Patient Room Service at St. Joseph Memorial Hospital
Patient Room Serviceat St. Joseph Memorial Hospital
St. Joseph Memorial HospitalPart of the 3-hospital Southern IllinoisHealthcare System25 bed critical access hospital
Press Ganey ScoresFrom 04/01/07 to 09/30/08 meanscores ranged from 82.0 to 85.1This fluctuation in mean scoresresulted in a percentile range of48 to 78 in the Press Ganey smallhospital data base
Things We TriedVerbal menusMenu rewrites (multiple times)Tray passingStocking and rotation of floorstock
Room Service DecisionStarted planning in October 2007Gathered a team of employees from theFood Services Department, Nursing andsome Ancillary DepartmentsUsed “Design for Six Sigma” methodologyto chart our course
Six Sigma HistorySix Sigma training throughout SouthernIllinois Healthcare began in 2004.GE Healthcare was utilized as ourtraining vendor.
Six SigmaA measure of quality that equates to 3.4defects per million opportunitiesDesign for Six Sigma is a way oftranslating customer needs andexpectations for a product or service into adesign that will meet those requirementsusing a variety of tools and dataA great method for mobilizing commitmentfrom staff by creating a shared need
So How Did We Get Started?It was important to formulate a plan for meeting our patient and staff needs.We scheduled a structured meeting with representatives from Food Services and Nursing to kick off the planning. During this meeting we started creating a shared need for Room Service.
Voice of the Customer and CTQ’s (critical to quality) Customer Needs Mapping Key Output Characteristics Customer Sample Comments Important to Customer (CTQs)Patient “Need wider variety of foods on Variety menu, and a menu given to patient upon entering room.”Patient “The food could be better tasting. Flavor, seasoning Very bland and I didn’t have a diet to follow.”Patient “Food was good but the green Texture beans was stringy.”Patient “Eggs cold.” TemperaturePatient “Did not have a lot of choices on Variety, texture the menu that I liked. Any meat I got was tough.”
Develop Team Charter 10/07Business Case:Improving meal satisfaction for St. JosephMemorial Hospital inpatients demonstratesour dedication to the SIH values of quality, Start / Stop Points for Project:compassion, collaboration and stewardship. Start Point: Physician’s diet order for patient.By adding variety and choice to our menuselections, and improving meal quality, we will Stop Point: Successful delivery of roomincrease our Press Ganey patient satisfaction service trayscores.Problem Statement: In Scope:Over a period of 2 years, quarterly patient meal Med/Surg unit, SCU/PCU unit, Foodsatisfaction scores have fluctuated from the Services, job descriptions/tasks, LEAN48th percentile to the 78th percentile in the process, Food Service DepartmentPress Ganey small hospital data base. Organization, purchase of new equipmentGoal Statement: Out of Scope:Improve Press Ganey patient satisfaction mean No additional FTEsscores by 5% over a period of 3 quartersbeginning 4th quarter 2008: mean scoreimprovement to 87.86 by July 2009 with nolosses over the 9 month period.
Action Plan from Patient Room Service Structured MeetingWhat Who: When:Action/CommitmentDevelop Menus Beth, Cathy, No Timeframe Stephanie, JackieDevelop Communication Rhonda, Cathy, No Timeframe Plan for Patients Sandy Jo, Vicki, DebbieDevelop Communication Debbi, Jo, Sandy, No Timeframe Plan for Staff Nadia, VickiDevelop Process for Room Cathy, Judy and No Timeframe Service others as needed- Ordering/Communica- tion- Screening/Eval for Room Service Appropriateness- Delivery process- Lean for kitchen
Stakeholder Analysis ToolAssessed where key players were in theirwillingness to assist with this change.Helped us to determine how to focus ourefforts with staff members for optimaloutcomes.
Stakeholder Analysis Strongly Moderately Neutral Moderately StronglyName/Title Against Against Supportive SupportiveNurse Manager – XMed SurgWard Clerk X-Today X- They need to be here for program to be successfulRN-SCU X- Today X-They need to be here for program to be successfulRN-Med Surg X-Today X- They need to be here for program to be successfulDietary Lead X-BorderlineFood Handler II X-BorderlineAssistant Dietary X-BorderlineAides CNA XDietician XPhysician X-Today X-They need to be here for program to be successful
Quality Functional Deployment (QFD)In the design process, QFD helps totranslate customer needs andexpectations into the finished product.Our project had 2 customers: Patients StaffBy combining QFD from both groups webuilt a 2nd QFD “house” and were able toaddress the needs of patients and staffwhen designing our program.
