Evaluating Patient Experience with Food in a Hospital-Wide Survey
Publication: Canadian Journal of Dietetic Practice and Research
6 June 2024
Abstract
Purpose: Patient dissatisfaction with hospital food is an important driver of poor food intake in hospitals. The objective of this study was to examine patient satisfaction with current menu offerings and explore patient preferences and values, in order to inform a patient-centred menu redesign.
Methods: Between July and September 2021, a cross-sectional survey was distributed to inpatients receiving a lunch tray at Vancouver General Hospital, a large tertiary care centre in Vancouver, Canada. The survey was based on the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire, with additional questions on food experience, factors impacting preferences for hospital meals, interest in plant-rich diets, and demographics.
Results: The response rate was 5.5%, with 271 patients completing at least part of the survey. On a 5-point Likert scale, (5 – highest score; 1 – lowest score) satisfaction with food quality (mean = 3.09, p < 0.001) and the overall experience (mean = 3.54, p < 0.001) was lower than industry benchmark of 4, and qualitative feedback was generally negative. Open-ended responses indicated patients were interested in expanded cultural diversity in food provision, more fresh produce and better flavours, and were generally open to trying plant-rich foods.
Conclusions: A number of opportunities for improvement were identified in this survey, which will inform an upcoming menu redesign in this institution.
Résumé
Objectif. L’insatisfaction des patients à l’égard des aliments servis dans les hôpitaux contribue fortement aux apports alimentaires insuffisants dans ces établissements. L’objectif de cette étude était d’examiner la satisfaction des patients quant aux menus offerts et d’explorer leurs préférences et valeurs dans le but d’étayer une refonte des menus axée sur les patients.
Méthodes. Entre juillet et septembre 2021, une enquête transversale a été distribuée aux patients hospitalisés ayant reçu un plateau-repas au Vancouver General Hospital, un important centre de soins tertiaires de Vancouver, Canada. L’enquête était basée sur l’Acute Care Hospital Foodservice Patient Satisfaction Questionnaire [Questionnaire de satisfaction des patients hospitalisés en soins de courte durée quant aux services alimentaires], avec des questions supplémentaires sur l’expérience alimentaire, les facteurs influençant les préférences quant aux repas à l’hôpital, l’intérêt envers une alimentation riche en végétaux et les données démographiques.
Résultats. Le taux de réponse a été de 5,5 %, 271 patients ayant répondu à au moins une partie de l’enquête. Selon une échelle de Likert à 5 points (5 – score le plus élevé; 1 – score le moins élevé), la satisfaction à l’égard de la qualité des aliments (moyenne = 3,09, p < 0,001) et de l’expérience globale (moyenne = 3,54, p < 0,001) était inférieure au point de référence de l’industrie établi à 4, et les commentaires qualitatifs étaient généralement négatifs. Les réponses aux questions ouvertes indiquaient que les patients souhaitaient que la diversité culturelle dans l’offre alimentaire, la quantité de légumes et fruits frais servis ainsi que les saveurs soient bonifiées, et qu’ils étaient de façon générale ouverts à l’idée d’essayer des aliments riches en végétaux.
Conclusions. Cette enquête a permis de cibler des possibilités d’amélioration qui seront prises en compte dans la refonte planifiée des menus de l’établissement.
Get full access to this article
View all available purchase options and get full access to this article.
Author contributions: AL and KP designed the study and survey under the supervision and guidance from AM and JZ. AL and KP carried out the literature review. AL, KP, and NG performed the data collection and analysis, under the guidance of JZ. AL was responsible for writing the manuscript, and all authors reviewed the manuscript. AM and JZ provided conceptual direction for the study. All authors have approved the final version of the article.
Sources of financial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest disclosures: The authors declare that they have no competing interests.
REFERENCES
1
Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010. Clin Nutr. 2013 Oct 1;32(5):737–45.
2
Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Malnutrition at hospital admission—Contributors and effect on length of stay. J Parenter Enter Nutr. 2016 May;40(4):487–497.
3
Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, and Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012 Jun;31(3):345–350.
4
Jeejeebhoy KN, Keller H, Gramlich L, Allard JP, Laporte M, Duerksen DR, et al. Nutritional assessment: comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission. Am J Clin Nutr. 2015 May;101(5):956–965.
