How To Improve Service Quality In Hospital Food
Nutr Res Pract. 2010 Apr; 4(2): 163–172.
Assessment of foodservice quality and identification of comeback strategies using hospital foodservice quality model
Kyungjoo Kim
iDepartment of Food and Nutrition, Seoul Women's University, 623 Hwarangro, Nowon-gu, Seoul 139-774, Korea.
Minyoung Kim
twoNutrition Team, Korea University, Guro Hospital, Seoul 152-703, Korea.
Kyung-Eun Lee
1Department of Nutrient and Nutrition, Seoul Women'south University, 623 Hwarangro, Nowon-gu, Seoul 139-774, Korea.
Received 2010 Feb 16; Revised 2010 Mar 30; Accepted 2010 Mar 30.
Abstract
The purposes of this study were to appraise infirmary foodservice quality and to identify causes of quality problems and improvement strategies. Based on the review of literature, hospital foodservice quality was defined and the Hospital Foodservice Quality model was presented. The written report was conducted in two steps. In Pace one, nutritional standards specified on diet manuals and nutrients of planned menus, served meals, and consumed meals for regular, diabetic, and depression-sodium diets were assessed in three general hospitals. Quality problems were establish in all three hospitals since patients consumed less than their nutritional requirements. Considering the effects of four gaps in the Hospital Foodservice Quality model, Gaps 3 and 4 were selected as disquisitional command points (CCPs) for hospital foodservice quality direction. In Step 2, the causes of the gaps and improvement strategies at CCPs were labeled every bit "quality hazards" and "corrective deportment", respectively and were identified using a case study. At Gap 3, inaccurate forecasting and a lack of control during production were identified as quality hazards and corrective actions proposed were establishing an authentic forecasting arrangement, improving standardized recipes, emphasizing the use of standardized recipes, and conducting employee preparation. At Gap 4, quality hazards were menus of depression preferences, inconsistency of bill of fare quality, a lack of menu variety, improper nutrient temperatures, and patients' lack of understanding of their nutritional requirements. To reduce Gap iv, the dietary departments should comport patient surveys on menu preferences on a regular basis, develop new menus, peculiarly for therapeutic diets, maintain food temperatures during distribution, provide more choices, conduct meal rounds, and provide diet education and counseling. The Hospital Foodservice Quality Model was a useful tool for identifying causes of the foodservice quality problems and improvement strategies from a holistic betoken of view.
Keywords: Hospital, foodservice, quality model, quality hazards, critical control point
Introduction
The goals of hospital foodservice are to provide in-patients with nutritious meals for their recovery and wellness and to present them with a nutritional model with meals tailored to their specific health conditions. When meals are carefully planned and served and when patients eat what they are served, the goals can be achieved [1,ii]. Hong, Kirk [three] stated that meal consumption of in-patients was a good indicator of dietary status and satisfaction with repast service. Furthermore, foodservice quality is known to influence patients' satisfaction with hospital stays [4,5].
Since the health care industry is becoming more competitive and patients are becoming more discriminating almost quality, the health care industry has redefined patients, recognizing them as customers [6,7]. The competitive environment has forced dietitians to provide higher-quality foodservice with limited resources. As Parasuraman et al. [8] asserted, quality is "an elusive and indistinct construct" and is not an easy one to define. The American Order for Quality [nine] defines quality in two means: "the characteristics of a product or service that touch its ability to satisfy stated or implied needs and a product or service that is complimentary of defects." In service marketing literature, service quality is conceptualized as service coming together customers' expectations [10]. Because these definitions of quality and the goals of hospital foodservice departments, hospital foodservice quality tin can be defined as foodservice that meets nutritional requirements of in-patients.
Even with the established definition, improving foodservice quality in hospital settings remains as a hard challenge. Since foodservice encompasses both tangible and intangible aspects, quality improvement for foodservice should involve various components including menu items, quantities of nutrient, tray presentation, sanitation, and service [11,12]. It has been reported that in-patients evaluate foodservice quality based on various factors including taste, nutrition, sanitation, temperature, portion size, meal fourth dimension, and servers' attitudes. Among the various factors, food temperature, service, meal time, nutrient taste, portion size, card pick, offering nutritional information, responsiveness to food problems, bill of fare diverseness, and sanitation were evaluated negatively [2,11,13-15].
