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No one chooses a hospital based on its food service. It’s a truth that Mary P. Malone, MS, JD, executive director at Press, Ganey Associates in South Bend, IN, understands. But that doesn’t mean those dismal scores your food service gets on its patient satisfaction surveys should be left to languish. "If you believe in performance improvement and are interested in measuring things and getting better at them, then you have to look at ways to improve everything," she says. "If you have the opportunity to improve something, you should."
The results can be astonishing. Boston-based Massachusetts General Hospital’s food service director was named restaurateur of the year last year by the Massachusetts Restaurant Association.
Fixes for your food service woes can range from simple revamps to complete overhauls. Swedish Hospital in Seattle has a room-service-style food-on-demand system that required $500,000 in renovations — including a computer system upgrade, natural gas appliances in the kitchen, new china, sauté pans, and glassware, as well as setting up a deli station. The cost also included consulting fees.
A similar revamp was done at Rush-Copley Medical Center in Aurora, IL. There, patients choose from a restaurant-style menu whenever they want to eat. Structured like room service in a hotel, the program allows patients to order anything, including snacks, from a menu anytime the kitchen is open, providing their orders meet their dietary restrictions. Food is delivered within 30 to 45 minutes of the order being placed. The hospital, says Malone, reports a 20% increase in patient satisfaction scores. But the cost will be recouped with annual savings of more than $18,000, in part through less food waste.
Sure money is tight, Malone says, but a lot of good ideas don’t involve building new kitchens or providing staff with silver service training. "Here’s a simple thing you can do. Make sure that people aren’t saying to patients who don’t eat their meals that they wouldn’t eat [the food] either." There’s also the "pizza-box test," which anyone can conduct. "Are there fast-food bags around? If your staff don’t eat the [facility’s] food, that sends a powerful message to the patients," Malone adds. "It tells them how to feel about it before they’ve even tasted it."
Another easy implementation: Tell staff not to open food in front of chemotherapy patients. They can be nauseated easily, and the sudden wafting of aromas can turn them off the idea of eating completely. (For more uncomplicated ideas, see "10 cheap and easy ways to improve food service," in this issue.)
A lot of improvement comes from training, says Malone. "What’s the point of putting in expanded menus if staff don’t let the patient know there is a choice?" she asks. Points that Malone likes to emphasize when talking about how to improve nutrition departments include:
• Food isn’t just about food service. "It’s the measurement of the entire patient experience with food," Malone notes. "And a lot of your score will be dependent on how food service and nursing departments work together." One facility solved the cold food problem by putting a service bell on the nursing desk in each unit. When the food came up, the bell was rung. If a staff member wasn’t working on a code, he or she came out immediately to deliver the food.
• Food service staff are ambassadors. They travel around the hospital in a way that other people don’t. "Go ask your cafeteria staff: What’s good today? If they say nothing, or say, Nothing,’ they aren’t being good ambassadors."
• Food is more than sustenance. "Food has symbolic meaning," Malone says. In times of crisis in her own family, everyone settles in around a cup of tea. "But I dare you to get a cup of tea in a hospital. You can get coffee, but not tea."
• Delivery of food may be the best thing that happens to patients that day. They are sick; they are poked, prodded, tested, and have to run around in flimsy hospital gowns. "If you act as if you are the best thing in their day, what gains could you make?" asks Malone.
It is a myth that any of the suggestions Malone has up her sleeve are simple. "They seem easy to think of, but they aren’t necessarily easy to implement. You have to get everyone doing these things all of the time."
Getting employee buy-in and including them in performance improvement from the start is as key to achieving success in food service as in any other area, says Malone. And she has a whole slew of clients who have taken that rule to heart to prove it. For instance, in 1997, peer group comparisons put Champlain Valley Physicians Hospital’s food service scores in the bottom 2%. A 356-bed hospital in Plattsburgh, NY, the facility had some 10,800 admissions in 2000, and its mean scores in food service are now in the 90th percentile compared to its peers.
William Myers, director of nutrition services for the facility, created several programs, including "Sizzle with Service" and "Give Them What They Want" — certainly not something that springs to mind when thinking of hospital food services.
"All of the programs that we have developed and implemented are built on the principles of good customer service and doing all that we can to exceed our customer’s expectations," says Myers. "We present the material differently each time and keep it fresh. We use stories or case studies to put examples in real-life terms. We keep our staff informed of our patient satisfaction scores and actively solicit ideas and suggestions from [everyone] we interact with," he says. "We actively follow up on any issue or suggestion that is brought to us, which has resulted in countless system modifications that have greatly improved our quality and service," Myers adds.
For those who already take food service seriously, keep it in context, warns Malone. "Food service and noise are always pretty low scores. If you have a score of 79 in food service, that is hugely better than an 80 in nursing. And if you are a hospital that is in the 25th percentile overall but in the 50th in food, your food service is outperforming the institution, and you probably have bigger problems than cold meals."
Patients and visitors complain about food service — reason enough for administrators to care about it. "We did some work a couple years ago on the trend among patients to recommend hospitals to friends and relations," says Malone. "That trend is slipping — in line with how customers of other industries are less likely to make recommendations," she explains. "The point is that you can continue to make improvements, but you will have a hard time keeping up with the speed at which customer needs and desires are changing. We face a lot of challenges in this industry, and the role of food services in patient satisfaction is just one. But that doesn’t mean you shouldn’t act."
The issue is how high the bar should be set, Malone concludes. "If you are only happy to have your food service staff show up for work, then you don’t have the bar high enough," she says. "Southwest Airlines continually has a large number of people apply for entry-level counter-help positions, even in a hot economy. Disney can get minimum wage earners to perform beautifully. Rethink your assumptions about what to expect from food service.
"Create an underlying sense of pride among your employees. Motivate them to understand the importance of taking care of patients and their families. Yes, you have to have good systems and processes. Food temperature is important, but so are staff attitudes," Malone adds.
[For more information, contact:
• William Myers, Director of Nutrition Services, Champlain Valley Physicians’ Hospital, 75 Beekman St., Plattsburgh, NY 12901. Telephone: (518) 561-2000.
• Mary P. Malone, MS, JD, Executive Director of Consulting Services, Press, Ganey Associates, 404 Columbia Place, South Bend, IN 46601. Telephone: (800) 232-8032.]