QFD #1Patient requirements (Y) Taste Timely Temperature Texture
QFD #1Staff requirements (Y) Limited and manageable program Menus need to reflect simple and fast preparation Standard recipes Scripting
Combined QFD Houses Look at requirements for both patients and staff Compare these requirements with steps in the process
QFD #2Combined expectations (Y)In order to meet patient and staffexpectations, we must build ourprogram to reflect Timely service Courteous service Standard recipes with pictures Scripting Adequate training and updated job descriptions
QFD #2 Combined Requirements (X)The most important steps in the design process are: Menu development Patient explanation of Room Service Patient orders meal Meal is prepared Meal is delivered
Room Service Timeline10-07 11-07 12-07 01-08 02-08 03-08 04-08 05-08 06-08 07-08Project Develop QFD Surveys Develop Patient New Present Print BeginKick off Patient house 1 Done Patient Menu Equip- To Menus Trial survey patients Screen Dev ment Medical In house Runs Done Ordered Staff QFD QFD Dev Begin Recipes Dev Dev Senior house 1 House 2 Patient Dev of Develop Recipes Substitu- Renewal Staff Done Diet Comm Done Con’t tion menus Order Plan List Pugh Begin Site Begin Dev Dev Staff matrix Dev. Of Visits Dev of Of Patient Training menu Done Job Training Data Descrip- Program Base tions Fishbone FMEA Begin Scripts Comm Work With Recipe Develop Plan area group? Dev Initiated Redesign Dev Dev Policy CallDone Group Process Service Updates center Map Hours Set-up1 2 3 LEAN PicturesMenu Comm Process Consult of menu items
Room Service SurveyWhat is your favorite breakfast food?What is your favorite main course?What is your favorite vegetable?What is your favorite fruit?What is your favorite dessert?What is your favorite beverage?What is your favorite snack?Once you have placed your meal order, how long shouldit take to receive it?What other suggestions/ideas do you have that couldhelp make this program successfully?
Menu DevelopmentPatient survey resultsStaff preferences-what do we do well?What can we prepare and deliver within 30minutes?Garnishing very importantRecipes testedPictures attached to recipes to assist withconsistency of presentation
Recipe ExampleRECIPE: Spinach & Cranberry SaladDIET: AllINGREDIENTS Side Entree Fresh spinach, bite-size 1 ½ oz. 3 ½ oz. Red onion, thinly slice ¼ oz. ½ oz. Feta cheese crumbles ½ oz. 1 oz. Mandarin oranges, drained 1/8 c. ¼ c. Dried cranberries ¼ oz. ½ oz.
Recipe ExampleRECIPE: Sun-Dried Tomato Chicken PORTION SIZE: 5 oz.DIETS: All PORTION TOOL: ScaleKCAL: 275GM FAT: 15 1 5 INGREDIENTS 10 6 oz. Boneless, skinless 1 5 10 chicken breast Sun-Dried Tomato ¼ cup 1 ¼ cup 2 ½ cups vinaigrette Garnish: parsley/kale & tomato
Education for Nursing StaffINFORMATION FOR NURSES REGARDING ROOM SERVICERoom service overview: Patient satisfaction initiative Name of program: “Meals Your Way” Patient is admitted and screened Diet order is entered Food Services brings a menu to the patient and explains the program Patients call the room service number to order between 0630 and 1830 each day Any item on the menu can be ordered at any time (breakfast for dinner, etc.).Standard Operating Procedure: attachedPatient screen: See next slideCommunication is very important: timely entry of NPO orders timely entry of status changes/rescreens (becomes eligible or ineligible for room service) timely entry of isolation statusMeds diabetics will receive meals at scheduled times so you will know when a tray is coming patients needing meds with meals should easily be accommodated since these need to be given 30 minutes before to 30 minutes after the meal
Room Service Ordering ScreenIs the patient alert and able to converse? Y____ N____Can the patient read and understand the menu? Y____ N____Is the patient able to order and use the telephone? Y____ N____If patient is diabetic, what are the home meal times?B______ L______ D______Diet as ordered: ______________________________________________Styrofoam needed? Y____ N____Calories: ___________ Fluid Restriction? Y____ N____cc per day: _______
Standard Operating Procedures (SOP) Standard Operating Procedure Room Service Operation Patient arrives to the nursing unit. Patient is screened (order) using the Room Service Screen Form (will place in admission packet) Rescreen as needed. If diabetic patient is identified, please follow the procedure below, if not, move to bullet # 4. Obtain the normal eating time for the patient at home (try to accommodate the patient times) Place times on the screen (using breakfast, lunch, and dinner) Adjust the accu-checks and/or medication times according to the meal delivery times Notify pharmacy of profile changes if needed (nurse needs to do this). Ward clerk/ Nurse given screen and entered as Meditech OE. Food Services processes order. Food Services visits patient, issues menu and explains Room Service process, etc (education is done). Patient places order. Food Services prepares tray and updates data base. Food Services delivers tray to the patient. Tray is picked up by Food Services and intake is documented on I & O sheet posted by Nursing staff.
