Case Study

Patient Experience feedback provides a rich source of data to support continuous improvement of the Trust’s services. Patient feedback is sought continuously by the Trust though a range of formats and findings inform improvement activity at strategic and local level. The intention of the Perfect Dining Week was to deliver a perfect personalised dining experience to all patients at every meal throughout the week and beyond.

This project was the first of its kind at Central Manchester to look in detail at all aspects of the food service and delivery, working in partnership with the external organisation which provides this, as well as all levels of staff in the organisation, both clinical and non-clinical.

The cross-divisional working allowed colleagues to understand each areas individual responsibilities for the delivery of food and drink services, as well as highlighting issues and concerns in a safe and receptive environment which promoted the ability to change what had been in place. Staff engagement as a result was very high, with each of the Hospital’s divisions taking part, and having ‘champions’ to help with the momentum of the event, as well as incident reporting as the week progressed.

As a result of the project, a Trust wide review of the process and quality standards for the Breakfast service were identified, as well as a review into the ordering process for Bonne Sant and Bulk meals which were provided on the main hospital site. A re-launch of protected meal times is also planned as a result of patient feedback as well as changes to the portion sizes for children and young adults in the Children’s Hospital.

Finally, a Patient Environment of Care Steering Group has been formed and will plan a 6-12 month programme to enhance and improve on the patient dining experience.

The overall public impression of hospital food is not something which has received good press in recent years, and good nutrition during illness is essential as part of the recovery process. Through Perfect Dining Week, the hospital had the opportunity to look at the full meal delivery process as well as allow the intervention and suggestions of staff and partners to look at how this could be improved.

Where any hospital organisation is looking at the catering aspect of their trust, this is a very good opportunity to involve people at different levels and bring together the shared knowledge and experiences of staff. Patient Experience can be improved with the catering service provided, and more nutritious food and drink will help patients during recovery and feel more energetic.

This project allowed corporate, clinical, technological and administrative professionals to be able to effect the change and improve the quality of the patient experience � however by gaining real time feedback from patients, changes could be implemented within hours instead of weeks or months, by which time the patient may have been discharged. This provided the opportunity for colleagues to follow up with patients at the next mealtime and see how experiences and opinions had changed.

A thematic review of the Trust’s National Inpatient Survey results over a four year period identified food as an area where sustained improvement in patient experience had not been achieved. In addition bespoke monthly Quality of Care Rounds and Patient Experience Tracker data captured as part of in-house projects and systems, support the themes identified in the National Patient Surveys, in that they demonstrated variability in the patient dining experience across the Trust. The Trust wide Patient Experience Tracker metric for satisfaction with food was 84.8% in 2015/16 compared to 82.5% in 2014/15.The aim is to achieve and sustain over 85% in the first instance moving to 90% and ultimately 95% patient satisfaction in this metric.

Despite a continued focus on food and nutrition, data provided by these monitoring tools, provided limited assurance that individual patient needs were being met consistently in all areas in relation to choice, food service and quality of the food provided.

If the food and dining service does not consistently meet the patients personal needs this could impact on the quality of the patient experience and outcomes. To support and encourage a continued focus and deliver improvements to the patient dining experience a Perfect Dining Week was scheduled and undertaken 4th –  10th July 2016.

The aim was to achieve a collaborative approach in the planning and delivery of the event. Divisional Champions were identified who attended weekly preparation meetings from the beginning of May 2016. The preparation meetings were also attended by members of the Corporate Senior Nursing Team and representatives from Dietetics (adults and children’s), Estates and Facilities, Communications Team, Patient Services Team, including Quality Improvement Team, Patient Advice and Liaison Service (PALS) and the Patient Experience Team. Our Private Catering delivery / PFI partner, Sodexo Healthcare, was also a part of the initial meetings and a key stakeholder in the project.

During the week a Command Centre approach was developed that provided the hub of all of the activities which operated from 09.00 – 19.00 hours 4th – 10th July 2016.The Centre was staffed by a senior Nurse, a member of the Estates and Facilities Team, a member of the Sodexo Management Team and was supported by one of the PALS or Patient Experience Team who provided administrative support. The team were available to support all clinical areas during the operating hours.

Three additional meetings were held each day following each meal which was attended by the Divisional Champions. In addition the meetings provided a placement opportunity for student nurses/midwives to attend.

