Salary discrepancies between male and female foodservice directors in JCAHO-accredited hospitals.

This study profiles foodservice directors employed in US hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and examines the effect of gender and work-related characteristics on salary. A 37-item questionnaire was sent to 1,002 randomly selected directors of foodservice programs at JCAHO-accredited hospitals in the United States and Puerto Rico. Usable data were received from 663 directors, a response rate of 66%. Foodservice directors answered questions on background information, work-related information, academic and professional certification, and salary range. Findings indicate that foodservice directors are predominantly white, female, college graduates, and more than half are registered dietitians. On the average, foodservice directors had 16 years of experience in foodservice, had spent 9 years with their current employer and 6 years in their present position, and worked a mean of 48 hours each week; more than two thirds earned greater than $30,000. Salaries, however, were significantly higher for men than for women. When controlling for experience (employment in foodservice, years with present employer and in present position), size of hospital, academic preparation, and professional certification, salaries remained consistently higher for men. Although the dietetics profession is predominantly female, gender appears to be the major factor accounting for inequalities in salaries. These findings may alert hospital administrators of the need to review hiring practices and establish standards that promote equitable salary opportunities for persons most qualified for positions, regardless of gender.     

Use of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire to monitor trends in patient satisfaction with foodservice at an acute care private hospital

Aim:  To demonstrate how the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire can be used to monitor trends in foodservice satisfaction.
Methods:  Three one-day surveys of foodservice satisfaction were conducted in 2003–05. All adult hospital inpatients with the exception of intensive care, cardiac post-operative care, labour ward and day surgery patients were eligible. The response rate was 48% (2003), 42% (2004) and 60% (2005). This took place in an acute care 440-bed private hospital. Overall foodservice satisfaction, dimensions of foodservice satisfaction (food quality, meal service quality, staff/service issues and the physical environment) and two independent statements (temperature of the hot foods, ability to choose different sized meals); satisfaction by gender, length of stay, age, diet type and appetite for 2005. Scores were calculated for overall satisfaction, four dimensions of satisfaction and two independent statements. Chi-squared analysis was used to determine the effect of gender, age, diet type and appetite on overall satisfaction. Correlation analysis was used to assess the association between overall foodservice satisfaction and length of stay.
Results:  Ratings of overall foodservice satisfaction, four dimensions of foodservice and two independent foodservice items were high, consistent with previous findings. Of the foodservice dimensions, the staff/service issues were the most positively rated and food quality the least positively rated. Patients' expectations of the foodservice were significantly associated with overall satisfaction. Quality improvement activities focused on the lowest scoring components of the questionnaire.
Conclusion:  The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire can be used to determine trends in foodservice satisfaction and identify areas to target for quality improvement initiatives.     

Use of the microcomputer to determine direct costs of menu items

Recent developments brought about by the government's prospective payment system as well as by new restrictions on hospitalization imposed by private insurance companies are placing greater emphasis on cost-containment measures within hospital foodservice systems. The research reported in this article focuses upon the development of a microcomputer technique that produces direct (labor and ingredient) cost information on menu items. Such information can assist foodservice directors in identifying and controlling costs associated with their current menu offerings. In addition, this information can assist in planning and decision making for future menu planning efforts as well as in make-or-buy decisions.     

Determinants of foodservice satisfaction for patients in geriatrics/rehabilitation and residents in residential aged care

Background Poor satisfaction with institutional food is a significant moderator of food intake in geriatrics/rehabilitation and residential aged care. Purpose To quantify the relationship between foodservice satisfaction, foodservice characteristics, demographic and contextual variables in geriatrics/rehabilitation and residential aged care. Methods The Resident Foodservice Satisfaction Questionnaire was administered to 103 patients of 2 geriatrics/rehabilitation units and 210 residents of nine residential aged care facilities in Brisbane, Australia. Ordered probit regression analysis measured the association of age, gender, ethnicity and appetite, timing and amount of meal choice, menu selectivity, menu cycle, production system, meal delivery system and therapeutic diets with foodservice satisfaction. Results Patient and resident appetite (P < 0.01), the amount and timing of meal choice (P < 0.01), self‐rated health (P < 0.01), accommodation style (P < 0.05) and age (P < 0.10) significantly moderated foodservice satisfaction. High protein/high energy therapeutic diets (P < 0.01), foodservice production (P < 0.01) and delivery systems (P > 0.01) were significant moderators for those with ‘fair’ self‐rated health. Conclusions Patient and resident characteristics and structural and systems‐related foodservice variables were more important for influencing foodservice satisfaction than characteristics of food quality. The results suggest modifications to current menu planning and foodservice delivery methods: reducing the time‐lapse between meal choice and consumption, augmenting the number of meals at which choice is offered, and revising food production and delivery systems.It is important that residents in poorer health who are a high risk of under‐nutrition are provided with sufficient high protein/high energy therapeutic diets. Diets that restrict macro‐ and micro‐nutrients should be minimized for all patients and residents.     

