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When it comes to renovating hospital facilities, foodservice continues to have trouble competing with other capital investment projects. And efforts at overall cost control are putting a damper on such initiatives generally.

"There are not as many RFPs for large design projects these days," says Christine Guyott, RD, FCSI, a principal with Robert Rippe and Associates. "The large hospitals aren't doing as much as they once did." The big projects that are going on tend to involve towers, a move from double rooms to single rooms and aging government facilities that require modernization, she says.

"As systems have become larger and absorbed smaller hospitals, it is also becoming harder to reach the decision makers for these systems.  A system person may be in charge, but he or she may not be the ultimate decision maker. The individuals who select the design team are the decision makers at a system level, rather than at the hospital level. you might be part of a system in which the headquarters is a few states away.

At the same time, this can give the smaller hospitals resources they did not have before, she adds, including access to more powerful menu management systems, executive chefs and programs that are implemented across a system.

"For foodservice directors, the same issues are causing an interest in standardization, whether that implies outsourcing or a structuring with one director over several hospitals. Things are swinging back to more top-down management and control."

Guyott also observes that many administrators like the ideas of making healthcare campuses "hubs" within their communities and there are often efforts to make them more attractive to patients and staff  by adding resources that can include foodservice. At the same time, "the challenge of foodservice in outpatient facilities is that it can be hard to make money in them. Directors will need to plan carefully to meet these demands" while keeping such operations financially viable.

An End to "Cigar Box Accounting"

Not everyone is convinced that room service is an inevitable model for best practice hospital foodservice, and Hysen is one of those who takes a contrarian view.

"Improved outcomes and rising healthcare costs will continue to be primary concerns," he says. "Is patient satisfaction going to contribute to reduced re-admissions and shorter stays in a hospital? If something doesn't contribute to these things, and it has costs, it will be cut.

"The top four complaint areas for hospital customers are parking, nursing service, housekeeping and foodservice. But when you ask the same people 'why did you pick this hospital,' foodservice doesn't show up in the top ten reasons that are given."

Hysen thinks "spoken menu" and similar models will prove just as functional in the accountable care era as do room service models. Further, he makes the point that agility will be a highly valued characteristic of any hospital department in future years.

Guyott echoes a similar view. "The idea that a patient should be able to order what they want when they want it is very popular. But that is not the only system that is successful. Any approach that gives a patient a greater sense of face-to-face contact and control over their options has many of the same benefits."

As directors seek to plan for the future, "You don't know what is going to happen, so you need to be flexible," concludes Hysen. "If cost reductions hit your department hard, and you are faced with an immediate ten percent reduction, you need to have a Plan B to deal with that."

Hysen also believes that traditional "net cost per patient day" accounting for food and nutrition services in hospitals will come under scrutiny. "It is archaic methodology," he says. " It is 'cigar box accounting.'

"Accountable care means that hospitals will be expected to know what an appendectomy will cost, what a gall bladder removal will cost. In contrast, in foodservice accounting, you typically take total cost, then subtract cafeteria revenue,  and the result is patient cost per day.

"We should have separate accounting for retail, for catering, for patient services, for clinical services. Each should have its own P&L, with an honest allocation of true cost. Management companies do this for their internal use, but it should become standard practice for all oprations."

The shape of healthcare in the future remains a moving target. “Accountable Care still presents many unknowns," says Hysen." It puts a lot of emphasis on patient satisfaction, but that is not always linked to better outcomes, to reduced readmissions and other metrics that will affect reimbursement rates.

“The dust hasn’t settled,” he adds.

What’s Trending: Healthcare

HCAHPS satisfaction surveys are the new hot button in acute care and are driving efforts to improve teamwork and coordination among nursing, foodservice and other patient-facing staff.
Upscale coffee kiosks are popping up more frequently in high traffic hospital lobbies and satellite buildings, supported by administrations impressed by high margin revenues and rave customer reviews. With careful design, planning and staffing, these can support "campus community" initiatives and generate profitable revenue.
Employee wellness programs tied to HR initiatives and healthy choice “loyalty” programs, modeled after those at corporate dining facilities, are becoming more common.
There’s no free lunch. Poorly-managed floor stock and late tray orders that increase patient meal costs are receiving more scrutiny. Room service helps control them, but an emphasis on keeping nursing staff happy and engaged remains a top administrative priority, even if it means entails some costs in this area.