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“Reinventing the Meal” An “Amazing Service” Business Strategy Initiative

Because good ideas should be recognised

Press Ganey's Success Storie s and testimonials acknowledge and reward the innovative efforts of our clients who integratetheir satisfaction data and Press Ganey's solutions support to produce outstanding clinical outcomes, improvements in patient perceptions, staff morale, operational efficienciesand financial  performance. We hope these experiences willenlighten and motivate individuals in all types of health care organisations.

Success Story

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Table of Contents

Introduction 2

Approach 3

Planning Strategies 4

Program Goals 5

Program and Initiatives 5

Fresh and Local: A Fundamental Change in Food Preparation 5

Contemporary Practice: Chefs Lift their Game 6

Patient Health and Wellbeing: The Role of the Dietitian 8

Chefmax: Incorporating New Technologies 8

Service and Safety: Working with Supervisors and Assistants 9

The Full Spread: Enhanced Café, Theatre and Clinic Meals 10

Celebrity and Celebration: Getting All Staff on Board 10

Results 11

Meeting Our Goals: Patient and Staff Satisfaction 11

Putting Staff First: Retention and Occupational Health 13

Complaints and Other Obstacles: Turning Around Attitudes and Morale 14

Looking Ahead 14

Contact Information 15

Appendix 1 16

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Introduction

Hollywood Private Hospital, a member of the Ramsay Health Care group, is an acute-care private teaching hospital situated in the Perth suburb of Nedlands, in Western Australia. It is a 659-bed licensed hospital making it one of Australia’s largest private hospitals. Hollywood is recognised as a centre for excellence in surgery and medicine specialising in a wide range of specialty areas including cardiology, chemotherapy, gastroenterology, general medicine, general surgery, haematology, mental health, neurosurgery, orthopaedics, oncology and palliative care, pain management, plastic surgery, rehabilitation, respiratory medicine, urology and vascular surgery and is certified under ISO 9001. Values are an integral part of Hollywood’s culture and express in clear terms the way we

operate. The Ramsay Way values are:

Respect for the individual

Teamwork

Pursuit of excellence

The Ramsay Spirit

Contribution to the community

The Press Ganey Satisfaction Surveys have provided feedback from Hollywood’s patients on a regular basis for over ten years. In order to gain confirmation that improvement strategies were effective, continuous surveying of patients was introduced in 2006 enabling more immediate feedback. A target of reaching the 90th

percentile score in all categories was introduced with a traffic light system to demonstrate progress. Initially progress in achieving the target was patchy and inconsistent. Over the decades, long-term negative attitudes about the Hospital’s food had become

entrenched. Demotivation and boredom were evident at all levels: amongst chefs, catering supervisors, catering assistants and ward staff. In recognition of the fact patients and staff were dissatisfied with the quality of the Hospital’s food,

Hollywood’s Executive saw this as an opportunity to add to its Amazing Service strategy.

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Approach

In 2010, Hollywood launched its Amazing Service business strategy. The strategy aimed to implement what it loosely termed a ‘five-star’ model across all Hospital services. For the Hospital’s catering services, the Amazing Service approach laid the groundwork for a story of exceptional change and success.

In May 2011, change began when Hollywood brought on board hotel-trained Executive Chef, Javier Ferrandez, with the explicit aim of turning around the quality of the Hospital’s food. A

new Catering Manager, Chris Jowett, also with extensive hotel and customer service experience, followed in October of that year.

Executive Chef, Javier Ferrandez and Catering Manager, Chris Jowett.

Further momentum for change had come in early 2011 when high-profile celebrity “foodie”,

Ian Parmenter, had a surgical procedure at Hollywood. After being discharged, he contacted Hollywood’s then Executive Director, Kevin Cass-Ryall, and provided feedback on his hospital stay. Ian described the food as average, at best, and inconsistent with Hollywood’s

amazing reputation, clearly evident in areas such as clinical and medical care. Ian believed strongly in the potential to provide patients with a significantly better dining experience which would, in turn, boost patient satisfaction and health outcomes.

