QUALITY MANAGEMENT PROJECT

Thorek Memorial Hospital

Kristine SullivanHannah Lapkin

IDENTIFICATION OF PROBLEMProblems Implications

No forecasting/tallying system No standardization of recipes Portion sizes not monitored Waste not recorded Excess house diets

Patient not consulted on menu preferences

Diet clerk

Cooks made uninformed guesses on food quantities Leading to unnecessary waste

Cooks not following recipes Inconsistency in food taste

Too little/too much food on patient trays Increased waste

Difficult to determine over/underproduction of food

Patients unsatisfied with tray May get items not asked for

(added waste)

PRODUCTION SHEET MANAGEMENT PROJECT

Aramark standards require production sheet usage Thorek out of compliance

Production sheets offer solutions to previously mentioned problems Enforces a patient tally system

Diet clerks must tally according to patient selections

Requires use of standardized, quantified recipes Clearly states portion sizes Carefully monitors waste/leftovers

Preceptors solicited our help to oversee/supervise the implementation of system Example of production sheet

PARAMETERS AND STANDARDS FOR OUTCOME MEASUREMENT

Minimal house diets Goal rate: Less than 10%

Accurate and timely patient tallies Limited food waste if accurate Cooks receiving quantified recipes with adequate time for production

Cooks following standardized recipes Accurate recording of waste Patient satisfaction

Received desired items Taste and temperature appropriate

DATA COLLECTION Collected production sheets from each day (B, L, D)

Investigated over/under food production Helped to determine if tallying was completed accurately

Assessed accuracy of diet clerks tally Ensured proper production prior to giving recipes to cooks Helped identify when padding occurred

Determined if cooks adhered to recipes Assessed amount served vs. portions made Helped identify occurrence of padding

Lots of paperwork! Created 3-ring binder to help organize

EMPLOYEE SUPERVISION Helped cooks learn to read/make recipes Assisted with necessary tasks to ensure proper tray line timing Taught diet clerks appropriate tallying procedures Ensured diet clerks received actual patient selections

Minimize house diets Ensured recipes were printed in a timely fashion Monitored/confirmed recording of waste

ANALYSIS After two weeks of supervising new system, findings were as

followed: Both diet office and cooks were padding

Due to fear of running out of food for patients/late trays Waste still not being recorded Cold production cook overwhelmed with new responsibilities Poor employee morale/job dissatisfaction Some employees not following portion sizes on production sheets

Lack of knowledge (scoop sizes) Many needed corrections on production sheets

Recipe numbers and job responsibilities Supervisors/clerks reluctant to embrace changes

CORRECTIVE ACTION PLAN Thorek audited by Aramark after production sheet

implementation Deductions for many items stated previously

Developed corrective action plan with RDs Based on audit and data collection/analysis

Included: Switch to forecasting from patient tallying Education and increased supervision of waste tracking Education and increased supervision of portion sizing Education on adequate completion of production sheets Ensure accurate standardized recipes for each menu item

IN-SERVICES To implement corrective action plan, in-services planned/executed to staff Forecasting and waste logging

Forecasting: assessment of patient census, diet orders, and previous production sheets for determination of recipe quantification

Diet clerks Waste Logging: accurate completion of production sheets

Specifically total prepared, total served, waste, leftovers For use for future forecasting

Supervisors monitor the weighing and throwing out waste

Accurate portion sizing Education on translating scoop numbers to portion size Not over/under filling scoops Educated on where to find portion size on production sheet Difference between fluid ounces and weight

SUMMARY

Production sheet management program to: Minimize waste Standardize recipes/menu items provided Compliance with Aramark standards Patient tally preferences to reduce house diets

Corrective actions Made exponential progress, still room for growth/improvement In-services

Lessons Learned