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Associate involvement improves associate satisfaction
WEDNESDAY, OCTOBER 19 POSTER SESSION: QUALITY ASSURANCE/QUALITY IMPROVEMENT DO PATIENTS GET THE FOODS THEY ORDER? J.B. Manda, MS, RD; M.M.Lynch, MS, RD and S.H. Laramee,MS, RD, Department of Dietetics, Massachusetts General Hospital, Boston, MA Many aspects ofpatient satisfaction are regularly studied to improve quality ofpatient foodservce at Massachusetts General Hospital. This study was done to find out how well our current food selection and delivery system provides patents with the foods they have selected for meals. The system includes a prnted, restaurant-style menu with complete descriptions of all items, a brochure describing the week's daily specials for each meal, and a computer-generated, patent-specific scannable selection sheet. All of these elements are fumished by Nutrition Service Coordinators (NSC's), who assist patients with meal selections. They are also responsible for tray assembly, finishing, and service. Patents receiving meals on all non-ICU floors were candidates for infusion in the study. Each patient was interviewed by a manager or clinical dietitian. Trays, tray assembly tickets, and menu selection sheets were compared for all patents included in the study. Complete responses werereceived from373of 754 patients (50%). Most(93%)oftheremaining patients were in ICU's,not eating, unable to respond, discharged, out of the room, busy with other health care team members, or required meal delays. 48 patients (13.5%) reported that they didnotreceive whatthey ordered. 78% ofpatients said that theyunderstood how to complete the meal selection sheet. Over half (55%) of patients completed their selection sheets without assistance, while an additional 22% reported receiving assistance in completing meal selections. 9% of patents had asked someone else to complete the selection sheets for them. The remaining 14% of patients had not made meal selectons for that meal, and received a standard tray. Most common reasons for receiving a standard tray induded new admissions and diet changes.
THE IMPACT OF EDUCATION ON THE APPROPRIATE USE OF NUTRITION SUPPORT. V.L. McDonald, RD, K. Afrasiabi, RD, and D.M. Arquilla, RD, Meadville Medical Center, Meadville, PA of pa renteral and ex amined the appropriate use post-medical staff education. A Nutrition Support Committee (NSC), consisting of physicians, dietitians, nurses and pharmacists developed criteria for monitoring appropriate use of both enteral and parenteral nutrition. Included in the criteria were anthropometric on whether a and a section data and laboratory functioning gastrointestinal tract was documented. The indicators were studied for over one year and then ato were Studied for over one year and then a two-part educational program was planned and presented on both enteral and parenteral nutrition. Guest physicians and the NSC presented information and results on the appropriate use of these two nutrition support options. The indicators were again monitored for six more months (June - December 1993) and compared to this same time period of the previous year (June December 1992). The number of patients on parenteral nutrition decreased by 32% with a
Comparison of meal tickets with trays revealed 79 (21%) with discrepancies (tray assembly errors), mostof whichwereof a mrnornature. 35mealtickets (9%)didnotmatchselection sheets. Sources of discrepancy included diet order changes (3%) and adjustments to meet diet order(2%). 59 patients (16%)had no selection sheets at thetime of the survey. Of patients who stated that they did not receive what they ordered, 13 ofthese patients (27%.) actually did receive what they had ordered. Twelve (25%) had tray assembly errors, and 21 (44%) received standard trays. The survey results were used to focus quality improvement efforts on tray assembly, both in the trayfine and in the galley, and to underline the importanceof a newcomputersystemcurrentlyunderconsideration. Thenew computer system, which allows diet changes to occurwithout deleting patient meal selections, should result in a 10% improvement in patients receiving meal selections. Meal adjustments to meet diet orders, which were hypothesized to be a source of dissatisfacton, were not found to have a large effect on patients receiving selections.
criteria for justified use of parenteral nutrition. The projected cost savings, per year, of using enteral versus parenteral nutrition on this number of patients (29), for an average of two weeks, would be estimated at The data suggests that increased > $76,400. awareness and continuing education may improve the appropriate use of nutrition support modalities. As a result of this study, a Nutrition Support Team is being considered.