Three types of data were captured during the week including:
–  Food delivery service
–  Quality standards
–  The patient experience

On each department, a minimum of 5 patient experience surveys were to be collected, asking patients for feedback on their meal service, and 1 process survey which looked at how staff had found the service levels and highlight any issues they’d encountered. To provide real time data, an online capture tool was developed in-house which enabled the quality standards and patient experience data to be streamed live via a dashboard to the command centre within minutes of being completed across the Hospital’s dual site.

The post-meal meetings held three times daily in the Command Centre enabled the senior nurse the opportunity to provide a summary of the issues identified from the Patient Experience questionnaires received to date and the Quality Standard assessments. In addition, the senior nurse was able to detail what actions had already been taken as soon as the issues were highlighted through the real-time data streams from across the hospital, and discuss what further action was required to follow up after the meetings. The involvement of Divisional Champions at these meetings provided an opportunity to identify and discuss any issues which had not already been logged, and request actions before the next mealtime.

In total, the Perfect Dining Week generated a vast amount of both qualitative and quantitative data. In total, 5872 patient experience audits and 1175 process audits were completed. In addition over 900 postcards were distributed to patients asking the question ‘If you could Change-1-Thing about your dining experience what would it be?’

Early results provided an initial basis for quality improvement initiatives relating to the food service, such as the processes which took place on each ward, designed to increase patient experience levels for the next mealtime. A score was provided for each individual area depending on the patient and process surveys, allowing areas to seek improvement over the course of the week, and an overall trust score for each mealtime. These are included in the appendix of this submission. The final trust score demonstrated an improvement in the overall quality score for each meal compared to the baseline data.

The trust is aware that every member of staff who is involved in the meal delivery process at the hospital would be paramount to this project and from the start it was acknowledged that all levels should be involved in the planning meetings. As a result of staff involvement, colleagues were extremely enthusiastic about the week and the teamwork and commitment displayed was palpable. Comments from staff who were involved in the Perfect Dining week were captured for example:

‘The Perfect Dining Week is a perfect opportunity to give the patients a voice’
(Hospital housekeeper)

‘By observing processes you can see that small things really make a difference to the patients’ (Senior Sister)

The overall Quality Score achieved during Perfect Dining Week exceeded initial targets, and reached 90% or above throughout the week. Extremely positive feedback was received from some patients, with actions taken to enhance the service provided at the following mealtime.

This initiative was unique as no previous project of this type had been completed at Central Manchester beforehand and due to the size of the organisation, required high levels of planning and testing with colleagues across all levels involved to ensure that it would be successful.

62 wards and departments took part in the project, of which 7 were at one of our satellite sites (8 miles away) and 1 in a NHS Facility within a private facility in Gorton (1.5 miles away). Technology allowed communication in real time across the organisation allowing comparison and differences between different levels of service to be analysed.

It can be very difficult to personalise the dining experience due to the intricately personal opinions of each patient and family member at our hospital. However, the data demonstrated that despite the size of the organisation, and the different opinions of patients, the overall experience improved on a daily basis demonstrating the level of understanding and commitment from all of the staff involved.

• From the start of the project in early 2016, it was identified that a multi-level involvement was essential, and for the first project meeting, interested individuals from any grade or level on the ward areas were welcome to attend and provide their input. Meetings involved discussions from each area on how they delivered patient dining, and differences were acknowledged and further meetings undertaken to map these out.
• On the main island site, catering services are provided by Sodexo Healthcare, and as a result, representatives from the company were involved in the initial meetings and were present in the command centre each day throughout the full week to help with queries and provide their own input.
• As a result of these weekly meetings from the start, the teams felt motivated about the upcoming event, and were able to disseminate and prepare their own areas for the week ahead. Areas which needed support (such as during annual leave) felt able to ask for help from the meetings, and full cover could be provided,  something which has also been highlighted as an on-going improvement opportunity.
• The post-meal meetings also allowed a ‘forum’ to discuss issues, best practice and (if required) raise concerns for the next meal service.
• Staff especially appreciated the ability to meet Directors of service and senior nursing staff at the hospital during the ‘back to the floor’ event, and many people who may never have experienced the meal service donned aprons and served up meals direct to patients – this provided great motivation between colleagues, but also a more personal opportunity for patients to speak openly to people at different levels of the organisation.
• Open ended questions on each patient survey also provided a different insight into their experiences during mealtimes. Patients could comment about anything they felt, with comments about specific meals being received, but also praise for individual colleagues, which resulted in internal ‘thank you’ cards being sent to colleagues for their support and help in delivering the best possible patient experience at mealtimes.

Watch the Perfect Dining Week presentation here!