A systematic review of hospital foodservice patient satisfaction studies

The association between patient-reported experiences with hospital food services and recovery outcomes - A population survey of patients from 75 public hospitals

BACKGROUND

The quality of food service is vital to patients' experiences in care and recovery in hospitals. This study aimed to identify opportunities for improving hospital food services to enhance overall patient experiences and outcomes.

METHODS

This retrospective cross-sectional study uses the Adult Admitted Patient Survey in 2019. Adult patients discharged from acute or rehabilitation care across 75 public hospitals were surveyed about their in-hospital experiences, including ratings of hospital food services, overall ratings of hospital care, complications acquired, and delayed discharge due to feeling unwell. Population weighting was applied in descriptive and multivariable logistic regression analyses. We used adjusted odds ratios (AORs) and 95% confidence intervals (CIs) to estimate the association between hospital food service and the overall rating of hospital care and two recovery outcomes.

RESULTS

Eight in ten participants (weighted, 16,919/21,900) consumed food in a hospital [mean age: 60.6 years (SE:0.5; SD: 18.3), 53% female]. Compared to a fair rating, adults who rated "poor/very poor" of hospital food service were 2.7 times more likely to report dissatisfaction with overall care in the hospital [Adjusted Odds Ratio (AOR) (95% CI): 2.73 (1.49, 4.99)], 1.4 times more likely to report complications [AOR:1.43 (1.11, 1.83)] and 1.9 times more likely to report delayed discharge [AOR 1.85 (1.30, 2.62)]. More moderate ratings were associated with attenuation of risk for these outcomes. Furthermore, the magnitude of the effect for these associations was more substantial among patients from non-English-speaking backgrounds (n = 1,759) after controlling for patient characteristics. Food service attributes, including received food as ordered, food delivered within reach, the taste of the meals, and meal interruption, were significant factors for the outcomes assessed.

CONCLUSION

These findings underscore the importance of patients' positive experiences of hospital food service in recovery outcomes and identify several food service indicators that can be used to monitor and improve patient experiences and recovery outcomes in hospitals.

Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey

BACKGROUND

The COVID-19 pandemic is bringing about substantial changes in health care systems, leading to a significant shift toward telemedicine for the delivery of health care services.

OBJECTIVE

This study aims to examine the relationship between perceived usefulness and ease of use of telemedicine services and their association with the behavioral intention to use telemedicine.

METHODS

An anonymous cross-sectional survey was conducted in China. Partial least squares structural equation modeling was used to determine significant predictors of intention to use telemedicine consultation. Types of illnesses that favored seeking telemedicine consultation, as well as the most preferred platform for conducting telemedicine consultations, were also investigated.

RESULTS

In total, 1006 participants completed the survey. A total of 44.3% (n=446) reported being very likely and 49.3% (n=496) reported being likely to seek telemedicine consultation. Overall, the majority of participants expressed strong agreement or agreement regarding the perceived usefulness of telemedicine. Likewise, the majority indicated strong agreement or agreement when it came to their perception of the ease of using telemedicine. In the partial least squares structural equation modeling, perceived usefulness (β=0.322; P<.001) and perceived ease of use (β=0.118; P=.01) were significantly associated with a higher likelihood of seeking telemedicine consultation. A considerable number of participants expressed willingness to use telemedicine services for various medical conditions, particularly respiratory (n=340, 33.8%), skin (n=316, 31.4%), and musculoskeletal issues (n=316, 31.4%) while showing less interest in seeking telemedicine consultations for reproductive health (n=44, 4.4%) and cancer (n=64, 6.4%). The majority preferred video chat (n=443, 44%) and text chat (n=317, 31.5%) as their most preferred platforms for telemedicine consultation, while a smaller proportion preferred telephone (n=193, 19.2%) and email (n=53, 5.3%).

CONCLUSIONS

Telemedicine has the potential to play a larger role in China's health care system. The preferences for certain platforms over others may influence service design and implementation.

Development and Psychometric Test of the Inpatients Experiences Measurement Scale (IEMS)

Purpose

In South Korea, hospitalized patients' experiences significantly impact satisfaction and treatment outcomes. This study developed and evaluated the Inpatients Experience Measurement Scale (IEMS) for its psychometric properties.

Patients and Methods

Participants from three hospitals were recruited using convenience sampling. Scale item generation involved patient interviews and a Delphi survey with experts. Psychometric testing used Exploratory Factor Analysis (EFA) with 150 participants and Confirmatory Factor Analysis (CFA) with 151 participants.

Results

A total of 301 patients participated, resulting in a 20-item scale across four factors: "Care Quality and Information Provision", "Patient Safety and Dietary Services", "Facility and Comfort Infrastructure", and "Comprehensive Patient Support Services". Rated on a 5-point Likert scale, the scale showed a high Content Validity Index (CVI) over 0.80. EFA explained 61.43% of the variance. The four-factor model was validated using CFA with favorable fit indices. The IEMS demonstrated strong convergent validity, supported by high composite reliability (CR) and average variance extracted (AVE) values. Significant correlations with the Patient Satisfaction Scale reinforced its convergent validity. Discriminant validity was confirmed, and all reliability measures exceeded the minimum threshold of 0.80.

Conclusion

The IEMS effectively captures inpatients' experiences, demonstrating robust reliability and validity. This scale is a valuable tool for assessing patient experiences, facilitating enhancements in patient care and satisfaction within hospital settings.

Evaluating Patient Experience with Food in a Hospital-Wide Survey

Purpose: Patient dissatisfaction with hospital food is an important driver of poor food intake in hospitals. The objective of this study was to examine patient satisfaction with current menu offerings and explore patient preferences and values, in order to inform a patient-centred menu redesign.Methods: Between July and September 2021, a cross-sectional survey was distributed to inpatients receiving a lunch tray at Vancouver General Hospital, a large tertiary care centre in Vancouver, Canada. The survey was based on the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire, with additional questions on food experience, factors impacting preferences for hospital meals, interest in plant-rich diets, and demographics.Results: The response rate was 5.5%, with 271 patients completing at least part of the survey. On a 5-point Likert scale, (5 - highest score; 1 - lowest score) satisfaction with food quality (mean = 3.09, p < 0.001) and the overall experience (mean = 3.54, p < 0.001) was lower than industry benchmark of 4, and qualitative feedback was generally negative. Open-ended responses indicated patients were interested in expanded cultural diversity in food provision, more fresh produce and better flavours, and were generally open to trying plant-rich foods.Conclusions: A number of opportunities for improvement were identified in this survey, which will inform an upcoming menu redesign in this institution.