Most research in hospital foodservice quality, to date, has focused on patients' expectations, perceptions of operation, and satisfaction. Although it is the patients who ascertain and evaluate quality, findings based on patients' surveys practise non provide rich enough data on what causes quality problems or what foodservice professionals take to do in terms of quality comeback. Hospital foodservice is a arrangement where subsystems, including procurement, product, distribution/service, and safety/sanitation, are interrelated [16]. Thus, a determination in i part can influence another office of the organisation, and quality should exist managed in an integrated manner.
Parasuraman et al. [8] presented their Service Quality Model for investigating bug related to service quality management and identifying causes of the problems. Co-ordinate to the model, service quality management is the procedure that maintains a balance between customers' expectations and perceptions of service quality and minimizes the discrepancy betwixt the two. The gap betwixt expectation and perception is a service problem that results from four other gaps on the service provider's side. Parasuraman et al. [viii] stated that a service manager should identify causes of the 4 other gaps on the side of the service provider and develop strategies to reduce the gaps to meliorate service quality.
To meliorate empathize infirmary foodservice quality management, the Service Quality Model [8] was modified to reverberate the hospital foodservice environment based on the review of literature. The modified Service Quality Model was named "Hospital Foodservice Quality Model" (Fig. 1). For this written report, infirmary foodservice quality was defined as "foodservice meeting patients' nutritional requirements" based on the review of literature and the modified model. The purposes of the study were to evaluate hospital foodservice quality and to identify causes of quality issues and improvement strategies for hospital foodservice quality using the new model.
Infirmary foodservice quality model
Subjects and Methods
The study was conducted in two steps to assess hospital foodservice quality and to identify the causes of the quality issues and improvement strategies.
Stride one: Cess of hospital foodservice quality and identification of critical control points of infirmary foodservice management
Three general hospitals, two located in Seoul and 1 in Chon-An, were selected for the study. Data were collected over three randomly selected days (ii weekdays and ane weekend solar day) betwixt March 2007 and May 2007. Regular, diabetic, and low-sodium diets were studied. Nutritional standards for each diet were determined by the diet manuals of the hospitals, and planned menus and recipes for the selected diets were obtained from the hospitals. Served and consumed meals were measured using a weighed plate method.
A total of 516 in-patients (373 for regular diet, 106 for diabetic diet, and 37 for low-sodium diet) were selected randomly and served meals on different colored trays. Since diabetic diets varied by energy levels, different colored stickers were placed on the bottoms of the trays to distinguish energy levels. Before the meal trays were delivered to the patients, 3 trays were randomly called for each diet type and the card items were weighed. An obtained average weight of the items was considered every bit a portion size. At the finish of the meal time, foodservice staff collected the selected trays and scraped carte du jour items remaining on the trays into split containers. Dietitians measured the collected plate waste product and divided the weight past the number of the trays collected to calculate the average plate waste product for each menu item. Average consumption by patients was calculated past deducting the average plate waste from the portion size.
Boilerplate consumption (one thousand) = portion size (g) - average plate waste (thousand)
Information technology was causeless that the patients consumed all milk and fruits served since many patients ate them as snacks even though they were served with meals. Nutrient contents of the each menu item and meals planned, served, and consumed were calculated using CAN Pro (Ver iii.0). The nutrients analyzed included energy, carbohydrates, poly peptide, and fats, which were specified on the diet manuals of the hospitals. Then the gaps in the Hospital Foodservice Quality Model were calculated by percentage and the problematic gaps were adamant as critical control points (CCPs).
Step ii: Identification of quality hazards and corrective actions at ccps of hospital foodservice quality direction using a case study
To investigate causes and command measures of quality problems at the identified CCPs, a example study was conducted in Infirmary A. First, a total of 14 carte items were selected based on the characteristics of the ingredients and training methods. The selected menus were cooked rice, rice gruel, seaweed soup, Chinese cabbage soup with perilla seeds, egg custard with fake crab meats, braised beef shank, broiled salted mackerel, sautéed beefiness and shiitake mushrooms, chicken salad, mini tofu and veggie burgers, seasoned fresh bellflower roots, seasoned spinach, soy sauce glazed konyak and sea tangles, and fried vegetables.
For each card particular, so, a process catamenia diagram was drawn and product processes were observed and recorded past researchers. Examples of the process menses diagrams are presented in Fig. 2 and Fig. 3. The process included all steps - receiving, storage, pre-preparation, preparation, portioning, tray associates, holding, and meal service. Finally nine dietitians including two manager-level dietitians, five clinical dietitians, and two dietitians) were interviewed well-nigh the causes of the gaps and strategies for decreasing the gaps were discussed. The working experiences of the dietitians ranged from less than 1 year to longer than 25 years (one for longer than 25 years, one for x-25 years, ane for 5-x years, four for 1-3 years, and two less than 1 year).
