Environmental services workers are key members of hospital health care teams

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be "The Informed Patient," with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Today we're talking about some important members of the hospital health care team who may be overlooked, the men and women who work in environmental services.

I have three guests from Upstate Telisa stewart is an associate professor of public health and preventive medicine, Nick Allis is a medical student, and Anita Rouse is a janitor.

Welcome, all of you, to "The Informed Patient."

Nick Allis: Hi. Thank you so much for having me.

Anita Rouse: Thank you for having me.

Telisa Stewart, DrPH: Hi. Thank you.

Host Amber Smith: Now, Mr. Allis, I know you had a paper published recently about "perceptions of clinical connectedness among hospital environmental service workers."

Why did you choose to look into this topic?

Nick Allis: So this topic was something that we chose to work on during my MPH year, last year here at Upstate. We felt that this was a topic that there isn't much research on trying to figure out perceptions and perspectives from the environmental service workers.

There isn't a lot of literature (published research) out there, and we feel like we needed to address that because of how crucial the environmental service workers are to the clinical care team, and we just wanted to help shed light on that topic.

Host Amber Smith: So MPH, that's for a master's (degree) in public health, right?

Nick Allis: Yes, that is correct.

Host Amber Smith: OK. So this topic really fits into that pretty well. So, Dr. Stewart, can you explain how the study was done?

Telisa Stewart, DrPH: We used a really exciting process. We used a method called PhotoVoice. And PhotoVoice is a method where we give people cameras, or we ask them to use their cameras on their phone, and they take pictures of their lived experience.

So we asked the EVS (environmental services) workers, we had 10 EVS workers, and we asked them: Show me a picture about how you feel proud of being an EVS worker, show me a picture of how you feel connected to your clinical team, and then show me a picture of how you feel not connected to your clinical team.

And the group of EVS workers, met. We met regularly, and we talked about the pictures that they took. They wrote really beautiful vignettes of each of those pictures, of what it represented and how it made them feel. And they worked with students to make a vignette that's paired with the picture.

And through that process, we got to learn a lot. We got to learn about what their experiences are like on the floor every day, working with people and families and communities and working with the clinical teams. We got to learn about all the things that make them feel supported and make them feel proud. And we found some areas that we could improve on.

And then once we were done with that process, we hosted an event called a community event. And we brought all the leaders of the institution together, and their pictures were on display, and the leaders of the institution came, and they learned, and they listened, and they connected. And they came up with areas of celebration and lots of critical thinking of how to improve what's happening on the floors with EVS workers.

That was a really inspiring process for me because, I didn't know EVS right? What I saw every day were people cleaning and doing various tasks, but I,didn't know what it was like to be an EVS worker. and I didn't know all the critical things that they do for patients, for families, for the clinical team.

And it kind of changed my entire view of EVS workers.

Host Amber Smith: So why did you choose photos?

Telisa Stewart, DrPH: So photos, as you imagine, speak a thousand words, right? And so you could ask somebody what is it like to be an EVS worker? And they could tell you, and you could write a sentence down, but to see a picture and to reflect on a picture and to experience that picture through the eyes of somebody else, that's a powerful tool. And I don't feel like it fades away quite like words, right? You have this image that's left over that people can continue to reflect on. And it helps us stay current in what's happening on the floor in real time, real place.

Host Amber Smith: Can you describe for me some of the images that told about pride or connectedness? What were some of the pictures of?

Telisa Stewart, DrPH: The participants took pictures of various things at the institution. They may have taken pictures of a particular sign, like the Upstate sign, and described how long they had been working at Upstate and how many years they had been engaging, even personally or professionally, at the institution. We had pictures of the amount of work that people did with images upon images of clean and shiny floors and no dust, and making sure that the area that patients were in were pristine and clean and really a place where you'd want your family member to be. (For photos: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829076; see supplement)

For photos https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829076 see supplement

Or feeling as a part of a team. We had pictures of people's shoes and the sea of people that worked together, and some of it was very symbolic, the images, and other ones were just kind of your factual place at Upstate.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with three people from Upstate, Doctor of Public Health Telisa Stewart, medical student Nick Allis and janitor Anita Rouse.

Ms. Rouse, can you tell us what your responsibilities are working in environmental services?

Anita Rouse: I start my day off every day about 5 o'clock. And I come in early just so I could get the schedule ready just in case we have call-ins. I could try to replace where people call in at. And the people come in about 6 o'clock. The other employees come in about 6 o'clock. And I just make sure that everybody's in, the right place and do our work.

And then I go ahead and start my day by cleaning my area or help out where there's need.

Host Amber Smith: So the nurses, if they have a task that comes up that they didn't anticipate, they can reach you and ask you to come back and help out with something?

Anita Rouse: Correct.

Host Amber Smith: What do you like most about your job?

