During the recession, it seemed that one of the only thriving service sectors in the country was healthcare. Hospitals and medical clinics continued to be expanded and built even as retail and office spaces ran increasingly vacant. The demand for medical services is a result of changing demographics — Baby Boomers are maturing and health care systems are anticipating their needs as they age. But as many of those companies prepare to handle more patients, they are also streamlining costs.

Outsourcing cleaning services to building service contractors has helped healthcare providers and organizations remain profitable, as it has cut down on labor costs associated with running an in-house janitorial department.

Thus, specializing in healthcare and medical facility cleaning is something that more and more BSCs are seeing the benefit of. Healthcare and medical accounts, such as hospitals, doctor's offices, ambulatory surgical centers, medical clinics and private practice facilities, view outsourcing of some or all cleaning and periodic maintenance as a budget-friendly way to trim costs.

Outsourcing janitorial services helps companies in any sector focus on what they do best, says Travis Ryan, general manager at EnviroTech Building Services in St. Cloud, Minn. The recession only reinforced that fact for customers, he says, who may not want to become experts in cleaning and literally be running what amounts to their own in-house cleaning companies.

"Many administrators, boards and facility managers previously looked at just the labor it took to complete the cleaning, but didn't consider the additional time it took to hire, train and manage those personnel and cleaning programs," Ryan says.

Raising the Bar

Some BSCs providing medical cleaning services have dedicated a branch of their commercial cleaning to the healthcare sector.

EnviroTech, for example, offers a specialized medical cleaning division for medical clinics, doctor and dental offices, surgical center and other healthcare facility accounts.

"Cleaning medical facilities is much more specialized than other commercial cleaning and it starts with the more-encompassing training that is involved," Ryan says. "Besides training, you have to consider the different types of shots and medical tests that are necessary for each employee to have before they can even stop foot in a surgical or operating room/area."

Mike Kelley, president of Combat Cleanerz in Old Forge, Pa., says his company's specialty in cleaning ambulatory surgical centers (ASCs) has elevated the level of cleaning the company can provide.

"One of the things we've found is that the healthier places we've done pushed our level of cleaning up several levels as far as quality goes," Kelley says.

Healthcare accounts, including ASCs and periodic floor maintenance work at local medical facilities and hospitals, make up about 25 percent of Combat Cleanerz's revenue, Kelley says.

"For us, it's a niche," he says.

ASCs perform outpatient surgeries during the day and are closed by 5 p.m. They have staff who keep up with surgical-related cleaning during working hours, but a BSC's staff is brought in to do floor work and general cleaning at night.

"At night, our responsibilities are the floors, medical waste, operating rooms. It's different from office park stuff — which is great cleaning — but healthcare cleaning is totally different," Kelley says. "You have to inspect your work every night."

Not only should janitorial staff be inspecting their own work, but they should be prepared for an audit by the state or federal health departments, says Bryan Lazorik, president of Bryco Building Services in Merrillville, Ind. A few years ago, federal and state departments of health came out with new regulations for ASCs and hospitals, raising the bar for cleaning. Within a few months, an ASC client was audited by the state DOH.

"It was a neat experience to go through the audit — they actually came at night when we were there cleaning and we had to explain to them how we dilute the chemicals, are we following the directions on the chemicals. So it was a lot of stuff that we figured out, going through the audit," he says. "The auditor said that with these new regulations, a lot of people are going to be in for a surprise, because it's affecting everyone across the board. So I was kind of thankful that we went through that early on. It's really made us a better company."

Know Regional Trends and Regulations

BSCs also benefit from being aware of building and acquisition trends in their areas, as well as the regulations that affect their customers. For instance, some states have stringent regulations on private ASCs, Lazorik says; because Illinois makes it tougher to open an ASC, there isn't as much potential for securing accounts there as there is in Indiana.

In the northeast region of Pennsylvania, a leading national operator of acute care hospitals has acquired a number of hospitals and is working to upgrade the quality of care they give — and Combat Cleanerz is working on securing more work within that system.

While many BSCs are experiencing spikes in the number of healthcare facilities outsourcing services, Kelley says it has been pretty static over the past year.

"I think a lot of cleaning companies that have decent contracts have knuckled down and are doing a better job," he says.

One of the perks of securing contracts with customers in the healthcare sector is, typically, they can be counted on to pay on time.

"Cash flow is your lifeblood and they're consistent payers. You typically don't have to chase them for money," Kelley says. "They have you figured into their budget."

Also, since many hospitals and clinics are affiliated or networked with other medical facilities in a region — or, in some cases, nationwide — earning a good reputation with one account can yield more work in other locations.

"If you actually perform the procedures the way they should be done and do them well and build up a nice repertoire of referrals, that's a big deal," Lazorik says. "In fact, the first ASC we cleaned, the administrator in charge there referred us to two others."

Cleaning for medical facilities requires investment in education and training; for instance, knowledge of and adherence to OSHA's bloodborne pathogen standard. Specific chemicals, tools and machines need to be used, and each janitor needs to have proper personal protective equipment. It also requires a level of quality control that other cleaning doesn't have — as patients' health depend on it. Partnering with a BSC can save customers money while providing a high level of service.

"It's fairly detail-oriented cleaning so they can't take a chance on being shut down because of environmental housekeeping issues," Kelley says. "It's cheaper for them to outsource a bulk of the work to us rather than have a staff that get full-time benefits and vacation and everything."

To take on healthcare accounts might mean a bit more education and training — but it mainly requires that a BSC have great recordkeeping, Lazorik says.

"Whether you're big or small, a lot of [BSCs] are still doing things the old way and that just doesn't work in these medical environments," he says. "I think if you're willing to invest the time and resources, which isn't a whole lot to begin with, it doesn't take a huge commitment. It's fairly easy to do. If you're willing to put that investment in, you'll come out on top."