Environmental Service workers (ESWs), such as janitors and cleaners in hospitals, are crucial to patient safety, infection prevention, and the overall quality of care in healthcare settings. These workers help maintain hospital cleanliness, handle hazardous waste, and contribute to infection control, significantly reducing the risk of healthcare-associated infections.

Despite their important work, ESWs may feel undervalued and overlooked in health care teams, according to a study in JAMA Network Open Jan. 13. Read the study here.

A new study, Perceptions of Clinical Connectedness Among Hospital Environmental Service Workers, aimed to explore the experiences of ESWs using photovoice, where participants are asked to take photos and share their feelings about their work. The study focused on understanding how ESWs feel proud of their work, connected to their clinical team, and where they feel disconnected. The project took place at SUNY Upstate Medical University in Syracuse, N.Y., involving 10 ESWs who participated in virtual meetings with researchers over five weeks. They took pictures in response to three key prompts and discussed their thoughts with the team comprised of the university’s public health and preventive medicine faculty and students.

The findings reveal the experiences of ESWs, highlighting areas where they feel proud, but also where they feel disconnected from the rest of the hospital team.

ESWs felt proud when maintaining clean spaces in the hospital and building meaningful relationships within their community. Their pride also stemmed from helping others and completing their work diligently.

ESWs felt disconnected when clinical team members did not follow established rules or when they were ignored or undervalued. This led to feelings of disrespect.

ESWs felt connected to the clinical team when they experienced a sense of community and strong relationships, with open communication and support from clinical members. They expressed happiness when the clinical team went out of their way to help them and wanted more support to continue feeling part of the team.

“Photovoice proved a valuable research tool in providing us a way to broaden the understanding of the outlook of this important hospital workforce,” said Telisa Stewart, DrPh, associate professor of Public Health and Preventive Medicine, who co-authored the study with Scott Rosas, PhD, both faculty members in public health and preventive medicine, along with master’s of public health students and environmental service workers. "Photovoice is a valuable tool for us to better understand people's perspectives."

Environmental service employees Michelle M. Robinson and Moustapha Salawu, who both participated in the Photovoice project, lauded the project for helping highlight the importance of their work. “This project reinforces the importance of the work we do: clean room, clean mind, our care is better.”

Salawu agreed.  “If the room doesn’t get cleaned, the doctors, nurses, pharmacists and others cannot get into the room to do their job,” he said. “I think the project showed how respected these positions should be.”

Students involved in the project also walked away with a memorable experience.

“As a student, this was a very eye-opening experience to learn about the different perspectives of the EVS members on how they feel connected and not connected to their clinical teams,” said lead author of the study Nick Allis, MPH, MBS. “The most notable conclusion for me was getting to know these 10 members and being able to take the experiences they have shared with all of us into account going forward. Our goal needs to be to continue to make all members of the clinical care team feel connected, valued, and proud members. As a future physician, this experience will help remind me how all members of the clinical team are important.”

The project culminated with the viewing of the photos and vignettes when decision makers and managers throughout the institution were asked to come to better understand workers' lives.

The authors say the study provides valuable insights into how leaders can better support and engage ESWs to improve their work satisfaction and enhance collaboration with clinical teams. This work has the potential to lead to systematic changes that improve the hospital environment for both workers and patients, they say.

The study suggests that improving communication between ESWs and clinical teams, as well as acknowledging and recognizing ESWs as equal team members, could help address these concerns. Successful teams were seen to foster connectedness through appreciation and cultural humility.

This study also calls for more research on ESW experiences and urges leadership to create a more supportive environment for them. It suggests that creating an advisory board of ESWs and decision-makers could help improve communication, morale, and job satisfaction, ultimately benefiting patient outcomes and the well-being of environmental service employees.

Interim Director of Environmental Services Jason Rupert, MBA, said he was proud of the opportunity the study gave Environmental Services employees to highlight their work. "These employees are such an important part of providing quality care at Upstate," he said. "Photovoice allowed them to express their experience in an impactful way. We hope to expand Photovoice to allow all Environmental Service staff to share their experience at Upstate.”

Upstate President Mantosh Dewan, MD, expressed gratitude for the work of all who brought this project to fruition. "Gratitude and recognition are due to the Environmental Service employees whose dedication is central to patient safety and the quality of care in healthcare settings,“ said Dewan. “We are deeply thankful to them for sharing their stories through this project, and to the students and faculty who came together to amplify their voices. Their collaboration highlights the importance of every role in healthcare and the need to create a more inclusive, appreciative environment for all team members."

Study authors include Nicholas Allis, MBS, MPH; Zhi Chen, MPH; Leah G. Jones, MPH; Timothy Kohanski, MPH; Zane Suttmore, MPH; Samantha Turnquest, MPH; Joyce Appiah-Asare; Stephen Appiah-Asare; Kendell Battle Sr; Terry Frayer; Fateen Gilkey; Sherry D. Jones; Kelvin Little; Susan Murphy, MBA; Michelle Robinson; Anita Rouse; Jason Rupert, MBA; Moustapha Salawu; Zoreslava Osiv, MBA; Scott Rosas, PhD; and Telisa Stewart, MPH, DrPH.

Caption: Environmental Service team members and former Director Susan Murphy, with flowers, at the unveiling of the photovoice project.