Business Plan: Select Menu. In line with goals of providing progressive, patient-centered care, NFS strives to improve
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1 Business Plan: Select Menu Executive Summary In line with goals of providing progressive, patient-centered care, NFS strives to improve the food service system by implementing a modern patient selected menu program. Patients will be able to select meals at bedside and customize meal trays to fit personal preferences. NFS employees will continue to provide in-person support, guidance and healthy, quality meals and services to patients. A financial investment will be required to purchase and install the electronic bedside meal selection system and all NFS employees will require training on the new system and food preparation processes. Labor may marginally increase as some additional resources will be temporarily needed to provide technical support in the diet office. Retraining staff will be critical to implement new processes and increase efficiency while producing hot food in a timely manner. These investment costs will be offset by increasing patient satisfaction, improving productivity and decreasing food waste, which aligns with the department s sustainability goals, and improving the VA s market positioning. Mission/Vision Nutrition & Food Service (NFS) provides progressive, patient-centered nutrition services for Veterans through a fiscally sound operation that optimizes their dignity, recovery, rehabilitation, and wellness. Our team is dedicated to providing expertise in patient nutritional care; food management processes; research; and education of patients, their families, staff, dietetic interns, and the community. NFS provide evidenced-based care and promote a nationally recognized performance model in the areas of nutrition care, patient and employee education, food service systems,
2 research, and internship programs. NFS exceeds customer expectations in the delivery of patient meals, quality and variety of food. NFS is fully committed to practicing the principles of performance improvement and is a model within the VA Medical Center and the San Diego Community. Marketing Analysis Patient care and satisfaction ratings are high priorities in the health care market. A large aspect of patient satisfaction relates to food service and many surveys illustrate that patients want to have wider selections and more control over the meals they receive. NFS at the VA San Diego Medical Center strives to be on the forefront of patient care. Driven by market trends, many other health care settings are also moving towards patient selected menus and soon it will be what patients expect as standard when they are admitted to any hospital. Implementing a technology based solution for a select menu program offers significant benefits including offering the patient a menu choice while maintaining management and control of the meals by NFS. It also offers efficiency improvements as well as the ability to integrate nutrition data with the patient electronic records and the food management program used in the kitchen. Marketing Plan Public relations activities by the VA marketing department include news coverage in local news and publications. In order to draw attention to this new patient selected menu system, the marketing department of the VA could be included to design and implement a PR and Communication campaign to advertise the new system in the local media, as well as implement an internal communication plan to co-opt, inform and educate all the staff inside the hospital. Service Plan
3 NFS seeks to improve the patient experience within the medical center to retain its model role within the VA and local community in performance improvement standards. Currently, NFS at the VA San Diego has a non-select menu, where patients are provided meals based on a predetermined standard menu cycle. In order to be on the forefront of food services and retain competitive positioning in the market, the department seeks to implement a modern patientselected menu. Patients, who are on regular diets and have no dietary restrictions, will have the option to select the food on their meal trays. If a patient does not want to choose their meal items, or is unable to due to dietary restrictions, the system will automatically provide the recommended standard menu for that day and meal time. If a patient is on a regular diet but is unable to use the bedside system to select choices, the patient s nurse, family or caregiver will be able to assist and select the food for the patient. Using an electronic system, located at the patient s bedside, patients will be able to choose their foods and drinks for breakfast, lunch, and dinner meals daily. An electronic menu will be displayed on a screen in the patient s room. This menu will display a variety of entrees and sides, such as salads, soups and desserts, each with a brief description and a picture. When a patient selects a meal, with use of a remote, the patient will enter personal identifiers and provide their room number in order for the system to recognize the appropriate patient and location. The system will prompt the patient to select which meal, breakfast, lunch or dinner and the food entree they would like. The food sides for the entrée, such as the salad, soup, dessert, and drinks will remain the same as the standard preselected menu, unless the patient choses to manually remove an item or substitute it from a list of alternatives.
4 Late order trays can also be patient selected but will be limited to specific cold entrees only so as to reduce the additional preparation and labor needed to make and deliver these trays. Other food items, such as nourishments, will not be an option for selection by a patient. While the patients may view the menu at any time, they are required to submit their choices within a certain time limit to ensure the kitchen has enough lead time to make the food items selected, prior to serving times. Hot meal service times will remain the same and patients will be unable to receive hot food outside of these service times. If a patient has questions or concerns regarding their meals, they can request to contact an NFS representative. This request is automatically sent to the diet office, who will use the information provided in the request to forward the issue to the appropriate area or resolve themselves. These requests can only be submitted and resolved during NFS operational hours. Finance Analysis The cost per meal will remain the same because the alternative entrees and sides listed will be within the same parameters as the meals on the current menu. Food waste costs are expected to decrease as patients will be more satisfied with the food they receive and less food is returned to the kitchen as waste. This decrease food waste aligns closely with the sustainability initiative and goals of NFS. Implementing the technology to support bedside selection will be a large up-front cost as the system needs to be set-up in each patient room. A change management program for staff, including various levels of training, will need to be designed and implemented in order to achieve the productivity improvements using a new meal preparation process, and also to manage staff expectations, as this new process may be seen as threatening to the long-time employees within the department. Training on the new system, as well as the new meal
5 preparation processes, will need to be completed by all NFS employees. A basic introduction will be provided to nursing staff in an electronic format so that nursing can chose when it is a good time for them to learn more about the new system. It is important for nursing to have this basic understanding so that they will be able orient patients to the program to make their own selections, assist patients with ordering if necessary, or guide them to the correct area of the screen if additional questions need to be submitted to NFS. As the department and the medical center transitions to this new way of ordering meals, there may be an increased need for workers in the diet office in the short term, to help manage the influx of questions and concerns from patients and staff on the floors, and to help off-set any issues in meal tickets being created by the patients. The need for shift staggering should be assessed so that there is at least one diet aide in the office at all times, preferably two. As the diet office currently only has two work stations, additional stations may need to be allocated. In order to keep up with the changed need for timely food production and menu variation, retraining of food preparation processing will allow for better time utilization and the resultant increase in productivity without the need for more foodservice workers or cooks. Investing in a modern patient select menu system like this would allow NFS to remain a model within the community and be represented on national boards so that other VA medical centers are aware of the progress made in San Diego.
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