Production procedure of egg custard with imitation crab meats
Production procedure of seasoned fresh bellflower roots
Results
General characteristics of the dietary departments
General characteristics of the participating dietary departments are presented in Table 1. In Step 1, iii hospital dietary departments participated in the study and one of them (Hospital A) participated in the study in Stride 2. In all the hospitals, foodservice was self-operated. Selective menus were available for regular and some therapeutic diets in Hospital A whereas selective menus were available only for the regular diet in Hospitals B and C. In Hospitals A and C, tray assembly was centralized but Hospital B used a decentralized tray assembly organization. To maintain appropriate meal temperatures during distribution, Hospital A used hot and cold holding carts, only Hospitals B and C used hot holding carts. All hospitals served four side dishes (excluding rice and soups/stews). A clinical nutrition segmentation operated independently of the foodservice direction segmentation at each infirmary.
Table 1
General characteristics of participating hospital dietary departments
Cess of hospital foodservice quality and identification of critical control points of infirmary foodservice quality management (Stride one)
Co-ordinate to the Infirmary Foodservice Quality Model (Fig. ane), five different gaps in infirmary foodservice quality be. Gap v is the discrepancy between nutritional requirements and food consumption of in-patients, which has significant begetting on hospital foodservice quality equally defined in the study. If the nutrient contents of the meals consumed by the patients are equal to their nutritional requirements, the hospital foodservice quality is considered practiced. If patients eat more or less than their nutritional requirements, notwithstanding, the foodservice has quality problems. Since the sizes and directions of Gaps i-4 determine Gap 5, Gap 5 is a function of the other iv gaps in the model (Fig. 1).
Nutritional standards (specified on diet manuals), nutrients of planned menus and served meals, and nutrients consumed are presented in Tabular array 2. The gaps calculated based on the results are shown in Table 3. In terms of Gap five, poly peptide consumption of patients on a regular diet and carbohydrate consumption of the patients on a diabetic diet met nutritional requirements, but energy, carbohydrate, and protein consumption of patients on a low-sodium diet were less than 90% of the requirements in Hospital A. In Hospital B, fat consumption of patients on regular and diabetic diets, and energy, saccharide, protein, and fatty consumption of patients on low-sodium diets were below 90% of the nutritional requirements. In Hospital C, patients consumed only seventy-ninety% of the required free energy, carbohydrates, protein, and fat (with the exception of poly peptide consumption past patients on diabetic diets and fat consumption by patients on low-sodium diets). In detail, fatty consumption past patients on regular and diabetic diets met lxx and 75% of the requirements, respectively.
Table 2
Nutritional standards and nutrients planned, served, and consumed
Table three
Four gaps in the hospital foodservice quality model (%)
Next, Gaps ii, iii, and 4 were examined to make up one's mind the causes of the foodservice quality problems (Gap 5). Infirmary dietary departments should provide dissimilar types of meals that, with limited resources, meet the diverse nutritional requirements of the patients. Diet manuals are therefore used in hospitals to standardize nutrition management and to help dietary departments perform in an economical and efficient way. Doctors identify orders and dietitians plan menus based on the diet manuals. Gap i occurs when a medico places inappropriate diet orders (Fig. 1). Since Gap ane is across the control of the dietary departments, information technology was adamant that the research was express to Gaps 2-5. Thus, nutritional requirements of the patients were assumed to stand for with the nutritional standards in the diet manuals (Gap 1 = 0).
Gap 2 is the discrepancy between nutritional standards on diet manuals and nutrient values of planned menus (Fig. 1). In Hospital A, planned menus for regular diets provided 102-110% of nutritional standards for energy, carbohydrates, and protein, but 96% of the standard for fatty (Tabular array 3). Planned menus for the diabetic nutrition provided 98-105% of the nutritional standards for all the nutrients and the discrepancies were considered acceptable. Planned menus for the low-sodium diet, withal, did not encounter the nutritional standards specified on the diet manual for free energy, carbohydrates, protein, and fat. In Hospitals B and C, the nutrients of the planned menus for regular, diabetic, and low-sodium diets did not meet the nutritional standards on the diet transmission, just the differences were less than x% of the nutritional standards.
Gap iii was determined by comparison nutrients on the planned menus with meals provided to the patients (Fig. 1). In Hospital A, more nutrients were provided than planned nutrients for regular, diabetic, and low-sodium diets. Most significantly, patients on the regular nutrition were served more than 110% of the planned standards for free energy, sugar, and fat. In-patients on diabetic and low-sodium diets were served 112% of their poly peptide and fat planned, respectively.
