Do You Want To Provide Food or Do You Want Your Patients To Eat? - - PowerPoint PPT Presentation

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
• perational (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 phones when ready to place

• rder

(6.30am- 7.00pm) Food is made to order and assembled in kitchen Expediter checks the tray for all items Meal is delivered within 45 mins of order Tray is tracked through software and picked up 1 hr after delivery

Operationalising 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

Australian National Hospital Accreditation Standards Sustainability agenda Staff satisfaction

Financial sustainability Put the patient first Be responsive Provide safe quality healthcare Financial performance

• Managed to budget
• Profit margin (private)

Patient experience

• Patient satisfaction (Press Ganey)
• Consumer engagement (Standard 2)

System integration and change

• Manual → electronic
• Process efficiencies
• Patient identification (Standard 5)

Clinical care and outcomes

• Reduction errors/ defaults
• Nutritional intake (Standard 12)

• 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

• Reduced food cost and waste
• Enhanced stock control and

purchasing; forecasting

• Reduced kitchen and plate waste
• Reduced paper
• Use of seasonal produce
• Right meal at the right time
• Menu responsive to patient

preferences and clinical needs

• Improved menu variety and quality
• Taste, temperature, service

improvements System Integration and Efficiencies

Clinical Outcomes

• Efficient processes
• Overcome paper and manual

processing problems

• Introduce patient identification

process

• Nutrition embedded into clinical

care environment

• Improved nutritional intake –

protein and energy

• Enhanced monitoring and real time

data

• Enhanced safety for allergies and

special diets Improved Decision Making

Improved monitoring Regular audits Patient identification ACHS standards compliant Meal record Data analysis and reporting Forecasting Cost/ meal/ day Accurate budgeting

Risk Minimisation

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

• 1. Menu Design & Standards
• 2. Meal Ordering - Timing
• Meets nutritional requirements
• Diet integration - variety and

quality; minimise production load

• Responsive to patient preferences

and clinical needs

• Use of local and seasonal produce
• Accurate diet information
• Accurate patient location
• Patient safety
• Patient appetite and preferences
• 3. Meal Delivery – Timing
• 4. Patient Interaction
• According to patient’s schedule
• Meet appetite & improve intake
• Patient safety - identification

process

• Engagement and empowerment
• Participatory medicine
• Educational opportunity
• Integrate staff into clinical/ treating

team

Minimise risk Enhance safety Improved monitoring ACHS standards compliant

Safety Framework

Patient Centred Care and Outcomes

System Capability

Real time data Monitoring Menu change agility

Technology - Electronic Menu Management System

• 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
• 3. Meal Delivery – Timing
• 4. Patient Interaction
• 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
• Focus of Nutrition in Funding

Instruments and Accreditation

• Healthy Eating Guidelines for

Elderly – flavour/joy of eating

• Use of Australian Produce
• Resident’s schedule
• Appetite and preferences
• 3. Meal Delivery – Timing
• 4. Patient Interaction
• Resident’s schedule
• Appetite & improve intake
• Engage and Empower Residents

and Families in Food Decisions

• Edible gardens – involve and

connect

• Educate and empower catering

staff

Patient Centred Care and Outcomes The Lantern Project - Objectives

• Research team: Sally McCray, Renee Krikowa, Karmen

Regan, Kirsty Maunder

• Data collection: Griffith University and Bond University

foodservices students

• Statistical analysis: Dr Alwyn Todd
• Mater Foodservices team

Sally McCray, APD Director Nutrition and Dietetics Mater Health Services, Brisbane, Australia sally.mccray@mater.org.au

Acknowledgements