Family Caregivers' Role in Navigating Diet: Perspectives from Caregivers of Older Asian Americans

Family caregivers uphold significant healthcare responsibilities including language translation and diet management. This study sought to understand family caregivers' experiences and challenges navigating and managing their older Asian American relative's diet. We conducted an exploratory sequential mixed-methods study with family caregivers involving (1) qualitative interviews (n = 40) and (2) a nationwide survey (n = 100). Interviewees discussed their role and challenges with (a) applying American/Western clinical dietary recommendations to their relative's traditional meal preferences and (b) managing misalignment between their relative's traditional dietary preferences and the food offered in hospitals and long-term care environments. Survey responses triangulated; almost 65% of family caregivers prepared and brought traditional meals to healthcare facilities upon observing a lack of culturally relevant food options. Culturally relevant nutrition training for family caregivers can help them support their relative in community settings. Creating an inclusive healthcare system requires transforming the food environment within healthcare facilities.

Assessing nourishment problems at a hospital: what can we learn from them?

INTRODUCTION

Patient safety is a high priority in the Danish health care system, including that hospital patients get the proper nutrition during their stay. A Nutrition Committee at Odense University Hospital is responsible for policy regarding nourishment at the hospital. If patients experience suboptimal treatment, i.e. improper nourishment, in the Danish health care system, they have the right to file a complaint. These complaints enable the improvement potentials based on the patients' first hand experiences. Therefore, our aim was to examine the nutrition complaint pattern and to get a deeper understanding of the context surrounding nutrition problems, allowing the extraction of learning potentials.

METHODS

We analysed complaints submitted to Odense University Hospital between 2018 and 2022 using the Healthcare Complaint Analysis Tool. The complaints were categorised into categories, levels of severity and overall patient harm. The complaints containing a high-severity nutrition problem were read through and thematised into aspects not defined in the Healthcare Complaint Analysis Tool.

RESULTS

Between 2018 and 2022, 60 complaint cases containing 89 nutrition problems were filed to Odense University Hospital. Most (58.3%) of these were filed by the patients' relatives. The nutrition problems were mostly of low severity (56.2%), while 23.6% were severe, and 20.2% were very severe. The reading of 18 very severe nutrition complaints revealed a cascade of problems triggered by the nutrition problem in six cases. Moreover, we saw that two high-severity nutrition problems led to catastrophic harm.

DISCUSSION

A low proportion of nutrition problems may express an underestimation regarding nourishment at the hospital. A patient's threshold may not be exceeded by suboptimal nutrition and therefore does not file a complaint. However, complaints contain important insights contributing to wider learning, given that improvements at the hospital so far are based on clinicians' reporting, overlooking the patient perspective.

'On-Demand' snack service in a rehabilitation setting: Impact on satisfaction, intake, waste and costs

AIM

To evaluate an 'On-Demand' snack service in a rehabilitation setting for satisfaction, intake, waste and cost.

METHODS

In September 2021, a trial of an 'On-Demand' snack service was conducted on two general rehabilitation wards in a purpose-built rehabilitation hospital. A retrospective comparison of pre-implementation, 1-month and 8-month post-implementation audit data was used to evaluate staff and patient satisfaction, nutritional intake, waste and cost (labour and food). Descriptive and inferential statistical analyses were performed for intake quantitative data and content analysis was conducted for qualitative data.

RESULTS

A total of 26 responses from staff and 34 from patients were received. Staff reported higher overall satisfaction with the 'tea-trolley' service (50% vs. 32%; χ2 6.815 [2]; p < 0.05). Patient satisfaction ratings of the original 'tea-trolley' system were higher than the 'On-Demand' snacks system (96% vs. 59%; χ2 41.60 [2]; p < 0.0001). Median daily intake from snack food and drinks was maintained (938 kJ and 6 g protein vs. 925 kJ and 6 g protein) and waste (23.3% vs. 20.9%; p < 0.05) decreased with the 'On-Demand' service. Cost of ordered food was similar ($778.15 'tea-trolley' vs. $746.1 'On-Demand'), however cost of waste ($179.47 'tea-trolley' vs. $128.7 'On-Demand') and labour ($1650.46 'tea-trolley' vs. $926.44 'On-Demand') reduced by 28% and 44%, respectively, with the 'On-Demand' snack service.

CONCLUSION

Implementing an 'On-Demand' snack service in the general inpatient rehabilitation setting resulted in reductions in food waste, foodservice staff labour and waste costs, while intake was maintained. Patient and staff satisfaction decreased warranting further investigation into appropriate implementation methods.

Is meal order timing and flexibility key to improving patient satisfaction with hospital foodservice?

AIM

The aim of this study was to retrospectively evaluate and compare patient foodservice (FS) satisfaction using a validated tool and consistent methodology in an acute health service for four different FS models as the organisation transitioned through traditional model (TM), choice at point of service (CaPOS), bedside menu ordering systems (BMOS) and room service (RS) from 2013 to 2016.

METHODS

Patient satisfaction data were collected using the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. For the purposes of this study, patients' rating of their overall experience with FS (very good, good, okay, poor or very poor) was compared for each site and model.

RESULTS

Satisfaction was significantly higher in the CaPOS and RS models compared with TM. BMOS, although somewhat higher, was not shown to be significantly higher than TM. The RS model was significantly higher than BMOS, but there was no significant difference observed between RS and CaPOS.

CONCLUSION

FS models that support patient flexibility and meal ordering closer to the meal delivery time (as seen with RS and CaPOS) show higher patient satisfaction among hospital patients. It is recommended that sites consistently opt to include patient satisfaction as part of routine auditing. This would enable clear conclusions to be drawn regarding best practice FS models, based on specific and individual hospital requirements.

