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Beyond ‘Hospital Food’

By Hadley Turner

Hospitals are making strides in improving patient satisfaction through more healthful—and tastier—food options.

At age 23, Erica was diagnosed with a rare kidney disease that required a several-month hospital stay, during which she longed to go home to sleep in her own bed and enjoy her mother’s delicious home-cooked meals. She was tired of eating hospital food.

Five years later, Erica is healthy and receives the ongoing treatments she needs to stay well, and generally, she eats what she wants within certain limits.

But what about the hospital food she ate for all those months? Have the offerings changed? It’s likely the answer is “Yes.”

For hospitals today, patient satisfaction has never been a higher priority. Following the passage of the Affordable Care Act in 2010, a shift has occurred in the way hospitals are reimbursed for their services. Traditionally, the Centers for Medicare & Medicaid Services (CMS) reimbursed health care providers based on the volume of services they provide (eg, per mammogram). Now, however, hospitals largely are paid based on the quality of their patient care. Providers are expected to quantitatively measure patient satisfaction and report these data to CMS, which reimburses based on these figures.1

While many factors impact patient satisfaction, foodservice in particular plays a large role in hospital inpatients’ quality of life. Unfortunately for patients and hospitals alike, negative stereotypes of hospital foodservice traditionally have held true. Patients typically have been restricted to ordering and eating meals within specific, often short, time frames from limited menus. But those patterns of thinking and methods of foodservice are changing in this era of improving patient satisfaction.

Just Like Home
One recent major change in health care foodservice has been the transition to hotel room service-style meal ordering for hospital inpatients and restaurant-quality offerings for inpatients, visitors, and staff. This makes inpatients feel at home and improves their quality of life, which is especially important for those suffering from chronic conditions that require long hospital stays.

“The flexibility [of the room service model] helps keep [patients] more relaxed,” says Michael Tolliver, vice president of operations at ABM Healthcare Support Services, a facility management service provider that has consulted with numerous health care facilities to help them improve their foodservice. “They have the ability to have breakfast at 5 in the evening, if they want it. The menu variety and flexibility of eating when they want to eat as opposed to having a set menu time—these things are appealing.”

Mercy Medical Center in Des Moines, Iowa, is among the hospitals that have used ABM’s services to improve patient satisfaction through tastier and more healthful food choices. According to Ron Muecke, MPA, vice president of facilities and support services at Mercy Medical Center, Mercy made the decision to change their foodservice style about 10 years ago. Before, they served mostly the same food to their inpatients at predesignated times. Today, Mercy’s foodservice system functions more like a restaurant, with made-to-order meals served at almost any time of day. 

“We’re not doing the traditional batch-cooking [in which] you make bulk food ahead of time and all at one time,” Muecke says. “In room service, you make it to order. In a big institution like this where we serve 1,300 patient meals a day, that’s kind of a stretch for a room service concept, but we’ve been able to make it work even at these high volumes.”

Mercy’s room service menu is available from 6:30 AM to 6:30 PM and includes a wide variety of foods. Daily specials are offered for lunch and dinner, and the rest of the menu includes options from salads and build-your-own sandwiches to veggie burgers and quesadillas. Mercy’s menu also boasts personal pizzas, soups, pasta dishes, stir-fries, and vegetables, along with traditional breakfast fare including baked goods, cereal, fruit, and eggs.

Muecke says the quality and presentation of the food has been the primary goal in improving food options and, consequently, patient satisfaction. “People don’t think of great food when they go to a hospital; generally speaking, it’s not what [they] expect,” he says. “That is our avenue for providing extraordinary service and a great experience. If you have terrific food, you’re not going to talk about patient care necessarily, but you’re going to talk about something you didn’t expect, and that is great food.” He adds that while patients may not always be able to interpret the quality of their medical care, “everybody is an expert on what tastes good and what looks good to them.”

For Pleasure and Health
Choosing food served to inpatients and sold in Mercy’s staff and visitor cafeteria and cafés is a balancing act between pleasure and health. “We try to stay healthy but popular,” Muecke says, referring to many Midwestern patients’ preferences for traditional stick-to-your-ribs dishes like Salisbury steak and mashed potatoes. “It’s a bit of a balance. We do serve some traditional comfort food, but we try to maintain a healthy aspect” by offering a variety of healthful menu options.

One way in which Mercy maintains healthful menu options is by working closely with a dietitian who uses nutrition software to ensure the healthfulness of both regular entrées and meals for patients with medically restricted diets, according to Mary Jo Kurko, MPH, RD, LDN, director of nutrition services at ABM.

In addition, Mercy works with the Partnership for a Healthier America (PHA), a nonprofit organization that works with the private sector to develop strategies to end childhood obesity. As part of PHA’s Hospital Healthier Food Initiative, hospital foodservice operations make commitments to meet PHA standards for meals.

Mercy’s foodservice program almost met PHA’s requirements before they signed on. According to Kurko, they simply had to add more fruit options to meals. As part of their partnership with PHA, all menu items also include a list of nutrition information. “We’re making sure everybody is aware of the contents of the food when it comes to the nutritional value of everything,” Muecke says. “We have that [information] on our menus, and we talk to our [patients] about it.”

Kurko adds, “[Mercy’s] patient menu has some comfort foods and some foods that are popular in Iowa,” such as mashed potatoes, ice cream, biscuits and gravy, and Salisbury steak, “but there’s always a PHA-sanctioned meal choice for the patients in addition to that.” Mercy also offers half-portions of menu choices high in sodium and/or cholesterol, including bacon, scrambled eggs, and macaroni and cheese.

Investing in Satisfaction
While Mercy’s efforts to improve their foodservice operation required significant investments of time, money, personnel, and creativity, their work has paid off, Muecke says.

“It all goes back to reimbursement,” he says. “It touches everything we do.” And currently, while there are no food-related questions on CMS’ patient satisfaction questionnaire for reimbursement and health care provider ratings, Muecke says, there’s an overall patient satisfaction that he thinks quality food impacts. “It’s a good opportunity to raise the bar on [patients’] overall satisfaction.”

In addition to receiving greater reimbursements, Muecke says their made-to-order model of room service (as opposed to the bulk-preparation method), has greatly helped reduce Mercy’s food waste as well—a good outcome for both the hospital and the environment.

Mercy works with LeanPath, a food waste reduction consultant, to minimize food waste. Mercy physically weighs food waste every day to keep track of its progress and apply better strategies to further decrease it. “I would [estimate] that since we started this program [four or five years ago], we’ve reduced our waste by 75%,” Muecke says.

As gratifying as all these benefits are, Tolliver believes that CMS will add food-related questions to patient satisfaction questionnaires and that hospital foodservice will continue to improve: “We think a [food-related question] is coming around the corner. It all ties to reimbursement.”

— Hadley Turner is an editorial assistant for Today’s Dietitian.

1. Know the challenges: value-based reimbursement vs. volume-based care. McKesson website. http://www.mckesson.com/population-health-management/population-health/know-the-challenges/. Accessed May 18, 2016