The convergence, therefore, of the Hospital’s Amazing Service business strategy, a skilled

and motivated catering management team and the whole-hearted support of Hollywood’s

Executive team produced the initiative ‘Reinventing the Meal’ – an example of innovative change at Hollywood that has recast the notion of ‘hospital food’ as something healthy and

tasty, that has brought not only nutritional benefits to the healing process, but an increased level of dignity to people at a vulnerable time in their lives.

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Planning Strategies

The core planning team for Reinventing the Meal included; Catering Manager Chris Jowett, Executive Chef Javier Ferrandez and Catering Dietician Janine von Retzlaff. Ian Parmenter worked as food and dining consultant with the group.

Together the project leadership committee developed a multi-faceted program of change to transform Hollywood’s patient meals. Team roles included:

Strategic Leadership: The Hollywood Executive had responsibility for the overall initiative that included liaising with Hollywood Executive, managing hospital-wide communications, and reviewing supporting systems

Staff and Process Management: Chris Jowett was responsible for reviewing and implementing a series of new initiatives, including staff training (supervisors and assistants) and kitchen process improvement and change

Chef and Menu Management: Javier Ferrandez worked with chefs to develop a new approach to meal preparation, to develop new recipes and to professionally up-skill the team of chefs

Dietetic Review of New Menu: Janine von Retzlaff had responsibility for advising on special menu items and for reviewing every ingredient in every meal to ensure compliance with food safety and special meals protocols

Dining Experience Vision: Ian Parmenter assisted with providing a new vision of contemporary dining at Hollywood and changing long-held staff attitudes towards hospital food.

Catering assistant platting up for lunch service

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Program Goals

Hollywood has partnered with Press Ganey for more than ten years to conduct patient satisfaction surveys with the aim of implementing continuous improvement and innovation initiatives across the Hospital. Press Ganey surveys identified catering as lagging behind other areas of service, with Hollywood results from mid-2011 (incorporating pre-2011 feedback) placing the hospital in the 60th percentile (see Figure 1).

Hollywood had already set the overall target of being in the top 10 per cent of private hospitals with over 300 beds in Australia across all survey areas. From mid-2011, the hospital made a concerted effort to ensure catering results were also in the 90th percentile.

In addition to improving the overall Press Ganey ranking, other goals of Reinventing the Meal were to:

overhaul the menu by way of a new approach to food ingredients and preparation,

ensure professional development for staff to support the new approach,

upgrade equipment and processes, where possible, to support the new approach,

implement an electronic meal ordering system that would enhance individualised meal ordering and enhance the patient experience, and

roll out a program of internal communications to ensure staff awareness of, and enthusiasm for, the initiative.

Program and Initiatives

While Reinventing the Meal had menu revision as its primary initiative, a host of related activities were also implemented to ensure the success of the program.

Fresh and Local: A Fundamental Change in Food Preparation

Javier began with a fundamental shift in approach to food preparation in the Hollywood kitchen: he moved away from a cook-chill method of production to a cooked-fresh method, utilising fresh produce wherever possible. Javier’s success has emerged through his

constant focus on ‘fresh, fresh, fresh’ with every aspect of meal preparation.

To get the freshest result, Chris and Javier changed many of the Hospital’s food suppliers so

they could source fresh produce wherever possible. In addition, soon after starting in the position, Javier visited Carnarvon – Western Australia’s fruit bowl – where he spent three days talking to fruit and vegetable growers. This gave him an immediate understanding of where Hollywood could get the best seasonal produce from and he also established direct relationships with growers.

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Javier also changed meat suppliers to get more tender and tasty cuts. Premium suppliers now include Amelia Park for lamb, Linley Valley Pork for organic pork and Kailis for fresh fish.

“We try to source local products, injecting as much money as possible back into the Western Australian economy.” (Javier Ferrandez, Executive Chef, Hollywood Private Hospital, pictured).

Contemporary Practice: Chefs Lift their Game

Javier also turned around the professional practice of chefs, addressing the boredom and disengagement that had grown amongst the chefs over the years.

