When Laurent Gueris took over the housekeeping department at Providence Little Company of Mary Medical Center in San Pedro, Calif., the staff of 15 was well-trained in cleaning, but any people skills they had, they'd picked up on their own. Some entered rooms without knocking, did their jobs wordlessly with heads down, and then rushed out. Wanting to be invisible, they instead came off as sullen and unhelpful.
"They would do their little cleanup and leave," recalls Gueris' boss, Providence CEO Nancy Carlson. "They were very intimidated by other staff in the hospital and they were not being respected and valued."
At first, Gueris, manager of environmental services, concerned himself with easy fixes in his department, like purchasing paper towel dispensers that didn't have to be changed as often and swapping out conventional mops for microfiber ones. But a trip to France to visit his dying mother in the hospital prompted him to think about bigger issues, such as getting his workers to say "hello," be pleasant, even chitchat occasionally with patients.
"One day, I would see a housekeeper who was very friendly and connected with my mom," he says. "And another day, somebody would just go into the room and not even knock on the door."
Gueris became a student of the hospital's staff, noticing how some were able to defuse difficult situations and others made it worse. He also saw how a few pleasantries — and treating difficult patients as otherwise decent people reacting with fear and anxiety to a very stressful situation — made a big difference.
Back home, Gueris introduced role-playing sessions. Every morning, the staff met to rehearse interactions with patients. Gueris offered guidelines, something they hadn't had: Knock on the door. Ask permission to come in. Introduce yourself and tell them you're from housekeeping.
At first, Gueris played the patient, really throwing himself into his role. Sometimes, he'd be angry, sometimes insulting — whatever he knew would push a particular worker's buttons. After the session, he gave pointers on such matters as looking people in the eye or defusing an overly flirtatious patient with "Thank you very much, I appreciate that, but I'm not interested."
Gradually, the staff started coming around. After six months, they grew confident to the point that they wanted to take turns playing the patient.
"They give each other a real hard time," Carlson says. "They come up with scenarios that really challenge their peers."
They also began challenging Gueris.
"I'd say, 'You didn't look me in the eye,' and they'd say, 'Yes, Laurent, I did.'" So he started recording the morning sessions, which the staff would watch, discuss and then erase.
He was expecting resistance with the videotaping, but didn't get much. "I'd been working with them for a while to build that trust," he says. "We did the first video, it broke the ice and, by the next day, they were fine with it.
"Seeing it on their own was very powerful," he adds. "Not just the eye contact, but their facial expressions, their body language. Maybe they thought they did not look nervous, but they were [twitching] their legs."
They now follow a script: "Hi, I'm here; my name is …. I'm here to clean your room. I'm hoping you're having a good day today; here's a flower," then hand the patient a card with a flower printed on it. Once the room is clean, they ask whether the patient would like his or her curtains open or closed and whether they need anything else.
"Even though they can't answer a clinical question or stop an IV from alarming," says Carlson, "they can move a telephone closer, get a blanket, or ask a nurse to come in and respond to a clinical concern or question."
The housekeepers' patient satisfaction scores have jumped from the 60th to the 70th percentile to the 90th percentile in 2012. For his efforts, the Hospital Association of Southern California named Gueris a Hospital Hero for 2012.
Gueris' training techniques are now rolling out to other parts of the hospital, starting with nurses' aides and administrative staff. "Our goal is to roll it out to anybody who has interaction with a patient, including the phlebotomist who comes in, sticks a patient with a sharp object and leaves," Carlson says.