The elderly woman—evidently a visitor, not a patient—sat in her wheelchair in the Call Center at Medical City Hospital Dallas. When asked if she needed help, she simply beamed and said, “No,” explaining that she’d just stopped by to visit “her girls” who’d made her recent stay so pleasant…
“That’s what it’s all about,” says FSD Mary Ann Moser.
Blessed is the weary traveler whose hotel offers Room Service. The restaurant-style menu in the room—right next to the phone or across from the TV—allows for easy ordering either by speaking to the operator or by entering “data” into a TV-based order-entry system.
Based on this hotel model, patients in a growing number of hospitals across the country can similarly place an order from their room by selecting items from a restaurant-style menu, typically delivered within 45 minutes of ordering, any time between 7 a.m. and 7 p.m. They’re ordering what they want (within diet restrictions), how they want it, when they want it. That, plain and simple, is the classic, standard definition of hospital Room Service.
Today, 38% of hospitals reportedly already have a room service program, with another 43% of facilities saying they’re in the planning stages. That's according to Don Miller, founder of DM&A Webb Food Service Design & Consulting, Tustin, CA—and passionate proponent of classic, standard hospital Room Service. Increased patient satisfaction scores and decreased departmental costs are the prize to be won.
As overall healthcare cost pressures continue to mount, administrators are motivated to find a better way to reduce food and labor costs, and leverage the documented patient satisfaction scores that have been shown to improve when Room Service is in place—and operating efficiently (a caveat that can’t be ignored).
Miller and his staff of more than 40 consultants (many of them retired healthcare FSDs) make the argument to those seeking their advice in implementing Room Service that there are really only two key models for its implementation in acute care environments:
“The challenge is that some folks want to put in Room Service, but are unable to do so for various reasons, and then sometimes fudge a little," Miller asserts. He argues they will often refer to other strategies "such as the spoken menu process (where orders are taken at bedside but meals are delivered at specified time periods, e.g., 7a.m., 12p.m., and 5p.m.) as ‘modified Room Service,’ or ‘hybrid Room Service,’ or ‘whatever Room Service.’"
In Miller's view, such monikers muddy the waters since "that is not Room Service at all; it’s misinformation and leads to confusion in the industry.”
Miller believes the lower-cost "No Call Center Model" represents a better option for some hospital environments. He offers a Florida hospital case study as back-up evidence, pointing to 850-bed Lakeland (FL) Regional Medical Center where John Biswanger (a DM&A employee) until recently served as the foodservice director. A master chef and now a DM&A senior vice president, Biswanger cheerfully describes himself as having spent the past four decades “on the bloody edge of what’s new in foodservice.”
Having introduced Room Service at Lakeland in 2007, Biswanger ditched the Call Center three years later. “Administration mandated we reduce staff by seven FTEs, so we scrambled to find staff whose jobs we might do without. We decided to eliminate the Call Center, going back to the old ‘bedside data entry’ system. But we found we could continue offering room service by modifying its procedures with wireless technology.”
In Biswanger's approach, a patient's tray ticket is sent directly from bedside to the kitchen “pod” or room service production line.
He says that also retained the huge advantage hospitals gain by having increasing face-time between f/s staff and patients and generated an additional two to three percentage increase in the hospital's Press Ganey patient satisfaction scores.
Miller takes pains to point out that when a facility eliminates its call center (usually a multi-employee operation) or doesn’t implement one in the first place, that doesn't mean the traditional Diet Office is eliminated.
“In a 200-bed hospital or larger, one person still staffs the Diet Office and performs various duties. After all, the phone still rings for reasons other than placing meal orders.” He believes that, on balance, there are a number of reasons this approach could become the norm.
In DM&A's experience, “This approach requires one fewer paid FTE per 100 occupied beds," Miller says. "Secondly, the meal order is taken by a person in the room vs. via the phone. That's perceived as more personal service by the patient.
“Another advantage is that nurses like having a foodservice ambassador taking the orders since, properly staffed, they can assist with a few routine functions related to patient care and food service that might otherwise have to be performed by nurses." Finally, he says, when such operations are staffed properly, floor ambassadors may be easier to reach by phone than is possible at peak periods, when patients phoning a call center may often have to be put on hold.
When pressed, Miller acknowledges that this approach can bring its own disadvantages, especially if it is pushed too far in terms of the workload placed on staff ambassadors. But in a coming era in which cost management will have an even higher priority in hospitals, he argues it is an important option if the traditional room service model becomes FTE-prohibitive.
Still, DM&A President Bill Klein notes that "the infrastructure at every hospital is different. When room service programs are designed, you have to take these differences into account: whether the facilities are largely vertical or largely horizontal; how many beds and zones exist; elevator availability" and other meal transport and service factors.
"You have to get the metrics right," Klein adds. "The number of calls a center operator can take in an hour, the number of trays an ambassador can pass in an hour, and so on, are still limited. You have to allow for the right amount of interactive time per patient and with nursing. If an administration tries to pump those ratios up because of a fixation on FTE numbers, it has a negative impact.
"You also have to staff these positions carefully. Ambassadors need to have the right speaking, demeanor and other skills to be relationship builders, and often have to be coached to help them fine-tune these skills."
Antoinette (Toni) Watkins, MS, RD, LD, is the FSD at Texas Health Presbyterian Hospital Dallas, another DM&A client. When she accepted the position as director of food, nutrition and conference services there two years ago, a retherm system was in place at the 898-bed facility (the average census runs 400 to 500). She says her evaluation showed it just “wasn’t going to take us where we needed to go.”
In evaluating other options, she brought in DM&A to conduct a cost analysis. Room Service with conventional call center eventually debuted in July of 2012. So far, Watkins sees that food costs have decreased “because we’re not putting additional items on the tray that the patient doesn’t eat because they didn’t want or request them. Plus, we knew the demand for Floor Stocks would decrease since patients can order whatever they want from the menu. We saw that impact immediately.”
Watkins reports that the hospital's overall patient satisfaction scores have increased 18% and that, so far, original forecasts have proven out. The decrease in food cost has more than made up for the increased labor cost associated with hiring nine additional FTEs in the call center.
She struggles with the idea of eliminating the call center function since “it’s the first interaction our patients have with the process. Operators can help guide a patient in terms of procedures and, if a concern is mentioned, can determine if a member of the clinical staff or a diet tech needs to check in with the patient.”
Watkins says there are other advantages as well. She points as an example to the center's ready access to an outside vendor’s Translation Line. This, she says, is especially helpful in serving the facility’s large number of Spanish, Burmese and Nepali-speaking patients. “The call center operators conferences with a translator and the patient simultaneously." Nurses and the department's room service ambassadors can also have access to the service if it is needed."