It's football season. High school, college and professional games are in full swing. One of the oldest football adages also provides an apt analogy for this article: that the last yard to the goal line is the longest yard, the hardest yard to gain.
Many food service directors are confronted with a similar challenge—achieving that last incremental increase in patient satisfaction ratings. After much work, a department may be doing well but still needs to strive to reach that next elusive level. He or she finds oneself repeatedly asking— what is the silver bullet, the missing ingredient or strategy, that will get us to our goal?
Is it food quality? Tray presentation? Employee training? Technology? Menu design? Is that next “level” even attainable...or am I up against structural/organizational issues within the department that can't be resolved?
Many healthcare foodservice operators have engineered a remarkable turnaround in the past 10 years in both retail and patient service components, converting from stainless steel “straight as an arrow” cafeteria lines to state-of-the-art commercial-quality facilities. Huge advances have been made in dining environments and food quality and in moving from the traditional “order one day in advance” menu selection process to spoken-menu and on-demand customer-oriented programs.
But in today’s fluid, competitive and highly scrutinized healthcare marketplace, yesterday’s results never remain valid for very long. Continuous process improvement, with increasing emphasis on patient satisfaction scores and cost containment/reduction, must be a continuing mantra.
Start with the food
Where to start? Well, we are in the food service business – yes! So let’s start with food. Is that chicken breast in the “Chicken Marsala” fresh? Locally raised? Organic? Sautéed in wine and vegetable stock? Placed on a bed of whole grain organic noodles?
Sure, menu item descriptions can be carried to an extreme. But the point is, according to a time-honored, marketing/selling premise: “you can’t leave the customer alone with the product.” In other words, you must describe the benefits and the quality attributes to the customer; he or she will often not recognize them without some “help.” In terms of patient satisfaction, especially, that means providing interpersonal support to the information presented by the menu booklet in the patient’s room.
Patient ambassadors or tray passers need to be trained to highlight the qualities and benefit attributes of menu offerings and note the care taken in their preparation. It is in that interactive engagement with a patient that expectations are established and the groundwork for satisfaction laid. In some cases, you may want to establish a basic script for those in this role, much as some restaurants do for serving staff.
Remember that patients find themselves in a strange environment, without much control. Food service should be designed to give them a level of comfort and familiarity. That means it's important to offer comfort and ethnic foods in addition to trendy items. The use of phrases like “fresh baked,” “slow roasted,” “creamy macaroni and cheese,” and “German style potato salad,” are touchstones to which a patient can relate.
That sensibility also needs to be expressed in the printed menu. Consider one with offerings like these:
• "All breakfast baked goods— muffins, rolls, corn bread, biscuits—are prepared fresh daily." (Did you ever notice the highway billboard of a national chain that proclaims “biscuits cut fresh every morning” – think they know something about customer satisfaction?)
• "Breakfast omelets are individually prepared with your choice of ingredients."
• "All desserts are prepared fresh, daily, and on site (warm cobbler is a big plus)."
• "Soups, chili, sauces and gravies (and spaghetti sauce) are fresh-made from raw ingredients (or from 'scratch')."
• "Lasagna or the enchiladas are both made on site."
• "Beef bordelaise is made with hand-trimmed beef tenderloin."
• "The chicken potpie is made in-house with a puff pastry crust and is one of our signature items."
• "Our salmon filets are cut fresh daily and can be ordered with either our special herb sauce or an Oriental glaze."
If you have an on-site executive chef, say so; provide his/her name and professional experience and training if that's appropriate. Has the chef or the department won any culinary awards? (Chefs are today’s rock stars, as they say.)
The tray as tabletop
Tray presentation is the patient service equivalent of restaurant tabletop design. The tray presentation is as important to overall visual appeal as is the arrangement and presentation of the entrée, starch and vegetable.
Size, durability and cost considerations differentiate a white tablecloth restaurant from a hospital patient service program, but the tray and dinnerware presented to a patient should not look like they have been through three wars – as we have often, unfortunately, noticed. One of the most appreciated and easily recognized sign of quality is a simple cloth napkin!
Another quality-suggesting touch is the placement of condiment packets in a small side dish or container (or better yet, fresh condiments in small paper soufflé cups as appropriate to the menu item – this can be less expensive, too). Contrast that approach to the use of an institutional, pre-packaged condiment kit.
Food quality and presentation are major contributors to patient satisfaction with your food and nutrition service program, as are many other tangible characteristics, such as proper temperature, delivery timeliness and tray accuracy. These are visual and/or measurable issues—in other words, the hard stuff. Consider this old adage:
"The hard stuff is the easy stuff.
"The soft stuff is the hard stuff.
"The soft stuff is much harder than the hard stuff."
So what is the “soft stuff”? It is people stuff—attitude, communications, coordination (notice I didn’t list skills – those can be taught) and passion. Yes, passion. Do employees, particularly those staff members who have contact with patients and staff outside of the department, have a passion for what they do? Do they understand their importance to the mission of the hospital and of your department? Do they just follow the “script” that was given to them or do they interject their own warm and caring personality? When one delivers a meal tray, does he or she offer a final “is there anything else I can get you?” before leaving the room? In case of a service lapse or failure, is every member of staff trained to address that immediately with appropriate "service recovery" techniques and actions?
This "soft stuff" is where patient satisfaction is gained or lost.
Patient satisfaction is not just up to front line employees. The director and middle managers are vitally important. One director has traced a significant improvement in temperature, quality and courtesy scores to a concentrated program of “rounding”—to making her own patient visitations at every meal period. Showing true concern and, most importantly, responding to problems or complaints immediately has documented efficacy in all customer situations, not just food service. Does it mean preparing something special to solve a problem? Going to the supermarket for something not in inventory? Customer relationship experts will tell you that solving a problem fast is critical.
Unfortunately the football analogy we started with—that achieving top drawer patient satisfaction is "the longest yard—ultimately doesn’t apply to the quest for improved patient satisfaction because in this effort there is no last yard, no silver bullet, no quick and easy solution.
Success is achieved by performing solid blocking and tackling and skillful strategy every day, every day with every patient engagement, while practicing continuous process improvement. As every successful restaurateur knows—you’re only as good as your last meal.