hospital room service dining

HOSPITAL ROOM SERVICE DINING: A PARADIGM SHIFT WITH HIGH ORGANIZATIONAL IMPACT HELEN M. NICHOLS, MSW, HEALTHCARE RESEARCH ANALYST, SODEXO

In 2014, U.S. hospitals admitted more than 35 million patients and generated expenses in excess of $890 billion.1 As the demand for healthcare services continues to grow, hospitals are under mounting pressure to remain competitive in an industry that is increasingly focused on the cost-effective delivery of personalized, high-quality and comprehensive patient-centered care.2,3,4,5 Foodservice providers in hospitals have also shifted their focus toward the provision of patient-centered care.6,7,8 This shift has led to the adoption of room service-style food delivery programs within hospitals – a trend that shows no signs of slowing down9 with proven benefits for patients, workers and organizations. In the not-so-recent past, food service in hospitals was limited to unimaginative and standardized procedures and options. Menu options were typically on rotation and served only at predetermined times each day. Patients who missed meals would receive a boxed meal in its place. Assembly lines and production prepared food well in advance of meal times, with little variation or attention to individual preferences of patients. This system led to common complaints of cold meals, poor timing and unappetizing choices. Today, many hospitals have turned to room service dining in an effort to improve patient satisfaction and realize a number of other benefits for patients, workers and hospitals alike.

Key Components of Room Service Dining in Hospitals10,11

• Meals are ordered by patients using their bedside telephone or a tablet computer.

Patients decide when they eat – meals are prepared at their request.

• Orders are routed through a central call/order system.

Food is delivered when patients want – meal ordering times are flexible.

• Patients can order any menu item at any time that the kitchen is open for business.

Patients choose the food items – foodservice menus have a variety of choices.

• Each patient has access to a bedside menu with numerous food options from which to choose.

• Meals are delivered within 30-45 minutes of ordering.

• Items available for each patient are limited to those that meet their physician-prescribed diet order.

2 The information and concepts contained in this document are the proprietary property of Sodexo. As such, they cannot be reproduced or utilized without permission. ©2016

Room Service Benefits for Patients, Workers and Hospitals

intake. Indeed, multiple studies have shown that food consumption after the introduction of room service increased more than 40% 22,23 and caloric and protein intake improved by 18%.24

»» Increased Patient Satisfaction

»» Greater Efficiency and Job Satisfaction for Workers

Room service in hospitals has been associated with increased flexibility of meal delivery and variety of food choice, along with improved taste, temperature and quality of foods; all resulting in improved patient satisfaction and dietary intake.12,13,14 Hospital foodservice quality is a key component of overall patient satisfaction,15 and the addition of room service programs can increase patient satisfaction with meals up to 9%.16

The implementation of room service-style food delivery also has benefits for nurses and foodservice workers. Nurses benefit from such a program because it allows them to spend more time performing other clinical duties. With respect to hospital foodservice workers, in one study, they reported feeling more motivated and satisfied with their jobs due to the positive patient feedback that resulted from room service dining.25

»» Improved Patient Nutrition

Job satisfaction among frontline healthcare workers, such as hospital foodservice staff, is especially important for organizational success. Job satisfaction is the necessary precursor to establishing a patientcentered organization26 – a primary goal for hospitals. Additionally, job satisfaction is linked to patient satisfaction; patients develop perceptions of their hospital experience based on the workers with whom they have frequent direct contact, which are usually the frontline workers.27

The routine diet designed for hospital inpatients is largely unrestricted; as a result, nutritional requirements are often not met,17 which is a contributing factor to undesirable clinical outcomes.18 In fact, nutrition intake is especially important for the healing patient,19 as insufficient nutrition has been linked to increased rates of infection, complication and mortality.20,21 Delivering high-quality meals in a more flexible manner, with greater variety and improved taste, has the potential to improve patient nutrition by increasing food