Developing and validating a novel staff questionnaire to identify barriers and enablers to nutrition and mealtime care on hospital wards

AIMS

Improving hospital nutrition and mealtime care is complex and often requires multifaceted interventions and implementation strategies to change how staff, wards and systems operate. This study aimed to develop and validate a staff questionnaire to identify multilevel barriers and enablers to optimal nutrition and mealtime care on hospital wards, to inform and evaluate local quality improvement.

METHODS

Literature review, multidisciplinary focus groups and end-user testing informed questionnaire development and establishment of content and face validity. To determine the construct validity, the questionnaire was administered to ward staff working in five wards across two facilities (acute hospital, rehabilitation unit). Exploratory factor analysis was used to estimate the number of factors and to guide decisions about whether to retain or reject individual items. Scale reliability was assessed using Cronbach's alpha.

RESULTS

The questionnaire was completed by 138 staff, with most respondents being nurses (57%) and working in the acute care facility (76%). Exploratory factor analysis supported construct validity of four of the original seven subscales. The final questionnaire consisted of 17 items and 4 sub sub-scales related to (1) Personal Staff Role; (2) Food Service; (3) Organisational Support, and (4) Family Involvement; each sub-scale demonstrated good reliability with Cronbach's alpha values all >0.70.

CONCLUSION

This novel and brief questionnaire shows good reliability and preliminary evidence of construct validity in this small sample. It provides a potentially useful instrument to identify barriers and enablers to nutrition and mealtime care from the staff perspective and inform where improvement efforts should be focused.

Patient Mealtime Experience: Capturing Patient Perceptions Using a Novel Patient Mealtime Experience Tool

INTRODUCTION

The aim of this study is to describe the mealtime experience using the qualitative components of the Austin Health Patient Mealtime Experience Tool (AHPMET) to complement the quantitative findings of this tool.

METHODS

A multiphase, cross-sectional study was undertaken across all sites of Austin Health (Victoria, Australia) between March 2020 and November 2021. Patient mealtime experience was measured using the AHPMET. Descriptive statistics and a deductive thematic analysis approach described the patients' mealtime experiences.

RESULTS

Questionnaire data were collected from 149 participants. Patients were most satisfied with staff interactions, and least satisfied with dimensions of food quality, specifically, flavour, presentation, and menu variety. Clinical symptoms, nutrition impact symptoms and the patient's position were barriers to consumption.

DISCUSSION

Food quality was perceived as the poorest aspect of patient satisfaction with the hospital foodservice, particularly flavour, presentation, and menu variety. Future foodservice quality improvements must prioritise improving food quality to have the greatest impact on patient satisfaction. While clinical and organisational systems have a role in improving mealtime experience and oral intake, communicating patient perceptions of the mealtime experience is critical for responding to current perceptions of hospital food quality.

CONCLUSION

Mealtime experience in the hospital has a significant impact on oral intake and patients' wider perception of hospital services. Questionnaires have been used to capture patient satisfaction with foodservice in the hospital; however, no comprehensive questionnaires including qualitative questions that capture the broader mealtime experience have been validated across different hospital settings. The tool developed through this study can be implemented in any acute and subacute health service to provide feedback and improve the mealtime experience of patients. This has the capacity to improve mealtime intake, mitigate malnutrition, and improve quality of life and patient outcomes.

The Hospital Food Experience Questionnaire Predicts Adult Patient Food Intake

Purpose: Describe food/beverage intake among all patients and those with low meal intake and determine if the Hospital Food Experience Questionnaire (HFEQ), or its shorter version (HFEQ-sv), predicts food intake while considering patient (e.g., gender) and hospital characteristics (e.g., foodservice model).Methods: Cross-sectional study of 1087 adult patients from 16 hospitals in Ontario, Canada. The valid and reliable HFEQ assessed patients' meal quality perceptions. Visual estimation determined overall meal and food/beverage intake using the Comstock method. Binary logistic regressions tested the association between patient and hospital characteristics and whether HFEQ or HFEQ-sv scores added utility in predicting overall meal intake (≤50% vs. ≥75%).Results: Approximately 29% of patients consumed ≤50% of their meal. Models assessing patient and hospital characteristics and either the HFEQ or the HFEQ-sv were significant (LRT(43) = 72.25, P = 0.003; LRT(43) = 93.46, P < 0.001). Men and higher HFEQ or HFEQ-sv scores demonstrated significantly higher odds of ≥75% meal consumption. Considering HFEQ or HFEQ-sv scores explained greater variance in meal intake and resulted in better model fits.Conclusions: The HFEQ and HFEQ-sv predict patient meal intake when adjusting for covariates and add utility in understanding meal intake. Either version can be confidently used to support menu planning and food delivery to promote food intake.

Factors Affecting Satisfaction With Inpatient Services Among Adult Patients Admitted to Arba Minch General Hospital, Southern Ethiopia: A Mixed Method Study

Previous studies on patient satisfaction in Ethiopia focused on satisfaction with nursing care and outpatient services. Therefore, this study aimed to assess factors affecting satisfaction with inpatient services among adult patients admitted to Arba Minch General Hospital, Southern Ethiopia. A mixed method cross-sectional study was conducted among randomly selected 462 admitted adult patients from March 7 to April 28, 2020. A standardized structured questionnaire and semi-structured interview guide were used to collect data. A total of 8 in-depth interviews were conducted to collect the qualitative data. SPSS version 20 was used to analyze the data, and a P-value <.05 in the multivariable logistic regression was used to declare the statistical significance of the predictor variables. The qualitative data was analyzed thematically. In this study, 43.7% of patients were satisfied with the inpatient services they received. Urban residences (AOR 95% CI 1.67 [1.00, 2.80]), educational status (AOR 95% CI 3.41 [1.21, 9.64]), treatment outcome (AOR 95% CI 2.28 [1.65, 4.32]), use of meal service (AOR 95% CI 0.51 [0.30, 0.85]), and duration of hospital stay (AOR 95% CI 1.98 [1.18, 2.06]) were the predictors of satisfaction with inpatient services. Compared to previous studies, the level of satisfaction with inpatient services was relatively low.

