Illuminated Path: Shining a Light on Healthcare's Best Operational Practices

Illuminated Path: Episode 6, Balancing Act in Healthcare Foodservice

September 07, 2018 Intalere: Healthcare Supply Chain Management Season 2 Episode 1
Illuminated Path: Shining a Light on Healthcare's Best Operational Practices
Illuminated Path: Episode 6, Balancing Act in Healthcare Foodservice
Chapters
Illuminated Path: Shining a Light on Healthcare's Best Operational Practices
Illuminated Path: Episode 6, Balancing Act in Healthcare Foodservice
Sep 07, 2018 Season 2 Episode 1
Intalere: Healthcare Supply Chain Management
In this episode of Illuminated Path, host Evan Danis welcomes guest Peter Cayan, vice president of supply chain and nutrition consulting at Intalere. Together they explore the balancing act in healthcare foodservice and discuss the absolutely critical role foodservice can play in terms of patient satisfaction. Cayan shares his insights and fantastic advice on trends in healthcare nutrition and how facilities can implement some best practices that are both cost effective and can move the needle in terms of quality and satisfaction.
Show Notes Transcript
In this episode of Illuminated Path, host Evan Danis welcomes guest Peter Cayan, vice president of supply chain and nutrition consulting at Intalere. Together they explore the balancing act in healthcare foodservice and discuss the absolutely critical role foodservice can play in terms of patient satisfaction. Cayan shares his insights and fantastic advice on trends in healthcare nutrition and how facilities can implement some best practices that are both cost effective and can move the needle in terms of quality and satisfaction.
Speaker 1:

You are listening to Illuminated Path, shining a light on healthcare's best operational practices brought to you by Intalere. I'm your host, Evan Danis, senior director of corporate communications for Intalere. Joining us in the studio today is Peter Cayan, vice president of supply chain and nutrition consulting for Intalere. Peter's vast experience in the healthcare food service industry spans more than 40 years and includes progressive executive sales and consulting roles. He's held a faculty appointment at Syracuse University and has published and presented nationally on quality and productivity improvement strategies, sustainability and cost management tactics. Peter's a registered dietitian and he served as food service director for the 1980 winter Olympics in Lake Placid, New York. Peter, let's talk about that a bit before we dive into our topic of the day. It sounds like a rather daunting yet rather unique and fun experience

Speaker 2:

A good day and thanks for this opportunity to have a fireside chat, so to speak. Yeah, actually, that was almost 40 years ago, and I'm kinda dating myself with that point in time in 1980. But the story as it goes, and there's a couple of anecdotal stories I'll share with you was that I was actually working down in Camden, New Jersey as a food service director at a hospital in Camden, New Jersey, and I lived in Lake Placid and obviously heard that the Olympics were coming up that way and made a few phone calls to Aramark; Aramark is a food service contractor to express an interest in helping to lead the food service operations in Lake Placid. Went up for a couple of interviews and hence, uh, was appointed the food service director at the Olympic Village, which was in a little town called Raybrook between Saranac Lake and Lake Placid that housed the Olympic village at that point in time. That was the easy part. The hard part was to get a leave of absence from my current employer, which they granted for almost two months at that point in time. So it was kind of an interesting scenario at that point in time back in 1980. And if you recall that was of course the "Miracle on Ice." And there's little story I'll share with you about that evening of the "Miracle on Ice" that we happen to have an Olympic village in Lake Placid. And the story as it goes out to be true was we at Olympic village had a disco, believe it or not. So again, dating ourselves, we had a disco inside the Olympic village and all of our deliveries for security reasons used to have to come in between midnight and 6:00 AM in the morning. And I believe that the day that we won, that was midweek and obviously a lot of athletes were training during the course of that. And that was the day, of course that we won. Uh, the, the, um, the gold and I think it was Wednesday or Thursday, unbenounced to me, um, we, uh, at the Olympic village ran out of beer for our disco. And as such we had to go out and buy beer at all these 7-11s around the north country of upstate New York to support, of course, the celebration that ensued at the, uh, the disco inside of the Olympic Village. So it was kind of entertaining thing, but we did get the beer; last thing you wanted to do was to run out of beer with hockey players and as such we did it and uh, was uh, a lot of lessons learned, a lot of fun. And of course that was the year that Eric Heiden won, I think it was five gold medals at that point in time, which he's actually a physician at Intermountain Healthcare. He's a chief of surgery, chief of orthopedics at Park City Hospital.

Speaker 1:

Unique nutrition challenges. It sounds like there.