»» Reduced Food Costs for the Organization The increased patient autonomy in meal decisions, driven by room service dining, has been proven to reduce the level of food waste – and subsequently food cost – to the organization.28,29,30 A study among pediatric patients demonstrated that implementing a room service-style food delivery system successfully reduced meal cost and food waste by reducing individual food and beverage item orders by 21% and overall meals by 23%.31 Another study that looked at various inpatient units found that the adoption of room service resulted in an average decrease of 27% in food waste per meal.32 »» Faster Patient Recovery and Decreased Length of Stay Lowers Hospital Costs The improved food quality and patient consumption resulting from the implementation of room service dining can also lower healthcare costs for hospitals. The promotion of optimal patient nutrition and foodservice quality through room service can help patients recover faster and reduce their length of stay in the hospital, in turn lowering hospital expenditures.33,34 »» Improved Patient Perception Contributes to Overall Financial Success for Hospitals Hospitals face new financial challenges resulting from the passage of the Affordable Care Act (ACA) and the concurrent authorization of the Value-Based Purchasing (VBP) program.35 This new reimbursement system provides monetary incentives and penalties aimed at ensuring that hospitals emphasize quality of care and patient perception. The incentive or bonus payments determined by VBP equate to 1-2% of inpatient Medicare billable services, a significant amount, considering hospitals reported an average operating margin of 7.2% in 2012.36 The Benefits of Hospital Room Service Dining financial impact that patient perception now wields is not insignificant, given that hospitals who regularly report high scores in patient satisfaction are also among the most financially successful,37 and foodservice is an important • Increased job • Increased satisfaction component of overall patient satisfaction • Better nutritional intake • Increased efficiency satisfaction.38,39

PATIENTS

WORKERS

SOCIETY

HOSPITALS

»» Positive Impact on Overall Public Health The improved nutrition that can result from room service dining also provides hospitals with an important opportunity – to reinforce public health messaging for a healthy lifestyle through a healthy diet. Research has shown that patients are responsive to making dietary changes postdischarge40,41,42 and hospitals can successfully promote healthy eating habits by serving nutritious meals that align with national recommendations.

• Improved public health through the promotion of healthy dietary choices

• Decreased food costs • Decreased healthcare costs


Implementation of Room Service Dining in Hospitals Best Practices 1. A multidisciplinary approach is ideal. All foodservice staff should be involved, including those who prepare the meals, those who deliver meals to patients, and staff who take meal orders. Nursing staff should also be familiar with room service, and hospital management support is critical for operational success. 2. Sufficient time should be allowed for development and implementation. Each hospital foodservice department will need to customize room service dining to its specific needs. This does not end after initial implementation – continual adaptation is vital to ongoing success. 3. Foodservice workers should receive thorough training in customer service. 4. Patients should drive overall decisions regarding program design and menus. Feedback from patients should be routinely solicited and incorporated into menu changes and additions. 5. Food and menu choices should be tailored by geographic area. Tailored menus allow for food options that not only reflect local preference, but are also healthy and taste good. 6. Automated technology should be utilized for diet changes, menu ordering and meal tracking. This is also important for patient safety – to ensure that meals meet physician orders and take allergies and other potential adverse reactions into account.

Potential Benefits Outweigh the Costs Costs are incurred when implementing any new service delivery system – while room service dining in hospitals is not an exception to this rule, the benefits and cost savings are likely to outweigh the associated costs. For instance, room service requires hospitals to make an initial investment in new equipment, computer software and training of staff.43,44 However, room service has been shown to reduce direct costs by eliminating late meals, reducing floor inventory requirements and preventing costly over-production.45 There are also the indirect cost savings generated by improved job satisfaction among workers and increased patient satisfaction with the overall hospital stay. Lastly, room service systems are sometimes associated with greater labor costs, but many hospitals report that these costs are only higher during implementation and subsequently drop back to normal.46

Conclusion When people are staying in the hospital, they care about the food they are served – meal choice, delivery timing, presentation and overall satisfaction with foodservice are all important to patients.47 Foodservice providers in hospitals face numerous challenges in meeting patient expectations, with the most common patient complaints including cold meals, meals served at odd times, lack of appetite and poor quality.48,49 To address these issues, hospitals are increasingly turning to room service-style food delivery. Room service dining benefits not only patients, but also healthcare workers and a hospital’s bottom line.


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