Beyond bariatric surgery and weight loss medicaments. A systematic review of the current practice in obesity rehabilitative inpatient programs in adults and pediatrics

Background

Obesity treatment strategies mainly include outpatient lifestyle modification, drugs and bariatric surgery. Voluntary rehabilitative inpatient programs are gaining relevance as potential alternative settings of care that focus on weight loss and prevention of weight regain through a multidisciplinary approach, but their prevalence is still limited due to the high costs.

Aim

Considering the lack of evidence in this area, the objective of this study is to systematically review the currently available literature on non-pharmacological and non-surgical inpatient programs aimed at weight loss, to clarify the efficacy and the characteristics of these interventions.

Methods

Proper English language articles from 2000 to 2022 were searched on relevant databases. Quality assessment was performed by two different authors using ROB2 and robvis tools. Adult and pediatric studies were reviewed separately and their characteristics were systematically displayed.

Results

36 articles were included (20 on adults, 16 on children, and adolescents) for a total of 5,510 individuals. The multidisciplinary approach was mainly comprehensive of a low-calorie diet, scheduled physical activity, and psychological support based on behavioral treatment. Educational and cooking sessions were present at a lower rate. Globally, inpatient weight loss programs showed a consistent efficacy in reducing body weight and inducing beneficial effects on quality of life, psychological well-being, eating behavior, physical performance, and fatigue. Follow-up data were scarce, but with a high percentage of patients regaining weight after a short period.

Conclusion

Weight loss inpatient rehabilitation is a promising area that has evidence of all-rounded success in the amelioration of several aspects related to obesity. Nevertheless, it appears to be quite inconsistent in preserving these benefits after the intervention. This might slow the innovation process in this area and preclude further investments from national healthcare. Personalized and enriched programs could show greater impact when focusing on the behavioral and educational aspects, which are crucial points, in particular in pediatrics, for setting up a long-lasting lifestyle modification. More studies are therefore necessary to evaluate long-term efficacy based on the different work-up models.

Patient-Reported Outcome and Experience Measures Administered by Dietitians in the Outpatient Setting: Systematic Review

Understanding how patients perceive their health and the experience with the dietitian is fundamental to providing patient-centred care. The types of patient reported measures (PRMs) used by outpatient dietitians is unclear. Guidance about use of PRMs for dietitians is also lacking. The aim of this systematic review was to synthesise evidence regarding the use of PRMs by dietitians in the outpatient setting and evaluate the methodological quality of studies evaluating the psychometric properties of PRMs. Eight databases were searched systematically for studies of dietitians working in the outpatient setting and administering a PRM. Forty-four studies were evaluated and described 58 different PRMs. These included direct nutrition related (n = 12 studies), clinical (n = 21 studies), and health-related quality of life PRMs (n = 24 studies); 1 study documented use of a patient-reported experience measure. A large range of PRMs are used by outpatient dietitians. Of the most common PRMs, the majority are administered in similar populations to the original validation study. Dietitians should use a combination of 3 PRMs: a generic health-related quality of life tool, an experience measure, and at least 1 clinical or direct nutrition-related measure. This will enable dietitians to fully capture the impact of their care on patients.

Patient Experience and Hospital Environment Measures at Military Treatment Facilities

SUMMARY

Investigating the patient food experience: Understanding hospital staffs' perspectives on what leads to quality food provision in Ontario hospitals

BACKGROUND

Food quality influences patient food satisfaction, which may subsequently affect food intake and recovery, influencing hospital costs. The present qualitative study aimed to gain an understanding of hospital staff/volunteers experiences of serving food in Ontario hospitals, perceptions of food quality and challenges to quality food provision.

METHODS

Sixteen Ontario hospitals participated. Semi-structured interviews (n = 64 participants) and focus groups (n = 24; 150 participants) were conducted. Transcripts were analysed using inductive thematic analysis.

RESULTS

Four themes emerged: (1) Providing Good Quality Food (e.g., attributes that comprise the construct of meal quality, patients' expectations and desires from meals); (2) Individualising the Food and Mealtime Experience (e.g., processes to identify and cater to patients' needs and preferences); (3) Acknowledging Organisational Constraints (e.g., staffing, budget, etc.); and (4) Innovating Beyond Constraints (e.g., identifying innovation within potential modifiable and unmodifiable organisational constraints).

CONCLUSIONS

Serving meals in hospital is complex because of organisational and patient factors; however, current efforts to serve quality food despite these complexities were uncovered in our investigation. Discussions highlighted current practices that promote food quality and strategies for improvement. Improving food quality and the hospital meal experience can support food intake and patient outcomes, as well as reduce waste and hospital associated costs. The findings can be used to support quality improvement measures aiming to serve high quality food that meets patients' expectations and nutritional needs.

Dining On Call: Outcomes of a hospital patient dining model

Dining On Call (DOC) is a hospital foodservice model allowing patients to order meals any time throughout the day and is delivered within 45 minutes of the order. It is positively correlated with patient satisfaction, improvements in malnutrition, and reducing costs. Pre- and post-DOC data were collected from BC Children's Hospital, BC Women's Hospital, and North York General Hospital (NYGH) using patient satisfaction surveys and tray waste audits to measure outcomes. Patient satisfaction scores increased at all hospitals. BC Children's and Women's hospitals demonstrated reductions in tray waste, food cost/meal/day, and labour cost/meal/day post-DOC. North York General Hospital observed decreases in tray waste; however, food cost/meal/day and labour cost/meal/day increased post-DOC. This research provides convincing evidence into the achievable benefits associated with DOC on mother and paediatric units in hospital settings. DOC may prove to be an effective dining model for hospitals seeking to improve patient outcomes and reduce overall costs.

