Made to Measure
Patient-satisfaction surveys provide hospitals with paths to improvement

By Margaret Sheridan, Senior Editor

Although healthcare foodservice doesn?t operate to build repeat business, patient satisfaction remains a major concern for food purveyors at hospitals and care centers. Surveys of customers? dining experiences contribute to a healthcare facility?s overall approval rating and provide it with a competitive marketing edge.

?Patients can?t make a judgment on the neurosurgeon, but they can on food,?? says Michael Giuffrida, executive director of the Washington, D.C.-based National Society for Healthcare Food Service Management.

What drives customer opinion of hospital dining and how it is measured depends on the healthcare system, its patient population and demographics.

Press Ganey scores are to hospital foodservice what stars from restaurant critics are to commercial operations. Providing one of several tools available to gauge patient satisfaction, Press Ganey Associates in South Bend, Ind., researches patient opinions about their hospitalization. It counts 30% of the nation?s hospitals as clients.

The basic survey includes 49 questions that respondents rate on a scale of 1 to 5, four of them are specific to foodservice. Press Ganey uses the scores to rank hospitals against other healthcare institutions in its database.

Overall Press Ganey scores placed 200-bed Marion General Hospital in Marion, Ind., in the 80th percentile, but satisfaction with its foodservice lagged in the 40th. ?More than half the hospitals rated higher than us,?? says Dorinda Alter, director of dietary services.

High scores are not easily accomplished, she says. Patients are increasingly more sophisticated and demanding about food. ?They want to control their care and food is something they relate to,?? Alter explains.

Seeking to improve the hospital?s foodservice ranking, Don Barger, Marion?s director of marketing, sought a role model. He found it in Parkview Medical Center, a Fort Wayne, Ind., facility whose foodservice ranked in the 90th percentile, according to Press Ganey.

Barger contacted Parkview and paid for an all-day visit to the medical center for himself and Alter. The pair discovered that not all ideas executed at Parkview applied to Marion General. Parkview?s delivery service involves kitchenettes on every floor and the use of portable hot plates, while Marion had traditional tray delivery.

But Alter could envision applying Parkview?s Spoken Menu program, which allows patients to place personal meal orders with a foodservice representative. The one-on-one approach replaces ordering by phone or checking off items on a menu card 24 hours in advance. With the hospital?s support, Alter hired two dietary aides to take meal orders and serve food. ?We?ll do almost anything to raise patient satisfaction,? she says.

The Spoken Menu initiative was launched in January 2001. The personable bedside service and faster delivery were improvements over trays that arrived late and entrées that often were less than hot.

?The food staff enjoys being more involved in patient care. And patients appreciate the attention,?? says Alter. The system also relieved nursing staff of meal-service chores. Errors in menu-taking dropped and food waste was cut.

Within a year, Marion General?s foodservice rose to the 70th percentile from the 40th in Press Ganey?s ranking of 800 hospitals. The operation eventually reached Parkview Medical?s rating in the 90s.

Background check
Linda Sceurman recalls when 460-bed Sinai Hospital in Philadelphia scored in the 15th percentile for foodservice on Press Ganey. That was two years ago. To improve the dismal ranking, Sceurman, general manager for food and nutrition services, introduced new customer-service initiatives, including enhanced training for foodservice staff and more communication via daily meetings. Briefings were held about individual patients and their special concerns. Supervisors and employees were commended for significant contributions to patient satisfaction.

Sinai Hospital worked with its contractor, Philadelphia-based Aramark Corp., to design foodservice survey cards that patients were asked to complete within a day of arrival. If any item registered an unsatisfactory score, it received priority status and was acted upon within 24 hours.

Patients making repeat visits receive special treatment. ?We treat them like old friends. Instead of a survey, they get a personal visit,?? she adds.

Sceurman views both the Press Ganey survey and Sinai Hospital?s own research as valuable benchmarking tools. Press Ganey provides monthly and quarterly rankings, sometimes up to 130 pages of raw data, specific analysis and trend information. Sinai?s survey yields immediate information. ?It tells me which systems are working now, and which aren?t. We can react immediately,?? she says.

Extra helpings
Over 18 months, 324-bed Presbyterian Medical Center in Philadelphia raised its Press Ganey ranking in patient foodservice satisfaction from the 9th to the 49th percentile. That improvement spurred a drive to improve all areas, from recipe development and plate presentation to menu flexibility and room service.

?It was a team effort,?? says Barry Giordano, director of food services, who previously spent 15 years in hotel foodservice. ?We agreed to raise food and service to restaurant-level quality.??

Daily meetings connected foodservice managers with supervisors from dietetics, retail operations and clinical departments. Giordano implemented a new training program for employees and created a concierge position. Within three hours of admission, patients are visited by the concierge, who explains menus and amenities. Giordano copied hotels? practice of delivering newspapers to rooms, adding a sticker?Compliments of Food Services?to each paper. Afternoon dessert-cart service supplies treats and coffee to all patients and guests. And helping patients understand special diets, such as low-sodium or low-fat, was simplified when Giordano hired a film production company to create a video with the dietetics staff that is shown on the hospital?s education channel.

Foodservice employees help market the hospital?s improved meals. Menus are announced and trays are served with flair, says Giordano. ?Staffers lift the plate covers like professional waiters do and describe the entrées, sauces and fresh herb garnishes from the hospital?s garden.?? At discharge, patients get a complimentary pen engraved with a 5, the highest score on the Press Ganey survey. ?We tell them to use it in filling out the survey, and to give us a 5,?? adds Giordano.

The lasting impact of hospital foodservice rating systems and surveys is how they connect and motivate employees. ?Striving for a common goal does wonders for team building,?? he adds.