CHICAGO — Randy Bartsch, president and CEO of Ecotex Healthcare Linen Service, which has operations in Seattle, Vancouver and Toronto, sees many challenges in the healthcare laundry industry.
An overriding challenge he points to is the rapid consolidation of the customer base.
“In December alone, we saw four of the top 10 health systems pair up in mergers,” he says. “First San Francisco-based Dignity Health, the fifth-largest health system in the nation, announced that it was merging with Colorado-based Catholic Health Initiatives (CHI) to form an even larger health system with 139 hospitals.
“Then, in the same week, St. Louis-based Ascension, the largest nonprofit health system in the United States and the world’s largest Catholic health system, announced it was combining with Providence St. Joseph Health, based in Renton, Wash., to create, according to The Wall Street Journal, the nation’s largest hospital operator. The Ascension-Providence deal would have 191 hospitals, and would dethrone the nation’s largest pure hospital operator, the Hospital Corporation of America (HCA), which has 177 hospitals.
“These big-three hospital systems combined will operate 507 hospitals across the country.”
Bartsch says this consolidation puts growing pressure on providers of non-clinical support services like laundry and linen.
“Ours is an industry where ‘no news is good news,’” says Bradley J. Bushman, president of the Healthcare Laundry Accreditation Council (HLAC). “When things are going great for the hospital, they’re going great for us. On the other hand, if there are quality or infection issues, we hear about them quickly. Of course, there’s an upfront cost to quality and infection prevention, and this isn’t always apparent to the customer. We have made progress here, but we tell an even better story when we can educate about the standards we follow and the steps we take to ensure quality assurance and infection.
“Arguably, the larger message to keep in mind is the cost of not taking these steps.”
That means healthcare laundries have to keep an eye on the bottom line while maintaining clean, quality linen.
For the most part, it seems that healthcare management and laundry are on the same page when it comes to the need to produce clean, quality linen.
“In the hospital market, regarding bed linen, there’s not much more convincing to do,” says Joseph Ricci, president and CEO of TRSA, the association for the linen, uniform and facility services industry. “Infection preventionists and environmental services management are well aware of the importance, and they’ve educated hospital administration.”
Bushman says that the industry has moved forward in convincing healthcare management of the importance of laundry infection control.
“In almost all hospitals now, the IP is a key stakeholder at the table,” he says. “Hospitals now understand the importance of preventing healthcare-associated infections (HAI) and the return on investment (ROI) in this prevention.”
According to Linda Fairbanks, executive director of the Association for Linen Management (ALM), in the grand scheme of things, healthcare management has far greater concerns.
“I believe laundry’s current place on the C-suite’s radar says a great deal about the reliability of our industry to do what we know is right,” she says. “The quality of the textiles used in healthcare is important, but right now the C-suite is, appropriately, more concerned about wrong-site surgery, medication errors, cost of services and supplies, adequate staffing, and delivery of care.”
However, Fairbanks cautions that the industry cannot become complacent.
“We realize the importance of improving outcomes through advancements in chemicals, textiles, equipment and practice,” she says. “We must carry through by validating the outcomes through independent, evidence-based research and establishing valid practice.”
That doesn’t mean that every type of healthcare facility is in step with essential laundry practices. Ricci points out that for outpatient facilities without staff, such as IP and EVS, it’s more of a challenge.
“In both markets, employee uniforms are the frontier in this respect,” he says. “We are confident that IP and EVS staff appreciate the infection-control value of preventing scrubs from being worn in public and laundering them professionally, so we are empowering them to take that message to the hospital executive suite.”
Ed McCauley, president and CEO of United Hospital Services and past president of the American Reusable Textile Association (ARTA), agrees the service/management relationship has moved forward, but he says there is more to accomplish.
“I think this area is really in its infancy,” he says. “As little as 10 years ago you’d be hard pressed to find an infection control professional on a hospitals staff. Now they have tremendous weight in decision making for supplies and internal cleanliness policies.
“As laundries still struggle with sharps and other debris that gets returned from the hospitals, the infection control professionals are actually paying close attention and trying to affect change at the hospitals.”
Healthcare laundries have made great strides in infection control and working with healthcare management; however, Ricci says TRSA is concerned about healthcare providers’ focus on quality assurance.
According to Ricci, the industry generally needs to pay more attention to outcome measures like microbial testing of linen, as opposed to just structural measures, such as whether a laundry separates its clean and soiled production work, or process measures, such as verifying use of best practices.
“It is important now, and we are making great strides here, too, to educate the industry about the intersection between IP and healthcare laundry,” Bushman adds. “For textile service providers, this means that it’s important to identify and build a relationship with this healthcare discipline—encouraging regular tours at both ends, where information can be shared for the betterment of all.”
While the healthcare laundry industry is making advances in the challenges it faces, the future will bring with it more obstacles to overcome.
For example, Fairbanks says that in speaking with materials management, supply chain, clinicians and value analysis professionals, their concerns (i.e., complaints) about quality seem to be of greater concern than infection control concerns.
“This seems to be where the single-use products are making inroads, and we must pay attention here and take action,” she says. “How are you ever going to get clinicians on-board to reduce utilization if they need 500 gowns, receive 500 gowns, but can only use 420 of them due to quality issues?”
As an industry, Fairbanks says healthcare laundry must continue to ask questions, especially, “How can we be better?” Advances in chemical applications, textile advancement (i.e., microfibers) and advances in the equipment used keeps the industry on track as a quality service.
“We need more conversations with materials management/value analysis professionals/GPOs, as they need to understand that if they continue to drive solely on price, they are going to have linen that doesn’t last, isn’t comfortable and doesn’t drive better patient outcomes,” she says. “In fact, they will achieve the exact opposite. Purchasing partners need to understand this and become aware of the recent advances in healthcare textiles that can deliver on the ‘triple aim’ of cost, quality and better outcomes.”
McCauley points out that the laundry industry doesn’t change simply for the sake of change. There has to be an underlying need for change.
“Change tends to be incrementally positive when there is no dire need,” he shares. “For instance, I would say that most laundries and hospitals have switched from T130 Muslin to T180 Percale sheeting and from open-end weaves to ring-spun weaves for terry products , etc. These subtle changes account for a better experience for the patient and caregiver through better comfort.”
Finally, Bartsch points to labor as a growing future challenge for the healthcare laundry industry, a major obstacle for the service sector across the country. He says the laws of supply and demand are easily apparent.
“Rising labor costs, especially in the entry or low-skilled areas, accelerated in part by the $15 and Now movement, combined with a general shortage of labor, which results in more turnover, employee churn, and a less-skilled, less-experienced workforce, is something we all need to address,” he says. “When you look at the demographic trends, it’s not going to get any easier.”
While it may not get easier, the healthcare laundry industry has a history of rising to meet challenges, and veterans like Bartsch, Fairbanks, Ricci, Bushman and McCauley will continue to push it forward.
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