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Hitting the ‘Mark’ in Laundry/Linen (Part 1)

Benchmarks in linen utilization

CHICAGO — In laundry and linen services, benchmarking, the process of checking against a standard, helps in the effective usage and processing of textiles.

But what standards should be used for such measurements, and how can improvements be made?

Two experts discussed these topics during the webinar Benchmarking Basics, presented by the Association for Linen Management (ALM).

In this post, Janice Larson, vice president of clinical resources and consulting for Encompass Group LLC, a manufacturer of healthcare textiles and products, discusses benchmarks in linen utilization, specifically hospital linen utilization. 

UTILIZATION

“The most top level is something known as pounds per adjusted patient day (PPAPD),” Larson says. “Basically, the calculation is to get total processed, clean pounds divided by adjusted patient day.” 

An adjusted patient day is the in-patient, room-night census, adjusted for outpatient activity. Larson says it’s a financial calculation that is the same calculation throughout all hospitals because it has to be reported to the American Hospital Association. 

“Every hospital calculates an adjusted patient day on a monthly basis,” she says. 

Another common top-level benchmark for linen utilization is pounds per patient day. Larson says this mark uses the same total processed, clean pounds divided by the in-patient census only. 

The last benchmark she says has been used is cost per adjusted patient day. 

“This is a pretty complicated benchmark,” Larson remarks. “There are so many variables contributing to cost per piece, one being cost per pound. Another is the replacement price per item. Is there tax included in your replacement? Is there freight included? Then there’s product life, the quality of the products that you’re buying. National contracts. It can be extremely complicated to arrive at.” 

Larson points out that PPAPD benchmark in hospitals has been going down consistently over the past 20 years. 

“While I’m proud to say that some of this is due to better linen utilization practices and more awareness around how to drive linen down while being able to maintain patient care both on the part of the hospital and on the part of the commercial laundry as they partner,” she says, “there’s also that dynamic where outpatient activity is increasing. 

“The dynamic of outpatient in the adjusted patient day means that you have less pounds contributing because outpatient activity uses less pounds, that also contributes to the adjusted patient day number trending down, that number being diluted by more outpatient activity and less outpatient pounds.” 

Larson then moved beyond top-level measurements to the “next level down of benchmarking,” which is items by adjusted patient day.

“In other words, taking your adjusted patient days and looking at individual usage by item,” she says. 

After that, the measurement looks at pounds by activity per department. 

“Honestly, benchmarking usage by individual item and by pounds per activity in a department is the level of detail that kind of tells you where the bodies are buried,” Larson quips. “This really tells you what items and what departments you should be focusing on, that have the most opportunity to improve. Nurses are scientists. They really rely on data to make decisions. You need data to convince them that, A) there’s a problem, and B) there is an opportunity to change. This data is key to get their buy-in that they to change utilization processes. 

“The value you get from that data is so much greater than dealing with just the top-level benchmarks.”

Larson cautions that people often get “national average” and “best practice” confused. They are not the same thing. 

“If anyone says the best practice linen use for a 500-bed hospital is 12.2 per adjusted patient day, they’re really not referring to best practice,” she points out. “They’re saying that 12.2 might be the desired result, something you want to build toward. Best practice is not the number. It’s products and processes and how they’re being used and in what quantities that make up best practice.” 

The problem with the calculating by cost is the variables associated with the products and the quality of the products, both of which can affect the cost, Larson shares. The variables can also influence weight. 

“If you are benchmarking yourself against a hospital who’s using a lesser-quality product, they are naturally going to have a much lower usage than you do in pounds,” she says. “Also, when you’re looking at pounds per adjusted patient day, you have to say is this hospital a big user of reusable underpads. In some cases, a hospital may be using more disposable products. 

“You have to also think about what percentage of poundage is scrubs. More hospitals are providing scrubs compared to the previous decade.”

Larson cautions that when it comes to hospital utilization benchmarking, real data must be gathered and collected, and it has to use the same factors and calculations in order to represent a benchmark that is reliable. 

“To me, it’s important that benchmarking be derived by data that you can you can go back and fact check,” she says. 

Another caution: Benchmarking against different kinds of hospitals and different kinds of units. For example, comparing an acute-care hospital against a long-term care hospital, each of which has very different practices and level of nursing care.

“You also have to make sure you’ve established a baseline in the same way the benchmark is calculated,” she adds. 

Larson also sees hospitals that don’t research best practices thoroughly. 

“When you do find a best practice that is delivering an outcome that is a lower pounds per adjusted patient day and you want to adopt it, if you don’t really research how that’s being done and what products are being used and what kind of patient outcomes they’re getting, a change can really backfire,” she points out. 

Also, hospitals have to think about customer and staff satisfaction. “If staff isn’t happy with the changes you’re making and the benchmarking you’re doing, they’re going to sabotage this,” she shares. 

Finally, Larson cautions against thinking that there are benchmarks for every department and every item. 

“It might be a level of complexity that is impossible to track,” she says.  

Check back Thursday for a look into benchmarking laundry production.