Competitive foods sales are associated with a negative effect on school finances

Background

It is widely presumed that competitive foods—foods offered for sale in schools in addition to reimbursable federal meals programs—provide revenue that is essential to maintain school foodservices. However, evidence is lacking to demonstrate whether competitive foods sales truly improve foodservice financial viability.

Objective

The aim of this research was to assess whether or not competitive foods sales have an overall positive financial effect on school foodservice finances.

Design and statistical analyses

This observational study used a multivariate time series analysis of annual foodservice financial data from repeated observations of 344 Minnesota public school districts between 2001 and 2008 (N=2,695). First, revenue from competitive foods was assessed in terms of whether or not such revenue displaced or complemented revenue from reimbursable meals. Second, profit from competitive foods was assessed in terms of whether or not such profit displaced or increased total school foodservice profit.

Results

Fixed effects models indicated small but significant negative relationships between competitive foods sales and reimbursable meals revenue, as well as overall foodservice profit. A 10% increase in competitive foods revenue was associated with a 0.1% decrease in reimbursable meals revenue (P<0.05). A 10% increase in competitive foods profit was associated with a 0.7% decrease in overall foodservice profit among schools with profitable competitive sales (P<0.10).

Conclusions

Study findings suggest that competitive foods can have a negative effect on school foodservice finances. Better understanding of foodservice finances could influence current approaches to improve school nutrition. Improved recordkeeping may be necessary to ensure that public funds are not used to subsidize schools' competitive offerings.     

Marketing nutrition in restaurants: a survey of current practices and attitudes

This study sought to determine attitudes toward nutrition, nutrition marketing practices, the relationship between attitudes toward nutrition and nutrition marketing practices, and nutrition training practices in restaurants. A written questionnaire was mailed to 200 research and development (R & D) directors in restaurant companies included in Restaurants & Institutions' list of top 400 foodservice organizations ranked by sales. Seventy (35%) responded. Most R & D directors did not think they were responsible for improving the health of their consumers. A positive relationship existed between attitudes toward nutrition and nutrition marketing practices (P = .013). Forty-four reported that they marketed nutrition and planned to add nutritious menu items in the future. Forty-six reported that nutritious meal options represented 0 to 10% of total sales. Nutrition information was provided to consumers by 27 restaurant companies but such information often had to be requested. The American Heart Association was a popular source of nutrition and menu-planning information. Twelve companies employed a registered dietitian, and 14 used registered dietitians as consultants. Nutrition-related training for restaurant employees was limited. These findings indicate that dietitians have opportunities to market their skills in developing nutritious menu items and providing staff training. Also, dietitians should encourage consumers (especially those with special dietary needs) to let restaurant managers know their menu and nutrition information needs.     

Inclusion of Nutrition Expertise in Catering Operations at a Major Global Sporting Event: A Qualitative Case Study Using a Foodservice Systems Approach