5
Curtis LJ, Bernier P, Jeejeebhoy K, Allard J, Duerksen D, Gramlich L, et al. Costs of hospital malnutrition. Clin Nutr Edinb Scotl. 2017 Oct;36(5):1391–1396.
6
Maharaj J. Take back the tray: revolutionizing food in hospitals, schools, and other institutions. Toronto: ECW Press; 2020. 250 p.
7
Hartwell HJ, Shepherd PA, Edwards JSA, and Johns N. What do patients value in the hospital meal experience? Appetite. 2016 Jan;96:293–8.
8
Dall’Oglio I, Nicolò R, Di Ciommo V, Bianchi N, Ciliento G, Gawronski O, et al. A Systematic Review of Hospital Foodservice Patient Satisfaction Studies. J Acad Nutr Diet. 2015 Apr;115(4):567–584.
9
Trinca V, Duizer L, and Keller H. Putting quality food on the tray: Factors associated with patients’ perceptions of the hospital food experience. J Hum Nutr Diet. 2022 Feb;35(1):81–93.
10
Lai H and Gemming L. Approaches to patient satisfaction measurement of the healthcare food services: A systematic review. Clin Nutr ESPEN. 2021 Apr;42:61–72.
11
Sorensen J, Fletcher H, Macdonald B, Whittington-Carter L, Nasser R, and Gramlich L. Canadian Hospital Food Service Practices to Prevent Malnutrition. Can J Diet Pract Res. 2021 Jul 21;1–9.
12
Greig S, Hekmat S, and Garcia AC. Current Practices and Priority Issues Regarding Nutritional Assessment and Patient Satisfaction with Hospital Menus. Can J Diet Pract Res. 2018 Jun 1;79(2):48–54.
13
Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. The Lancet Commissions Food in the Anthropocene: the EAT – Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019. 393 (10170):447–492.
14
Fakhri M. Right to food. UN Human Rights Council; 2020 Dec p. 20. Report No.: A/HRC/46/33.
15
Walker R, Cromarty H, Linkewich B, and Semple D, St. Pierre-Hansen N. Achieving Cultural Integration in Health Services: Design of Comprehensive Hospital Model for Traditional Healing, Medicines, Foods and Supports. Int J Indig Health. 2013 Jun 4;6(1):58–69.
16
Bodirsky M and Johnson J. Decolonizing Diet: Healing by Reclaiming Traditional Indigenous Foodways. Cuizine. 2008;1(1):0–0.
17
Atwoli L, Baqui AH, Benfield T, Bosurgi R, Godlee F, Hancocks S, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. BMJ. 2021 Sep 5;n1734.
18
Health Standards Organization. British Columbia Cultural Safety and Humility Standard. British Columbia; 2022 Jun p. 120.
19
Alami H, Lehoux P, Miller FA, Shaw SE, Fortin J. An urgent call for the environmental sustainability of health systems: A ‘sextuple aim’ to care for patients, costs, providers, population equity and the planet. Int J Health Plann Manage. 2023 Feb 3;hpm.3616.
20
Dijxhoorn DN, Mortier MJMJ, van den Berg MGA, and Wanten GJA. The Currently Available Literature on Inpatient Foodservices: Systematic Review and Critical Appraisal. J Acad Nutr Diet. 2019 Jul;119(7):1118–1141.e36.
21
Keller H, Allard J, Vesnaver E, Laporte M, Gramlich L, Bernier P, et al. Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force. J Hum Nutr Diet. 2015 Dec;28(6):546–557.
22
Williams P and Walton K. Plate waste in hospitals and strategies for change. E-SPEN Eur E-J Clin Nutr Metab. 2011 Dec;6(6):e235–e241.
23
Dias-Ferreira C, Santos T, and Oliveira V. Hospital food waste and environmental and economic indicators – A Portuguese case study. Waste Manag. 2015 Dec;46:146–54.
24
Barton AD, Beigg CL, Macdonald IA, and Allison SP. High food wastage and low nutritional intakes in hospital patients. Clin Nutr. 2000 Dec;19(6):445–449.
25
van Bokhorst–de van der Schueren MAE, Roosemalen MM, Weijs PJM, and Langius JAE. High Waste Contributes to Low Food Intake in Hospitalized Patients. Nutr Clin Pract. 2012 Apr;27(2):274–80.
26
Nikkel L., Maguire M., Gooch M., Bucknell D., LaPlain D., Dent B., Whitehead P., and Felfel A. The avoidable crisis of Food Waste: The Roadmap. Second Harvest Value Chain Manag Int. 2019;32.