Speaker 2:

Well, the interesting thing about it, which is an iconomy of today's challenges, is that you had an unlimited budget. You bought whatever you wanted. We had chocolate was imported from Germany and Switzerland. We had fresh produce delivered every single day from California. So really budget was no option at all. It was more of a challenge making the diversity of our menus for the athletes were coming from all the countries. No budget; just make it happen.

Speaker 1:

Nice. That's interesting. And it kind of leads nicely into our topic for discussion of the day. Obviously when you're talking about athletes, nutrition is so important to their performance level, but I think what people don't really understand is how important nutrition is in the overall healthcare equation in terms of, of just health quality outcomes, patient satisfaction, um, things of that nature. So that's what we want to talk about today to a certain degree, but before we, we dive deeper into, you know, the balancing act and healthcare food service, which is kind of a little bit when you talked about he didn't really have a balancing act. It was more making sure things were there with, with, with the cost not being an option. Healthcare has a little bit differently nowadays. Um, but before we kinda dive into the topic specifically, I wanted to ask you about just in general healthcare being faced with so many economic challenges today and what are your thoughts on sort of how, how in a general sense healthcare got here to where we are now in terms of cost and quality and how we're dealing with things?

Speaker 2:

Yeah. Great. Great question. And then a little bit of a history lesson to lead to the answer to the question you're asking. We had to take a step back and look back at how do we get to where we're at today and let's take a quick look back in history in terms of the evolution of the economics of healthcare. And the biggest point today is the fact that we're spending almost 20 percent of GDP on healthcare in America today, which is nearly double in terms of our spend capabilities of Europe, French France, England, Great Britain, Italy. So if you look at nearly again twenty cents on the dollar, twenty cents on the dollar out of your pocket and my pocket today is being spent on healthcare in America today. It's huge. So the question is how did we get there to that point and how is it that other countries, and I wouldn't call them third world countries, are spending half that? So if you take a look back back to 19, really 1930, was really what I believe was the tipping point, if you will, in 1930 when LBJ signed that Medicaid, 1965, I think it was the exact date when LBJ signed on Medicaid and Medicare. What that did is it opened the flood gates of free care to those people who needed it. So what happened, it triggered again, a floodgate of people, millions of people who are now going to be insured and having to be cared for. So if you look at the graph of GDP since then and the evolution of how much money is being spent on healthcare since 1930, it's pretty incredible. And I think the impetus of that beginning was of course, uh, the signage of Medicaid, Medicare 1965 and you know, the history lesson thereafter, of course, the evolution of DRGs to help keep under control HMO are part of that. And now to the day of Obamacare in every effort to put a cap on the healthcare expense. So to kind of put a little thing in perspective, Evan, relative to that whole story of the economic factor, if you took a look at what it costs as an example to buy a dozen of eggs in 1930. All right, think of that, 1930. Any idea what that may have cost in 1930? It was roughly about, I don't even know now. Okay. My wife does all the grocery shopping. It was about 18 cents at cost to buy a dozen of eggs back in, uh, back at that point in time. So if you looked at simply putting the, the math behind that equation of CPI on terms of the price inflationary indexes, and you took that CPI index and you compared it to the index of inflation in healthcare, the explosion of how much we're spending on healthcare to that simple cost of eggs today, it would cost you today, 88 bucks a dozen. So if you compare to, and I don't know exactly what a dozen of eggs are either quite honestly, but it's probably about four bucks or so, three bucks, maybe, but not 88 bucks that's for sure. So if you compare the inflation rate of healthcare just out of control today, compare it to something we know of today, like eggs, it's just out of sight at this point in time. So as a result of that, putting, trying to put a cap on this big snowball rolling down hill has challenged every entity within a hospital environment, from the food people to the caregivers to insurance companies. Everybody's all over it. And as such as we know today, the evolution of that has created a, if you want to call it a very scrutinous review of how many hospitals today have gone out of business as a result of just being able not able to sustain themselves on the economic side.

Speaker 1:

So let's, let's kind of keep that economic discussion and then talk specifically then about these economic challenges and what they mean, you know, how they impact food service and just to healthcare satisfaction index overall as well.

