Missed part one? Read it here
Welcome back! In our last edition of Infuse, we were lucky enough to spend time with Sally McCray, APD, Director Mater Group Brisbane, to learn her role in creating and implementing Mater’s “Room Service” concept.
As a refresher, this highly innovative program lets inpatients across Mater’s campuses order from a menu, room service-style, across extended hours. While food choices remain in line with individual health and nutrition needs, these patients suddenly have access to a scrumptious array of offerings and, from a dietitian’s point of view, helps reduce food waste, better manage patients’ nutritional needs of their patients and heighten overall food quality. Truly, it’s a revolution in food service. So without further ado, let’s jump back into part two of our interview with Sally, where our conversation turns to challenges faced; results secured; and advice for those seeking to implement a similar program.
What has the biggest challenge been with the Room Service program to date, and how have you worked to overcome it?
One of the greatest challenges we have seen has been staff becoming familiar with this new, innovative model. As we were the first in Australia to implement room service, none of the staff had worked with this model before. It is quite a change for all staff — not only the foodservice staff producing and delivering the food, but also for clinical staff on the ward treating the patients.
Given that it is a very patient-centric model, whereby the patient decides when they will eat rather than having food delivered to them at set times, the hospital schedule needs to account for this and shift from being focused solely on the treating clinicians schedule to taking into account the patient’s preferences. All staff need to become familiar with the new food service model, including clinicians, such as nurses giving medication, physiotherapy or other allied health staff providing therapy to patients on the ward, and medical staff conducting ward rounds.
A patient can order food whenever they feel like it, and whilst this is often at usual meal times, it can also be between these times. We have seen patients ordering scrambled eggs at 3pm in the afternoon or a pizza at 11am. It also required a significant shift toIt also required a significant shift to embrace the use of technology in implementation of our electronic menu management system. Many of the previously manual tasks are replaced by this electronic system, which allows us to take personalised meal orders, track each meal delivery, and then monitor a patient’s meal order pattern and nutritional intake to ensure that their nutritional requirements are being met. This was a major change to the way we produce and deliver food, and has greatly enhanced the safety and clinical monitoring around our patients’ food intake.
Reduction of food wastage has been a benefit of the room service program. Was this intentional, or an unexpected yet positive side effect [and can you share any examples or stats on the percentages of reduction]?
There is typically significant food waste in traditional hospital foodservice models because patients orders are taken well in advance of meal times, and large amounts of food are produced in a bulk cooking model to be delivered at set meals time each day. With the room service or the “cook on demand” model, food is only produced when ordered and when a patient feels like eating; therefore, the significant food waste associated with the bulk cooking, long lead time forecasting models is expected to reduce. In addition to this, plate waste, which is well documented in the literature between 30-50%, is significantly reduced, as patients order when the feel like eating, and therefore eat almost all of the food that they have ordered.
Our research has shown that our overall average plate waste has reduced from 29% to 12%. Specifically, we have seen the greatest reduction in plate waste in groups that are typically the hardest to feed, such as the oncology group. This group saw a reduction from 34% to 6%. These reductions in waste contribute to significant cost savings for the organisation.
What advice would you have for dietitians in foodservice who may be seeking to implement a similar initiative at their institution?
Firstly, understand your clinical case mix or the type of patients that you have.
This not only helps to understand the types of diets or combinations of diets that your organisation may need which will inform you menu design, but also the specific symptoms that these groups may have that may impact on their nutritional intake and how they may benefit from a more flexible room service ordering model. The challenge is then to integrate all diets into the one a la carte restaurant style room service menu.
Secondly, the introduction of a comprehensive electronic menu management system is essential, ensure the capability required for safe and flexible meal ordering, meal tray tracking and nutritional intake monitoring. Shifting from a paper-based manual system to a fully electronic system is a significant challenge for many staff who may have worked in traditional foodservice models for a long time, so some technology readiness assessment is useful.
Thirdly, engage the whole multidisciplinary team from the beginning in the room service journey.
You will be surprised at how many staff, clinical as well as operational, are affected by the change — and everyone needs to be engaged in the new process redesign. And finally, make sure you have baseline data on your key outcome measures before starting your implementation. To be able to demonstrate both effectiveness and return on investment, it is important to be able to measure the change in these outcomes as key drivers of the move to a room service model.
LEARN MORE: • View a brief video to learn more about the Room Service Initiative. • View the news of Room Service’s rollout on the South Brisbane campus of Mater, including an accompanying video. • View the patient-facing information page on Room Service. • View the research behind Room Service.
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