Winning a healthcare cleaning contract can open the door to significant growth for a building service contractor (BSC). But after years of working in healthcare environmental services, I’ve learned that winning the contract and successfully operating it are two very different challenges.

I’ve had the opportunity to view that challenge from multiple perspectives. I’ve worked for large healthcare support service organizations, smaller contractors entering the healthcare market and larger BSCs building or strengthening their healthcare divisions. I’ve also served in hospital environmental services leadership roles and as a healthcare executive responsible for evaluating contractor performance. Today, as a consultant, I often find myself helping organizations address problems that can frequently be traced back to decisions made during the bidding and pricing process.

The lowest bid may become an expensive mistake

Some of the most troubled healthcare contracts I’ve encountered didn’t fail because the cleaning teams lacked effort or commitment. They struggled because the work was underpriced from the beginning.

The problems often start long before the first employee walks through the door.

They start during the bidding process.

A request for proposal (RFP) arrives outlining square footage, frequencies, operating hours and a few notes about cleaning requirements. A pricing model gets built around labor assumptions, production rates, supplies, equipment, overhead and margin. On paper, the numbers make sense.

Then the contract starts.

The team discovers that properly cleaning the radiology and pharmacy areas takes an additional hour every day. Clinical staff expect additional support that wasn’t fully captured in the original staffing model. New employees require healthcare-specific training and documented competencies. Questions emerge about approved disinfectants, personal protective equipment (PPE) responsibilities, response times and turnover cleaning expectations. Many of those requirements were never clearly defined in the original scope.

That’s when margins start disappearing.

I’ve found that healthcare cleaning cannot be priced successfully unless the contractor first understands the clinical environment and the operational infrastructure required to support it.

Not all square footage is created equal

One of the biggest misconceptions in healthcare pricing is that square footage tells you everything you need to know about staffing requirements.

It doesn’t. Square footage matters, but it is only one piece of a much larger operational picture.

I’ve seen facilities with nearly identical footprints require dramatically different staffing levels because of what’s happening inside those spaces. A professional office building and an outpatient medical center may occupy the same amount of square footage, but they create completely different cleaning demands.

The office building may consist primarily of workstations, conference rooms, restrooms and break areas.

The medical center may contain examination rooms, treatment areas, diagnostic equipment, waiting spaces and clinical support functions that require more detailed cleaning and disinfection.

The square footage might match. The workload does not.

Training is not optional

Training is another area where healthcare pricing models often fall short. In many commercial environments, onboarding focuses on cleaning procedures, equipment operation and basic safety practices.

Healthcare requires much more. Employees need to understand infection prevention principles, cross-contamination risks, disinfectant contact times, PPE requirements, chemical safety and the specific protocols associated with the spaces they clean. Depending on the environment, additional training may involve bloodborne pathogen exposure prevention, isolation precautions, procedural areas or specialized equipment.

Those requirements carry real costs.

The Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Pathogens Standard also establishes specific training and exposure control requirements for employees whose work involves reasonably anticipated occupational exposure to blood or other potentially infectious materials.

Over the years, I’ve seen organizations underestimate the amount of time and money required just to prepare employees to begin work. Background checks, occupational health requirements, medical clearances and missing vaccination records can all delay onboarding while generating costs that weren’t included in the original budget.

The employee hasn’t cleaned a single room yet, but the expense has already begun.

If those realities are not reflected in the pricing model, the contract starts operating at a disadvantage from day one.

The supplies aren’t always what you expect

Another area where I’ve seen contractors get caught off guard is the cost of the products and supplies required in healthcare. The disinfectants used in commercial buildings may not be approved for the healthcare environments you’re entering. Certain facilities also have specific requirements for cleaning textiles, including whether they must be professionally laundered or replaced with disposable alternatives.

I’ve seen contractors discover these requirements after pricing the contract, only to realize that their original supply assumptions were no longer realistic.

And then there’s PPE. Gloves, gowns, eye protection and respiratory protection aren’t simply line items you can estimate using a standard percentage of revenue. Depending on the environment and the tasks being performed, consumption can vary considerably. I’ve worked with contracts where respiratory fit testing for employees required to wear tight-fitting respirators costs approximately $90 per person. When you’re staffing a large operation, and factoring in turnover and additional testing requirements, that becomes a significant expense that needs to be included in the budget.

These aren’t necessarily enormous expenses individually. But across a large healthcare operation, they add up quickly.

The cost of leadership and operational support

One mistake I see repeatedly is an overemphasis on front-line labor while the support structure behind that labor receives far less attention.