BackgroundMajor sporting event catering is a significant undertaking for foodservice providers, particularly with an increasing focus on sustainability, global health, and nutrition demands of athletes. Yet, the inclusion of nutrition expertise in catering varies significantly between events. Foodservice systems models are commonly used to evaluate foodservice operations but to date have not been applied to catering and nutrition at major sporting events.ObjectiveThe aim of this exploratory case study was to gain in-depth insights of key stakeholders (catering management, chefs, organizers, and dietitians) regarding the integration of nutrition into the catering operation of a major global sporting event, with a focus on future continuity, and map this to the foodservice systems model using a program logic model.SettingSemistructured interviews were conducted with 12 stakeholders during and after the 2018 Commonwealth Games, Gold Coast, Australia.ResultsThe 8 themes that emerged were related to planning and preparation, refining processes, improvement of the menu, better technology, increase in food allergies/intolerances, organization controls, experience of the workforce, and increased client knowledge of nutrition. The logic model demonstrated that the system is driven by policy and budget at the level of control prior to and during the planning phase but modified by the environment during operation.ConclusionsDespite recognition by stakeholders on the importance of change, there are barriers to the provision of suitable food. Integration of nutrition expertise into tender documents and budgets in major event catering will help ensure nutritionally adequate, culturally suitable, and safe menus for future events.     

Consumer evaluation of hospital foodservice quality: an empirical investigation

PURPOSE: The purpose of this article is to estimate the relationship between acute care consumers' satisfaction with hospital foodservices, foodservice characteristics, demographic and contextual variables. DDESIGN/METHODOLOGY/APPROACH: The acute care hospital foodservice patient satisfaction questionnaire was administered to 2347 patients in Queensland, Australia from 1996-2001. Regression analysis was conducted to measure the influence of 21 foodservice attributes and seven contextual/demographic items on overall foodservice satisfaction. FFINDINGS: Foodservice satisfaction was strongly associated with variety, flavour, meat texture, temperature, meal taste, and menu staff (p < 0.01). Consumers aged 70 years or more rated their overall satisfaction significantly lower than younger consumers (p < 0.01), but no statistically significant differences in overall ratings existed for other contextual or demographic groups. RESEARCH LIMITATIONS/IMPLICATIONS: This new foodservice instrument and the methods of analysis may be generalisable, but application is likely to be context-specific. Further applications of the instrument are required to produce greater confidence in its validity and reliability across different foodservice settings. PRACTICAL IMPLICATIONS: Global statements often used in health service satisfaction surveys (e.g. a single rating of "food quality") provide insufficient information to allow managers to adapt foodservices to suit consumers' preferences. ORIGINALITY/VALUE: Detailed information of the kind produced here is required for the formulation of managerial and sectoral policies to improve the quality of health and consumer nutrition care. The findings are noteworthy and, as far as the literature review showed, no previously published study has produced this level of detail on consumer preferences across foodservice attributes or their relationship to overall foodservice satisfaction.     

Effects of Federal Legislation on Wellness Policy Formation in School Districts in the United States

The Reauthorization Act of 2004 required local education agencies sponsoring school meal programs to establish a wellness policy by the beginning of school year 2006-2007. The purpose of this study was to examine the process and outcome of wellness policy development in school districts. Phase 1 examined states' school nutrition legislation. Phase 2 consisted of qualitative interviews with foodservice directors. Phase 3 utilized an e-mail and mail survey. The sampling frame was a stratified random sample selected from medium-sized or larger schools (n=847). Factor analysis was conducted with Cronbach's α. Correlations tested relationships among variables using analysis of variance with Tukey's post hoc test. Before the federal mandate, few wellness components (37.4%) were in place for foodservice outside of the federally regulated meal program. Following the legislation, 72.4% of the wellness components were in place. Nutrition components were the variables that changed the most and were reported as the components most frequently implemented. Changes particularly noted in foodservice operations were the use of nutrition guidelines for a la carte foods, beverages, fundraisers, parties, and vending. Foodservice directors noted improvements in nutrition education and physical education. Foodservice directors reported less progress in the implementation and monitoring of the wellness policy than in the development of the policy. The top barriers to wellness policy development and implementation were the need to use food in fundraising and competition for time.     

