Problem Statement

Feedback suggested there were issues with the hospital food service, with the assumption that all of these issues stem from the service provided by Compass.

However, further analysis of the patient comments indicated that there were potentially issues at various other steps in the system for ensuring the correct meal is ordered for the patient.

Examples of the feedback received are difficulties in obtaining correct special diets, incorrect meal orders and around the quality of the food, in particular the taste and appearance of meals. Incorrect meals for cultural and religious requirements were noted as a particular issue.

What are we trying to achieve?

Our goal is to ensure patients receive the correct meal for their therapeutic, cultural and religious requirements.

It quickly became evident that there was a hospital-wide issue, affecting achievement of this goal, with several other factors involved along with the input from the Compass food service.

What have we done?

We have taken several steps to improve the service for patients. Our investigations indicated that the ward process for ordering of meals – for the correct diet type and on time – was just the beginning of the issue. Our plan was based on getting it right in the wards as the first step.

We attended the nursing Friday Focus sessions, and developed easy guides on the process for ordering meals to keep beside the computers on the wards and an interactive e-learning module. The process starts with asking the patient what their food requirements are.

These initiatives have been followed up on the wards by the healthcare assistant from the Acute Dietetic team who has moved around the wards updating the staff responsible for ordering the meals.

With Compass, we have arranged for meal orders to be taken directly from the patients, once the diet type order has been confirmed by the ward. This ensures patients can only be offered menu items that are compliant with their diet type order. We have also looked at processing menu orders, and checking the menu order against what is on the completed trays at the end of the tray line. Our discussions with Compass on production issues are ongoing.

What did we find?

Improvements on the ward have been small, and in some areas are better than others. Cultural and religious requirements have been most improved. Therapeutic requirements, especially when not specifically required for the current admission (eg allergens) are often not ordered.

In production, there have been ordering shortfalls, as well as supplier product availability issues.

Gaining traction has been made more difficult with a change of the two Compass Food Service managers at Middlemore Hospital and a three-month vacancy for the food service manager for the Manukau SuperClinic food service and the satellite sites.

How did we make a difference?

We have potentially made some difference.

This assumption is based on patient feedback comments gathered from the Cemplicity post-discharge survey. Each month, there are more comments that include a positive note. Negative comments are still represented, but do not dominate to the extent they previously did.

Where to from here?

There is an opportunity to promote correct meal ordering processes, as the Trendcare diet order module is introduced. The meal ordering material for ward staff will be updated with Trendcare references.

We will continue to work with Compass to improve production process issues. Achieving any significant changes to the menu to address cultural preferences is more difficult, as CM Health is just one of six district health boards signed to the current FSA contract requiring the same menu to be in place. The individual DHB patient demographics are all very different presenting a menu planning challenge.

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