Anita Rouse: The thing I like about my job is really just being me, just helping everyone here. I love my job. I love what I do because I love helping people. I just love it. I just love my job.

Host Amber Smith: Do you get to interact with patients very much?

Anita Rouse: Sometimes I do. Well, on the weekends I do, because I'm working more in patient care on the weekend. During the weekday, I do clinics. I have one clinic that I do, but I really don't see patients as much down there because I clean before they get there.

Host Amber Smith: Would you say that you do feel like you're part of a team when you're working?

Anita Rouse: Oh, definitely. Definitely I feel if I, can't do my job, the nurses or the doctors can't do their job. So I feel that we are here for the same thing. Take care of the patient.

Host Amber Smith: Mr. Allis, in your abstract you describe how environmental services workers have a critical role in the hospital infrastructure.

Can you tell us more about that?

Nick Allis: Yeah, of course. Like Anita was saying that this is definitely a team effort when it comes to the clinical team, and they're for sure on it because it has been shown throughout the literature that without environmental service workers -- that's what the term EVS means -- in general, patients are at an eight times greater risk of getting a hospital-acquired infection.

So without EVS it's very difficult for patients to stay healthy, other workers, employees at the hospital to stay healthy. Anybody that comes within the hospital infrastructure in general. So that also includes, obviously, family members. And everybody has a role in the team, and in my personal opinion, EVS's role is just as important as any other role in the team because, again, without them, this wouldn't be possible.

Host Amber Smith: So it sounds like they're key for infection prevention.

Nick Allis: Certainly. I would definitely say that they are at the front line of infection prevention because without them, that wouldn't exist.

Host Amber Smith: What do they contribute to infection prevention? What do they do?

Nick Allis: The EVS workers, when it comes to infection prevention, they are managing all forms of waste. Whether that's biohazardous waste, normal trash recycling, all aspects of waste. They are the ones who. Are at the front of that. So without them, that puts at risk. Patient safety, family safety, employee safety, and they're the most critical part of the team when it comes to infection prevention for those reasons.

Host Amber Smith: Mr. Allis, what year of medical school are you in?

Nick Allis: I am a current first-year medical student here at Upstate.

Host Amber Smith: And you were able to be involved in research like this in your first year?

Nick Allis: Yes. So this started last year, during my Master's in Public Health program here at Upstate. And what initially started as what seemed at first of just being another project, like another assignment for school, it turned into so much more. Because throughout my entire high school career, undergraduate career at Le Moyne College, my first master's degree at Rutgers University, and then here now at Upstate for the Master's in Public Health, and now, my first year of medical school, this is by far the most meaningful and important project that I've ever been a part of because it's something tangible. It's something real. It's something that clearly needed to be done and for the world to see something of this magnitude because it just needed to have light shed on EVS workers and how crucial they are to the clinical care team. And I know that I'm able to speak for my cohort that was a part of this project that everyone will definitely agree with me when I say all that.

Host Amber Smith: I imagine it was pretty eye-opening. Because if you don't think about what environmental services workers do and you don't really know the depth of what their responsibilities are, to learn that is probably pretty eye-opening.

Nick Allis: Most definitely, and that's also why I think it is so meaningful, because prior to this and being a part of this project, we, as students, definitely didn't realize how crucial they are to the team and how big of a role that they play. And after going through the process, being a part of the PhotoVoice, the photos, the vignettes, the community event, everyone was able to see truly how important they are.

And open everyone's eyes to that. And I think that is why this was such a big deal for all of us.

Host Amber Smith: Well, Ms. Rouse, what do you think can be done to raise the profile of environmental services jobs and attract more people to these positions?

Because it sounds like you have a job that you really enjoy and you get a lot out of, and you're a, key member of a health care team. How can we let other people know about that?

Anita Rouse: To have the PhotoVoice class more often than what we did. To have this program every year, so others can experience and tell their story of how they feel about environmental services.

Host Amber Smith: Do you think some of your coworkers maybe don't think about these things until they're asked: What makes you feel like part of the team and what are you proud of?

Anita Rouse: I'm proud of being here where I can sanitize and help it stay clean for our patients.

Host Amber Smith: Well, all of you. I appreciate you making time for this interview. Thank you for telling us about your research.

Nick Allis: Thank you so much for having us.

Anita Rouse: Thank you.

Telisa Stewart, DrPH: Thank you.

Host Amber Smith: My guests have been Doctor of Public Health Telisa Stewart, medical student Nick Allis and janitor Anita Rouse.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

Find our archive of previous episodes at upstate.edu/informed.

If you enjoyed this episode, please invite a friend to listen. You can also rate and review "The Informed Patient" podcast on Spotify, Apple Podcasts, YouTube or wherever you tune in.

This is your host, Amber Smith, thanking you for listening.