Canadian Hospital Food Service Practices to Prevent Malnutrition

Purpose: The study aimed to determine current practice, barriers, and enablers of foodservices in Canadian hospitals relative to guiding principles for best practice to prevent malnutrition.Methods: Foodservice managers completed a 55-item cross-sectional, online survey (closed- and open-ended questions).Results: Survey responses (n = 286) were from diverse hospitals in all Canadian regions; 56% acute care; 13% had foodservices contracted out; and 60% had a reporting structure combined with clinical nutrition. Predominantly, foodservice systems were 43% in-house versus 41% pre-prepared, 46% cook-serve food production, 64% meals assembled centrally (on-site), and 40% non-selective menus with limited opportunities for patient choice in advance or at meals. The "regular menu" (44%) was most commonly served as 3 meals, no snacks at specific times. Energy and protein-dense menus were available, but not widespread (9%). Daily energy targets ranged from 1200 to 2400 kcal and 32% of respondents viewed protein targets as important. The number of therapeutic diets varied from 2 to 150.Conclusions: Although hospital foodservice practices vary across Canada, the survey results demonstrate gaps in national evidence-based practices and an opportunity to formalize guiding principles. This work highlights the need for standards to improve practice through patient-centered, foodservice practices focused on addressing malnutrition.

Putting quality food on the tray: Factors associated with patients' perceptions of the hospital food experience

INTRODUCTION

Perceptions of hospital meal quality can influence patient food intake. Understanding what patients prioritise and what they think of current meals can support menu development. The present study assessed patients' food and food-related priorities for hospital meals and their sensory experience using the Hospital Food Experience Questionnaire (HFEQ). Factors independently associated with the HFEQ were determined.

METHODS

Cross-sectional study (n = 1087 patients; 16 Ontario hospitals). Patients completed the HFEQ at a single meal. Descriptive statistics determined the importance of food traits and ratings of a served meal using 22 HFEQ questions (five-point Likert scales, total score 110). Bivariate and multivariable linear regression tested the association between patient and hospital characteristics and HFEQ score.

RESULTS

Most food traits were rated as 'important' (4) or 'very important' (5) by two-thirds or more of patients. Patients typically rated served meal items as 'good' (4). Mean HFEQ score was 90.60 (SD 10.83) and was associated with patient and hospital traits in multivariable analyses (F_42,556  = 2.34, p < 0.001). Older and woman-identifying patients were more likely to have a higher score. Foodservice models were associated with HFEQ. Cold-plated rethermed food resulted in the lowest HFEQ. Local food use > 10% was associated with lower HFEQ score, whereas larger hospitals had a higher score.

CONCLUSIONS

Patients prioritised taste, freshness and food that met their dietary needs. Meal sensory ratings were average. A gap exists between what patients want in hospital meals and what they receive. Attention to patient demographics and food delivery that retains sensory properties and supports choice may increase HFEQ score.

Consumer expectation and responses to environmental sustainability initiatives and their impact in foodservice operations: A systematic review

BACKGROUND

With increasing pressure on the Earth's finite resources, there is significant demand for environmentally sustainable practices in foodservice. A shift to sustainable foodservice operations can decrease its environmental impact and may align with consumer expectations. This systematic review explored consumer expectations (attitudes pre-intervention) and responses (behaviour, cognitive attitudes and affective attitudes post-intervention) towards environmentally sustainable initiatives of foodservice operations.

METHODS

A systematic search following PRISMA guidelines was conducted across MEDLINE, EMABASE, CINAHL and Web of Science databases. English and full-text research articles published up to November 2019 were identified. Consumers' expectations and responses to interventions were extracted. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Thirty-three studies were included and, given the heterogeneity of the studies, the results were synthesised narratively. The main outcomes analysed included changes in behaviour and attitudes (cognitive and affective), including knowledge and satisfaction. Intervention strategies were interpreted and categorised into three groups: food waste reduction, single-use item and packaging waste reduction, and initiatives related to menu, messaging and labelling. Most studies resulted in significant pro-environmental changes towards decreasing food waste, decreasing single use-item and packaging waste, as well as engaging consumers in sustainable eating.

CONCLUSIONS

There are a range of successful environmentally sustainable strategies that when implemented by foodservices can have a mostly positive impact on consumer attitudes and responses. However, positive consumer attitudes did not always translate to changes in behaviour. Foodservices should carefully consider implementing interventions that support changes in consumer behaviour.

Hospital Food Experience Questionnaire (HFEQ): Reliable, valid and predicts food intake in adult patients

BACKGROUND & AIMS

Low food intake is a primary contributor to iatrogenic hospital malnutrition and can be influenced by perceptions of poor food quality. Valid and reliable tools to assess the food experience of hospital patients are lacking. This study aimed to determine the internal reliability, convergent construct and predictive validity of the new Hospital Food Experience Questionnaire (HFEQ) and to methodically derive and test a shortened version of the questionnaire (HFEQ-sv).

METHODS

Data from a multi-site study on 1087 patients from 16 Ontario hospitals were used. The HFEQ was developed to assess the importance of food (n = 6) and food-related (n = 10) traits using a 5-point Likert scale anchored by "not important" (1) and "very important" (5), and ratings of a single meal served (n = 7) using a 5-point Likert scale anchored by "very poor" (1) and "very good" (5). Food intake at the same meal was assessed using visual estimation (0%, 25%, 50%, 75%, 100%). Internal reliability was determined using Cronbach's alpha, and principal components analysis (PCA). Convergent validity was assessed using ordinal logistic regression with a single question on patients' overall meal quality rating. Cross validation was conducted in an attempt to shorten the questionnaire and binary logistic regression determined predictive validity with food intake.

RESULTS

The HFEQ demonstrated good internal reliability (α = .86), and all but one of the questionnaire items clustered together in PCA, revealing 5 factors. Subscales and the total HFEQ demonstrated convergent validity, with the importance of food taste, choice, easy-to-open packaging, easy-to-eat food and local food provision, in addition to meal ratings of taste, appearance, texture, temperature and combination of food served being associated with the overall meal quality rating (p < .050). These items became the basis for the HFEQ-sv, which was found to independently predict food intake (LRT(42) = 142.17, p < .001).