SOPs Continued Standard Operating Procedure for Room Service CallsAnswer telephone before third ring.“Meals Your Way Room Service. This is ________. How may I help you?”Ask for name and room number.Check Kardex for diet order and special notes/restrictions.Take order making sure all items ordered fit within diet parameters. Also, be sureto ask about condiments, drinks, etc. appropriate to the meal.If diabetic, check carbs ordered. If too many, ask what they would like the most. Iftoo few, suggest other options to get them to their correct carb. level.Read the order back to the patient. “Is there anything else I can get for you?”“Thank you for calling Room Service. Your meal will be delivered in 30 minutes.”Prepare and deliver tray.Record time of delivery on data board.Deliver tray to patient checking name and birth date every time.Set the tray up. “Is there anything else I can do for you?”Pick-up tray 30 to 45 minutes after delivery. Record Intake.
SOPs Continued SOP for Patient VisitationDiet order is received and recorded on data base.Menu is selected to match patient diet and patient is visited.Knock on door.“Good day, I am ________ from the Food Service Dept. Is now a good time to talk to you about our“Meals Your Way” Room Service program?We hope that by ordering your own meals from our restaurant-style menu, at the times you choosethat we can provide a meal service that suits your needs.Let me point out some things about the menu: The phone number, 55EAT or 55328 is printed on the front of the menu and at the top on the inside Our hours of service are 6:30 a.m. until 6:30 p.m. You may order your meals at any time as long as you are not on a diabetic diet If you are on a diabetic diet, we will take your menu each day after breakfast for lunch, dinner and breakfast the next day. We will do this in order to provide consistent carbohydrates to you throughout the day and to adjust your insulin accordingly. The special menus have information specific to your diet. This information is listed here (show them).The phone is located here and this is the way to use it (show them).Do you have any questions? Please do not hesitate to call us if you have any concerns. Ournumber is 55EAT.We’re very proud that every meal will be cooked to order and our plan is to serve your meal to youwithin 30 minutes of receiving your order. However, since this is a brand new program, we hope thatyou will be patient with us if we encounter a few snags in the beginning.We will be checking back with you to be sure that you are completely satisfied with your meals and tosee how we can better serve you. We hope to provide the best meals and service to make your staymore pleasant.If you would like a copy of our menu, please ask your food server. We will be happy to provide youwith a take-home copy.Is there anything else I can do for you before I go?”
Patients Ineligible for Room ServiceRoom Service Host visits daily to assistwith menu selection.Meet with family members to assist withmenu selection, if possible.Status can change either way (from roomservice able to unable and back)
Job ResponsibilitiesEach position was reviewed withconsideration given to each of the jobs inthe department.Roles were reassigned as needed withcreation of new job descriptionsTraining was provided
Data BaseDeveloped for quick review of patientmeals statusMade sense because of our small bed size(licensed for 25 inpatient but total of 40beds) (OR recovery/observation/etc.)If patient misses one meal, we call thepatient to encourage them to eat.If patient misses two meals, we callnursing to notify them.
Follow Up for the ProgramFood Services staff complete 3 surveys each day usingthe following key phrases:“This is _______from the Food Service Department, isnow a good time to talk to you about your meal service?If “no”, ask if you may call back later.If “yes”, ask the questions below“Was your hot food hot and your cold food cold?Record concerns and offer to send something else.How would you rate your food?: Very Good, Good, orPoor?
Follow Up Continued Based on the answerVery Good Thank you, we take pride in what we do. You may be receiving a survey in the mail, please take a moment to let us know any comments you may have.Good What can we do to make it very good?Poor I’m sorry, is there anything I can get for you right now? How can I make it better?And finally“Thank you for assisting us in improving our meal service. Please do not hesitate to call if we can do anything for you.”