In Hospital B, the fat levels of the regular diet; free energy, protein, and fatty levels of the diabetic diet; and energy, saccharide, and protein of the low-sodium diet did not meet the planned nutrient standards, but the charge per unit of discrepancy was less than 10%. Infirmary C provided more energy, carbohydrates, protein, and fatty than the planned for all diet types. Poly peptide and fat served on the regular diet, protein served on the diabetic diet, and protein and fat served on the depression-sodium nutrition all amounted to more than 110% of the planned standards.
Gap 4, the discrepancy between nutrients served and consumed, was the biggest gap in all three hospitals. Except those on regular and diabetic diets in Infirmary B, all patients consumed less than xc% of the nutrients they were served. Large discrepancies were found in the low-sodium diets of all iii hospitals, which indicated low meal acceptance by patients. Patients on the regular diet in Infirmary C consumed only 59% of the fatty they were served.
As an accumulative effect of the discrepancies at Gaps ii-4, the patients did not consume the nutrients they needed. To decrease the quality problem and improve hospital foodservice quality, dietary departments should control Gaps 2 through iv, which decide Gap 5. When considering the adverse furnishings on Gap five, Gap 3 and Gap 4 were adamant to be critical control points (CCPs) in hospital foodservice quality direction. The efforts of the dietary departments should be focused on these.
Identification of quality hazards and corrective actions at disquisitional control points of foodservice quality management using a case written report(Step 2)
A case written report was conducted in Hospital A to identify causes of hospital foodservice quality problems and improvement strategies at the CCPs identified in Stride ane (Gap 3 and Gap 4). The causes of the gaps were qualified as "quality hazards" since they caused deterioration in infirmary foodservice quality. The comeback strategies were labeled as "corrective deportment" for the purposes of this study.
Quality hazards and corrective actions at gap three
Gap three occurred because patients were not served the meals that dietitians planned based on diet manuals. A process assay and interviews with dietitians revealed various quality hazards at Gap iii (Table 4). The get-go quality hazard was fluctuation of quantity demands and inaccurate forecasting. Errors in forecasting differed by menu item (Table 5). The highest error charge per unit (80%) practical to the soy sauce glazed konyak and sea tangles, which was in footling need. Inaccurate forecasting was too a problem for seasoned fresh bellflower roots, fried vegetables, and seasoned spinach. On the other manus, no forecasting error was establish for chicken salads. Accurate forecasting was also performed for braised beef shank, Chinese cabbage soup with perilla seeds, and broiled salted mackerel (Table 5). The establishment of an authentic forecasting system was identified as a cosmetic action for this quality hazard.
Table 4
Quality hazards and corrective deportment at CCPs of hospital foodservice quality
Tabular array 5
Forecasted meal demands, actual repast counts, and forecast errors
The second quality hazard at Gap three related to the food production procedure. It was observed that foodservice staff used all food ingredients received on the production day without because standardized recipes or dietitian'south planned quantities. To correct the problem, dietitians should order the required amounts of ingredients based on forecasted meal demands and the foodservice staff should be trained to follow production plans (Tabular array 5).
The third quality hazard likewise related to the production process. The process analysis revealed that cooking times and temperatures, amount of water added, preparation procedures, and cooking equipment all influenced quality and total yields of end-products (Table vi). Even though standardized recipes were available at the hospital, the foodservice staff did not use the recipes. To prevent this quality gamble, dietitians should make an effort to improve standardized recipes and provide foodservice staff with teaching and training on how to use standardized recipes. Apply of standardized recipes should be emphasized continuously.
Table 6
Factors related to product and portion control at Gap three by bill of fare item
The final quality hazard at Gap 3 was lack of portion control. The foodservice staff did not conform to specified portion sizes. As a corrective action, it was noted that foodservice staff should be trained on the importance of portion command and how to comply with portion sizes. To make portion control easier, staff must be provided with proper equipment and tools.
Quality hazards and corrective deportment at gap four
Gap 4 resulted from patients not eating what they were served. The quality hazards and cosmetic deportment at Gap four are presented in Table 4. The quality hazards at Gap iv were menus with low preference, inconsistency of menu quality, a lack of card variety, and improper nutrient temperature. Patients not understanding their nutritional requirements were another quality hazard.
Corrective deportment for the quality hazards included periodic patient surveys, meal rounding, bill of fare development, and more opportunities for menu selection (Tabular array 4). In add-on, dietitians should test production quality before serving meals to the patients and to maintain food temperatures during distribution. Finally, patients should exist provided with data about their diets and educated on the importance of their diets to their health and recovery. They need to empathise the importance of consuming the provided meals.
