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Being ‘clean’ in 2023: Key drivers of cleanliness in ambulatory surgical and perioperative spaces

Ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) are experiencing increasingly higher volumes of patients. ASCs perform more than half of U.S. outpatient surgical procedures, and that number is only expected to grow. Why? People don’t want to stay in the hospital if they don’t have to—and insurance companies don’t want to pay for lengthy hospital stays if they’re necessary.

The Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) survey was first implemented in 2016. And participation in this survey has always been voluntary. But that’s all about to change. In calendar year 2024, the survey will be required and linked to reimbursement for HOPDs, with ASCs following suit in 2025. These new requirements are driving many of these organizations to seek out innovative  and out-of-the-box ways to improve the patient experience.

You’re probably not surprised that the overall patient experience and their perceptions of cleanliness are connected. But new research shows that the ways in which they are intertwined are not as intuitive as most people might think.

Compass One Healthcare, an environmental service industry leader, partnered with Press Ganey to identify key drivers of cleanliness in the ambulatory surgical and perioperative setting. Since 2022, we’ve worked together to determine best practices for promoting cleanliness in those spaces—and beyond. By analyzing survey responses from millions of patients, we are able to get a better sense of how to deliver the ideal ambulatory experience—one that is clean, safe, and exceeds patient expectations. Download the full report here, and check out some of the key insights below.

Respect and courtesy are linked to perceptions of cleanliness

Previous research1 suggests that teamwork and perceptions of cleanliness are closely related in the inpatient environment. In the ambulatory setting, we see similar trends. Our analysis revealed the overall drivers of cleanliness to include:

  • The courtesy of nonclinical staff members, from the front-desk receptionist to environmental services team members
  • Whether staff made sure patients felt comfortable
  • Overall efficiency (for example, a seamless check-in process)

What’s becoming increasingly clear is that clean, sanitized spaces are table stakes—the bare minimum patients expect in any healthcare environment. To improve patients’ perceptions of cleanliness, ASCs and HOPDs must reinforce positive behaviors that impact the entire experience. This means that everyone—from the environmental services worker, to the receptionist at the front desk, to the surgeon—must promote core standards of behavior and communication. But, when it comes to positively transforming their perceptions of “clean,” there’s no silver bullet.

Improving patients’ perceptions of cleanliness isn’t one size fits all

Not surprisingly, perceptions of cleanliness differ based on key demographics. For example, our data shows:

  • Those in the Midwest maintain high overall perceptions of facility cleanliness, while organizations in the South fall below the national top-box average.
  • Male respondents’ perceptions of cleanliness are more highly influenced by staff’s “courtesy and respect,” whereas female respondents are more affected by how helpful the patient access team was.
  • For some surgical specialties, like ophthalmology and dental, the smoothness of the check-in process makes it to the top of the key-drivers list.

Reports of infection rise when perception of cleanliness is poor

Our data suggests a statistically significant relationship between a patient’s perception of facility cleanliness and reported signs of infection after they leave. Patients are 2.3x more likely to report signs of infections if they don’t think a facility is as clean as it could be. On the flip side, if a patient awards a facility with the highest rating for cleanliness, they were less likely to report signs of infection after leaving.

To put things in plain language, ASCs and HOPDs can reduce infection rates among post-surgical patients and improve the patient experience by promoting cleanliness and focusing on how patients perceive the cleanliness of the environment.

Although staff courtesy, comfort, compassion, and efficiency may seem like nontraditional drivers, data suggests they have a significant and direct impact on patients’ perceptions of cleanliness. And that can mean big things for their experience of care.

Dive deeper into these insights—and more—from Compass One Healthcare and Press Ganey. Download “Beyond the physical environment: Defining key drivers of cleanliness in the ambulatory surgical and perioperative setting” here.


1. "Emerging Best Practices in Response to Evolving Patient Perceptions of Clean." Compass One and Press Ganey, 2022.

About the author

Marty oversees the Experience solutions team in Strategic Consulting, partnering with clients to improve culture, employee and physician engagement, and diversity, equity, and inclusion. He drives improvement by reducing turnover, sustaining change, and develop tools and techniques to create an inclusive and equitable environment. Prior to joining Press Ganey, Marty was Vice President of Engagement Services at Avatar Solutions.

Profile Photo of Martin Wright