AUTHOR(s): Momyer, Robert K. TITLE(s): How we straightened out the meal service using CQI: a small example of a major approach to problem-solving. (continuous quality improvement) (How to be a Quality Standout: Adventures in Nursing Homes CQI) Nursing Homes p40(1) March 1994 v43 n2 DESCRIPTORS: Nursing homes_Food service Quality control_Technique We're reading more and more articles about Continuous Quality Improvement. The Manchester House Nursing and Convalescent Center in Media, Pennsylvania applied the theory to solving a problem in the food service, and the results were pleasantly surprising. During his involvement with a project team dealing with nutrition and pressure sores, the then Food Service Manager William Schultz had been hearing grumblings from the nursing department that evening meals were arriving late and cold. Schultz decided to try a CQI approach introduced into Manchester House by management consultant Steve Barr and Schultz recruited Barr to help out. In describing how the process worked, Schultz said, "We started by forming a Quality Improvement Team to examine the system. Our first task was to develop a focus. We determined that in order to satisfy the residents who were our ultimate 'customers,' we had to first satisfy the nursing staff. We created a survey that was sent out to Nursing and discovered that part of the problem was perception, or nurses swapping 'anecdotal information,' as it is called in the CQI process. The survey also revealed that some of the procedures in the kitchen needed attention. When nutrition staff were asked why we did certain things, the answer was, 'because we always did them that way.'" The survey indicated that the evening meal was being delivered in untimely fashion. Sometimes it would be early, sometimes late, and Nursing was never exactly sure when it would arrive. Early was just as bad as late because, in either case, the residents received cold food because of the inconsistent scheduling. "The best thing about CQI is that the staff fixes its own problems," said Schultz. "There isn't the direction from above. Instead, the people who live with the problem and its impact are empowered to do something about it. When other departments saw that we wanted to improve our service, they bought into the survey and cooperated with us. We developed a mutual appreciation and understanding of each other's function and responsibility. There is also increased teamwork within Food Services." The first system improvement was to rearrange the serving line areas. High-end usage items were moved closest to the serving line to reduce wasted motion. Once the serving line time was improved, Food Services worked on improving its understanding of delivery time to each nursing station. The project team determined, in fact, that the greatest problem was in meal delivery cycle time, so each meal cart was timed to record an "average time" which might be susceptible to improvement. To achieve such improvement, it was pivotal to know when the nursing assistants would be able to begin the tray pass. Tray pass was timed by nursing supervisors and the carts rearranged for peak efficiency. This also resulted in some table assignments being adjusted so all residents at a table were served at the same time. Nursing picked up on this and did some rearranging of seating in the dining rooms so that all the residents at a table were served at the same time and could all begin eating together. "We have the time of delivery and tray pass down to eight to twelve minutes as a result of this team approach," noted Schultz. "Our customer satisfaction has gone way up. Nursing and the residents are much happier with our service." Once the delivery problem was corrected, Food Service created a survey to be circulated among the residents. The Service's intent was to make corrections in any survey category that received less than 80% satisfaction. This survey is conducted monthly. Schultz summarizes the CQI concept as being "employee-oriented." Rather than the boss handing down an edict, the staff determines the problem, and then works together to fix it. Everyone has ownership in the solution, because those on the front line know best what is wrong and what it takes to correct it. Resident service is improved -- and everyone wins. Robert K. Momyer is Marketing Director of Manchester House Nursing and Convalescent Center, Media, PA.