27
Aggarwal M, Grady A, Desai D, Hartog K, Correa L, Ostfeld RJ, et al. Successful Implementation of Healthful Nutrition Initiatives into Hospitals. Am J Med. 2020 Jan;133(1):19–25.
28
Osman NS, Md Nor N, Md Sharif MS, Hamid SBA, and Rahamat S. Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review. Nutrients. 2021 Oct 18;13(10):3649.
29
Ottrey E and Porter J. Hospital menu interventions: a systematic review of research. Int J Health Care Qual Assur. 2016 Feb 8;29(1):62–74.
30
Sathiaraj E, Priya K, Chakraborthy S, and Rajagopal R. Patient-Centered Foodservice Model Improves Body Weight, Nutritional Intake and Patient Satisfaction in Patients Undergoing Cancer Treatment. Nutr Cancer. 2019 Apr 3;71(3):418–423.
31
Keller H, Koechl JM, Laur C, Chen H, Curtis L, Dubin JA, et al. More-2-Eat implementation demonstrates that screening, assessment and treatment of malnourished patients can be spread and sustained in acute care; a multi-site, pretest post-test time series study. Clin Nutr. 2021 Apr;40(4):2100–2108.
32
Ministry of Health BC. Cleaning, dietary workers coming back in-house at B.C. hospitals [Internet]. Government of British Columbia. 2021 [cited 2023 Apr 26]. Available from: https://news.gov.bc.ca/releases/2021HLTH0157-001703
33
Vancouver Coastal Health. Planetary Health [Internet]. About Us/Our Vision. 2023 [cited 2023 Apr 26]. Available from: https://www.vch.ca/en/about-us/our-vision
34
Capra S, Wright O, Sardie M, Bauer J, and Askew D. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire: the development of a valid and reliable tool to measure Patient Satisfaction with Acute Care Hospital Foodservices. Foodserv Res Int. 2005 Mar;16(1–2):1–14.
35
Trinca V, Iraniparast M, Morrison-Koechl J, Duizer L, and Keller H. Hospital Food Experience Questionnaire (HFEQ): Reliable, valid and predicts food intake in adult patients. Clin Nutr. 2021 Jun 1;40(6):4011–4021.
36
Kondrup J, Allison SP, Elia M, Vellas B, and Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21.
37
Chryst B, Marlon J, van der Linden S, Leiserowitz A, Maibach E, and Roser-Renouf C. Global Warming’s “Six Americas Short Survey”: Audience Segmentation of Climate Change Views Using a Four Question Instrument. Environ Commun. 2018 Nov 17;12(8):1109–1122.
38
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, and Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–381.
39
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208.
40
R Core Team. R: A language and environment for statistical computing. [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2022. Available from: https://www.R-project.org/
41
Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, and Kyngäs H. Qualitative content analysis: a focus on trustworthiness. SAGE Open. 2014 Jan 1;4(1):215824401452263.
42
Rollins C and Dobak S. Creating a great patient experience: improving care with food and nutrition services. J Acad Nutr Diet. 2018 May;118(5):805–808.
43
McCray S, Maunder K, Norris R, Moir J, and MacKenzie-Shalders K. Bedside menu ordering system increases energy and protein intake while decreasing plate waste and food costs in hospital patients. Clin Nutr ESPEN. 2018 Aug 1;26:66–71.
44
Doorduijn AS, van Gameren Y, Vasse E, and de Roos NM. At Your Request® room service dining improves patient satisfaction, maintains nutritional status, and offers opportunities to improve intake. Clin Nutr. 2016 Oct;35(5):1174–1180.
45
Abou El Hassan D, Lewis R, Howe N, and Vlietstra E. Dining On Call: Outcomes of a hospital patient dining model. Healthc Manage Forum. 2021 Nov;34(6):336–339.
46
Johns N, Hartwell H, and Morgan M. Improving the provision of meals in hospital. The patients’ viewpoint. Appetite. 2010 Feb;54(1):181–185.
47
Health Canada. Canada’s dietary guidelines for health professionals and policy makers [Internet]. Health Canada. 2019. 62 p. Available from: https://food-guide.canada.ca/static/assets/pdf/CDG-EN-2018.pdf
48
Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, and Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021 Feb 14;125(3):308–318.
