Historically, linen and laundry service has been a function that’s earned little respect in the healthcare environment. Linens were sorted, cleaned and distributed to their rightful departments without much consideration of the value the textiles – or the staff members who managed them – brought to the facility and its patients. While no one could dispute that the linens were necessary, most failed to recognize just how much.

Today, that mindset is slowly beginning to change as healthcare administrators strive to maintain a competitive advantage over neighboring hospitals and acknowledge that the quality and availability of linens directly impacts patient care and satisfaction.

"More and more, linen and laundry departments are becoming recognized as contributors to quality patient care," said Bill Jones, chief operating officer, Hospital Laundry Services, Wheeling, IL. "We are seeing more facilities interested not only in having higher quality linens, but also more effective [processes] to increase efficiencies and better meet the demands of caregivers and patients."

Getting there requires facilities to first gain a better understanding of the actual costs associated with providing linen and laundry service – a key element that has often been overlooked in the past, but is now beginning to be better understood and evaluated by administrators. Armed with that data, facilities can then determine a linen strategy best suited to their unique needs. Some may opt to outsource the entire function, while others may decide to keep the service on-premise, perhaps revamping the design layout of the department and bringing in modern equipment to maximize resources and overall value. Others may take a more a la carte approach by maintaining an on-premise laundry facility, but outsourcing the management function. Then there’s the question of whether to rent linens or own them. And the list goes on.

Whatever the approach, sources agree that, much like other cost-conscious departmental functions, the bottom line will weigh heavily in the decision.

Speed Queen

Outsourcing picks up speed
For a growing number of healthcare organizations, outsourcing some or all of the laundry function is becoming an increasingly popular option in light of rising utility, materials and labor costs, and the ongoing push to convert non-revenue departments into profit-generating space.

According to 1996 figures from the Textile Rental Services Association, linen rental, in particular, is gaining in popularity. Some 35% of hospitals rely on a textile rental service, TRSA reports.

"Today, more hospital and healthcare facility administrators are outsourcing their linen and laundry services to textile rental companies because they find that on-premise laundries are no longer cost-effective to operate," TRSA noted. "Textile rental customers need not invest capital expenses on equipment or merchandise. Their costs can be carefully budgeted, closely monitored and expensed against operations." The association also points out that there are no financial "surprises" with textile rental services and that hospitals require little linen storage space because textiles are replenished regularly.

Jones said he’s seen firsthand the growing trend in outsourcing, both in terms of linen rental and management of on-premise laundries. HLS, which provides linen rental, direct linen sales and onsite linen management, among other services, has garnered a 40% growth in business over the past year, with the company now managing approximately 83 million pounds of linens annually.

Chicago’s Swedish Covenant Hospital is one facility that has found value in outsourcing the management function of its on-premise laundry department. "We have been involved in HLS’ linen management program for [more than ten years]. Outsourcing gave us more flexibility and better quality. We don’t have to worry about laundry backing up because we don’t have enough [staff on hand to manage it]. We rent our linens, so we never have to worry about not having them where and when we need them."

Jones credits at least part of the growth in outsourcing to the booming outpatient sector, which has made it increasingly challenging for facilities to keep up with the rising linen demands – and the labor-associated expenses that go along with them. While many facilities believe that outpatient surgery and diagnostic centers require fewer linens because overnight stays are eliminated, Jones stressed that’s a common – and costly – miscalculation.

"People often assume that the cost per pound per adjusted patient day should decline in outpatient settings, but they aren’t realizing that their needs will actually be increasing because they will be taking care of more patients each day," he explained. "In a radiology clinic, for example, there could be 35 patients needing X-rays or MRIs, and they all will require gowns. Meeting those requirements can be difficult for many facilities." Such an example, he said, further underscores the value of selecting an outsourcing partner that calculates cost per adjusted patient day, rather than per pound.

To better meet the increasing linen demands in healthcare, some laundry service providers that offered textile services to numerous industries are now focusing entirely on the healthcare market. Angelica Textile Services in Atlanta, for example, divested its uniform business and now is involved solely in healthcare linens. In just one year, the company expanded from 28 laundry plants to 34 – all of which are designated to the healthcare segment.