CONCLUSIONS

The HFEQ is internally reliable, demonstrates convergent validity with the construct of meal quality and predicts food intake. The 11-item HFEQ-sv promotes feasibility. The HFEQ has potential to be used globally to benchmark and quantify the patient food experience in hospital, contributing to quality improvement strategies that will support food intake among patients.

Exploring patient satisfaction with hospital foodservice: A Swedish study using the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire

AIM

The aim of this study was to explore patient satisfaction with hospital foodservice in the Swedish setting, using a validated instrument, adding this context to the existing body of research.

METHODS

The study was carried out at three hospitals employing cyclic menus and conventional cook-serve foodservice systems with centralised tray assemblies and hot-trolley distributions to the wards for service. Patient satisfaction was explored using a translated version of the validated Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Groups were compared with Mann-Whitney U-test and Kruskal Wallis test with a set significance level of P < .05.

RESULTS

Questionnaires from 439 patients were included in the analysis. The majority (80%) reported an overall satisfaction of "good" or "very good." Questions related to Staff and Service received mostly the highest possible ratings, while questions related to Food Quality and Meal Size had slightly lower ratings and higher variation. Comparisons between groups showed that differences were small even when statistically significant. Low appetite and a long hospital stay had an adverse effect on overall satisfaction and food quality-related questions. Men and younger patients reported more often being hungry after and between meals.

CONCLUSIONS

Hospital foodservice faces the challenge of catering to multiple patient needs. Monitoring patient satisfaction is crucial to ensure that foodservice operations remain evidence based. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire provided a general overview that indicated foodservice areas with potential for improvement, although patient satisfaction overall was high. However, patient satisfaction is a complex measure and reflexivity is required when interpreting empirical results.

Patient-reported experiences of mealtime care and food access in acute and rehabilitation hospital settings: a cross-sectional survey

BACKGROUND

Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient-reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient-reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care.

METHODS

A cross-sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27-item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital.

RESULTS

Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P = 0.01).

CONCLUSIONS

This survey highlights areas of positive patient-reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements.

Approaches to patient satisfaction measurement of the healthcare food services: A systematic review

BACKGROUND & AIMS

Monitoring consumer's satisfaction is important in ensuring effective foodservice improvements and to provide a patient-centred foodservice experience. The aim of this study is to systematically review available patient foodservice satisfaction survey instruments developed and validated within the acute and long-term care settings.

METHODS

A literature search of four scientific databases was performed to identify relevant studies with 50 participants or greater. Study characteristics, such as identifying information, contexts, and descriptive data regarding the tool and its evaluation study, were extracted and synthesised. Quality appraisal of individual studies was undertaken to assess the risk of bias during data collection.

RESULTS

Majority of the survey instruments included utilised a quantitative research approach in the form of self- or interview-administered questionnaires. Tools within the long-term care settings were more likely to be administered via interviews using a shorter and even rating scale, potentially resulting in a higher degree of bias and reduced data sensitivity. Food quality was consistently shown to be the main predictor of the overall satisfaction in food services. Factors that are context-specific to the settings, opportunities to allow open-ended comments, and the involvement of patients' perspectives in instrument development were also critical in improving survey quality.

CONCLUSION

The available validated survey instruments are generally valid and of acceptable quality, enabling effective foodservice satisfaction measurement in the healthcare settings. Nonetheless, gaps have been identified in the literature with limited evidence available for foodservice satisfaction measurement within the paediatric settings, supporting the value of future research in this field.

The Hospital Experience Through the Patients' Eyes

Background:

Posthospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on contributors to this decline (eg, poor sleep and nutrition), but other factors may also contribute. This study seeks to explain how patients experience hospitalization with particular attention on what makes the hospital stay difficult.

Design:

Qualitative interview study using grounded theory methodology.

Setting:

Single-site academic medical center.

Patients:

Hospitalized general medicine patients.

Measurements:

Interviews using a semistructured interview guide.

Results:

We recruited 20 general medicine inpatients from an academic medical center. Of the participants, 12 were women and the mean age was 55 years (range = 22-82 years). We found 4 major themes contributing to the hospital experience: (1) hospital environment (eg, food quality and entertainment), (2) patient factors (eg, indifference and expectations), (3) hospital personnel (eg, care team size and level of helpfulness), and (4) patient feelings (eg, level of control and feeling like an object). We discovered that these emotions arising from hospital experiences, together with the other 3 major themes, led to the patients’ perception of their hospital experience overall. We also explore the role that patient tolerance may play in the reporting of patient satisfaction.

Conclusions:

This article demonstrates the factors affecting how patients experience hospitalization. It provides insight into possible contributors to posthospital syndrome and offers a blueprint for specific quality improvement initiatives. Lastly, it briefly explores how patient tolerance may prove a challenge to the current system of quality reporting.

Patient Satisfaction and Food Waste in Obstetrics And Gynaecology Wards

INTRODUCTION

Patient satisfaction is an indicator of healthcare quality, and expectation is an important determinant. A component of patient satisfaction is the quality of foodservice. An indicator of this quality is the food wasted by hospitalised patients. In the present study, we investigated patient satisfaction regarding food and foodservice, the expectation on food quality and the amount of food wasted in two obstetrics and gynaecology wards in Northern and Southern Italy.

PATIENTS AND METHODS

A questionnaire, including sociodemographic data, rate of food waste, expectations of food quality and characteristics of food and foodservice, was administrated to 550 inpatients in obstetrics and gynaecology wards (275 for each hospital). Univariate analysis was performed to describe the results, and multivariate analysis was carried out to control for sociodemographic data.

RESULTS

Northern patients were more satisfied with the quality of food (54.2% vs 36.0%) and foodservice (54.5% vs 38.2%) than southern patients. Northern patients had more positive expectations about the quality of food (69.5% vs 31.6%), whereas southern patients stated that they had no expectations. Southern patients gave more importance to mealtime (72.7% vs 26.2%), and many of them brought food from home to the hospital (30.2% vs 2.2%) through relatives who came to visit them. Southern patients discarded about 41.7% of food served, whereas northern patients discarded only about 15.3%.

DISCUSSION

Food waste is a worldwide problem due to its economic, social and environmental effects. Especially in hospitals, food waste could have a negative impact on the overall patient satisfaction.