QUALITY ATTRIBUTES USED BY CUSTOMERS, MANAGERS AND SERVICE PROVIDERS IN UNIVERSITY FOODSERVICE. P.S. McMahon, PhD,RD, Department of Nutrition and Food Science, University of Kentucky, Lexington, KY, and Janet M. Noble, PhD, Department of Home Economics, University of Arkansas, Fayetteville, AK The purpose of this study was to identify and quantify the attributes that are used to measure service quality in university foodservice by customers, managers, and service providers. A service quality survey instrument was developed and pilot tested. The instrument included five point rating and importance scales of twenty-eight attributes. Surveys were distributed using convenience sampling techniques to the four state universities in Kentucky who were non-contract operations and members of NACUFS. Surveys were returned by 51 managers, 75 service providers and 1047 customers, representing response rates of 81.3%, 59.4% and 83.7%. Data analysis included univariate statistics on the attitude and behavior item scores, reliability of the items using Cronbach's coefficient alpha, and a principal factor analysis of the attitude scale using an orthogonal varimax rotation. Tangible attributes were rated highest by the customer, including available seating, convenient locations, neat and clean employees. The attributes that were rated the most important also related to the tangible dimension of service quality. Factor analysis of customer surveys identified four factors, described as product, information, facility, and people. The highest mean quality rating scores by employees were variety in types of services, available seating, clean and neat employees, convenient operating nours, and food preparation presents no health hazards. Importance racing for employees were skewed in the very important range. The two most important attributes were related to safety and sanitation. This study represented an initial investigation into quality attributes usen y managers, service providers and :customers in ul-nvrsltr¥ foodservice. The limited sample uhat was studio cndicsted tliat the tangible attributes of quality represent the most mportant dimension when evaluating quality in a university foodservice setting.
A-46 / SEI'TEMBER 1994 SUPPLEMENT VOIUME 94 NUMBER 9
5% increase of cases meeting established
ASSOCIATE INVOLVEMENT IMPROVES ASSOCIATE SATISFACTION. H. Mullan, MBA, RD, LD, S. Miller, RD, LD, CNSD, V. Muscalli, RD, LD, B. Keith, RD, LD, The Johns Hopkins Hospital and the Marriott Corporation, Baltimore, MD For hospitals to keep pace with a changing environment, associates (employees) must have a high level of job satisfaction, feel secure with the organization and management, and understand their role and importance to the organization. Associate involvement is a process the Department of Nutrition started in 1991 to develop teamwork and challenge our associates to be more involved in work place decisions. We formally evaluated associate satisfaction in 1992 to determine their perceived level of involvement in the Department. Questions included use of their opinions, management's concern for them, management trust in their decisions, and happiness with their job. With this information, the Department hoped to form a base from which to move the employees out of entitlement and into empowerment. Survey results between 1992 and 1993 improved by 12%. The dietitian assistants responsible for tray service and menus demonstrated the highest level of improvement, 32;%. The results of the original survey indicated the dietitian assistants had some concerns about their job. They did not feel their ideas were used or they were rewarded for good performance. We started by asking them for input and involving them in total quality management projects. For the staff who felt uncomfortable sharing ideas as part of a team, a suggestion box was implemented. The ideas obtained were discussed at an open meeting, and when possible, were used in problem resolution. As the staff recognized their ideas were worthwhile, ideas came forth. While their willingness to share ideas was improving, it was necessary to increase recognition for good performance. Quarterly recognition meetings were held, where those who excelled in various aspects of their job were rewarded. These aspects included perfect attendance, accuracy of job performance, and volunteering or performing beyond the scope of their job. Recognition was given to those associates whose names were mentioned in the patient and nursing satisfaction surveys. This recognition enhanced the merit-based performance evaluation that was in place. The managers recognized that self-confidence in the staff's decision-making needed to be developed. Sessions were held which involved the associates discussing various aspects of their jobs with a consultant from outside the Department. These sessions ended with role playing that involved the associates' interactions with the patients, nurses, and physicians. As a result of their involvement in the quality aspects of their job, the associates are more secure in making recommendations and more confident in their role in the care of the patient.
THE IMPACT OF EDUCATION ON THE APPROPRIATE USE OF NUTRITION SUPPORT. V.L. McDonald, RD, K. Afrasiabi, RD, and D.M. Arquilla, RD, Meadville Medical Center, Meadville, PA of pa renteral and ex amined the appropriate use post-medical staff education. A Nutrition Support Committee (NSC), consisting of physicians, dietitians, nurses and pharmacists developed criteria for monitoring appropriate use of both enteral and parenteral nutrition. Included in the criteria were anthropometric on whether a and a section data and laboratory functioning gastrointestinal tract was documented. The indicators were studied for over one year and then ato were Studied for over one year and then a two-part educational program was planned and presented on both enteral and parenteral nutrition. Guest physicians and the NSC presented information and results on the appropriate use of these two nutrition support options. The indicators were again monitored for six more months (June - December 1993) and compared to this same time period of the previous year (June December 1992). The number of patients on parenteral nutrition decreased by 32% with a
Comparison of meal tickets with trays revealed 79 (21%) with discrepancies (tray assembly errors), mostof whichwereof a mrnornature. 35mealtickets (9%)didnotmatchselection sheets. Sources of discrepancy included diet order changes (3%) and adjustments to meet diet order(2%). 59 patients (16%)had no selection sheets at thetime of the survey. Of patients who stated that they did not receive what they ordered, 13 ofthese patients (27%.) actually did receive what they had ordered. Twelve (25%) had tray assembly errors, and 21 (44%) received standard trays. The survey results were used to focus quality improvement efforts on tray assembly, both in the trayfine and in the galley, and to underline the importanceof a newcomputersystemcurrentlyunderconsideration. Thenew computer system, which allows diet changes to occurwithout deleting patient meal selections, should result in a 10% improvement in patients receiving meal selections. Meal adjustments to meet diet orders, which were hypothesized to be a source of dissatisfacton, were not found to have a large effect on patients receiving selections.