"We believe this industry will only continue to grow. Outsourcing is a [trend] that offers a lot of opportunity for facilities who want to partner with a [service provider] that can do the job for them, and do it well," explained Paul Anderegg, president, Angelica Textile Services. He added that the laundry service industry is currently undergoing a great deal of consolidation; quality firms that make an ongoing effort to build on their services and core values, and find innovative ways to meet evolving customer demands, will survive the shakedown.

To help promote standardized quality and level the playing field amongst laundry service providers, TRSA is working to develop a certification for laundry service providers. According to Jones, the certification will serve as "a seal of approval" for laundries that meet the quality requirements set forth by the association. He said the TRSA certification requirements are currently in their first draft, but when approved, will be supported by numerous healthcare agencies, including the Joint Commission on Accreditation of Healthcare Organizations. "Facilities will be encouraged to only do business with those who are certified."

UniMac UW Washer Extractor

OPLs extracting more value
Despite the growth in outsourcing, some healthcare organizations are not willing to move their laundries offsite. In fact, some facilities – even small, rural ones that some believe are a good fit for outsourcing — are dedicating a significant amount of resources to develop a state-of-the-art on-premise laundry facility.

"Some are recapitalizing their investment and expanding their on-premise laundries," noted Robert Hewitt, director of laundry services for ARAMARK Healthcare Management Services, Philadelphia. He described one formerly outdated hospital in rural Indiana that underwent a facility-wide renovation. "They now have a brand new, state of the art in-house laundry," he said, noting that while the hospital opted to keep the department onsite, it partnered with ARAMARK to manage it. "Some find it is in their best interest to have the linen and laundry function onsite. The bottom line is still quality and what best fits with the goals of each facility." ARAMARK manages large central laundries, shared-service laundries and on-premise plants for hospitals and residential care facilities. ARAMARK also manages various aspects of laundry and linen programs, from feasibility studies and planning to ongoing implementation, training and support, and even consultation for complete renovation or system replacements.

Many hospitals committed to keeping an OPL are tapping every available resource – working with equipment and chemical distributors and factoring design considerations and equipment upgrades into the big picture to streamline operations, increase throughput and quality, and reduce overall expenses.

From a pure equipment perspective, OPLs have more options and innovative features available than ever before. Today, OPL equipment is designed to accommodate larger loads, allow for greater programmability and flexibility, and significantly reduce cycle times and utility consumption. According to Joel Jorgensen, sales and marketing director for Continental Girbau, Oshkosh, WI, a subsidiary of the European-based Girbau Group, both labor and utility costs are the driving factors behind evolving equipment technology. "Labor has always been the number one cost factor for OPL operations, but now with the price of utilities spiking – with no apparent end in sight – hospitals are looking for ways to keep those costs to a minimum."

Jorgensen said the U.S. market is beginning to apply proven European technologies to its own equipment. Higher G-force is one area that is picking up speed. Continental Girbau offers a soft-mounted washer-extractor that suspends the wash module and allows it to spin up to 1,000 RPMs. Jorgensen said even the highest performing hard mount models top out at 600-700 RPMs. The higher G-force in soft-mount system can cut drying cycles by as much as 50%. Soft-mounted systems also vibrate less than their hard-mount counterparts, placing less strain on bearings and reducing maintenance costs, he said.

Spray-through-the door technology is also drawing attention because of its ability to fill the machine more quickly and reduce water consumption. "It’s much like taking a shower versus a bath," explained Kim Shady, national sales manager for UniMac, Ripon, WI. Because door spray machines are filled from the bottom up and through the door, they are equipped with four fill valves, as opposed to the two found on traditional bottom-fill models. Shady said the four-valve models can shave two to three minutes off each cycle.

Equipment manufacturers are also offering larger capacity baskets and across-the-board feature upgrades, according to Shady. "In all industries, including healthcare, there are larger volumes of linens coming to the laundry room, so customers are having to upsize their equipment to handle that linen in the same amount of time as before. Running on overtime in laundries is very expensive, so many are looking to new equipment to help them meet their increasing needs."

Like other pieces of equipment used in healthcare, flexibility and customization are also on customers’ radars. Craig Dakauskas, national sales manager for Speed Queen, Ripon, WI, said the latest OPL equipment features upgraded electronic controls that "allow the facility to have more flexible control and customized cycles for different types of loads and linens." Such controls not only maximize staff productivity and efficiencies, they also help extend the life of linens, he explained.