Javier put into place the following practices:

Consulting key stakeholders and trialling new recipes extensively

Implementing a new recipe production card sysem for all chefs to follow to ensure consistency

Implementing a daily chef’s toolbox meeting to discuss and implement any feedback

from staff and patients as well as any changes to the menu

Making all sauces, condiments and dressing from scratch in-house, rather than using pre-packaged products

Implementing a chef’s daily tasting session for that day’s meals prior to the meals

being plated, and then making adjustments to seasonings, like fresh herbs, to optimise taste, quality and presentation

Ensuring a multi-cultural chef team that brings diversity to food offerings, enables authentic recipes to be used, and considers Hollywood’s multi-cultural patient profile through its meal options.

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New plating and presentation practices included (pictured below):

Implementing a process for the senior chef on duty to prepare a ‘dummy’ of each

dish down the belting line for plating staff to see, so that each meal is consistently presented

Empowering the chefs to stop the belting line if they are not satisfied with the presentation of any meals.

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Patient Health and Wellbeing: The Role of the Dietitian

Hollywood’s Dietitian Janine von Retzlaff reviewed every proposed ingredient in each new

menu item to flag potential allergens and to perform a nutritional analysis of all new recipes before they could become an official menu item.

Dietitian Janine von Retzlaff

In addition to a standard diet, there are more than 75 specialised meals accounting for all the different dietary needs of different patient conditions. For example, there are 12 special ‘dysphagia’ menu options alone catering for patients with swallowing problems. Additional special menu options include low-lactose, low-salt and low-residue diets – amongst many others.

“The team’s focus on freshly made food has helped immensely with addressing patient

dietary needs. Because we now prepare the majority of meals in our own kitchen, it means we know exactly what goes into a menu item. It gives us so much more control over potential allergens – like gluten, sulphur and certain proteins.” (Janine von Retzlaff, Catering Dietitian,

Hollywood Private Hospital).

Chefmax: Incorporating New Technologies

In December 2011, Hollywood implemented a new computerised food ordering system called Chefmax to support changes taking place in the kitchen. The system aimed to minimise meal ordering errors and provide an opportunity for customer service to up-sell the Hospital’s meals through display of a visual menu on the tablet and through inidividualised

ordering capacity.

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Using Chefmax, staff take meal orders on a small hand-held computer tablet. Because Chefmax offers a comprehensive suite of functions that address individualised patient dietary needs, staff can spend more time with patients, finding out what they need and like, and entering those choices into the system.

A Hollywood nurse taking patient’s meal requirements using the Chefmax system

Chefmax is also linked to TrendCare – Hollywood’s electronic patient care system, which

nurses use to notate all relevant allergy and dietary details. Chefmax retrieves this information from TrendCare directly, reducing the need for data entry and eliminating the clinical risk with meal errors

Service and Safety: Working with Supervisors and Assistants

Chris worked with catering supervisors and catering assistants to up-skill the kitchen’s core

support staff. Chris implemented a system of task rotation for catering assistants who had previously been doing a single task day-in and day-out. The new rotation scheme provided new skills, allowed for professional development and ensured the kitchen had a better trained team of assistants.

Meal service equipment and methods also improved to overcome the fundamental challenge of Hollywood’s physical campus, which is a connected set of different buildings, each hosting wards that need meal service. Hollywood is investing in a suite of new trolleys with superior temperature control and warming systems that now keep meals at the right temperature until delivered to patients. The first 12 of these trolleys are already in use.

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The Full Spread: Enhanced Café, Theatre and Clinic Meals

In addition to patient meals, Reinventing The Meal was rolled out across the Hospital’s

Nedlands campus to the cafeteria, theatre and clinic locations.

An entirely new menu was implemented at the staff cafeteria. Doctors and staff in the Operating Suite now receive gourmet buffet-style meals. The Hollywood Clinic (mental health unit) also moved from a plated meal system to a buffet-style menu, which has been well received by the patients. The catering team also provides catering for hospital events, preparing contemporary canapés and tapas-style items that have replaced brought-in frozen convenience foods.

Celebrity and Celebration: Getting All Staff on Board

Ian Parmenter played an important role in communicating messages about Reinventing the Meal to staff across the hospital. Ian hosted a number of special events at Hollywood, aimed at updating staff on catering developments. He helped change staff attitudes towards hospital food, enabling ward staff to up-sell the meals to patients and thus improve patient satisfaction. One of Ian’s initiatives – the ‘Three Taste Buds’ – proved to be a fun and engaging series of events led by Javier, Chris and Ian.