Speaker 2:

Sure. Well, today, you know, um, food service per se in a hospital is a support service function. Think of it as a hotel. You go to a hotel, you stay at a hotel per se, so you, the housekeeping and the food is a component of part of this stay and as a result of that, everybody knows food service, you know, food service because you have it at home is, so it's very, very much a touching point in people's mind today, not only the patient's mind, but also the family who's there supporting them today. So it was a result of that, uh, what's happened over the past really the 15 or 20 years is the role of consumerism in healthcare today. Meaning specifically that there's a huge emphasis today related to the patient experience. So you as a patient, in a hospital today experience many things, obviously the care that you are given, the parking that your family had to get you there, return you there, the food, the cleanliness, etc. Etc. So where food kind of plays into that. Obviously everyone knows food, you know it, your family knows it and everyone is cooked it. So it's not something like controlling pain or a procedure that you don't know. So it has a huge, huge role in the patient experience side. If you look at the economic side of food service and hospitals today versus senior living, this is where the huge dichotomy on the economic factor plays into it. And here's a story, roughly about 7 to 10 percent of what hospitals spend today, 7 to 10 percent is in the food arena. In nursing homes or senior living, it's about 30 percent--a bigger fish in a small pond. So it does play a significant role in terms of spend on the senior living side, not so much on the acute care side, seven percent or so, but it does play a huge role in the patient experience. So here's where I'm going with this.

Speaker 1:

Yeah, let's stick with that a little bit because I think people don't understand. You talked about the economic factors and it may be on the acute care side being somewhat less and we can talk about the long-term care side and the large amount of spend that is there. But I think that even though it's a smaller percentage of spend, it means so much based on the factors that you just talked about to the overall patient experience, what people remember in terms of how their experience was many times has a lot to do with, maybe it's cleanliness, but food is a large part of that as well, right?

Speaker 2:

Absolutely. And not only the food component of it. So when you look at food service, you look at really four things, the patient experience, 4 things. They look at, did I get what I ordered? Is the food hot? Is the food good? And the most important factor of all of those is the person courteous to me who's delivering the tray? So when you look at those four indexes, if you will, that are measured in satisfaction instruments today, the single most important feature of the patient experience and food service today is what I call the courtesy question. Courtesy. And think of it today, when you go into a restaurant today, again, you could have a fabulous meal at a pretty good rate, could price if you will, but if you get bad service, nasty service, poor service, it kind of dilutes the whole experience versus contrary great courtesy, mediocre quality. So the bottom line is the research is, is that if you get the courtesy question right, experience, right, you're going to do fairly well in terms of your patient experience on the food service experience factor questions.

Speaker 1:

Excellent. So let's kind of keep with that a little bit and what are some of the trends that you're seeing in healthcare nutrition and food service from that perspective, and what folks can do at a very high level, maybe three or four tips that they can take with them to do in terms of their food service operation to make sure they're hitting the high points and touching on patient satisfaction as much as they can. Obviously there's a lot of factors and deeper factors, but maybe three or four things that they can look at and implement relatively easy, easily or quickly.

Speaker 2:

There's two things. One, one in terms of trends is the length of stay today continues to decline in all facets of hospitals today. So in terms of a procedure being done, whether it's having a baby or any type of elective procedure, the length of stay has been significantly shortened. That's number one. So the ability to focus on that short term stay and getting someone what they want when they want, has been a challenge. So that has caused, in my opinion, the evolution of quote room service. So as such, what the trend has been and continues to be. If I as a patient today want to have my breakfast at 3:00 in the afternoon, I should be able to get on the phone and call and get breakfast at 3:00 in the afternoon unbeknownst to the traditional breakfast time at 8:00 and filling a menu out. So those are really kind of the two, the two trends that have occurred and a lot of hospitals have noticed it and begun to adapt to it. The ability to get on the phone and actually interact with the patient and give them what they want when they want in terms of a room service scenario and a delivery scenario. Okay.

Speaker 1:

Right. So let's kind of take that example a little bit further and, and move into. One of the things you mentioned was length of stay and that kind of takes us into a little bit further past just the cost equation of cost, quality and outcomes. Okay. You know, I think I've heard you mentioned before, if there's, there's a kind of a triangle now in healthcare that folks have are aiming for and they call it, I think they call it the Triple Aim actually. It's, it's all about cost, quality and outcomes. And how does food service play into that directly in nutrition, you know, I don't want to keep saying just food service, but nutrition being such a vital part of a healthy population really.

Speaker 2:

It does. And sadly, on a, on a similar note in terms of the public health session about nutrition, you know, one of the big alarming concerns that we as professionals have out there is the explosion and exponential growth of adolescent obesity and diabetes and that hope comes with a whole host of reasons related to the social situation today. So going back to the Triple Aim though, is that there really are kind of three parts to a food service operation's performance if you will, performance. And as you mentioned, the Triple Aim, the number one thing that we talked about extensively here already was the food service experiences based upon a, as we talked about, quality, temperature, got what I ordered and the courtesy of you delivering my tray or my meal to me. So that's all measured. And in fact, the patient experience is a key element of all patient satisfaction indexes, whether it's using Press Ganey or any other type of index. The second thing on that Triple Aim is the ability to manage cost, both supply, labor and food within a legitimate budget. Now, one of the, the never ending questions that's raised today is that do I need to the relationship or correlation between spend or cost and outcome? And again, depending on who you ask, um, is there a correlation? In other words, do I need to have a high spend operation? Do I need to serve filet minon and lobster tails and have room service galore on China and so on and so forth to have a positive patient experience? The answer is no. And there's been research done on that. So using the excuse that I need more money to support a better experience doesn't hold water in terms of patient experience outcomes. The thIrd piece that plays into that, that continues to grow are the regulations associated with department of health and Joint Commission and so on and so forth. So all three of these cogs in the wheel, if you will, patient experience, the economic side of spend, and regulatory agencies are all three independent cogs that have to be addressed. They don't all work in sync with one another. And as we've talked about before, you can have facilities that have superior patient outcomes experience, to the t, they can also be well within budget and benchmark statistics nationally. But on the other side they have some significant, serious, um, regulatory violations, whether it be food safety, temperature concerns and so on and so forth. So all three of those, what I call the balancing act, if you think about three balls in the air, are exactly that. Being able to manage patient experience, the economic side of things as well as maintaining any of the regulatory agency requirements.

Speaker 1:

We, talked about there's acute care and there's long-term care you talked about. And these are the, these kind of balancing act pieces are similar in each of those classes of trade, correct? Would say yeah. Okay. But there are different, at least in terms of. I guess maybe let's talk a little bit about how long-term care differs from acute care and nutrition sense and maybe some of the things that those folks would do a little bit differently or some of the concerns they have that are different. And then how they might address them. Um, it seems like the cost, quality and outcomes is universal in the sense for both of those sorts of classes of trade. But what are some of the things that are different in terms of what they might watch out for the other way they might do things differently.

Speaker 2:

Yeah. Well, okay, great question because we already talked about the fact that they're different on the economic side, we've talked about, and I'm going to characterize senior living, whether it's skilled nursing, CCRCs, long-term care and so on, into one bucket and acute and the other. They're hugely different in terms of the spend capacity. Thirty percent or thirty cents on the dollar in any senior living is spent on food versus the seven percent. The other piece that's far different, of course, and we talked a little bit about is the length of stay. People are in and out of hospitals in America today about 3.2 days, and that's generally speaking, it changes, but about three days they're in and out and some cases less, more or less. Senior living is where they live so as such, the menus that they subscribe to in senior living are far more, it's a dining experience, often congregate dining, depending on the nature of the facility. Uh, it may be super elite, if you will, in terms of the lobster tail and the senior and, and the, uh, filet minon, etc. But the whole patient experience or resident experience in the senior living, they play a significant role as they should in the governance or the destiny of their menus versus hospital in and out. Here's what's on our menu today. You can get it if you have room service, but think of it as this is that the senior living environment, they live there. This is their home, this is where they socially engage with one another. This is their dining experience. So it's a whole different approach in terms of the delivery of the food, the food service delivery system, in terms of how they're engaged with demonstration cooking. Actively involved in the food service council where they actually helped plan the menus in advance. They actively participate in food taste studies, but they really provide a governance in what they're choosing as you do at home, as I know you do at home all the time. Right?

Speaker 1:

Right. It's interesting because some of our Intalere members, um, as we've engaged with them in our awards program and other sort of interactions we have with them, it seems like a lot of these facilities are moving into, as we talked about at the top of much more consumer-focused experience. It's almost restaurant quality, um, in terms of the way that they're approaching their, their membership. I think we even talked about, um, the concept of a food truck. One of our members did I think or a last year and and taking that out into the community not only to provide nutrition, but also as a point of reference for a lot of folks in the rural communities who didn't get care otherwise. So it became almost a communal sort of experience that was not just about nutrition and food, but it was also about helping to deliver healthcare. So it, it seems like it, it really, again, is becoming much more consumer focused. And that's, I think, what people really have to look for is on the acute and non-acute care side as they're looking to grow and optimize their nutrition and food service experiences it sounds like.

