Do You Want To Provide Food or Do You Want Your Patients To Eat? Manipulating a foodservice system to achieve patient centred outcomes . Sally McCray, APD Director Nutrition and Dietetics Mater Health Services, Brisbane, Australia sally.mccray@mater.org.au
Mater Private Hospital 323 patient beds 10 Operating theatres + 35 clinical services 24 hour Emergency
Foodservice Challenges • Costs / budget restrictions • Clinical needs Vs financial measures • Disconnect between the clinical (patient) world and the operational (foodservices) world • Meal orders and mealtimes dictated by hospital schedule Low patient interaction or assistance in meal ordering Meal orders taken well in advance of meal Artificial meal times, especially dinner (5.30pm) • High use of paper and manual processes • Prevalence of malnutrition in hospitals Generally not a customer focused environment
Our Issues Not a patient centric model of care Fully manual menu system Standard therapeutic diets with mid meals and supplements Kitchen waste High plate waste Many late meal deliveries and default meals Patient feedback – Press Ganey survey Quality and temperature of food
Our Solution? Room Service Choice on Demand – “ RSCoD ” • “The right meal to the right patient at the right time” • Shift from healthcare foodservice focus to a hotel foodservice focus ….. whilst still maintaining healthcare risk management and clinical acuity framework • Focus on patient driven care Shift to customer focused service vs hospital driven timetable Shift to greater patient engagement and participation
Room Service Choice on Demand Patient Tray is tracked phones when Food is made Expediter Meal is through ready to place to order and checks the delivered software and order assembled in tray for all within 45 picked up 1 hr (6.30am- kitchen items mins of order after delivery 7.00pm)
Opera tionalisin g Room Service • Redesign of whole kitchen, menu, meal service framework • 1 hotel style a la carte menu – challenge to integrate diets • Meal order driven by the patient – what and when they like • Safety measures – electronic menu management system • Strong customer focus – training, service delivery • Integrated multidisciplinary team, focus on nutrition
Food and Nutrition Balanced Scorecard Financial performance Patient experience - Managed to budget - Patient satisfaction (Press Ganey) - Profit margin (private) - Consumer engagement (Standard 2) Financial sustainability Put the patient first Clinical care and outcomes System integration and change - Reduction errors/ defaults - Manual → electronic - Nutritional intake (Standard 12) - Process efficiencies - Patient identification (Standard 5) Provide safe quality healthcare Be responsive Australian National Hospital Accreditation Standards Sustainability agenda Staff satisfaction
1. Financial Savings Reduction in total food costs; reduction supplements Improved stock control and purchasing Reduction in kitchen and plate waste (bulk cooking cooking on demand) Nil incorrect or default meals FTE neutral – reallocation of staffing Manual → electronic processes
Plate Waste Reduction in total plate waste across hospital from 30% 12% Greatest reduction in surgical and oncology wards Reasons for wastage changed from nausea / feeling unwell (pre RSCoD) to satiation (post RSCoD) Greater reporting of taste / temperature/ appearance as wastage reasons compared to nausea/ feeling unwell Taste/ appearance feedback data allows timely changes to menu
2. Patient Satisfaction • Patient centric model - patient controls what & when • Increased patient interactions • Integrated menu – better options for therapeutic diets • Menu variety and flexibility – responsive according to consumer feedback • Nil default meals – less dissatisfaction • Press Ganey measures (Quality, temperature, flavour, timeliness, courtesy)
Patient Satisfaction 2013 - 2015
3. System integration & efficiencies • Manual → electronic processes • Evidence for national standards: #2 – Consumer Engagement #5 – Patient Identification #12 – Nutrition Care • Food and nutrition embedded as a priority into the clinical team • Integrated patient safety measures Patient identification process Diet compliance measures
4. Clinical Outcomes • Energy and protein intake • Minimise risks → wrong meals/ food items → nil default meals • Food allergies and intolerances • Patient satisfaction – translates to nutritional benefits • Multidisciplinary focus on nutrition – Standard 12 Meal order patterns Nutritional intake patterns
Nutritional Intake • Energy and protein intake significantly increased in RSCoD compared with TM (traditional tray line model) • Significant increases in energy and protein as a % of requirements • Greatest increases seen in medical and surgical cohorts • Meal ordering and intake patterns shifted to significantly less at midmeals, especially supper
Sustainability agenda • Decreased food and kitchen waste • Forecasting benefits • Significant reduction in paper & manual processes • Seasonal, local produce and menu • Flexible menu able to be changed
Staff satisfaction • Clinical stakeholders • Ordering staff – increased patient interaction & part of the clinical team • Production staff – utilise cooking skills • Customer focused and service oriented culture • Staff feel they are making a difference → instant patient feedback (Sheehan-Smith, 2006)
Financial Performance Patient Satisfaction Risk Minimisation Data analysis and • • Reduced food cost and waste Right meal at the right time reporting • Forecasting Enhanced stock control and • Menu responsive to patient purchasing; forecasting Cost/ meal/ day preferences and clinical needs Accurate • Reduced kitchen and plate waste • Improved menu variety and quality budgeting • Reduced paper • Taste, temperature, service improvements • Use of seasonal produce System Integration and Clinical Outcomes Efficiencies • • Efficient processes Improved nutritional intake – Improved protein and energy monitoring • Overcome paper and manual Regular audits • processing problems Enhanced monitoring and real time Patient data identification • Introduce patient identification ACHS standards • process Enhanced safety for allergies and compliant Improved special diets • Meal record Nutrition embedded into clinical Decision care environment Making Foodservice Balanced Scorecard
Key Messages • We can manipulate each aspect of the foodservice system to meet all key requirements – “The BSC of Food and Nutrition” • Patients know what they want and when they want it • Increasing role of consumers in their healthcare decisions participatory medicine • Our role is to provide a safe and clinically appropriate framework and environment to assist consumers to do this
Technology - Electronic Menu Management System 1. Menu Design & Standards 2. Meal Ordering - Timing Safety Framework • Meets nutritional requirements • Accurate diet information Real time data • Diet integration - variety and • Accurate patient location Monitoring quality; minimise production load • Patient safety • Menu change Responsive to patient preferences • Patient appetite and preferences agility and clinical needs • Use of local and seasonal produce 4. Patient Interaction 3. Meal Delivery – Timing • Engagement and empowerment • According to patient’s schedule Minimise risk • • Participatory medicine Meet appetite & improve intake Enhance safety • • Educational opportunity Patient safety - identification Improved monitoring process • Integrate staff into clinical/ treating team ACHS standards System compliant Capability Patient Centred Care and Outcomes
The Lantern Project - Objectives 1. Menu Design & Standards 2. Meal Ordering - Timing • Value of Good Nutrition • Focus of Nutrition in Funding Instruments and Accreditation • Healthy Eating Guidelines for Elderly – flavour/joy of eating • Use of Australian Produce 4. Patient Interaction 3. Meal Delivery – Timing • Engage and Empower Residents and Families in Food Decisions • Edible gardens – involve and connect • Educate and empower catering staff
The Lantern Project - Objectives 1. Menu Design & Standards 2. Meal Ordering - Timing • Value of Good Nutrition • Resident’s schedule • Focus of Nutrition in Funding • Appetite and preferences Instruments and Accreditation • Healthy Eating Guidelines for Elderly – flavour/joy of eating • Use of Australian Produce 4. Patient Interaction 3. Meal Delivery – Timing • Engage and Empower Residents • Resident’s schedule and Families in Food Decisions • Appetite & improve intake • Edible gardens – involve and connect • Educate and empower catering staff Patient Centred Care and Outcomes
Recommend
More recommend
