Understanding Christmas Holiday Linen Volume

Eric Frederick |

The Christmas holiday is a very special holiday to most employees, and they want to spend it at home with their families. Unfortunately, hospitals don’t close for holidays, and linen still needs to be present in order to deliver proper patient care. Each year, we healthcare managers try to accurately predict the volume of linen that will need to be processed and plan work schedules accordingly.
In planning for this recent Christmas slow period, we met with a number of hospital administrators to discuss reduced deliveries. They were all concerned about a reduction in service based on their perception that the patient load in hospitals over the Christmas holiday was very inconsistent. They didn’t feel that past experience could accurately predict what to expect.
Over the past decade, I’ve developed a system to help explain the variable nature of Christmas holiday healthcare volume. I would propose that at the heart of the variance is the very calendar we use to measure the passage of time. Christmas, like some other holidays, will fall on a different weekday each year. It’s the day of the week that seems to have the most bearing on hospital volume, versus any other factor.
To explain this theory, let’s look at 2007 as an example. Christmas Day fell on a Tuesday. This meant that normal healthcare volume continued until Friday, Dec. 21.
Most hospitals experience a drop in census over the weekends. Large amounts of soiled linen are generated and equal amounts of clean linen are used during the discharge process. Because Christmas Eve fell on Monday, hospital census was in a gradual decline from Friday to Tuesday. On Monday afternoon, anyone who could be discharged was sent home to be with his or her family for Christmas.
This three-day lowering of the census created extremely low linen usage on Dec. 25-26.
To further illustrate my point, Christmas falls on a Thursday this year because 2008 is a leap year. It’s highly likely that hospitals will experience a short-term increase in workload on Monday, Dec. 22, and Tuesday, Dec. 23. This will result in an extremely large and sudden drop in hospital census on Wednesday, Dec. 24.
The higher volume going into the holiday will make it more difficult to reduce staff for that time, even though the period right after the holiday, Friday, Dec. 26, through Sunday, Dec. 28, will be less busy than normal.
To focus on just one factor, such as the day of the week, without considering other external factors would be foolish. As managers, we need every tool available to us to accurately predict our staffing needs.
Other factors that need to be accounted for include the current status of infectious diseases in your area (i.e. flu epidemics), weather-related problems and local or regional economic problems.
I remember one year when the hospitals had a robust December because a major employer had announced upcoming layoffs and the affected employees were trying to use their healthcare benefits before they lost them.
Ice storms or extreme cold can also help to fill hospital beds. We’ve all seen how a bad flu season can increase the use of hospital facilities.
By taking all these factors into account, we can reasonably predict whether this Christmas will be busier or less busy than the previous year. This analysis will allow us to reduce staffing, hours of operation and, often, costs.

About the author

Eric Frederick

Carilion Laundry Service

Director of Laundry Services

Eric Frederick is director of laundry services for Carilion Laundry Service, Roanoke, Va., and past president of the National Association of Institutional Linen Management (NAILM), now called the Association for Linen Management (ALM). He’s a two-time association manager of the year. You can reach him by e-mail at


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