While such bells and whistles do cost more initially, Shady assured that the efficiencies garnered over the equipment’s lifespan will far outweigh the expense. "These features may cost $1000 to $2000 more initially, but they could end up saving the hospital $10,000 to $12,000 over the equipment’s lifetime."

Vendors are also offering attractive leasing programs, allowing hospitals to upgrade their equipment without having to invest a lot of capital. Dakauskas said leasing is becoming increasingly popular because hospitals have the option to buy at the end of the lease cycle or can upgrade to new, more efficient models for only a modest rate increase.

In the future, facilities will have even more high-tech features at their disposal. Dakauskas has seen a growing demand for fire-suppressed laundry systems and the ability to remotely access laundry room operations – both of which will be addressed by vendors. Equipment vendors agreed that better controls, electronics and simplified graphics are also on the horizon, along with integrated software management systems that will monitor washer and dryer cycles and generate productivity reports.

Laundries scanning new trends
Today’s innovative laundry technology goes beyond washer-extractors and tumblers, however. As facilities become more committed to data mining and benchmarking they are turning to information systems to pinpoint gaps in productivity and profitability.

Recognizing that this need also extends to the hospital laundry market, Centrex Technologies, Oakbrook, IL, developed the Linenweb Linen Information System – an integrated inventory control, billing, production management and reporting system. According to the company’s CEO, Kevin O’Hara, Linenweb is the only fully internet-based linen and laundry management system, and is available either as a standalone hospital system, a standalone laundry system or a fully integrated system linking multiple hospitals to the laundry.

Building on the Linenweb technology, which is now being deployed to more than 200 sites across the U.S., Centrex recently added the new product Linenweb Benchmarking Services, which mines through masses of data to allow comparison of individual hospital performance at a unit and item level. According to O’Hara, this allows the rapid identification of inefficient usage and the accurate estimation of potential savings. Centrex consultants can then work with the hospital to develop an action plan to capture and maintain these savings.

Radio frequency identification is also finding its place in the healthcare laundry market, as more operators aim to track linen usage and loss. HLS has been implementing the technology for about a decade. According to Jones, all non-barrier garments are chipped, which speeds up the garment sorting process and allows hospital customers to monitor the units that enter and leave their facility. "With RFID, we can have garments from numerous hospitals hanging together on the conveyor line and the system can sort them all very quickly." Jones said the chips are roughly the size of a dress shirt button and are attached to the garments with a heat-sealed label. The label includes the chip number and the customer’s information to serve as a back-up in case the RFID chip fails to function properly. HLS relies on scanning technology to track every aspect of the laundering process – from receipt to inspection. The technology also lets the company know when an item has reached its laundering limit and should be retired. Hospitals can use the tracking information to monitor loss and identify if staff are going against policy and laundering their garments at home, Jones added.

In October 2004, Centrex Technologies announced a new internet-based OR Surgical Pack information system that utilizes RFID technology. The system allows for reusable OR pack items to be individually tagged and assembled in a wide range of pack "recipes" that are easily set up and managed within the system. Packs are then assigned to customers according to their daily order requirements. Each item is scanned upon receipt using RFID tag readers positioned beneath inspection light tables. Operators are alerted to any testing or repair requirement immediately upon scanning, and pack assemblers are stepped through each item in a pre-arranged packing sequence, with the packs receiving an individual identifier. Customer orders can then be filled using mobile handheld computers and weighted with scales integrated directly to the Linenweb OR Pack system.

Both O’Hara and Jones predict the healthcare laundry industry will rely even more on RFID technology in the future, as its associated cost and size is reduced. Hospital demands for higher quality, customized linens may also drive the tracking trend.

Hewitt and Jones said they are seeing more hospitals take a page from the hotel industry’s book by requesting higher quality linens and garments in different colors, fabrics and patterns. "They are making patient comfort and satisfaction a priority and are looking for ways to differentiate themselves in the marketplace," explained Hewitt.

While facilities may be more willing to invest in high quality, customized textiles, it only makes sense that they will push for technology to help maximize their investment. "Cost and quality will always be the key driving factors," Jones said. HPN