Transforming patient experience and reducing food waste through room service
OVERVIEW:
Pediatric hospital CHU Sainte-Justine is celebrated in Quebec and across Canada for its innovative approach to food services. Ever since they launched their room service program, Délipapilles!, in 2016, hospital staff have seen remarkable gains in patient satisfaction and decreases in food waste. Now, they have turned their attention to making their food services more climate-friendly by procuring and serving more local and sustainable menu items. Read this practice study to learn how CHU Sainte-Justine, under the guidance of Manager of Food Services Josée Lavoie, continues to transform its food services for the health and well-being of patients and the planet.
THE PROBLEM: CHU Sainte-Justine needed to address the quality of their food services: they were getting low patient satisfaction scores (50% satisfaction) and seeing significant food waste (45% tray waste), including from untouched patient trays. Overall, the importance of food services as an essential part of care was being overlooked and patients and the planet both suffered.
THE INTERVENTION: The food services team made the case to their leadership to implement a new room service model that would deliver meals to patients on demand, giving them more choice, flexibility and control around their food. The hospital then built the infrastructure and relationships necessary to implement room service.
THE OUTCOMES: Since the launch of the room service program Délipapilles!, patient satisfaction scores have skyrocketed (to 99% in 2019) and food waste has plummeted (to 5% in 2019). Staff are happier too, and express a sense of pride in their work. Food is now served with a more human touch, for comfort and healing. The hospital is now motivated to actively engage in more sustainable procurement, seeing direct returns for their efforts.
THE SYSTEMIC IMPACTS: An intervention like room service can significantly reduce food waste, which is ranked as the third most-impactful solution to mitigate climate change, as identified by the scientific team behind Drawdown. Room service has enabled the kitchen staff to think more strategically about values-based sourcing and meeting the cultural needs of their patients. Happier staff also make for a healthier workplace. Their leadership contributed to creation of a new 2020 provincial policy to catalyze local and sustainable purchasing in Quebec institutions.
[The problem] Low patient satisfaction scores and significant food waste
In 2012, CHU Sainte-Justine knew that they needed to drastically overhaul their food services for the sake of both their patients and the planet.
The impact of hospital food waste on the climate
According to scientist and author Paul Hawken’s research (Project Drawdown), reducing food waste is the third most-impactful solution to mitigate climate change. Hospitals are a significant source of food waste: in 2010, the value of food wasted in Canadian hospitals was about $45 million. This is the result of either kitchen food waste, where food may be overproduced or prepared inefficiently, or patient food waste, where food is left uneaten on the plate.
The signals were clear: patient satisfaction scores were only at 50% and parents and children were complaining about the temperature and quality of the food.
Another alarming issue was the amount of food waste; 25% of patient trays were returning to the kitchen completely untouched, and 45% of the food was being thrown out. Food waste was costing the hospital up to $90,000 each year.
Food waste carries environmental as well as financial consequences: food waste is one of the most significant drivers of global emissions and climate change. The patient, financial, and planetary incentives were well aligned for Sainte-Justine to take action.
[The intervention] Making the case for room service
CHU Sainte-Justine was also facing an incredible opportunity: the hospital was in the process of renovating.
The food services team started researching innovative ways to improve the patient food experience. Very quickly, Manager of Food Services Josée Lavoie discovered that room service—a form of meal delivery inspired by hotel-style room service—could be a desirable option. Josée was intrigued by the clear benefits of the room service model to patients, but she needed to do more research; only one hospital in Quebec had implemented room service, with a private company, so this option could be perceived as risky by hospital leadership.
1. Research and assessment
What is room service?
Inspired by the hospitality industry, room service is a just-in-time system where food is ordered from a menu and delivered to patients at their convenience. Instead of receiving a tray of food at set times of the day, as in a traditional meal service, patients can order from a restaurant-style menu at any time and be served their meal at a defined time (usually within 45–60 minutes).
Room service gives patience more choice and flexibility to exercise their personal eating habits and cultural preferences.
Having evaluated their services and identified both the need and the potential for change, the food services team at CHU Sainte-Justine researched and analyzed different food service models for hospitals, including room service. The team also visited four hospitals in Canada that had already implemented room service to gather more data about the model and its impact. Three of the four hospitals shared the same results:
Patient satisfaction scores increased significantly.
Tray waste was reduced.
They saved money in the long run.
Analyzed against their own numbers, there was a clear basis to pursue room service.
2. Demonstrating value to senior leadership
“We were able to do [room service] because the hospital trusted us. ”
After validating room service as a good option for the hospital, the food services team had to demonstrate to senior leadership why room service would be worth the investment. Their ask was significant: $2 million for a new kitchen and IT system, as well as the training and adoption of new practices for food services staff and clinical care providers. The team used two arguments and a window of opportunity to make their case:
It would be a more effective, less wasteful use of resources: The team demonstrated, through evidence from other hospitals, that patient satisfaction scores would improve, that waste would be reduced, and that money could be saved. The team projected a savings of $200,000 a year, which would cover the upfront renovation costs in 10 years. The strategy would produce financial and ecological savings.
