Meet Sally McCray, an outlier in dietetics

In Conversation provides a glimpse into the life on an ‘outlier’ — an exceptional person going above and beyond to innovate in their field and improve patient outcomes. In this issue our guest is Sally McCray, Accredited Practising Dietitian and Director of Nutrition and Dietetics at Mater Health Services, Queensland. Sally is the recipient of the 2017 Dietitians Association of Australia (DAA) President’s Award for Innovation for her research and implementation of ‘room service’, a five-star inspired food service model for hospitals.

Welcome Sally. Can you tell me what inspired you to become a dietitian?

I have always been passionate about food — all types of foods, new and different foods and the cultural and social aspects of food. I have also always been interested in health and fitness, so dietetics is a natural fit bringing together the two. Combining this with my personal desire to pursue a career helping people, clinical or hospital dietetics seemed a good choice for me.

How has your journey led you to become involved with the room service model?

I was a clinical dietitian for many years working across a range of areas in the hospital setting, so was well aware of the many challenges that patients face in getting adequate nutrition during their illness or treatment. I moved into management and the director of nutrition and dietetics role at Mater in 2001 and so began to have a much greater input into our foodservice system and processes. As a result, I became interested in how we could manipulate the traditional hospital foodservice model to have a greater impact on both patient and organisational outcomes. We were aware of and had seen the innovative room service model in hospitals in the USA, which is a very customer-focused environment, and so we started to look into it as a potential model for us, not only from a customer satisfaction perspective but also in terms of other potential benefits, particularly for patients in terms of their nutritional intake.

Room service has won a number of awards from The Private Hospital Association of Queensland and the response from patients has been overwhelmingly positive. Why is this program proving so successful?

Room service is a very customer- or patient-centric model. It allows patients to choose from a flexible and contemporary à la carte-style menu, at a time that they feel like eating and around their individual clinical schedule of tests and procedures in hospital. The cook-to-order model not only allows a range of menu items to be offered, not normally available on a traditional hospital menu, but it also allows a better quality of food to be provided as meals are cooked fresh, immediately prior to being served. Our menu has all-day breakfast options and hot main meal options available from 11 am. In addition to this we have a wide range of sandwiches, soups, salads, desserts and snack-type items available throughout the day. If a patient feels like scrambled eggs at 3 pm, they are able to order this. The room service model and menu caters to individual taste and meal timing preferences unlike any other hospital model. As a result, patients are happier, they eat more, we have less waste and overall food costs go down. We are lucky enough to have been recognised both nationally and internationally, receiving a number of awards for innovation, not only because we were the first hospital in Australia to implement this model, but we have been the first to comprehensively measure a range of patient-centred and organisational outcomes associated with it. Patients’ improved nutritional intake is one of the greatest breakthroughs from my perspective, as this can have a significant impact on their nutritional status and recovery through illness and treatment. We have seen nutritional intake increase between 20 and 30% and average plate waste decrease by 17%. Recent research has shown that 32% of hospital patients are malnourished and that one in three of these patients eats less than 25% of food that they are offered. This model may help us address this significant issue of malnutrition and poor nutritional intake in hospitals.

You have been honoured this year with the DAA’s President’s Award for Innovation for your work with room service. Was that a surprise?

It was a lovely surprise. It is always nice to be recognised with awards, but to be recognised by your professional association and peers is certainly an honour. I have been a member of DAA and an accredited practising dietitian (APD) for over 20 years so it is an important part of my professional identity. There are a lot of innovative dietitians out there doing lot of creative things, so receiving this award has been an honour. It is also a great opportunity to increase awareness of the model and our findings so that hopefully others can consider this model for their healthcare organisation and the potential benefits for their patients. The more patients who can benefit from this change to the traditional hospital foodservice model, the better.

What do you think are the key ingredients for innovation?

I have always been drawn to innovation and pursuing the question “how can we do it better?” Rather than asking why, I always try to ask why not? I think the key ingredients for innovation are an open mind, consistently seeking to improve systems and processes, and sometimes looking outside your immediate environment and possible limitations to see what others are doing. Of course it can take a fair bit of patience and persistence and the ability to consistently challenge the doubters! Our innovation and research was a result of significant collaboration between many people — our nutrition and dietetics and foodservices teams work very closely together with each other and also with our academic and industry partners. Above all, though, I think that an innovation never really reaches its full potential unless it is shared and we are very passionate about sharing our experience and research findings so that others, especially patients, can benefit from these.

Are there plans in the pipeline to implement the room service model beyond Queensland?

We have been working steadily since 2013 to implement the model in all of our Mater facilities in Brisbane, in our public and private hospitals and across a range of our patient groups, including adult, maternity and paediatric populations. After each implementation we have measured our key outcomes — nutritional intake, patient satisfaction, waste and costs — so hopefully very soon we will have comprehensive data across all of these groups that we can publish. How widespread the model becomes across Queensland and even Australia remains to be seen, but we are certainly getting a lot of interest from our colleagues both within Queensland and interstate as well as interest from overseas in regards to our outcomes research framework.