October 2012 Issue
Meal Service With a Personal Touch — A VA Medical Center’s New, Innovative Program Wins Gold
By Lori Zanteson
Vol. 14 No. 10 P. 24
Just over a year ago, the nutrition and food services team at G. V. (Sonny) Montgomery VA Medical Center in Jackson, Mississippi, did something courageous and nothing short of monumental: The team revitalized its inpatient meal service program to improve the culinary experience of its veterans.
Thus far, the innovative program has raised customer satisfaction by providing veteran-centered meals with a personal touch and has become a Gold Award winner, the highest honor ever received from the Veterans Integrated Service Network (VISN).
Tricia Mathias, MS, RD, chief of nutrition and food services, spearheaded the veteran-centered meal program, which staff members embraced from the outset as they worked to make it successful. Foodservice workers, cooks, and supervisors stepped out of their comfort zones to abandon what they’d been doing for many years and instead use their individual strengths and abilities to ensure a team commitment. More than just changing the menu, this team overhauled its processes, and the results have been more satisfying than anyone could’ve expected.
To provide veteran-centered meals, the medical center reexamined its conventional tray line delivery system, a process that involved foodservice personnel assembling meals on trays in a kitchen that resided several floors away from patients. Foodservice workers loaded the assembled meal trays onto carts, wheeled them to the individual floors, and delivered them—a task that required minimal interaction with patients.
Meals were preordered one day or hours before they were served, and there was little variety. Patients received meal choices based on their initial interview about food preferences when they first arrived at the hospital. And whether they liked it or not, they received the same types of foods each day. For example, at dinnertime patients always received a meat, starch, vegetable, salad, and dessert.
Mathias wanted to eliminate the tray line system, increase menu choices, and introduce a more personalized meal service for veterans that would allow them to order a wider variety of foods directly from the foodservice staff in the comfort of their rooms. She did some research on equipment that would enable workers to serve meals room to room and converse with patients one on one. Eventually, she made a proposal to purchase mobile service carts that would allow the food to be served to veterans on the wards and in the dining room. They’d be able to choose their meals on the spot based on what they desired at that moment and be served right away.
“When you’re in the hospital,” Mathias says, “doctors and nurses decide everything for you. You don’t feel like you have much say. This system gives veterans the opportunity to control their mealtimes and maybe even make it a little fun.”
Because the medical center is an acute care facility that offers various services, Mathias could purchase six mobile servers and six hostess carts plus another mobile server in the main kitchen to serve the intensive care and critical care units, outpatients, and late diners. All together, 200 inpatients are served at each meal.
The mobile service carts are equipped with built-in ovens to heat and keep food warm as well as refrigerated sections for cold storage. Because foodservice personnel can wheel the carts right up to a patient’s room and they have space for plating food to order, meals are served on request and at the desired temperature. Hostess carts travel alongside the servers to provide coffee, condiments, dishes, and other accoutrements.
The staff of cooks, who Mathias says “really stepped up,” streamlined making the transition from the tray line system to mobile carts. With the tray line, the cooks would prepare one main item per meal, but with the carts, they’re able to prepare several. “They accepted the challenge,” Mathias says. “There are now several new foods, and we tried a lot of new recipes. They were wonderful about thinking outside the box.”
While it’s often difficult to prepare a wider variety of foods, Mathias says it’s been more than worth it for the veterans. “We wanted them to have the opportunity to decide right then,” explains Mathias, who’s sensitive to patients’ changing needs. When choosing their food ahead of time, the veterans couldn’t predict the possibility that they might not be feeling well enough to eat that particular meal or that they might be hungry for something different than what they ordered. Taking this into consideration was one way Mathias and her team were able to improve patient care.
Despite the wider variety of menu items offered, food waste has leveled off. With the tray line system, patients received food items whether they wanted them or not. What they didn’t eat was thrown away. However, with the new meal delivery system, veterans choose only the foods they want. If they don’t want a salad, they don’t take it. And if they don’t like carrots, they can choose green beans instead. When Mathias and her team compared the amount of food consumed using the tray line system to the new system, they found that salad consumption increased from 21% to 66%, and vegetable intake rose from 38% to 80%.
The medical center always has followed the Veterans Health Administration Healthy Diet Guidelines, but the new meal program has made it easier and more enjoyable for veterans to make the best food choices and adhere to special diets. For example, a diabetes patient will want a sweet treat every now and then. And while a dietitian may advise against it and suggest fresh fruit instead, the decision lies with the patient. But it’s now easier for the patient to make the right food selection because there’s more variety of healthful choices.
“With more [foods] available,” Mathias says, “we haven’t had many issues. In fact, the variety has really turned the tables—even when it comes to the Friday fried catfish. The not-so-healthy southern staple has been a mainstay for years, but once it had a little competition with healthier options like teriyaki grilled fish and fish with lemon sauce, [the staff] was surprised there were so many takers.”
The new meal delivery system was born from Mathias’ vision that sprung from her core belief that “our veterans deserve the very best.” Mathias conveyed her enthusiasm about her vision, and it became a tangible reality when she submitted the program to be nominated as a best practice by the VISN. The program was scored according to innovation, effectiveness in customer satisfaction, efficiency, and sustained successful outcome for six months with supporting data. After the VISN evaluated Mathias’ program and those of 10 other facilities, it named the G. V. (Sonny) Montgomery VA Medical Center the winner and gave the hospital a gold medal and $50,000. This was “the first [medal] our VISN has ever given out,” Mathias says. “We were very thrilled!”
Mathias hasn’t decided how to spend the prize money yet, but she’s considering allocating it for employee education and training, new uniforms, and small equipment purchases. “We’re not used to having this extra money,” Mathias says.
But no matter how they allocate the funds, one thing’s definitely clear: The team at G. V. (Sonny) Montgomery will continue to focus on enhancing the care of its veterans.
— Lori Zanteson is a food, nutrition, and health writer based in southern California.