It would be better for patients: The team made a compelling argument about the impact of the transition to room service on patient experience. There is value in enhancing the choice and pleasure of children and parents during their stay, especially when they are already in an environment where they have so little control.
It was the right time and fit with strategic priorities: The hospital was already going through a renovation and was ready to take on new changes.
[The Intervention] Building critical infrastructure and relationships to implement room service
Getting approval for room service was half the battle; implementing room service was a journey in itself. Over the course of almost five years, Josée and her team committed to building both the critical infrastructure and the critical relationships to ensure success.
While the new kitchen and IT system were being built, the team prioritized communication and relationship-building with all those who would be involved in room service.
1. Building trust and co-developing processes with nurses and clinical teams
Nurses are the providers of care closest to patients, and for room service to be successful, nurses needed to feel confident that this system would be better for their patients. The food services team brought in a nurse from a hospital in Halifax to talk to the nurses at Sainte-Justine and to respond directly to their concerns, which included the following:
Nurse Question: “What if patients don’t eat?” Previously, meals were served on a regular cycle (breakfast at 7:30 am, lunch at 11 am, supper at 4 pm) that nurses understood and could work around. Nurses were worried that if food didn’t arrive automatically, at set times, patients wouldn’t eat.
Food Services Answer: “Now they’ll get to eat when and what they want.” The food services team reassured nurses that offering more choice to patients with room service would in fact encourage them to eat what they want and when they want it.Nurse Question: “What about patients’ dietary restrictions?” Nurses were concerned about managing patients’ dietary restrictions. How could they respect patients’ diets when, for example, “kids can call and ask for what they want?” How would they keep track of when they should give diabetic patients their insulin if mealtimes were inconsistent?
Food Services Answer: “We’ll help you keep track.” As recommended by the nurse from Halifax, the food service team reassured CHU Sainte-Justine nurses that the team would inform them if a patient didn't order a meal when they were supposed to. This would give the nurses a sense of confidence and stability around their patient’s eating habits.
The room service model requires more collaboration between nurses and food services staff, as well as more communication between patients and nurses. The food services team helped nurses feel confident about their role in respecting diets, and everyone was able to agree on the shared objective: feeding patients in a way that makes them happy will support their health and healing.
2. Getting project management support from administration
CHU Sainte-Justine gave the room service project a dedicated coordinator from the quality improvement department. The coordinator’s role was to ensure consultation with, and collaboration among, all the different departments.
3. Managing the cultural transition with food service employees
One of the most significant transitions in culture and practice was for the food services team. It was a difficult and stressful transition to new processes and workflows:
Before: “We don’t need to speak with the patients; we just prepare the meal and it goes to their room.”
After: “Room service means we have to communicate a lot with patients.”Before: “Because of the strict schedules, our breaks are regular.”
After: “We now have to manage varying rush times because our priority is the timing for the patient.”
Josée Lavoie admits that it was not easy for her staff in the first six months; a lot of patience and adaptation were required. However, the room service transition allowed the food services team to take full responsibility over meal service, so that nurses and other care attendants can devote themselves to patient care. Food services workers are now able to witness the happiness of their patients first-hand and receive appreciation and feedback about the meals that they serve.
Ultimately, the transition to room service led to a much happier and more engaged food service team at CHU Sainte-Justine.
“At the beginning, we needed to support the food service staff because it was really stressful for them. As a leader, you have to be part of that change. You can’t be in the office. You have to be with them, and give them the time to adapt to the change. ”
[Implementation] Launching Délipapilles!
It was a total transformation for the hospital when room service officially launched on January 19, 2016. Patients were suddenly given a restaurant experience in a hospital environment.
Patients were presented with a menu of delicious meals and snacks that they could choose and order any time between 6:30 am and 7:00 pm. Five different menus were created to meet all types of dietary restrictions: 1) regular, 2) transplant, 3) low residue, 4) kosher and 5) glycogen.
How does room service work at CHU Ste-Justine?
1. The patient chooses their meal from an à la carte menu.
2. They phone a food service technician to place their order.
3. About 45–60 minutes later, the freshly prepared meal is delivered to their room!
Patients, their parents, or the care team can also order meals ahead of time, from the hospital or from home. Everything has been designed to offer a flexible service that is adapted to the needs of clients—whether it’s a plate of pasta for a mother who has just given birth or a bowl of cereal for a toddler to snack on before bedtime.
pasta for a mother who has just given birth or a bowl of cereal for a toddler to snack on just before bedtime!
Developing healthy and kid-friendly menu items
In developing the menu, CHU Sainte-Justine wanted to avoid kid-favourite but unhealthy foods like french fries and hot dogs. However, they also wanted to offer exciting treats that would spark joy for children stuck inside the hospital. The kitchen developed homemade and healthy kid-friendly options like pizza, pasta and burgers.
The hospital does an annual survey and hosts patient taste panels to continually improve and get feedback on the menu. The food services team continues to learn what items are popular based on what their patients are ordering. For example, they learned that their young patients loved to order raw vegetables (such as carrots, cucumbers, Greek salad and Caesar salad) and fresh fruits (such as honeydew, cantaloupe and watermelon). This was in contrast to the typical hospital meals served previously, where vegetables were usually cooked and fruits were canned.