Discussion
In this written report, hospital foodservice quality was divers every bit "foodservice coming together patients' nutritional requirements" and measured past the discrepancies between patients' food consumption and their nutritional requirements. In evaluating Gap five, it was discovered that patients consumed eighty-ninety% of their nutritional requirements, which means problems existed in infirmary foodservice quality. Previous research also reported that more than 90% of in-patients experienced protein-energy malnutrition and weight loss [17,18] and that the issues resulted from poor monitoring of nutritional status, inadequate food intake prior to and post-obit access, and influences of diseases [19,20].
Using a plate waste study, Yang et al. [21] found that diabetic patients did not eat RDAs for energy, protein, calcium, iron, and vitamins B1 and B2 during infirmary stays. Energy and protein consumptions were at 85-96% and 85-87% of the RDAs, respectively, which proves similar to the upshot of this study. Yang et al. [22] also reported that patients on a regular diet consumed 97.seven% and 118.5% of RDAs for energy and protein, respectively. However consumption of calcium, fe, and vitamin B2 were all less than the RDAs. In the aforementioned written report, patients served a soft diet did not eat the RDAs for energy, calcium, fe, vitamin B2, and niacin.
The nutrients of the planned menus met ninety-110% of the nutritional standards on the diet manuals in the three hospitals. Although the discrepancies seemed small, they should non be ignored. The nutrients of the planned menus in Hospitals B and C, in item, did not encounter the nutritional standards for any of the diets. A planned menu is one of the most important controls in foodservice [16,23]. Since the planned menus play a role as standard in evaluating meals served to in-patients, careful menu planning should be emphasized and an evaluation procedure of the menu planning should exist followed.
The bigger discrepancies were plant at Gap 3 and Gap iv. More than nutrients than planned were provided for in-patients in Hospitals A and C, and more than 110% of planned amounts of some nutrients were provided. On the other hand, a few nutrients provided in Hospital B did not meet the planned nutrient amounts. Since the planned menus did non comply with the nutritional standards specified on the diet manual for diabetic and low-sodium diets in Hospital B, the accumulative discrepancies atomic number 82 to patients non existence served the nutrients they required. Patients on diabetic and low-sodium diets in Hospital B could not swallow what they needed even though they ate everything they were served.
The quality hazards identified at Gap three were fluctuations among meal demands and a lack of control during production and portioning. The fluctuation of meal demands is natural in infirmary settings, due to the continuous admission and discharge of the patients, the society of NPO (nothing by month), and changes in diet orders. The dietary departments should endeavour to improve the accuracy of forecasting systems since over- and underproduction create managerial problems and affect the lesser line of the foodservice departments [16]. Overproduction increases waste matter of food ingredients, energy and utilities, and labor, while underproduction results in increased costs, patient dissatisfaction, and job stress on the employees [16,23].
Accurateness of the forecasting seemed to be influenced past menu preference and quantities of the meals produced. Demand data were probable to exist accurate for highly preferred or in-demand menu items. Still, large deviations in forecasts were institute for seasoned spinach and stir-fried beefiness and shiitake mushroom, even though they were in demands. Observation revealed that these two items were side menus for liquid diets. Diet order changes afterward surgery, from a liquid diet to a soft diet, and then to a regular nutrition, were the root of the deviations. Accurate forecasting should be more strongly emphasized as more hospitals provide selective menus in the increasingly competitive health care industry.
The major quality hazard at Gap 3 was a lack of production control. Due to the lack of control during production, the meals produced did not arrange to quality and quantity standards set by dietitians. Command is defined as "the process of ensuring that plans have been followed" [16]. Control includes comparing what was planned (standards) with what was done and taking any necessary cosmetic actions [sixteen]. During food production, both quality and quantity are objects of command. Quantity command ways preparing the amount needed and quality control means assuring consistency in served meals.
In Infirmary A, purchase orders were placed 3-iv days prior to product, based on forecasts. Then, on production day, dietitians provided foodservice staff with a new forecast as part of a product plan. It was observed, however, that the foodservice staff did not consider the new meal count forecast and rather used all ingredients that were received on a given day, which resulted in overproduction. Kim et al. [24] also reported that infirmary foodservice staff did not mensurate ingredients using measuring equipments and did not use the standardized recipes during production.
