is essential to avoid misunderstanding the work procedure
Guidelines given to the workers should neither be over commanding, nor easy. They should be moderate.
New policies and procedures should immediately be communicated to the workers and their queries clarified.

Poor communication results in:

Following incorrect cleaning methods
Improper use of cleaning materials and equipment, which results in increased costs
Taking more time to finish the given task
Arguments with the housekeeper
Frequent absence from work
Discontinue from service

Inter departmental relationships:

Maintenance:
One of the most important functions of housekeeping is the maintenance of keeping furniture, fixtures and facilities in working order. Housekeepers need to constantly check on various things throughout the hospital on a daily or a weekly basis and inform the maintenance department through a requisition form about any repairs that need to be done. The maintenance work could cover a number of aspects such as plumbing, carpentry, electricity and civil works. Hence a close coordination with the maintenance department is absolutely necessary.

Stores:
Hospitals stock all housekeeping equipment, materials and supplies, except linen, in the general stores. Coordination with the stores ensures availability of day-today requirements of housekeeping. Housekeepers can indent materials from the stores on a daily or a weekly basis. These indented materials can be issued directly to the staff or can be stored inside the department or under the staircase with proper safety measures. The stores consult with the Housekeeping Department regarding purchase of materials.

Laundry:
Most small hospitals prefer to outsource laundry on account of limited space and manpower. Larger hospitals usually handle the laundry in-house to issue clean and quality linen to the operation theatres and other departments. Whether in-house or out-sourced, coordination between hospital and laundry is very important. The housekeepers should check the need and use of materials with the ward staff. The senior housekeeper should maintain registers for checking stock and transaction of materials, planning the laundry process, and salary of in-house dhobi.

Nursing:
The Nursing Department works closely with the Housekeeping Department. It is this department that is involved in bed-making in the patients rooms, and informs the Housekeeping Department about any requirements by the patients. The Nursing Department also contacts the Housekeeping Department if there is any need for emergency cleaning in a specific area, in case of spillage, breakage, or if the patient has vomited. The nurses maintain the admission and discharge details of the patients. When the patient is discharged, it is the nurses who check the room, lock the door and handover the key to the housekeeper. The housekeeper then sends a sweeper to clean the room thoroughly and get it ready for the next patient.

Catering:
If a hospital has catering facilities, then the kitchen and dining room needs to be cleaned at least twice a day. This comes under the purview of the Housekeeping Department. The Housekeeping Department also needs to co-ordinate with the Catering Department when making arrangements for guests and special occasions.

Personnel:
The Housekeeping Department deals with the Personnel Department for the recruitment of the housekeeping staff, salary administration, indiscipline and grievance, identity cards for the staff, promotions and exit facilities.

Other departments:
Since every department in the hospital needs to be kept clean, the Housekeeping Department interacts with every department. When electrical equipment is not working or a door does not close properly, it is the Housekeeping Department that takes down the complaint and makes sure that the problem is rectified. Thus, the Housekeeping Department is an important and indispensable department in the smooth functioning of a hospital.