Since July 2012, Joyce Hagen-Flint has served as Division Director of Food and Nutrition Services, Parallon Supply Chain Solutions, for the West Florida Division of HCA, Largo, FL. The consolidated division model is a new one at the for-profit HCA (originally known as Healthcare Corporation of America), and Hagen-Flint gamely divides her time among the 15 (soon to be 16) geographically spread-out facilities in her region. She is one who views room service as one viable model among others and for whom it is not always the one generating the highest patient satisfaction scores.
Of the 15 hospitals in her region, the foodservice programs at six are operated by one national contract management firm; two of these feature a room service program (each with a call center) and are, in fact, the only two of the 15 with room service.
Considering all the operations in her division Hagen-Flint observes that room service is not a magic pill that cures all ills and that when it comes to patient satisfaction, other variables are also at work. “Of my facilities, the two with the highest HCAHPS (Hospital Consumer Assessment of Health Plans Survey, pronounced H-Caps) scores are not room service accounts.
"One room service facility is always within the top five (and has been for years); the second has below-average HCAHPS scores compared to the rest.” She indicates the two facilities with the consistently highest patient satisfaction scores do not have room service.
“In regard to ‘Patient Experience’ Gallup scores for room service, they (i.e., these two facilities) are neither the best nor the worst for the division,” Hagen-Flint adds. “It’s one approach, but it’s not a magic pill that will always help you jump to the top.” In her experience, “any major change in the service model results in a change for the better, at least short term.”
The 13 Florida facilities in her division without room service offer pre-select menus that look much like a restaurant-style menu, with alternatives and a Daily “Chef Special” that is typically ordered by 80% to 85% of patients.
One of the hospitals, a facility with the most senior patient demographics, has just implemented a new food management software platform that allows staff to carry a tablet-based menu and ordering system when they visit patients. This allows them to take a patient’s selection at bedside and then generate a tray ticket in real time, with selections delivered at traditional meal times (7 a.m., noon, and 5 p.m.). The software will soon be available to all hospitals in Hagen-Flint’s region and is viewed as a high touch, high tech application that encourages real face time with patients.
Summing up, Hagen-Flint says, “Our facilities with Room Service have lower food costs but a slightly higher labor cost than the average for the division.” In the coming year, two more facilities will go live with room service, she reports.
From Re-therm to Room Service
Outside of Hagen-Flint’s region, Mary Ann Moser assumed the role of director of food, nutrition and conference services at another HCA account, Medical City Hospital of Dallas, thirteen years ago. At the time, patient satisfaction was down in the 30th percentile doldrums when it relied on a cook/chill and re-therm model. "No matter what we did by changing menu items, it was always [perceived as] ‘frozen food,'” she recalls.
A switch to room service nine years ago meant employing a full cook-to-serve production staff seven days a week versus five (for cook/chill production), and an overall net increase of about two cook staff positions. “We saw savings immediately in food and supply costs. Our experience was that with cook/chill you tend to have more ‘late trays’ and, if they’re cold, you end up sending another. Plus, there’s the waste of meal items [not requested by the patient and] not consumed.”
As Moser anticipated, she saw an 8% to 10% reduction in food and supply costs, including her floor stock reductions, within the first six months,
Moser says one of the most important results of her hospital's move to room service was the improvement in food quality it made possible. Now, many patient menu items are prepared from-scratch with a greater focus on variety.
“The old perception of ‘hospital food’ is no longer accepted and all facilities are upping their game in terms of food quality and service," she says.
"Patients can now check publicly-reported HCAHPS scores online and they have a choice of where to go. Every hospital and foodservice department is focusing on how to improve scores for that reason” (see note at end of article).
For the past two years, Moser has reported patient satisfaction HCAHPS scores in the 90thpercentile and in some cases as high as the 97th percentile. She points to new technology as the biggest positive change having an impact on room service implementation in recent years, including the use of touch screens in the kitchen; web-based ordering from a patient’s room (or even from a relative’s home); or the use of software to offer room service menu ordering from in-room TV sets.
"Depending on the patient population (for example, especially for the very ill or elderly), a room service ambassador will go to a bedside with tablet computer and transfer the order to the call center, similar to the way it would be done with a spoken menu,” Moser says. But she asserts it’s her Room Service staff—all 26 of them, including 11 ambassadors per-shift and the call center point person in the kitchen (not one off-site) that have the biggest influence on a patient’s perceived level of service. They are the ones who establish and build a relationship with patients and provide the personal touch in the course of delivering quality food on time.
(Editor’s Note: Since March of 2008, the 27-item survey has allowed for valid comparison to be made among hospitals across the country. The “transparent” public reporting of HCAHPS has provided new incentives for facilities to improve quality of care. There are also financial implications involved on several fronts, most recently, an incentive for IPPS (Inpatient Prospective Payment System) as hospitals look to improve patient experience/satisfaction as they prepare for full implementation of the Patient Protection and Affordable Care Act of 2010. The Act specifically includes HCAHPS performance in calculating value-based incentive payment in its Hospital Value-Based purchasing program. More details are available at http://www.hcahpsonline.org, or by contacting the Center for Medicare and Medicaid Services, Baltimore, MD. Phone: 1-888-884-4007)