Read a sample menu of Délipapilles!
Creating a brand with personality
In a departure from traditional hospital food services, CHU Sainte-Justine decided to brand their new room service, to have it stand out to their patients. They consulted with young patients to choose a new name that would communicate friendliness and joy: Délipapilles! Now, the colourful Délipapilles! brand shows up on all food services—from the menus and carts to the cafeteria—so that patients, families and staff can easily recognize it.
Over time, the delivery of fresh and delicious Délipapilles! meals to patients became so popular that the room service menu was extended to parents and hospital employees. This is now another revenue stream for the hospital and an opportunity to expand the program further.
[The impact]: 99% patient satisfaction and dramatic reduction in plate waste
From delighted patients to new revenue streams, the food services team at CHU Sainte-Justine has witnessed extraordinary cascading impacts since transitioning to room service.
Tremendous patient satisfaction: Patient satisfaction scores rose from 50% in 2012 to 99% in 2019.
Dramatic reduction in plate waste: The meal trays going into the garbage completely untouched decreased from 25% to 5%, and total food waste fell from 45% to 5%.
Cost savings:
Reduced cost per meal: The cost of one meal at CHU Sainte-Justine was reduced from $8 to $6.20 because the success of room service led the hospital away from working with a more expensive external supplier to preparing all the food served in-house.
Reduced number of meals: Before room service, CHU Sainte-Justine served around 180 patients per meal by default, but most of it would simply go to waste because many patients didn’t have any appetite or the meal timing coincided with sleep or appointments. With room service, the hospital serves a maximum of 130 patients who opt-in to a meal of their choosing.
New revenue streams:
Social eating with family members: Room service has been extended to visiting family members, who can now order and purchase food from the same Délipapilles! menu as patients. In addition to becoming a new revenue stream for the hospital, this allows families to socially eat together. CHU Sainte-Justine delivers food to 50 family members in patient rooms, resulting in $150,000 of additional annual sales revenue.
Expanded retail services: The sales revenue increase from room service to visiting family members (as well as the enhanced efficiency of the renovated kitchen and IT system) led the food services department to expand their food retail services, which now include a bar and cafe in the hospital.
Food Service and Clinical staff satisfaction: Food service staff reported being happier in directly engaging with patients. The team also received feedback from the nurses and unit managers that the switch to room service significantly improved their workload because they no longer have to manage patient feedback or concerns around food needs.
Public recognition and reputation: CHU Sainte-Justine has become one of the most recognized and profiled hospitals in Quebec because of its innovative food services. The hospital has been showcased in newspapers and on broadcast media (watch Josée Lavoie’s CBC Radio-Canada interview) and won multiple prizes for their room service program.
“Our name is now a slogan: everyone knows it. Our employees wear it proudly. Patients don’t ask for food service, they ask for Délipapilles! We’re proud of this. ”
[What’s next?] Local and sustainable food is on the agenda for CHU Sainte-Justine - and becomes provincial policy
Since the room service program launched in 2016, CHU Sainte-Justine has become known for its leading-edge work around hospital food. Now that leadership is shaping policy.
Josée was a Nourish Innovator from 2017 to 2019, and she credits her Nourish peers from across the country for inspiring her to think more ambitiously about how she can impact patient, community and planetary health through hospital food services. Since being part of the program, Josée and her team are excited to find more opportunities to source food more sustainably and to impact climate change. They realize that they can influence and motivate other Quebec hospitals by example—by showing how it is possible to make responsible and values-based food purchases within a budget.
Josée’s sights are set on moving hospital food towards more local and organic sourcing. Non-profit organizations Nourish and Équiterre, as well as the Ministry of Health in Quebec have given CHU Sainte-Justine the resources to look at how they can put more organic and sustainable foods on their menus, and Josée and her team have been attracting attention for buying food from a growing number of organic producers in Quebec (Read this [fr] Le Devoir article to learn more). If not the first, CHU Sainte-Justine is certainly among the first hospitals in Canada to intentionally source local and organic foods and they are leaders in a growing movement.
Throughout her journey as a Nourish Innovator, Josée has been calling for policy change to make it easier for public institutions to buy from local farmers. In September 2020, her vision got closer to reality when the Quebec government introduced new legislation to encourage public institutions to buy local and sustainable food. The policy calls institutions to set local supply targets by 2025. It hit the news with a profile of Sainte-Justine’s leadership in the space, as profiled in this CTV article.
On a journey to decrease food waste and increase patient satisfaction, Sainte-Justine unlocked the cascading benefits of valuing food as part of the care they provide. In an effort to enhance their menu offerings, their journey evolved into strategic, local and sustainable purchasing, helping to pave the way for new policy - and Josée hopes, for more institutions to follow the way.
““Getting to know other Nourish innovators across Canada who are just as passionate about how hospitals can lead change through food has led me to believe that everything is possible!” ”