Older patients' perspectives on mealtimes in hospitals: a scoping review of qualitative studies

The increasing age of populations throughout the world means that healthcare services are faced with new challenges, not least regarding the provision of food during hospital stay. There is a lack of knowledge of how hospital mealtimes are experienced by older patients, and so the aim of this article was to review current knowledge regarding mealtimes in hospitals from the perspectives of older patients. A literature search was performed using seven databases: PubMed, Web of Science, Scopus, Sociological Abstracts, SweMed+, ASSIA and CINAHL with no limits regarding publication date. The inclusion criteria were peer-reviewed articles in English or Swedish that used qualitative methods to examine older patients' (>65 years) mealtime experiences. The Five Aspect Meal Model (FAMM) served as a framework for understanding the complexity behind a mealtime experience. Qualitative content analysis was used as a guide when analysing the material. The search produced 415 studies, 14 of which were included in the review. The findings generated three main themes for understanding how older patients experience mealtimes while in hospital: (1) the food and the food service, (2) mealtime assistance and commensality during mealtimes and (3) the importance of retaining one's independence. The review also clearly indicated a shortage of studies that solely focus on older patients' experiences of their mealtime. More research is therefore needed to be fully able to understand the complex task of providing meals in hospitals.

The Impact of Food Service Attributes on Customer Satisfaction in a Rural University Campus Environment

The purpose of this study was to determine different food service attributes that have an impact on customers' overall satisfaction at a rural university cafeteria. Over 5 weeks, 676 cafeteria users, including academics, staff, and students, were selected through convenience sampling. They completed an anonymous-designed survey with closed questions (n = 29) assessing quality of food and beverages, quality of service and setting, and satisfaction with food service attributes. In order to measure the existence and degree of significant relationships between different research variables, Pearson correlation coefficients were employed to analyse the data. Means of scores and frequencies were calculated. Results indicated that customers' satisfaction with different service attributes was above average. All service attributes had a significant and positive effect on the overall satisfaction. Since most customers (62.9%) would like to continue eating at the cafeteria, the most common improvements suggested to the university management included among others, improving diet quality by offering more nutritious food. Gaining insight into the different food service attributes can enable the university management to meet the needs and expectations of its academics, staff, and students in order to increase their confidence in the food provided.

The impact of electronic meal ordering systems on hospital and patient outcomes: A systematic review

BACKGROUND

Malnutrition is a serious clinical issue associated with adverse patient and hospital outcomes. Hospitals need to consider interventions that support the provision of optimal nutritional management and care for patients. Electronic meal ordering (EMO) systems provide an alternative to traditional paper-based meal ordering with the capacity to support appropriate orders, monitor nutritional status, and potentially improve clinical outcomes.

METHODS

This review aimed to identify the impact of EMO systems on hospital and patient outcomes. We sought quantitative evidence (peer-reviewed and grey literature) from studies evaluating EMO systems in healthcare facilities, published after 1999 and available in the English language.

RESULTS

We identified 23 studies evaluating one of three distinct EMO system-supported models: spoken menu, room service, and self-service. While limited, the evidence indicated that EMO systems were associated with: improved patient satisfaction; decreased food waste; increased consumption; and, for spoken menus, more time with patients. There was no substantive evidence of impact on clinical outcomes.

CONCLUSIONS

Whether EMO systems meet their potential to support nutritional monitoring and positively impact clinical outcomes remains unanswered within the evidence. Thus, policy makers and hospital management currently have a poor evidence base upon which to make decisions about the value of implementing EMO. Whether these systems can provide support and guidance to patients during meal ordering, improve order appropriateness and accuracy through compliance checking, identify patients in need of dietary education or those at risk of malnutrition are critical areas of focus for future research.

South African foodservice quality: inpatient’s perceptions

Purpose

The purpose of this paper is to assess patient perceptions regarding South African hospital foodservice quality.

Design/methodology/approach

In total, 419 questionnaires were administered to surgical and medical inpatients consuming a normal diet in six South African provinces. A number of 23 urban and 10 rural hospitals were sampled. Inpatients were surveyed for their opinions on hospital foodservice quality with a view to improving meals and food delivery processes.

Findings

Results revealed lower patient satisfaction with aspects relating to foodservice reliability. Among other issues, inpatients were not informed about meal times (overall median=0), had to wait longer than expected for their meals and were not informed about delays (overall median=2). Menu items were not explained to inpatients (overall median=0), and inpatients were not informed about nutritional values (overall median=0). Consequently, patients opined that they were not willing to use the hospital foodservice in future (overall median=2).

Originality/value

To identify South African healthcare issues that need improvement, it is necessary to establish where to act. These findings create awareness among authorities and hospital managers to consider patient perceptions when they review and try to improve public hospital foodservice quality, which could also assist in ensuring improvement in food consumption levels, thereby combating South African hospital malnutrition.

Characteristics of dietary intake among adult patients in hospitals in a lower middle-income country in Southeast Asia

AIM

Low-dietary intake is a common problem and cause of malnutrition during hospitalisation. This study aims to determine the current dietary intake and food sources of hospitalised adults in Ho Chi Minh City.

METHODS

Participants were adult patients from six general public hospitals in a multi-site survey undertaken in 2016. Dietary intakes for all foods consumed in the previous day were collected via interview using the 24 hours recall method. Nutritional status was assessed using Subjective Global Assessment or BMI.

RESULTS

Data were collected from 887 participants. Most food consumed in hospital was from non-regulated foodservices. Food was self-provided and home-cooked (27.7%), bought from outside the hospital (13.6%), from the hospital canteen (16.8%) or a combination of these (39.4%). Only 1.3% of food was provided by the hospital. Energy intakes were very low with a median of 3550 kJ/day; and only 4.2% of participants met 100% of their energy requirements. Decreased appetite, fullness or restrictions due to medical indications were the most common reasons for low-dietary intake. Malnourished participants were 2.2 times more likely to have low-dietary intake compared to well-nourished participants.

