Measuring the quality of Hospital Food Services: Development and reliability of a Meal Quality Audit Tool

[Quality and safety in clinical nutrition]

Clinical nutrition and food provision in a hospital environment must be regulated by quality management programs that ensure maximum clinical benefit and maximum patient safety. This article gives an overview of quality management in clinical nutrition and hospital feeding. Likewise, keys and critical points to be taken into account in all the processes and threads that are carried out during specialized nutritional support and alimentation of patients are analyzed.

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.

Impact of room service on nutritional intake, plate and production waste, meal quality and patient satisfaction and meal costs: A single site pre-post evaluation

AIM

Room service is a patient-focused foodservice model gaining interest in Australian hospitals following demonstrated patient and organisational benefits. This study aimed to compare nutritional intake, waste, patient satisfaction, meal costs and meal quality between a bought-in, thaw-retherm foodservice model and a cook-fresh, on-demand room service model at a large tertiary public hospital.

METHODS

A retrospective analysis of quality assurance data compared thaw-retherm to room service. Nutritional intake and plate waste were measured using a visual intake analysis tool; production waste was measured using weighted analysis methodology; patient satisfaction was measured using a validated patient satisfaction survey; meal quality was assessed using a validated meal quality audit tool, and meal costs were obtained from hospital finance reports. Independent sample t-tests or nonparametric equivalent (Mann-Whitney U-test) for continuous variables and Pearson's Chi-square for categorical data were applied for comparative purposes.

RESULTS

Average energy and protein intake, as well as percentage requirements met, improved between thaw-retherm and room service (4320 kJ/day vs 7265 kJ/day; 42.4 g/day vs 82.5 g/day; and 46% vs 80.7%; 49.9% vs 98.4%; all P < .001. Reductions in plate waste (40% vs 15%) and production waste (15% vs 5.6%, P < .001) were observed and food costs decreased by 9% with room service. Meal quality audit results improved, and patient satisfaction increased with % respondents satisfied increasing from 75.0% to 89.8% (χ² 9.985[2]; P = .007) for room service.

CONCLUSIONS

This research demonstrates significant improvements in patient and organisational outcomes with room service compared to a thaw-retherm model in a large public hospital.

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.

Comparison of Patient Food Intake, Satisfaction and Meal Quality Between Two Meal Service Styles in a Geriatric Inpatient Unit

This pilot study evaluated the introduction of a bistro evening meal service in a geriatric inpatient unit by comparing patient intake, satisfaction and meal quality of this new service to the usual central preplated service. Ten meals were observed under each condition (n = 30; mean age 79 years, 47% male). Data were collected on intake of each meal component (none, ¼, ½, ¾, all; converted to energy and protein using known food composition data), patient satisfaction with meals (meal flavor/taste, appearance, quality, staff demeanor; seven-point scale) and meal quality (sensory properties, temperature; five-point scale). Independent t-tests were used to compare energy and protein intakes between bistro and preplated services. There was no difference in mean energy or protein intake (energy: 2524 ± 927 kJ vs. 2692 ± 857 kJ, p = 0.612; protein: 29 ± 12 g vs. 27 ± 11 g, p = 0.699) patient satisfaction or meal quality between the bistro and preplated meal services. Patients were provided with fewer meal items during the bistro service, but ate a higher proportion of what was provided to them. Implementing a bistro service did not increase intake, satisfaction or meal quality in this study, suggesting that meal plating may be only one of many factors influencing intake and satisfaction of older inpatients.