To right the problem, standardized recipes should be used. All recipes should exist standardized and management should educate foodservice staff on, and encourage them to utilise, standardized recipes. In detail the standardization of recipes and use of standardized recipes should exist emphasized for the preparation of therapeutic diets. Kim et al. [24] reported that foodservice staff did non control quantities of sodium, protein, or potassium in the diets of patients with renal failures, despite the critical nature of the nutrient components to such diets.
Room for comeback was found in portion control. Instead of using measuring tools and portioning specified amount, staff tended to determine portion sizes based on meal counts and total yields. Kim et al. [24] likewise found a similar phenomenon. Portioning should be strictly controlled since patients perceive meals served in hospitals as a model for a healthy diet that they could follow even afterwards discharge [25]. Therefore, education on the importance of portion control and portioning methods should be provided for foodservice staff.
Gap 4, measured every bit the discrepancy between provided nutrients and consumed nutrients, was the biggest and negative in direction. In Hospital A, more nutrients were served to patients than planned, but the patients did not consumed all they were served. Therefore, they consumed less than their nutritional requirements with the exception of a few nutrients. In Infirmary B, patients did not swallow their nutritional requirements either. Nutrient consumption by patients on low-sodium diet in particular met less than fourscore% of food requirements. In Hospital C, patients on regular diets consumed only seventy% of fat served. Thus patients' meal acceptance seemed to be low. In a survey study conducted in Hospital A, B, and C, patients on the regular diet responded that they consumed 72%, 69%, and 68% of cooked rice, soups, and side dishes they were served [2]. The patients on the diabetic and low-sodium diets were reported to consume less than 70% of the cooked rice, soups, and side dishes served [two]. Jung [26] also reported that in-patients consumed 70% of the meals served.
Dupertuis et al. [27] asserted that in-patients did not eat adequate nutrients even though they were provided for fairly and only 36.7% of in-patients with long hospital stays (longer than 46 days) ate more than fifty% of the meals they were served [28]. Yang et al. [21,22] reported that 30%, 50%, and 16.4-27.1% of the meals served were non consumed and concluded upwards every bit plate waste for regular, soft, and diabetic diets, respectively.
Gap four resulted from menus not reflecting patients' preference, inconsistency of food quality, a lack of menu variety, and improper nutrient temperatures. Patients also did non understand their nutritional requirements. According to surveys done on in-patients, patients did not eat what they were served because they did not have much strength, they had no appetite, the foods were not tasty, or too much food was served [1,two]. The most frequent response was, "I do non have much force," for regular diets, and "the foods were not tasty," for therapeutic diets [two].
To decrease the discrepancy at Gap 4, periodic patient surveys, menu development, repast quality management, more nutrient choices, and meal rounding were proposed. Repast tests conducted by dietitians prior to service and temperature command were as well necessary. Kim et al. [29] reported that plate waste of soups was primarily due to improper temperatures and Kim et al. [2] also reported that patients on therapeutic diets evaluated food temperatures and consistency of taste as poorer than those on regular diets did. Nonetheless, Yang et al. [22] asserted that food taste and temperatures were not significant predictors of consumption charge per unit for regular diets and plate waste was correlated positively with portion size, but negatively with carte preference. Bigger discrepancies found for the depression-sodium diet at Gap 4 suggested that menu evolution was important for increasing consumption of the depression-sodium diet. Menus should be evaluated and updated continuously to reflect the changes of the patients' preferences and foodservice trends.
Other researchers institute that food quality was not the merely crusade of low consumption in hospitals. McLymont et al. [30] reported that some patients did not eat because they slept or left the beds for medical tests during meal times. Even though they were allowed to request late trays, they did not want to bother others. Recently, new delivery systems including spoken menus and room service have been successfully introduced to improve satisfaction with foodservice and to increase patients' meal consumption in hospitals [31-33]. Under the spoken menus, called "menuless eating house style service", patients order their meals 1-2 hours prior to meal fourth dimension instead of selecting a bill of fare the 24-hour interval earlier service. Polio et al. [32] reported that the spoken menu concept increased overall patient satisfaction and tray accuracy without price increases. In add-on, more patients perceived that the quantity of food was enough after the spoken menu system was implemented.
A room service program allows patients to eat the meal they desire when they want it. The room service system is expected to be more than prevalent in US infirmary settings in the nearly futurity [31]. Advantages of the room service model include more food choices, decreased plate waste, patient empowerment, and improved nutrient quality. However, the room service system as well involves a disadvantageous increase in labor costs [v]. Considering the results, introducing a new delivery organization tin can be a cosmetic activity.