Other initiatives include the bi-annual Reinventing the Meal staff BBQs, featuring a different themed menu each time to showcase the quality produce that is now being used at the Hospital.

Javier, Ian and Chris are the “Three Taste Buds”

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Results

Meeting Our Goals: Patient and Staff Satisfaction

Less than 18 months after Reinventing the Meal was implemented, Hollywood not only met its goal of ranking in the top 10 per cent amongst its peer group, but exceeded it by being ranked as the number one hospital for its inpatient meals.

The Hollywood catering team has, in a very short period of time, innovatively re-invented the entire meal production, ordering and delivery process which has resulted in the department moving from an average result to the best hospital in its national benchmark peer group for patient satisfaction.

The scale of this improvement is illustrated by the Press Ganey patient survey results for all Australian private hospitals >300 beds for the period from early 2011 to late 2012, the period during which Reinventing the Meal was rolled out (see Table 1 below).

Survey Question

Survey for the Period

Ending July 2011

(Pre-the changes)

Percentile Rankings

Survey for the Period

Ending September 2012

(Post-the changes)

Percentile Rankings

Meals (overall) 67 99

Courtesy of staff who served the food 78 99

Temperature of food 99 99

Quality of food 56 99

Flavour of food 33 99

Table 1: Press Ganey Results for Private Hospitals > 300 beds July 2011 versus September 2012

The gradual increase in patient satisfaction over the period February 2011 to March 2013 can be directly attributable to Reinventing the Meal strategies. From early 2011, when Ian began his involvement with the initiative and Javier was recruited as Executive Chef, the ‘Quality of Food’ and ‘Flavour of Food’ indicators began a remarkable rise, with ‘Flavour of Food’ showing the most noteworthy increase.

For three sequential survey periods, Hollywood consistently ranked number 1 among Australiain private hospitals >300 beds in the Meals (overall) category. The short-lived decrease in overall rating from 99 to 75 for the period ending June 2012 can be directly linked to initial difficulties during early to mid-2012 with the Chefmax–TrendCare interface (see Figure 1; see Appendix 1 for full results).

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Figure 1: Press Ganey Results for Private Hospitals > 300 beds February 2011 to March 2013

Evidence amongst staff that the hospital has dramatically improved the quality of its cafeteria food is reflected by the 39 per cent increase in cafeteria revenue from $245,000 in FY11 to $341,000 in FY13. Simple observation and anecdotal evidence corroborate this. Walk through the cafeteria at meal times and the venue is buzzing with staff sharing a meal while talking and laughing. Attitude and ambience improvements are clear.

"I have seen a dramatic improvement in both the quality and taste of the food over the past five years I have been a patient at Hollywood. The fruit and vegetables are the latest in season, the bread is freshly baked each day, there is a huge menu selection and the plating is something you would see at a restaurant.

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Despite a poor appetite being one of the side effects of the treatment I am receiving, I can still happily say the food is the one thing I actually look forward to when I have to return to hospital. Well done to Hollywood’s wonderful catering team!" (Mr Graham Burston, current patient, Hollywood Private Hospital)

Hollywood Private Hospital CEO Peter Mott, Gosse Ward staff and Graham Burston

Putting Staff First: Retention and Occupational Health

With a system of creating contemporary best practice in catering, and providing meaningful oportunities for career develoment, Hollywood has improved overall career satisfaciton for its catering managers, chefs, catering supervisors and catering assistants. Our ability to recruit hotel-trained staff demonstrates that chef positions at Hollywood are now seen as sought-after.

Catering assistants are now trained in a variety of tasks, rather than just a single repeteitive task. Results from 2012 Occupational Health and Safety audit show that the number of Work Cover incidents dropped from 35 during 2010 to 29 during 2012.

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Complaints and Other Obstacles: Turning Around Attitudes and Morale

Amongst catering staff, the entire attitude towards ‘complaints’ has turned around. Whereas,

previously, complaints were numerous and ‘expected’, they have now reduced dramatically

and, when they do occur, staff take them as an opportunity for continuous improvement and a means of maintaining high standards.