Speaker 2:

Yeah. And it's interesting because you bring that up because where there's two examples to kind of articulate the the integration of nutrition from the hospital into the public healthcare arena. And here's a couple of examples. You know, we've got a very large client of ours in Boston who has a food truck and um, they use the food truck to help support community needs, and as such, where you used to have no one heard about the hospital, hospital food per se, they actually embrace hospital food because they actually as an outreach function of this food truck out into the communities and to help support various community activities or various functions and activities with the hospital's logo on the side with gourmet food. So it using as the food truck. Uh, another example of that would be one of our, actually our owner system, uh, our owner, Intermountain Healthcare today has partnered with a grocery store chain in Salt Lake City. And so what they've created that models their retail operations in the hospitals is the ability to choose nutritious food, if you choose to do so. And what they've done is helped to establish, um, rows in the grocery store of nutritious foods. So if you want to make a beeline just to the nutritious areas of the store, they branded it "Live Well," you can go to those particular rows that have the nutritious foods, low fat, low carbohydrate, low sugar fruits in it. So in terms of. It's interesting because the notion of patient experience, it's not just about patient experience anymore, it's about the public health piece and perception as exemplified by Intermountain Healthcare into the grocery community. And of course our client in Boston who is using it as a food truck out to the community.

Speaker 1:

Yeah, it's great if it works on so many levels. It's pretty interesting in the sense that it's, it's about population health management and treating people before they're even before they're in the hospital or in the long-term care center, but also coming from a marketing side of things, it's also a great branding opportunity, you know, for the healthcare provider, for whoever their partner may be in terms of a community awareness, providing a service, providing meals. So It's, it kind of works all the way around it seems like.

Speaker 2:

And I think the insurance companies to that point of being proactive, have slowly and gradually, uh, address that in terms of population health, if you will. In other words, you know, insurance companies has historically are in the reactive mode that we're going to pay based upon what has happened to you versus to incentivize you of not doing something and to prevent you from getting sick, so to speak. So a lot of the insurance companies, as you know, you have the ability, if you're a nonsmoker, you're going to get a discount on this. If you have this, you're going to get a discount on that. That's, that's going to continue to be a growing trend, I believe, but there had been, it's been slow in coming. It was very slow in coming.

Speaker 1:

And making some of those investments on the front end keep the costs from rising on the back end and acute care and in terms of folks coming into the hospital with illnesses, malnutrition things of that nature.

Speaker 2:

Absolutely.

Speaker 1:

So it sounds like we've covered a fair amount of, of some of the things we wanted to talk about. And I had one last question, but as I looked at it, it seems like we've covered it, but I'm gonna ask it anyways, and it's about any organization, again, acute care, long-term care in any, in any facet of nutrition and food services if they're currently struggling within their operation. What advice would you give them to help prepare for the future of not only of healthcare but a food service and those sort of two things combined?

Speaker 2:

There's two things. One, be informed about your operation, and I'll talk about that. And B, have the ability to turn on the dime for any course correction. So what does all that mean? We talked about this, a Triple Aim piece again, and the ability to understand and measure and articulate those three metric areas. What is your patient satisfaction index, and really understand the metrics of what's driving that. Understand the economic side of your spend and what's not only what's driving that, but how do you compare with competitors and benchmark statistics, those two. And thirdly, most importantly is your ability to execute a remedy or a plan for course correction if either two of those are out of sequence. And what we found, at least my personal opinion, is that in many cases, the ability to understand where you are in those two arenas, patient experience arena, what's your performance and what's your economic performance. There's, we need to continue to help our members to do that and understand and measure with any course correction things. So be, be informed, and be proactive in terms of course correction. Again, that two day length of stay that we talked about is a short stay, and your impression of staying for two days will have huge implications down the road thereafter related to what you're going to share it with your family and as you know today, the whole notion of public media and taking a picture of your food on your tray and then within seconds it's out to how many friends you have on Facebook has huge implications. So two things: be informed on what is the measurements on patient experience, how you measure it, what's driving it, and the economic side and the ability to make change if necessary.

Speaker 1:

Great. Well thanks, Peter. I think that's, it's been pretty enlightening and some things I think again, what we wanted to kind of share with folks is just the importance of the entire healthcare and food service dynamic. And how it's so important to so many aspects of the healthcare experience, patient satisfaction in terms of how folks view the experience in your facility, but also in terms of just the population health and treating people before they even get to the hospital. So it's, it's, it's got so many different aspects. So I'm glad we were able to kind of talk and touch upon a lot of those and hopefully our listeners will gain a little bit more from that. So I'm thrilled that you had some time to sit with us. I appreciate it. And, uh, we'll talk again soon, I'm sure. Thank you very much. This has been the Illuminated Path podcast, shining a light on healthcare's best operational practices and we hope to talk and walk along the illuminated path once again with you. Thanks very much. If you've enjoyed this episode, make sure you subscribe to the Illuminated Path podcast wherever you listen to podcasts. To learn more about Peter or Intalere, check out our show notes and visit our website at Intalere.com. And follow us on LinkedIn, Twitter, and Facebook to learn when the latest episodes will be available and to keep up with all things Intalere.