Kim et al. [two] reported that consumption of cooked rice was higher amidst the in-patient groups that received diet education (P < 0.05) and an explanation of therapeutic diets. Yang et al. [21] reported similar results. According to Gam et al. [34], approximately 80% of surveyed patients expected dietitians' meal rounds once or twice a calendar week. Along with serving the patients well planned meals, dietary departments should acquit bones nutrition management and provide nutrition education and counseling services. Nutrition instruction and counseling will help patients empathise human relationship between diets and their diseases and the importance of consuming all foods they are served.
Improving hospital foodservice quality is complicated since hospital foodservice includes both tangible and intangible aspects and foodservice is a system where subsystems including procurement, production, distribution/service, and safety/sanitation are interrelated. Therefore, quality comeback strategies should be adult from a holistic point of view. This was the start attempt at investigating hospital foodservice quality at all stages, from menu planning to meal service.
To date, one of the almost serious quality hazards, a lack of control has been overlooked in foodservice quality management. Foodservice professionals in hospitals tin can be compared with engineers in manufacturing factories. Engineers continuously enquiry, plan, and manage production processes to improve quality of products and efficiency of processes. Once dietitians set up goals and standards by planning menus, they should manage and control the processes to a point where the goals are met. Foodservice staff should be trained and empowered as valued squad members in hospital foodservice quality management. Communicating with patients should be bi-directional, which involve dietitians listening to patients' voices and helping patients understand their nutritional requirements. The findings of this research can be used to strengthen the competitive edges of dietary departments in the health care manufacture. A procedure analysis for quality control during production and process improvement will be the next research topics.
References
i. Hong WS, Kim HJ, Ryu KA. Example report on the analysis of patients' plate waste results. Journal of the Korean Lodge of Food Science and Diet. 1996;12:339–345. [Google Scholar]
2. Kim MY, Kim KJ, Lee KE. In-patients' food consumption and perception on foodservice quality at hospitals. Journal of the Korean Dietetic Association. 2008;thirteen:87–96. [Google Scholar]
3. Hong WS, Kirk D. The assay of edible plate wastes in eleven hospitals in the UK. J Foodservice Systems. 1995;ix:115–123. [Google Scholar]
4. Demir C, Celik YJ. Determinants of patient satisfaction in a military teaching hospital. J Healthcare Qual. 2002;24:xxx–34. [PubMed] [Google Scholar]
five. Sheehan-Smith 50. Key facilitators and best practices of hotel-style room service in hospitals. J Am Diet Assoc. 2006;106:581–586. [PubMed] [Google Scholar]
vi. Kleeb T. Service excellence: unit-based service objectives in CQI. Hospitals. 1998;66:50–54. [PubMed] [Google Scholar]
7. Lau C, Greogire MB. Quality ratings of a hospital foodservice department by inpatients and postdischarge patients. J Am Diet Assoc. 1998;98:1303–1307. [PubMed] [Google Scholar]
8. Parasuraman A, Zeithaml VA, Berry LL. A conceptual model of service quality and its implications for time to come inquiry. J Marketing. 1985;49:41–50. [Google Scholar]
10. Parasuraman A, Zeithaml VA, Berry LL. Servqual: a multiple-item scale for measuring consumer perceptions of service quality. J Retailing. 1988;64:12–40. [Google Scholar]
xi. Jung SH, Yeom HS, Sohn CM. The improvement of hospital food service in quality and customer satisfaction by using 6-sigma strategy. Journal of the Korean Dietetic Association. 2007;thirteen:331–334. [Google Scholar]
12. O'Hara PA, Harper DW, Kangas M, Bubeau J, Borsutzky C, Lemire North. Taste, temperature, and presentation predict satisfaction with foodservices in a Canadian continuing care infirmary. J Am Diet Assoc. 1997;97:401–405. [PubMed] [Google Scholar]
thirteen. Kim YS, Lyu ES. Evaluation of Patients' Satisfaction with Foodservice of mid-size hospitals in Busan area. Journal of the Korean Society of Food Science and Nutrition. 2003;32:1153–1156. [Google Scholar]
