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New surveys spur health care feeders to keep raising standards

Health care foodservice directors and their staffs have made notable progress in recent years improving scores on internal patient satisfaction surveys. They’ve successfully revamped their menus, improved food quality and introduced spoken menus, liberalized diets, room service, pods and a host of other programs to please patients.

But there’s no resting on laurels even for a brief moment in health care. Another challenge has appeared, bringing with it another test of flexibility, adaptability and ingenuity. Foodservice staffs must continue to raise standards for their menu programs and keep internal survey scores high, while also becoming more involved in a multidisciplinary approach to keep scores high on a new survey, the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, which is pronounced “H-caps.”

Developed by the Center for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality, HCAHPS is a standardized survey designed to measure patients’ perceptions of their hospital experience. It is the first national standard for collecting and publicly reporting information about patients’ experiences, and it is designed to allow valid comparisons between local, regional and national hospitals.

Data collection began in October 2006. The first results of the survey were reported via the Web in March 2008 and will continue to be reported quarterly on and . By making the results available to the public, the survey intends to create incentives for hospitals to improve quality of care from the patients’ perspective. Survey results do not reflect the quality of medical outcomes. Hospitals that don’t submit data may lose 2 percent of their annual CMS payment. Further financial implications aren’t yet defined.

“HCAHPS is like Consumer Reports, JD Power and Craigslist rolled into one,” said Tom Cooley, MA, RD, director of hospitality and nutrition services at Temple University Hospital in Philadelphia. “This survey measures health care like any consumer product, auto repair shop or long-distance carrier. With this kind of transparency, hospitals will have to back up their claims of being the ‘best’ hospital offering the best service.”

The survey contains 27 questions regarding the patient’s hospital experience, including such topics as the quality of communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, and the effectiveness of pain management. The survey also explores the quality of communication about medicines and discharge information and asks respondents to rate the overall hospital environment.

“Food is not part of the standard survey because it is not correlated with returning to the hospital,” said Kathy McClusky, MS, FADA, director of patient satisfaction for Morrison’s Healthcare.

On one hand, the absence of food questions is good news for foodservice directors and their staffs. The public will never know through these survey results if patients disliked the lemon chicken or received cold eggs during their hospital stay. On the other hand, no feedback means no direction for making improvements. With internal surveys like Press Ganey that have food questions, making changes can easily be correlated to improving scores. With HCAHPS’ focus on communication and pain control, how is foodservice going to justify renovating a cafeteria or upgrading delivery systems?

“A greater multidisciplinary team approach will have to take place in the hospital,” Cooley said. “Rather than touting our success in being in the highest Press Ganey percentile in the hospital, for example, we’ll get credit for being proactive and helping nurses and doctors improve patient perceptions of team communication and respect. For example, if I need a new tray delivery system because the food isn’t served at proper temperature, I’ll have to show how nurses waste valuable time dealing with patients’ complaints when they could be interacting with patients in a more positive way.”

McClusky agrees, emphasizing the importance of helping to identify and solve problems before patients complain.

Positive examples of multidisciplinary approaches to patient care abound, such as that at Pennswood Village in Newtown, Pa., where interdisciplinary care long has been the modus operandi. Mary Cooley, MA, RD, LDN, director of nutrition services at the continuing-care retirement center, explains that her staff takes note of patients’ conditions when delivering trays and reports observations to other facility staff.

HCAHPS and the new era of transparency are too new to conjure all the implications they may have for the future of health care. What is certain is foodservice staff will be adding yet another role or two to their already diverse repertoires.

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