The development of a methodology for assessing food quality in hospital food service systems.

There are few empirical studies of food quality within hospital food service systems. Although it is widely accepted that food quality is a multi-faceted phenomenon, much attention has been paid to single component explanations in the past. The aim of this study throughout has been two fold - to develop a model suitable for evaluating the quality of food in conventional hospital food service systems; and to evaluate food quality in selected hospitals in the Trent Regional Health Authority and West Midland Regional Health Authority using the model. A key outcome in this study has been the development of a multifaceted measurement of food quality to help catering managers deploy resources effectively, in conventional hospital food service systems. This approach was achieved using a variety of qualitative and quantitative information to score six food quality components and 15 influencing variables. Food quality was defined as a multi-dimensional measure to include measures of satisfaction of patients and catering staff, productivity, safety, and nutritional adequacy. Measures of influencing variables were chosen or adapted from those available in food service operations insofar as was possible. Where none was available, methods were developed. The variables were grouped into two major categories: human resources and system resources. A survey of 12 hospital conventional food service systems in the UK was undertaken and detailed information was collected from each, including surveys of 933 patients and 327 catering staff.Patient satisfaction with the quality of hospital food and food-related service was evaluated by patient questionnaires. It was measured by assessing 14variables. Patients seem to be generally satisfied with the food served. In the regression analysis none of the influencing variables explained the component of 'patient satisfaction' at the level of P<0.05, suggesting that it is a different kind of component from the other 4. Importantly the component 'patient satisfaction' appears to be explained predominantly by patients' own demographic and emotional variables rather than by objective catering system factors. Age and appetite were found to significantly correlate with patient satisfaction scores. The component of food waste was found to have a high negative correlation with patients' satisfaction. It may be possible to use food waste as an index of patient satisfaction in future research. Catering staff - satisfaction was evaluated by measuring employee job attitudes towards five aspects of their job using the Job Description Index (JDI). The JDI is directed toward specific areas of satisfaction rather than global or general satisfaction and was easily administered. The food service workers surveyed in this research were less satisfied with their jobs than are other types of workers in other industries. In the regression analysis total number of patients explains around 36% of the variation in staff satisfaction. The productivity level was based upon the total meal equivalents divided by the total labour hours required to produce and serve them. The regression analysis suggests that around 77% of the variance in productivity is explained by labour cost. The safety component was based upon two elements which were microbiological control and temperature control. The results of regression analysis suggest that the number of menu items and the subsidizing meal ratio explain around 74% of the variation in the safety component. Nutritional adequacy was evaluated indirectly by measurement of food waste. In the regression analysis more than 68% of food waste component can be explained by the variable occupancy rate. Correlations between the food quality components show that a non-significant relationship existed between all but one of the components of food quality studied. A significant negative correlation existed between the patients'satisfaction with the hospital meal and service and the food waste; this was expected. The non-significant correlations between the components of food quality showed the independence of components, confirming the need for a multi-dimensional model of food quality. The findings of this research support the notion that food quality is a multi-faceted phenomenon and have led to the development of a practical way of measuring it.