Healthcare environmental services programs don’t operate successfully because people show up with mops and disinfectants.

They succeed because somebody is recruiting employees, conducting training, validating competencies, managing schedules, handling employee relations issues, responding to client concerns, performing quality inspections and supporting the team when problems arise.

That work doesn’t disappear simply because it wasn’t included in the budget.

I remember reviewing one healthcare account that had been priced almost entirely from a sales perspective, with very little operational input. The proposal looked competitive on paper, but critical assumptions had never been challenged.

The facilities included large open clinical areas that should have been maintained with autoscrubbers, yet no major floor equipment had been budgeted. The plan relied on manual mopping instead. Dozens of patient stations requiring regular cleaning and disinfection also weren’t fully considered when labor hours were developed.

The pricing model further assumed that much of the work could be subcontracted, but the realities of service delivery proved far more complicated than anticipated. Within the first year, the account struggled to be profitable, customer complaints increased and operational expectations consistently exceeded the allocated resources. Eventually, the business was lost.

The lesson wasn’t that the team lacked effort. The problem was that the operational realities of the work were never fully reflected in the original pricing model. By the time the operational gaps became obvious, correcting them would have required changes that the original contract economics simply couldn’t support.

Quality assurance is another expense that often gets overlooked. Early in my career, I learned that healthcare isn’t just about making a room look clean. It’s about creating a safe environment for patients, staff and visitors. In healthcare, a room can appear spotless and still not be cleaned correctly.

Clients need confidence that cleaning procedures are being followed consistently, which requires inspections, employee competency assessments, documentation, and in some environments, objective validation tools. I’ve always believed that you can’t expect what you don’t inspect. A meaningful quality assurance program requires people, time and resources, and when those costs aren’t built into the pricing model, quality oversight is often one of the first casualties. Once customers begin to lose confidence in the consistency of your service delivery, rebuilding that trust can be far more expensive than investing in quality from the start.

I once worked in an operation where management and support positions had been minimized to make the pricing model work. The contract didn’t suddenly require less supervision because fewer positions existed. The recruiting demands remained. Employee issues remained. Client expectations remained. The work was still there. It was simply pushed onto already overextended leaders.

Removing positions from a pricing spreadsheet does not remove the responsibilities those positions were intended to perform.

Read the RFP—and question what is missing

One lesson I’ve learned over time is that an RFP is rarely a complete blueprint for the operation you’re being asked to support.

Some healthcare organizations provide excellent detail. Others leave contractors to make assumptions.

I’ve seen those assumptions turn into some very expensive surprises.

Before pricing a contract, I want to know exactly what services are expected, what products are approved, who supplies PPE and consumables, how performance will be measured, what response times are required and how requests outside the original scope will be handled.

I’ve never been comfortable pricing a healthcare account based solely on drawings and spreadsheets.

There are details you simply won’t learn from a spreadsheet. Storage limitations, access restrictions, room configurations, flooring types, workflow challenges and patient activity patterns can all affect staffing and productivity.

I’ve always believed the people responsible for operating the account should have a voice in developing the proposal. Sales teams understand what it takes to win the business. Operations teams understand what it takes to deliver it.

The strongest proposals I’ve seen are built when both perspectives are involved from the beginning.

The bottom line

Throughout my career, I’ve noticed that the costs left out of a healthcare cleaning proposal rarely stay small for long. They accumulate.

Training costs grow. Employee turnover creates additional expenses. Additional supervision becomes necessary to maintain the account. Quality programs require investment. Unexpected service demands emerge.

Eventually, the gap between what was priced and what is required becomes difficult for everyone involved.

The contractor struggles to fund the resources needed to deliver the service. The healthcare client expects the performance it was promised. Front-line employees and managers are left trying to bridge the difference.

That’s why I believe healthcare pricing should never be viewed as an exercise in producing the lowest possible number.

The goal is not to win a contract at any cost. The goal is to build a financial model that supports the operational commitments being made.

Most healthcare organizations aren’t looking for the lowest number on a spreadsheet. They’re looking for a contractor who understands what the work actually requires and can deliver it consistently.

Contractors deserve agreements that provide the resources necessary to deliver that work successfully.

Those objectives aren’t in conflict. In fact, the most successful healthcare partnerships are built when both sides recognize that sustainable performance requires realistic expectations, adequate resources and a clear understanding of the work involved.

Winning the contract is only the beginning. The real measure of success is whether the pricing allows you to deliver what you promised six months, one year and three years later—consistently, safely and profitably.