“Accountable Care is here and it's going to stay here,” affirms Bruce Thomas, vice president of guest services at Geisinger Healthcare. Mary Spicer, director of food, nutrition and conference services at Texas Health Resources, agrees.
“While the 2010 Affordable Care Act may or may not be implemented as passed and may or may not be the right solution, our leadership believes healthcare reform has to happen,” she adds.
The reforms that are moving ahead put an emphasis on reducing hospital admissions, improving the health of people in communities and making significant changes in reimbursement models. All will affect nutrition departments.
The new, national HCAHPS surveys that measure patient perceptions of hospital care are one of the clearest indicators. They are quickly displacing traditional benchmarks and as they will be publicly available on the Internet, influencing many consumer choices. They will also affect reimbursement rates.
Finding ways to show that foodservice has an impact on HCAHPS scores will be a holy grail for FSDs in coming years. The surveys do not ask about foodservice specifically, “so we are seen as contributing to patient satisfaction scores in only an indirect way,” worries one director.
“That's a mixed blessing — it means less direct pressure, but you'll also have less leverage when it's time to obtain capital.” Directors will look for other ways to connect scores with foodservice: room service's impact, morale-building programs for hospital staff, showing they've freed up nurses' time for patient contact, etc.
“It will be very different from measures like, ‘Was your hot food hot?’ says another FSD. “The question will be whether the hospital team worked well together to assure the quality of care and services provided.” (To see how HCAHPS will look to consumers, go to http://www.hospitalcompare.hhs.gov).
Room service programs are evolving rapidly, with variations multiplying as directors try to accommodate varying logistical, labor and other factors. At the same time, it remains impractical for many facilities and its justification will increasingly be weighed against demands for greater cost control. “Revenue neutral”claims will be more closely scrutinized.
“If we can keep it efficient, it will be seen as contribution to patient satisfaction. But if it is seen as an extravagance, it will go away,” says another FSD.
Performance metrics are growing more demanding and more technical. Some, like productivity measures relating labor hours to outputs, meals served and patient counts may not mesh well with internal operational constraints.
Geisinger's Thomas believes nutrition departments would do well to also establish internal quality metrics of their own. “Elsewhere in hospitals, it's becoming common to establish ‘Best Practice’ standards and to document they are performed 100 percent of the time,” he says. “We would do well to use the same approach as other healthcare professionals.”
Satellite and outreach service locations are growing in importance “as the shift to providing more ambulatory care off site continues,” says Mary Angela Miller, administrative director at The Ohio State University Medical Center.
“This raises questions about when and how food should be delivered to those points of service. How do we care for our patients, support staff and providers at locations that are often not within walking distance of main facilities?”
“When facilities are iplanned, it's important early on to establish this is a need that will or will not be addressed and whether traffic can support expected services. It is important for directors to have a seat at the planning table if they are to effectively satisfy expectations later,” she adds.
The move to electronic health records could have a significant impact on nutrition departments, especially in larger facilities, as data is integrated across hospital services and systems. Nutritional and intake data will be accessed alongside other patient chart information in real time. Better data analytics may make it possible to “connect the dots” between nutritional intakes and clinical results, availability of room service and customer satisfaction, etc.
On the retail side, hospital directors increasingly find themselves conflicted as they try satisfy demands that they promote healthier choices in cafés while maintaining “employee friendly” pricing and the sales/margin levels needed to keep budgets balanced.
“We do a lot of things right in this area but we don't market our efforts that well,” says Dan Henroid, director of nutrition and food services at University of California Medical Center. “Directors have to work harder to remind customers of the connections between food, personal choices and wellness.
Changing customer behavior. Henroid believes directors will have to seek ways to document how their policies have caused actual changes in customer behavior. But such concerns are also opening up new service opportunities as organizations look to promote healthier eating habits outside the workplace.
Operators are being asked to teach employees (and patients) how to better shop for groceries, evaluate food labels and better manage snacking habits.
Three trains and one track. In the end, competing priorities and budget constraints dominate management decisions in healthcare these days.
“Demands for efficiency and productivity, greater patient satisfaction and improved regulatory compliance are the main drivers,” says another director. “These are three high speed trains, all heading for the same station at the same time, but with only one track in.
“One train is usually leading the others in the minds of administrators at any given time. You need to be able to offer options to help the priority train get there first, along with an explanation of the impact those options will have on other priorities. That can help administrators make required strategic decisions.”