The past several weeks have been trying ones on one of the construction projects at my hospital.  The contractor has subs going steadily with plumbing, electrical, gyp board, sheet metal, insulation all occurring in various places on the job site.  There is time dedicated to clean up the work area, but they always seem to be behind the curb.  The past few weeks they have upped their housekeeping game with dedicated laborers focused on housekeeping, as well as each sub dedicating someone to cleanup.  It’s making a difference, but the difference has been small compared to the level of effort.  We had a discussion today about safety, cleanliness, etc.  In fact, we’ve had several of these discussions recently.  
Let me rewind a little bit. In order to reduce the impact on the hospital, the contractor removed a window on each floor early on in the project.  This allowed demolition debris to be removed from the floor, without sharing a path with patients or staff.  It also allows materials to be brought in, again without interfering with the hospital’s flow.  Great idea!  This results in an overall smaller effect of the construction project, and reduces the chances for construction related infections.  We’re now at a stage in the project where the vast majority of demolition is complete and many items have been brought in for installation.  The removal of the windows has served its purpose.  
Move forward back to where we are- construction moving along, yet housekeeping remaining a problem.  The meetings today had a few new faces as some upper management from the contractor were in attendance as they were on site to survey progress.  Housekeeping efforts came up in the meeting.  In the ensuing discussion, an alternate perspective was offered.  Our problem with housekeeping is not a housekeeping problem at all, instead it’s a logistics problem.  With the floor space taken up by stacks of gyp board, piles of ducts, bundles of conduit, boxes of insulation, and other construction materials the work space is overly congested.  This impacts housekeeping as well as the ability to work unimpeded.  The problem isn’t with the housekeeping, it’s with the logistics planning.  In seeking to reduce the effects on the hospital by advance staging supplies through a removed window, an unintended consequence was created.  Too many items were brought in, this manifested itself as a housekeeping problem.  Instead of being the root-cause however, the poor housekeeping was a symptom of the logistics planning not fully considering the impact that lots of materials has in a limited space.  
The contractor is now considering what changes they need to make in material staging and storage in order to address their housekeeping struggles.  We’ll see what they can figure out.
Sometimes a fresh perspective can make quite a difference.  Other times experience gives the edge needed.  Good ideas sometimes can have unintended consequences, and being able to properly identify the root cause is the surest way to a timely resolution.