Best practices net big food service savings
Hospitals use automated menu system
If your hospital's administration asked your food service department to cut three full-time equivalent positions and more than $200,000 out of your budget as well as cut supplies by at least 12%, could you do it?
That was the situation that faced Ed Fraine, director of food and nutrition services at Jordan Hospital in Plymouth, MA, in April 1997 when the 125-bed hospital started a redesign process that included budget reductions. "Our department was successful previously - our patient satisfaction ratings were always over 90% - so the end product was fine. The only problem was financial," says Fraine, who is now a contract manager for Sodexho Marriott Services, based in Bethesda, MD.
The department employed several strategies to meet the set goals, including use of a handheld menu entry system at the bedside. The system runs on a palmtop computer that eliminates paper menus. A food service associate takes the palmtop to the bedside, reads out the options and enters the patient's choices. The computer only offers choices that are consistent with that patient's diet and automatically offers alternatives if a patient dislikes the main selections. It also keeps track of room changes, discharges, and patient diet changes. It takes the associates about three minutes per patient to enter the choices.
"The system has reduced our paperwork by 80%," Fraine says. "We used to buy preprinted menus, and we'd have to handle them several times for distribution, collation, corrections, and tallying. Now we only print the final tallies. Plus we're adding a personalized touch that patients really like."
The food service department also went to a decentralized patient feeding system with two satellite kitchens located on the units. That way, patients' requests can be addressed immediately, which cuts down on running back and forth to the main kitchen. Also, there's less of a problem with trays being sent to patients who aren't there anymore.
A third improvement is use of a cook-chill system in which certain foods are prepared ahead of time, blast chilled, and then reheated in bulk before the meal. On Monday morning, for example, the cooks are preparing items for Tuesday's lunch. "That allows us to work with fewer people," Fraine says. "We stick to the schedule, and there's no waiting around for the tallies." It's a technique that has to be learned, he says, but the quality of the food remains high.
The three strategies work together well, Fraine says, and savings have reached $126,000 so far. Three full-time equivalent (FTE) positions have been cut, supplies are down 12%, and the meals prepared per inpatient day have dropped from 2.9 to 2.58 because of the reduction in waste.
Ingalls Memorial Hospital in Harvey, IL, went to spoken menus at the bedside two years ago and began using a handheld computer system 18 months ago, says Katie Freese, director of the food service department, which is contract managed by Service Master of Downers Grove, IL. "The spoken menu idea gets us closer to patients and allows them to make their selections closer to the actual mealtime when they know how they feel," Freese says. "It also improves our accuracy in production because the menus are printed with only the selections each patient has made."
Patrick Fritz, guest service manager at Ingalls Memorial, says the system has led to greater patient satisfaction because the patients are getting what they want to eat when they want to eat it.
The hospital uses Press, Ganey Associates of South Bend, IN, to measure its patient satisfaction, which has steadily increased since implementation of the automated bedside system. Within the hospital's Press, Ganey peer group of 60 hospitals of like size, the 472-bed Ingalls Memorial most recently ranked in the top 90% for the overall diet/meal rating. That compares to a 76% rating in the third quarter of 1997. The hospital also ranked in the 87th percentile for quality of food and the 95th percentile for temperature of food.
Computer keeps track of room transfers
The process also has saved time and money, Freese says. The department has cut three FTE positions for a savings of about $75,000 in salaries. With the automated system, one person can take orders from up to 120 patients per meal. The hospital has also cut its meal costs from $1.86 per meal to $1.76 per meal because of the reduction in waste brought on by more accurate forecasting. Also, the number of late trays requested has dropped 5%, mainly because the computerized system keeps track of room transfers so the meal choices follow the patients.
There's another benefit, Freese says, in that the department is now much more patient-focused. Staff covet the spoken menu positions, which have a high retention rate. It's viewed as a promotion, and only good people with excellent communication skills are chosen. "People love to interact," Freese says. "We organize the menu speakers so they go to the same floor each time and provide individual patient care. The patients love it because their speaker already knows they only drink coffee or whatever. Some returning patients will actually ask for a specific speaker."
Other successful practices in the department have included using hot pellets heated to between 180 degrees and 220 degrees to keep the plates warm, Fritz says. Routine tray temperature testing is done with a thermometer to make sure the correct temperature is maintained from the beginning of the meal to the last tray served. Managers also do routine tray tasting to evaluate flavor, appearance, and temperature.
Room, diet changes can be downloaded
At Virginia Mason Medical Center in Seattle, a computerized bedside system was introduced in January, says Diane Thomas, associate director of nutrition. "No matter what industry you're in these days, the whole notion of choice is important to the customer. This system offers that possibility for patients without using paper menus," Thomas says.
The menu system interfaces with the admission/discharge/transfer program used for the entire hospital so that room and diet changes are downloaded automatically to the handheld computer, Thomas says. The technicians who enter the menu choices at the bedside ask seven basic questions of new patients, including allergies and preferences of drinks and salad dressings. Those answers are recorded so they don't have to be asked at each meal. If a patient happens to be out of the room when the technician arrives, his or her meal still will have the basic items correct. "The downside to offering this level of service is that if you see a patient in the morning, and then you have a technology problem in the afternoon, then you really have a dissatisfied patient when the meal doesn't have what they chose," she says.
But the upside is that the system is tremendously efficient and allows patients to see a representative of the food service department daily, Thomas says.
[For more information on food service operations, contact:
· Ed Fraine, director of food and nutrition services, Jordan Hospital, 275 Sandwich St., Plymouth, MA 02360. Telephone: (508) 746-2000.
· Patrick Fritz or Katie Freese, food service department, Ingalls Memorial Hospital, 1 Ingalls Drive, Harvey, IL 60426. Telephone: (708) 333-2300.
· Diane Thomas, associate director of nutrition, Virginia Mason Medical Center, 1201 Terry Ave. X2-DTO, Seattle, WA 98101. Telephone: (206) 583-6047.]
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