Feeding Vs. Eating

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How the ‘Room Service’ model delivers on sustainability and the balanced scorecard for nutrition and food services.

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In June 2013, Mater Health Services in Brisbane implemented an innovative 5-star hotel inspired food service model, allowing patients to choose their meals when they feel like it.
It is the first and only hospital in Australia offering a hotel-style room service meal service to patients and in 2014 the service won The Private Hospital Association of Queensland’s Non Clinical Award for Innovation and the Overall Award for Queensland and the response from patients has been overwhelmingly positive. It is not only changing the way patients feel about hospital food but is also decreasing waste, improving patients’ nutritional intake whilst adding to the organisation’s bottom line.
Hospitals in Australia typically provide food to patients in a traditional set meal time model, taking meal orders well in advance of the mealtime, often with little interaction with patients, using pre prepared or frozen meals. Hospital food is often the butt of jokes and in the past has been criticised for being of very poor standard and quality.
Driven by a desire to create a better service for patients, Room Service, which enables patients to order from a personalised menu, clinically appropriate to individual dietary requirements, was implemented through a collaboration between Nutrition and Dietetics and Foodservices.
Prior to implementing Room Service, a fully manual, paper based, model was in place. Like many hospitals, patients completed their menu choice up to a day prior to meals via a paper menu which was collected at a designated time. Traditional hospital meal times were scheduled with dinner being served as early as 5.30pm. Many late meal deliveries were required as a result of patients not completing a menu, late admissions and significant changes to patients’ clinical status or dietary requirements between the time of menu ordering and their meal delivery.
Under this system, patient satisfaction with the quality and flavour of the food was rated poorly during feedback surveys and high levels of plate waste and general kitchen waste were also being recorded.
‘Room Service’ is a system most commonly seen in the USA and is more like a hotel style room service than a hospital foodservice system. One a-la-carte style menu integrates 97 per cent of therapeutic diets and specific educational symbols are used to assist patients understand appropriate choices. Patients are able to order their meals anytime between 6.30 am and 7.00 pm via trained staff in a designated call centre and their meal is prepared fresh and delivered within 45 minutes.
The model is underpinned by a specifically designed electronic menu management system that monitors meal choices for every patient, ensuring that patients not only receive options that are compatible with their current medical condition, but also alerts staff if patients miss meals, as well as allowing their nutritional intake to be consistently monitored. This is becoming increasingly important with prevalence of malnutrition in hospitals commonly at 25-30%.

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“...in 2014 the service won The Private Hospital Association of Queensland’s Non Clinical Award for Innovation and the Overall Award for Queensland and the response from patients has been overwhelmingly positive.”

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There were four key measures of success developed and measured as part of a broad room service research project:

1. Plate waste and reasons for waste through observation and patient semi structured interviews


2. Patient satisfaction measured through an external benchmarking organisation


3. Kitchen savings and food costs


4. Nutritional intake measured via the electronic menu management system calorie counts and patient consumption data

Whilst both protein and energy intake were clinically significantly increased in the room service model, there was also a 20% reduction in total food costs and an average 17% reduction in plate waste as compared with the traditional foodservice model. Some of the greatest plate waste reductions have been seen in patient groups who are traditionally the most difficult to feed – the oncology population recorded an average plate waste as low as 9%.
Reduced overall waste and cost savings are partly due to reduced stock holding but also due to significant reduction in kitchen waste in the move to cooking on demand, rather than forecasting and predicting patient choices in advance, saving the hospital a significant amount of money which has been reinvested into patient care.
Use of the electronic menu management system also allows relatively quick and easy menu changes to be made using patient preference data and popular or unpopular items can be added and deleted. Seasonal produce can also be utilised leading to decreased waste and reduced costs on food purchased.
There has been a clear meal order pattern when patients are left to order their meals and snacks themselves which has also assisted to reduce unnecessary food waste, particularly in relation to traditional midmeal and supplement items. Almost all patients order food at traditional breakfast and dinner times but a reduction in ordering at morning tea, afternoon tea and supper times has been noticed. Despite this reduction in ordering, total daily nutritional intake has increased as patients consume almost all of the food that they order.
Patient surveys have seen satisfaction with the quality and flavour of the food increased to be within the top 5-10% of peer hospitals.
The number one lesson learned is that if patients are left to decide for themselves what and when they will eat (within medically determined diet restrictions), their satisfaction increases, their nutritional intake increases and waste and costs decrease.
Looking to the future, meals for relatives and guests can also be purchased via the electronic menu management system, allowing an even more patient centred mealtime environment.
The implementation of an electronic menu management system and agile cook on demand model allows a focus and commitment to use of local and seasonal produce further enhancing the sustainability of the hospital’s menu.
‘Room Service’ is a food service model, allowing patients to choose their meals when they feel like it.
Patients order meals between 6.30 am and 7.00pm and their meal is prepared fresh and delivered within 45 minutes.
Improved patient satisfaction; decreased waste and costs; improved patient nutritional intake reported.
Electronic menu management system monitors patients food choices and intake.
Integrates seasonal produce and 97 per cent of therapeutic diets.
Sally McCray
Sally McCray is an Accredited Practising Dietitian and the Director of Nutrition and Dietetics at Mater Health Services.
Sally has worked within clinical dietetics for the past 20 years in a number of hospitals throughout Queensland as well as in Canada. She has had experience working within different healthcare foodservice production and delivery models as well as in restaurant and hotel foodservice environments.
Sally was instrumental in the planning and implementation of the Room Service model and led the Room Service research project. One of Sally’s particular areas of interest is the manipulation and development of innovative foodservice models to achieve optimal patient clinical outcomes, healthcare cost management and customer satisfaction.
The Dietitians Association of Australia recommends seeing an Accredited Practising Dietitian (APD) who can tailor an eating plan to benefit individual needs and assist community and corporate organisations develop healthier workplaces. To find an APD in your area, visit the DAA website www.daa.asn.au and look under ‘Find an Accredited Practising Dietitian’.