Instead of three scheduled meals delivered to patients whether they’re hungry or not, many hospitals across the country are switching to cooked-to-order, personalized tray service, an integral step toward overall improved patient satisfaction. Foodservice staff, called servers or hostesses, deliver trays of menu items chosen by patients, often at all hours of the day.
Even before the looming Medicare regulatory change linking payment to patient satisfaction, hospitals were changing their foodservice program to reflect patient needs. Two years ago, Utah Valley Regional Medical Center in Provo began a room service pilot program in its 36-bed mother/baby unit, yielding an increase in patient satisfaction from 40% to 68%, says Mike Austin, retail food service operations manager.
Since the majority of maternity patients don’t have strict dietary restrictions, it made the most sense to start there and then build a case for the rest of the hospital, adds Austin. An intensive in-house survey conducted over a two-month period determined maternity patients’ eating habits: Did they want comfort food or fine dining? Were they concerned about healthy foods? What did food mean to them?
The program has since expanded to most units in the hospital. Orders are now placed through a call center by patients rather than taken bedside by nurses. A computerized system tracks the orders, the trays, and the delivery time. Because of specialized patient needs, the Behavioral Medicine unit and some ICU patients do not participate.
“We tell patients their food will be delivered in 45 minutes, but it’s usually less than that,” says Austin. “Our goal is to have a cart leave with 10 trays or within 10 minutes.”
Foodservice staff, not nurses, deliver the trays. “Our number one goal is to be able to have interaction with the patients,” says Austin. “Nursing handles the healthcare; we knew we could own this part. If we violate the expectation of food service, patient satisfaction will suffer.”
A year-long of planning: In Kansas City, Mo., North Kansas City Hospital invested a full year of planning, new construction and hiring of 11 new FTEs for its room service program.
As of this past January, patients at this 460-bed facility can order one main meal and then several snacks throughout the day, depending on their dietary needs, says Nancy Herring, R.D., food and nutrition services manager. Servers dressed in classic black-and-white uniforms deliver fresh, hot food on black, non-skid trays, ditching the paper mats and packaged condiments.
The savings realized by the change offset added costs from hiring staff and adapting the kitchen line, says Herring. “Our tray count has gone down about 6% (partly due to a slight drop in patient census) since we switched to room service. We are preparing fewer meals and there are less leftovers because we’re cooking to order.”
Overall costs vs. savings are still being reviewed, but for Herring, the payoff is evident. “When I talk to patients or hear comments back, they say they love it,” says Herring. “People like that they can order a little or a lot. If people aren’t feeling well, they don’t want to eat.”
Two years ago, Children’s Hospital at the University of Pittsburgh Medical Center introduced “Moose on the Loose,” a pediatric-friendly program centered around the character “Bruce the Moose.”
“It’s balanced, made-to-order nutritional cuisine that kids can recognize,” says Jason Teears, CDM, director of food and nutrition services for the 296-bed facility. Baja soft tacos, house-made lasagna, fresh fruit kebabs and breakfast pizza are now on the menu. Patients or family members can place orders any time and kids on specialized diets, such as diabetic or nut-free, are given appropriate menus. The computer system has built-in alerts in case patients order something they aren’t allowed to eat.
While healthy choices like hummus and house-made pita crisps are offered, “sick kids want comfort food; we’re not forcing them to eat what they don’t want,” says Teears. Patients can order mac-and-cheese, french fries or Rice Krispie treats, if their diets allow it. A separate insert for the 16 and over crowd offers local favorites such as cheesesteak, and double portions to satisfy hungry teens.
The menu for infants and toddlers now reflects a “Stages” concept, featuring many Gerber products. “We went from seven to more than 20 different baby foods,” says Teears. “The idea of giving more variety to babies was very important to the parents filling out the surveys.”
The program is a success; since its implementation, a Press Ganey survey shows the hospital’s patient satisfaction ranking jumped from 33% to 81%, an increase of 48%.
Kitchen addition: At The Johns Hopkins Hospital in Baltimore, a second 30,000-square-foot addition to the kitchen was included as part of the hospital’s overall $1 billion renovation, says Leo Dorsey, director of food and clinical nutrition for Sodexo, which manages the foodservice.
The hospital, licensed for 1,100 beds, has two foodservice facilities that serve about 850 meals three times daily. The hospital’s size, along with the fact that the kitchens are not located in the same buildings as patients, led to a multi-tier approach to foodservice.
The surgical unit employs Expressly For You, in which a hostess takes orders bedside on tablets. The orders go directly to the call center and food is delivered at a scheduled time, after temperatures are boosted in the unit’s galley.
At Your Request allows patients to order off the menu any time of day and is used in the pediatrics, oncology, and obstetrics units.
A family-style option enables family members to dine with patients.
When appropriate, says Dorsey, “we encourage the family members to be a part of making the patients better. They eat with them and assist with their eating.”
After recognizing that certain meals were getting rave reviews from the higher-amenity patients, Dorsey extended the daily chef’s special to nearly every unit, giving patients added variety and quality. One day might be crab cakes, tenderloin the next.
“We know the chef’s specials are well-received through comments and surveys from patients,” says Dorsey. Managers and dieticians are required to interact with at least 10 patients a day to get feedback.
Specific to the oncology unit, a milkshake machine offers a choice for those patients too sick to eat anything else. Down the road, it may be an option for the Children’s Center as well.
“We have the sickest of the sick,” says Dorsey. “You really have to be conscientious of what each patient needs.”
Practices and pitfalls: While each of these hospitals is distinct in size and patient populations, common themes arise in terms of improving patient satisfaction.
“My advice is don’t expect it to be perfect in a month or two because this is such a huge change in process. It takes a while,” says Herring.
“I think the biggest concern was quality involvement with nursing,” says Austin. “Your partnership needs to be well-established before launch.” In fact Austin’s staff surveyed the nurses to get their feedback and buy-in to the changes.
Making sure foodservice staff is well trained and sensitive to patients’ needs is also key to making patients’ happier. Visiting patients regularly and holding seminars that focus on courtesy in healthcare foodservice are part of the improvement process, says Teears.
“If you take the mentality that you don’t know people’s situation or why they’re here, then you tend to be a lot more courteous and treat them with a lot more respect,” says Teears.