criteria for justified use of parenteral nutrition. The projected cost savings, per year, of using enteral versus parenteral nutrition on this number of patients (29), for an average of two weeks, would be estimated at The data suggests that increased > $76,400. awareness and continuing education may improve the appropriate use of nutrition support modalities. As a result of this study, a Nutrition Support Team is being considered.
QUALITY ATTRIBUTES USED BY CUSTOMERS, MANAGERS AND SERVICE PROVIDERS IN UNIVERSITY FOODSERVICE. P.S. McMahon, PhD,RD, Department of Nutrition and Food Science, University of Kentucky, Lexington, KY, and Janet M. Noble, PhD, Department of Home Economics, University of Arkansas, Fayetteville, AK The purpose of this study was to identify and quantify the attributes that are used to measure service quality in university foodservice by customers, managers, and service providers. A service quality survey instrument was developed and pilot tested. The instrument included five point rating and importance scales of twenty-eight attributes. Surveys were distributed using convenience sampling techniques to the four state universities in Kentucky who were non-contract operations and members of NACUFS. Surveys were returned by 51 managers, 75 service providers and 1047 customers, representing response rates of 81.3%, 59.4% and 83.7%. Data analysis included univariate statistics on the attitude and behavior item scores, reliability of the items using Cronbach's coefficient alpha, and a principal factor analysis of the attitude scale using an orthogonal varimax rotation. Tangible attributes were rated highest by the customer, including available seating, convenient locations, neat and clean employees. The attributes that were rated the most important also related to the tangible dimension of service quality. Factor analysis of customer surveys identified four factors, described as product, information, facility, and people. The highest mean quality rating scores by employees were variety in types of services, available seating, clean and neat employees, convenient operating nours, and food preparation presents no health hazards. Importance racing for employees were skewed in the very important range. The two most important attributes were related to safety and sanitation. This study represented an initial investigation into quality attributes usen y managers, service providers and :customers in ul-nvrsltr¥ foodservice. The limited sample uhat was studio cndicsted tliat the tangible attributes of quality represent the most mportant dimension when evaluating quality in a university foodservice setting.
A-46 / SEI'TEMBER 1994 SUPPLEMENT VOIUME 94 NUMBER 9
5% increase of cases meeting established
ASSOCIATE INVOLVEMENT IMPROVES ASSOCIATE SATISFACTION. H. Mullan, MBA, RD, LD, S. Miller, RD, LD, CNSD, V. Muscalli, RD, LD, B. Keith, RD, LD, The Johns Hopkins Hospital and the Marriott Corporation, Baltimore, MD For hospitals to keep pace with a changing environment, associates (employees) must have a high level of job satisfaction, feel secure with the organization and management, and understand their role and importance to the organization. Associate involvement is a process the Department of Nutrition started in 1991 to develop teamwork and challenge our associates to be more involved in work place decisions. We formally evaluated associate satisfaction in 1992 to determine their perceived level of involvement in the Department. Questions included use of their opinions, management's concern for them, management trust in their decisions, and happiness with their job. With this information, the Department hoped to form a base from which to move the employees out of entitlement and into empowerment. Survey results between 1992 and 1993 improved by 12%. The dietitian assistants responsible for tray service and menus demonstrated the highest level of improvement, 32;%. The results of the original survey indicated the dietitian assistants had some concerns about their job. They did not feel their ideas were used or they were rewarded for good performance. We started by asking them for input and involving them in total quality management projects. For the staff who felt uncomfortable sharing ideas as part of a team, a suggestion box was implemented. The ideas obtained were discussed at an open meeting, and when possible, were used in problem resolution. As the staff recognized their ideas were worthwhile, ideas came forth. While their willingness to share ideas was improving, it was necessary to increase recognition for good performance. Quarterly recognition meetings were held, where those who excelled in various aspects of their job were rewarded. These aspects included perfect attendance, accuracy of job performance, and volunteering or performing beyond the scope of their job. Recognition was given to those associates whose names were mentioned in the patient and nursing satisfaction surveys. This recognition enhanced the merit-based performance evaluation that was in place. The managers recognized that self-confidence in the staff's decision-making needed to be developed. Sessions were held which involved the associates discussing various aspects of their jobs with a consultant from outside the Department. These sessions ended with role playing that involved the associates' interactions with the patients, nurses, and physicians. As a result of their involvement in the quality aspects of their job, the associates are more secure in making recommendations and more confident in their role in the care of the patient.