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A new administrative team at Burlington Medical Center, Burlington, Iowa, decided it was time for a shift in the center’s operating philosophy and community reputation. From their predecessors, the administrators had inherited a center with a robust balance sheet and sufficient cash to pay for a significant amount of new construction that was on the drawing boards.

“Within our geographic area, we have market dominance but our image was not what it should be,” admits Mark Richardson, the new chief executive officer.“We wanted to shift our reputation within the community from one of budget conservatives to one of service and quality.”

The new emphasis was developed after extensive surveys and focus groups with community members, physicians, employees and patients. The research was designed to measure the current status, identify areas for improvement and serve as a benchmark for the coming changes.

When the medical center’s foodservice scored a basement level rating of 3% on the Press-Ganey patient satisfaction index, Paul Deignan, the center’s foodservice director, also new to the job, was not surprised.

“The entire philosophy of the organization had been budget driven,” he recalls today. “The financial priorities of the organization took precedence. There was minimal training and everything was done as economically as possible. The attention to quality just wasn’t there.”

This budget-driven philosophy translated into minimum menu variety, minimum choices and minimum equipment investment.

“Moving to an emphasis on quality has been difficult for employees,” admits Deignan. “It is difficult for people who have lived in a constrained economic environment to subscribe to the philosophy that quality saves money. But that is the message the new administration wants to get out.”

In foodservice, the quality changes included the addition of two FTEs and the introduction of restaurant-style patient menus. Refrigeration and beverage bars were installed on patient floors. A dietitian who had spent one day a month with foodservice now consults two days a week.

In the nursing home, big print menus were introduced and family members are encouraged to help the patients make selections. An attendant was hired for the communal dining room, food is served on china and placemats.

Food tastings were introduced and holiday parties to which family members are invited. Labor costs in foodservice have risen by 13% and 11% in each of the last two years, primarily because of the extension of benefits to employees who were moved from part-time to full-time status, but overall foodservice costs have increased by only three-tenths of one percent per patient day.

In the most recent Press-Ganey survey, the nursing home foodservice satisfaction score was 84%, among the highest in the hospital complex. Both Richardson and Deignan expect the hospital foodservice’s numbers to show comparable improvements with the changes introduced by a chef newly arrived on staff who is reworking the patient menu and will be training employees.