14. Lee HY, Chang SH, Yang IS. Development of quality assessment tool and application to customer-oriented hospital foodservice management. The Korean Journal of Diet. 2004;37:329–338. [Google Scholar]
15. Lim HS, Yang IS, Cha JA. Analysis of patient satisfaction and factors influencing satisfaction on hospital foodservice quality. Journal of the Korean Dietetic Association. 1999;5:29–47. [Google Scholar]
16. Gregoire MB, Spears MC. Foodservice Organizations: A Managerial and Systems Arroyo. 6th ed. Upper Saddle River (NJ): Pearson Prentice Hall; 2007. p. 204.p. 249. [Google Scholar]
17. Mowe One thousand, Bohmer T. The prevalence of undiagnosed proteincalorie undernutrition in a population of hospitalized elderly patients. J Am Geriatr Soc. 2002;39:1089–1092. [PubMed] [Google Scholar]
xviii. Thomas D, Zdrowski C, Wilson M, Conright K, Lewis C, Tarig S, Morley J. Malnutrition in subacute care. Am J Clin Nutr. 2002;75:308–313. [PubMed] [Google Scholar]
19. McNab H, Restivo R, Ber L. Dietetic quality assurance practices in Chicago area hospitals. J Am Diet Assoc. 1987;85:635–637. [PubMed] [Google Scholar]
20. Tobias A, Van Itallie T. Nutritional problems of hospitalized patients. J Am Diet Assoc. 1977;71:253–257. [PubMed] [Google Scholar]
21. Yang IS, Kim SJ, Lee HY, Cha JA. The indepth analysis of plate waste for DM diet served in full general hospital. The Korean Journal of Diet. 2002;35:394–401. [Google Scholar]
22. Yang IS, Kim JL, Lee HY. An assessment of factors affecting plate waste product and its effects in normal and soft diets provided from hospital foodservice. Korean Journal of Community Nutrition. 2001;half-dozen:830–836. [Google Scholar]
23. Kwak TK, Lyu ES, Lee HS, Ryu K, Choi SK, Hong WS, Jang MR, Shin ES, Moon HK, Jang HJ, Park SJ, Choi EH, Lee KE. Institutional Foodservice Operations. Seoul: Shinkwang Publishing Co.; 2008. pp. 156–166. [Google Scholar]
24. Kim HJ, Jang EJ, Hong WS. Task analysis on foodservice, clinical diet service in hospital dietetic association. Journal of the Korean Dietetic Association. 2000;vi:148–160. [Google Scholar]
25. Watters CA, Sorensen J, Fiala A, Wismer W. Exploring patient satisfaction with foodservice through focus groups and meal rounds. J Am Diet Assoc. 2003;103:1347–1349. [PubMed] [Google Scholar]
26. Jung JH. A survey on nutritive value of general hospital diet and appetite of hospitalized patients in Pusan city. Journal of Korean Abode Economics Instruction Association. 1986;24:65–74. [Google Scholar]
27. Dupertuis YM, Genton 50, Kossovsky MP, Kyle UG, Raguso CA, Pichard C. Food intake in 1707 hospitalized patients: a prospective comprehensive hospital survey. Clin Nutr. 2003;22:115–123. [PubMed] [Google Scholar]
28. Kandiah J, Stinnett L, Lutton D. Visual plate waste in hospitalized patients: length of stay and diet order. J Am Diet Assoc. 2006;106:1663–1666. [PubMed] [Google Scholar]
29. Kim HJ, Jang UJ, Hong WS. A case study of food quality in a hospital foodservice system: with special reference to patient satisfaction. The Korean Journal of Nutrition. 1996;29:348–356. [Google Scholar]
thirty. McLymont V, Cox South, Stell F. Improving patient meal satisfaction with room service meal delivery. J Nurs Care Qual. 2003;18:27–37. [PubMed] [Google Scholar]
31. Cox SA. Improving infirmary foodservice. Food Technol. 2006;60:28–36. [Google Scholar]
32. Folio D, O'Sullivan-Maillet J, Touger-Decker R. The spoken menu concept of patient foodservice delivery systems increases overall patient satisfaction, therapeutic and tray accuracy, and is cost neutral for nutrient and labor. J Am Diet Assoc. 2002;102:546–548. [PubMed] [Google Scholar]
33. Lambert LG, Boudreaux J, Conklin M, Yadrick K. Are new meal distribution systems worth the effort for improving patient satisfaction with foodservice? J Am Diet Assoc. 1999;9:1112–1114. [PubMed] [Google Scholar]
34. Gam And then, Park JR, Kim MJ, Lee MK, Shin KH. The study of patients satisfaction and expectation of infirmary foodservice. The Korean Journal of Nutrition. 2007;twoscore:281–287. [Google Scholar]
Articles from Nutrition Inquiry and Exercise are provided here courtesy of Korean Order of Community Nutrition and the Korean Nutrition Society
How To Improve Service Quality In Hospital Food,
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867228/
Posted by: crusedowasobod.blogspot.com
0 Response to "How To Improve Service Quality In Hospital Food"
Post a Comment