CONCLUSIONS

Non-regulated foodservices in hospital were not able to meet the dietary requirements of patients leading to hospital malnutrition. Standardisation of food from on-site canteens, covering meal costs from universal medical insurance, and developing guides for food provisioning for patients' families are potential solutions to improve patient nutritional status.

Current Practices and Priority Issues Regarding Nutritional Assessment and Patient Satisfaction with Hospital Menus

Purpose: Patient satisfaction with hospital food enhances consumption and adequate intake of nutrients required for recovery from illness/injury and maintenance of health; accordingly, the nutrient content of the menu must balance patient preferences. This study of Ontario hospital foodservice departments collected data on current practices of analyzing the nutritional adequacy and assessing patient satisfaction with menus, and it explored perceptions of priority issues.

Methods: Foodservice managers/directors from 57 of 140 (41%) hospitals responded to cross-sectional in-depth telephone interviews. Deductive analysis of responses to open-ended questions supplemented quantitative data from closed-ended questions.

Results: The hospitals without long-term care facilities (LTCFs) assessed regular (58%), therapeutic (53%), and texture-modified (47%) menus for nutritional adequacy. This differed from hospitals governing LTCFs where there was a higher frequency of assessment of regular (75%), therapeutic (75%), and textured-modified (66%) menus. Most departments (86%–94%) obtained patient satisfaction feedback at the departmental/corporate levels. Many identified budget and labour issues as priorities rather than assessing menus for nutritional adequacy and patient satisfaction.

Conclusions: Hospital menus were not consistently assessed for nutritional adequacy and patient satisfaction; common assessment methodologies and standards were absent. Compliance standards seem to increase the frequency of menu assessment as demonstrated by hospitals governing LTCFs.

Perbedaan Kepuasaan Pasien Terhadap Makanan Dengan Sistem Penyelenggaraan Outsourcing Dan Swakelola Di RS Islam Jemursari Surabaya

Background : Patient satisfaction is one of expected outputs of food provision. Food service system selection, especially in the hospital, will influence food and foodservice quality, which can influence patient’s acceptance and food intake. Objectives: The Purpose of this study was to analyze the difference between food satisfaction on foodservice as outsouching and self operated based on food quality and foodservice quality which had been held in RS Islam Jemursari Surabaya. Method : The study was a description research with cross sectional design. The study used two kinds of data, which were secondary data (to know the patient satisfaction of food by outsourcing system) and primaly data (to know the patient satisfaction of food by self operated system). Measures of food and foodservice quality by outsourcing system was same by self operated system. Population of the study were all of patient which in 2 and 3 class at Azzahra 1’room, Azzahra 2’room, and Mawar’room so that sampels of the study in each food service system were 43 patients. Analysis test used was Mann Whitney test.Results : The result of the statistical analysis showed that there was no significant difference in food quality (p<0.100) and total food satisfaction (p>0.100), but there was significant difference in foodservice quality (p<0.100).Conclusion : Patient satisfaction of food by outsourcing system was no difference from the patient satisfaction of food by self operated system.ABSTRAK Latar belakang : Kepuasan makan pasien merupakan salah satu output yang diharapkan oleh suatu penyelenggara makanan. Pemilihan dalam sistem penyelenggaraan makanan khususnya di rumah sakit akan mempengaruhi kualitas dan pelayanan makanan yang nantinya juga akan berpengaruh pada daya terima dan asupan makan pasien.Tujuan : Penelitian ini bertujuan untuk melihat perbedaan kepuasan makanan pasien pada penyelenggaraan makanan secara outsourcing dan swakelola berdasarkan kualitas makanan dan kualitas pelayanan makanan yang telah dilaksanakan di RS Islam Jemursari Surabaya.Metode : Penelitian ini merupakan penelitian deskriptif dengan desain penelitian cross sectional. Penelitian ini menggunakan dua jenis data yakni data sekunder (untuk mengetahui kepuasan pasien terhadap makanan pada saat sistem outsourcing) dan data primer (untuk mengetahui kepuasan pasien terhadap makanan pada sistem swakelola). Ukuran kualitas makanan dan kualitas pelayanan makanan yang digunakan pada saat survey outsourcing sama dengan yang digunakan saat swakelola. Populasi pada penelitian ini adalah semua pasien kelas 2 dan 3 yang ada di Ruang Azzahra 1, Azzahra 2, dan Mawar dengan sampel penelitian masing-masing sistem penyelenggaraan sebanyak 43 pasien. Uji analisis yang digunakan adalah uji Mann Whitney.Hasil : Hasil analisis statistik dari penelitian ini menunjukkan bahwa tidak ada perbedaan bermakna pada kualitas makanan (p>0,100) dan kepuasan makanna total (p>0,100), namun ada perbedaan bermakna pada kualitas pelayanan makanan (p<0,100).Kesimpulan : Kepuasan makan pasien pada penyelenggaraan makanan sistem outsourcing tidak berbeda dengan kepuasan makan pada penyelenggaraan sistem swakelola.

Developing a valid meal assessment tool for hospital patients

Patients' perspectives of meal items are critical in supporting effective decisions about meal provision in hospitals. The objective of this research was to develop a valid meal assessment tool (MAT), to quickly and accurately assess patient's views on meal items, for ultimate use in a large multi-centre trial. Nine iterations of the meal assessment tool were tested for content and construct validity in a large acute care hospital to determine wording, number scale and physical orientation for responses. Patients were interviewed to assess content validity, ease of completion, timing and assistance requirement. Following expert feedback, the resulting tool consisted of a 7 point scale measuring three meal components (meat, starch and vegetable), with ratings for flavour and taste combined, appearance and quality. Measures of overall satisfaction, meal expectation, age and gender were included for direct comparability with the valid published Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ). Three hundred and four surveys were completed in the development process (77% response), 53% male, mean age 56 years. Best completion rates were by interview with completion times of 2-5 min. The tool was then made available in a large multi-centre meal assessment project (n = 14,500) and was able to detect differences between variations of the same meal and between the same ingredient prepared in alternative ways. The MAT proved successful in discriminating meal components in terms of quality, taste and appearance and is useful for those planning and assessing meals in a variety of healthcare settings.