49
NYC Health + Hospitals. NYC Health + Hospitals Now Serving Culturally-Diverse Plant-Based Meals As Primary Dinner Option for Inpatients at All of Its 11 Public Hospitals [Internet]. NYC Health + Hospitals. 2023 [cited 2023 Feb 22]. Available from: https://www.nychealthandhospitals.org/pressrelease/nyc-health-hospitals-now-serving-plant-based-meals-as-primary-dinner-option-for-inpatients-at-all-of-its-11-public-hospitals/
50
Saldivar B, Al-Turk B, Brown M, and Aggarwal M. Successful incorporation of a plant-based menu into a large academic hospital. Am J Lifestyle Med. 2022 May;16(3):311–317.
51
da Silva JT, Garzillo JMF, Rauber F, Kluczkovski A, Rivera XS, da Cruz GL, et al. Greenhouse gas emissions, water footprint, and ecological footprint of food purchases according to their degree of processing in Brazilian metropolitan areas: a time-series study from 1987 to 2018. Lancet Planet Health. 2021 Nov;5(11):e775–e785.
52
Government of Canada. Canadian Net-Zero Emissions Accountability Act [Internet]. Justice Law Website. 2022 [cited 2022 Jan 13]. Available from: https://laws-lois.justice.gc.ca/eng/acts/C-19.3/FullText.html
53
Wilson ED and Garcia AC. Environmentally Friendly Health Care Food Services: A Survey of Beliefs, Behaviours, and Attitudes. Can J Diet Pract Res. 2011 Sep;72(3):117–122.
54
Hoek AC, Pearson D, James SW, Lawrence MA, and Friel S. Shrinking the food-print: A qualitative study into consumer perceptions, experiences and attitudes towards healthy and environmentally friendly food behaviours. Appetite. 2017 Jan;108:117–31.
55
Trinca V, Duizer L, Heather Keller, R. The Hospital Food Experience Questionnaire Predicts Adult Patient Food Intake. Cahill N, editor. Can J Diet Pract Res. 2022 Nov 22;1–11.
56
Hartwell, HJ, Edwards J, Symonds, C. Foodservice in hospital: development of a theoretical model for patient experience and satisfaction using one hospital in the UK National Health Service as a case study. Journal of Food Service. 2006 Dec 8;
57
Alison Payne S, Seymour JE, Chapman A, and Holloway M. Older Chinese people’s views on food: implications for supportive cancer care. Ethn Health. 2008 Nov 1;13(5):497–514.
58
Alpers LM. Hospital food: When nurses’ and ethnic minority patients’ understanding of Islamic dietary needs differ. Nurs Open. 2019 Oct;6(4):1455–1463.
59
Naithani S, Thomas JE, Whelan K, Morgan M, and Gulliford MC. Experiences of food access in hospital. A new questionnaire measure. Clin Nutr. 2009 Dec;28(6):625–630.
60
Fallon A, Gurr S, Hannan-Jones M, and Bauer JD. Use of the acute care hospital foodservice patient satisfaction questionnaire to monitor trends in patient satisfaction with foodservice at an acute care private hospital. Nutr Diet. 2008 Mar;65(1):41–46.
61
Wright ORL, Connelly LB, and Capra S. Consumer evaluation of hospital foodservice quality: an empirical investigation. Int J Health Care Qual Assur. 2006 Feb;19(2):181–194.
Supplementary Material
File (cjdpr-2023-027suppla.docx)
- Download
- 2.07 MB
Information & Authors
Information
Published In
Canadian Journal of Dietetic Practice and Research
Volume 85 • Number 3 • September 2024
Pages: 122 - 131
Editor: Naomi Cahill
History
Version of record online: 6 June 2024
Copyright
© 2024.
Key Words
Mots-clés
Authors
Metrics & Citations
Metrics
Other Metrics
Citations
Cite As
AnnieLalandeMD, KeikoPattersonBSc, NehaGadhariPhD, Andrea J.MacneillMD MSc, FRCSC, and JiayingZhaoPhD. 2024. Evaluating Patient Experience with Food in a Hospital-Wide Survey. Canadian Journal of Dietetic Practice and Research.
85(3): 122-131. https://doi.org/10.3148/cjdpr-2023-027
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
There are no citations for this item
View Options
Get Access
Login options
Check if you access through your login credentials or your institution to get full access on this article.
Subscribe
Click on the button below to subscribe to Canadian Journal of Dietetic Practice and Research
