Beyond Maintenance: How Hospitals are Rethinking Facilities Roles to Meet Patient Safety Demands

A new conversation is going viral among healthcare leadership: what if the team that maintains the building is as fundamental to healing as the clinical staff? Now, some experts say the upkeep of ventilation, power, and cleanliness is part of the healing process itself. Research published in the Journal of Facilities Management supports the paradigm: facilities maintenance often underpins the continuity of care in hospitals.

Clayton Smith, Senior Vice President of Facilities Management at Children's Health, a pediatric hospital in Texas, has been navigating this shift throughout his entire career, including world-renowned institutions like Moffitt Cancer Center and Mayo Clinic. Initially, he says he was nervous about moving into pediatrics. But that apprehension quickly transformed into passion when he discovered an environment where the energy creates a level of commitment transcending job descriptions.

When a system fails, the team's 'all hands on deck' mentality is fueled by the knowledge that "Somebody's child is plugged into the building, and that building is keeping them alive." Here, success depends on trust, and trust allows for rapid, clear communication. "Because leadership has been coached to accept fragmented information with the understanding of, 'Here's what I know right now... I'll give you more information when I get it,' this trust lets teams perform at their peak, even when the stakes are highest."

As an example, Smith points to the historical archetype of the facilities leader: a master technician, or 'good boiler tech,' who eventually becomes a director. It can be challenging for this type of leader to advocate for replacing costs on the balance sheet, like a boiler, when it's competing with the line items that generate revenue, like an MRI. Fail to bridge this gap, and facilities leaders will remain unheard, he cautions.

• Boiler tech to bilingual: Smith champions a new, multilingual leader instead. The strategy is twofold: develop business acumen while defending against cultural dilution by promoting from within. New leaders must translate technical needs into the language of their partners, he explains. "You have to be multilingual. I can talk about boilers all day, but if I can't make that resonate with an infection preventionist or articulate to HR how to write a job description for the best candidates, that's on me."

Not accidental, this type of integration is the result of a deliberate, top-down strategy. The solution was a powerful directive designed to foster shared ownership, acknowledging the essential role that unsung heroes like hospital EVS staff often play in patient safety.

• Taking it personally: Smith found a powerful motivator in the resilience of his young patients. "The patients bring an amazing energy. When you see a little kid riding his IV pole down the hall with a grin on his face, you realize your own day isn't so bad. It makes it easy to come to work." For Smith, that energy is anchored in a personal connection that makes the mission tangible. "Every day, my team does their job like it's a survey because they know it's impacting somebody's kid. For many of them, it has been their kid. They want to make sure every child gets the best care possible."

• Ten minutes to care: But this human-centric approach is only successful when paired with a rigorous focus on data, Smith says. The goal is to connect every metric to a human impact to make the results more tangible. "For example, our EVS team focused on improving room turnover time because they knew that 10 minutes quicker means a patient spends 10 fewer minutes waiting in the ER for a bed. We went from 76 minutes down to 52, with a goal of 45."

• The 'best friends' directive: According to Smith, real change began with a mandate from the top. "An EVP of operations gave us a directive to become 'best friends' with other departments. He told us it wasn't a suggestion. Since our teams touched nearly 90% of the hospital population, we were expected to solve problems together." The result? 'Back-of-house' teams are now seen as essential partners in clinical care. "Today, the housekeeper assigned to a unit sits in the daily nursing huddle about patient outcomes. They're part of the team, often as involved in patient care standards as the nurses."

For Smith, sustaining this culture means preparing the next generation of leaders. He says future leaders need three qualities: the ability to assimilate into a culture, the wisdom to lead by consensus, and a deep understanding of servant leadership. "Bring your idea, stand it up in the middle of the table, and let us all shoot holes in it. Whichever idea is left standing at the end, that's the idea we all walk out of the room with." In closing, he offers one final word of advice to the next generation on the topic of humility: "As a leader, your job is not to sit on top of the pyramid. You are the tip of the spear, deflecting bullets so your team can do their job. Your job is to be there for your team. Your team's not there for you."