“We used to have a special cupboard in the kitchen full of chocolates that were given to patients when they complained about meals. I am happy to say that we no longer need that store of chocolates.” (Chris Jowett, Catering Manager, Hollywood Private Hospital)

Looking Ahead

Recently appointed Hollywood Private Hospital CEO, Peter Mott has paid tribute to the amazing transformation in the Hospital’s meal service: “In just 18 months, the team at Hollywood has achieved phenomenal change. The fact that such substantial improvements were achieved in a 1940s terrine-style kitchen – the original one built when Hollywood was established as a veterans’ hospital almost 75 years ago – makes the achievements all the more remarkable."

Then serving just a few hundred meals a day, chefs now serve between 1800 and 2000 per day. It has been an extraordinary achievement to implement modern, strealimed processes in outdated infrastructure.

With additional wards currently being built at Hollywood, and corresponding growth in patient and staff numbers, catering figures are also set to increase. Further initiatives under the Reinventing the Meal banner are being implemented, and will ensure the Hospital remains a leader in the provision of healthy and tasty meals.

What has made the future even brighter for the catering team is the approval to construct a new purpose-built kitchen at a cost of two million dollars with an additional one million dollars allocated for state-of-the-art equipment. This will put Hollywood in a sound position to retain its number one ranking in its meal service to patients, further demonstrating the Hospital’s

ongoing commitment to excellence in patient care.

Reinventing the Meal has brought to life a unique vision: To prepare hospital food that is fresh, tasty and nutritional. This is now an integral part of Hollywood Private Hospital’s

holistic approach to patient care.

“Let food be they medicine, and medicine be they food.” (Hippocrates)

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Contact Information

Joanne Dunn Marketing Coordinator Hollywood Private Hospital Telephone (08) 9346 6663 dunnjoanne@ramsayhealth.com.au

Mailing address

Locked Bag 2002 NEDLANDS Western Australia 6909

Organisation Information

Organisation name Hollywood Private Hospital Address Locked Bag 2002 NEDLANDS Western Australia 6909

System affiliation Member of Ramsay Health Care Organisation Type Private Acute Care Hospital Volume 659-bed licenced (522 inpatient & 137 day patient) Location Metropolitan area close to the city of Perth Service Category Inpatient

APPENDIX 1: Press Ganey Survey Results for ‘Meals’ Category and Food Ratings, Private Hospitals > 300 beds, February 2011 to March 2013

Survey for the

Period Ending

April 2011

Survey for the

Period Ending

July 2011

Survey for the

Period Ending

October 2011

Survey for the

Period Ending

January 2012

Survey for the

Period Ending

March 2012

Survey for the

Period Ending

June 2012

Survey for the

Period Ending

September 2012

Survey for the

Period Ending

December 2012

Survey for the

Period Ending

March 2013

(1/2/11 – 30/4/11) (1/5/11 – 31/7/11) (1/8/11 – 31/10/11) (1/11/11 – 31/01/12) (1/02/12 – 31/03/12) (1/04/12 – 30/06/12) (1/7/12 – 30/9/12) (1/10/12 – 31/12/12) (1/01/13 – 31/03/13)

Pre the changes Pre the

changes Pre the changes

One month post

the changesPost the changes Post the changes Post the changes Post the changes Post the changes

Survey QuestionPercentile

Rankings

Percentile

Rankings

Percentile

Rankings

Percentile

Rankings

Percentile

Rankings

Percentile

Rankings

Percentile

Rankings

Percentile

Rankings

Percentile

Rankings

Meals (Overall Ranking) 78 67 78 67 99 75 99 99 99

Temperature of food 99 99 99 99 99 99 99 99 99

Quality of food 67 56 67 56 89 80 99 99 99

Flavour of food 33 33 67 56 78 75 78 99 99

Number of respondents 473 502 441 464 413 506 417 413 421

page: 16info@pressganey.com.au Ph: (07) 5560 7400 Fax: (07) 5560 7490Contact Press Ganey:

Success Story