Obstacles to Nutrition Labeling in Restaurants

Objective This study determined the major obstacles that foodservices face regarding nutrition labeling.Design Survey questionnaire was conducted in May 1994. In addition to demographic questions, the directors were asked questions addressing willingness, current practices, and perceived obstacles related to nutrition labeling.Subjects/setting Sixty-eight research and development directors of the largest foodservice corporations as shown in Restaurants &. Institutions magazine's list of the top 400 largest foodservices (July 1993).Statistical analyses performed P tests were used to determine significance within a group for the number of foodservices that were currently using nutrition labeling, perceived impact of nutrition labeling on sales, and perceived responsibility to add nutrition labels. Regression analysis was used to determine the importance of factors on willingness to label.Results Response rate was 45.3%. Most companies were neutral about their willingness to use nutrition labeling. Two thirds of the respondents were not currently using nutrition labels. Only one third thought that it was the foodservice's responsibility to provide such information. Several companies perceived that nutrition labeling would have a potentially negative effect on annual sales volume. Major obstacles were identified as menu or personnel related, rather than cost related. Menu-related obstacles included too many menu variations, limited space on the menu for labeling, and loss of flexibility in changing the menu. Personnel-related obstacles included difficulty in training employees to implement nutrition labeling, and not enough time for foodservice personnel to implement nutrition labeling.Applications Numerous opportunities will be created for dietetics professionals in helping foodservices overcome these menu- or personnel-related obstacles. J Am Diet Assoc. 1997; 97:157–161.     

The Currently Available Literature on Inpatient Foodservices: Systematic Review and Critical Appraisal

BackgroundAn adequate hospital foodservice is important to optimize protein and energy intake and to maintain or improve a patient’s nutritional status. Key elements that define an optimal foodservice have yet to be identified.ObjectivesTo systematically describe the effects of published foodservice interventions on nutrition and clinical outcomes and determine which elements should be considered essential. Secondly, to describe the outcome measures used in these studies and evaluate their relevance and validity to guide future research.MethodsPubMed, Embase, the Cochrane Library, and the Web of Science databases were searched. Studies that included assessment of nutrition and/or clinical outcomes of hospital foodservice up to December 2017 were eligible. The details of the subject population, the type of intervention, and the effects on reported outcomes were extracted from each study.ResultsIn total, 33 studies that met inclusion criteria were identified, but only nine (27%) were rated as having sufficient methodologic quality. These nine studies concluded that various elements of a foodservice can be considered essential, including using volunteers to provide mealtime assistance, encouraging patients to choose protein-rich foods, adding protein-enriched items to the menu, replacing existing items with protein-enriched items, giving patients the ability to order food by telephone from a printed menu (room service concept), or a combination of these interventions. The interstudy heterogeneity was high for both outcome measures and methods.ConclusionsVarious foodservice interventions have the potential to improve outcome measures. Recommendations are made to facilitate future research.     

Eating environment in the aged‐care residential setting in New Zealand: Promoters and barriers to achieving optimum nutrition. Observations of the foodservice,menu and meals

Aim: To investigate the foodservice, menu and meals in the aged‐care residential setting to identify promoters and barriers to achieving optimum nutrition. Method: An observational study conducted by the University of Otago Dietetic Training Programme. Rest home dietitians around New Zealand identified a final convenience sample of 50 facilities. Ten final‐year student dietitians each spent two days in their designated rest homes, administering a 19‐item questionnaire to ascertain practices relating to staffing, dining environment, menu, meals, snacks, feeding assistance, fluids, special diets, nutrition care, medications, nutrition policy and access to sunlight. Observations describing foodservice and meal‐related activities only are reported in this paper. Results: Most rest homes had the ability to provide for the needs of residents. Ninety per cent of facilities offered menu cycles of at least four weeks long. Potential barriers to meeting needs were inadequate amounts of protein‐rich food for numbers served and lack of perceived choice in menus and meal service. Lack of foodservice staff training and poor uptake of training opportunities contributed to these barriers. Conclusions: This is the first such study conducted in New Zealand. Results should be of interest to the Ministry of Health and district health boards that are charged with the responsibility to ensure that meals in long‐term care facilities meet the nutritional needs of this potentially vulnerable population. Shortcomings identified in the present study require a multidisciplinary approach that should include district health boards, auditing agencies, aged‐care organisations, training providers and dietitians.     

Cognitively impaired residents' risk of malnutrition is influenced by foodservice factors in long-term care

BACKGROUND: Several long-term care studies have shown that residents with dementia-related disorders are more prone to weight loss and malnutrition. Very few studies have investigated institutional characteristics, such as foodservice factors, and their possible link to malnutrition in this population. The objective of this study was to identify whether foodservice factors influence risk of malnutrition in cognitively impaired elderly nursing home residents. METHODS: Cognitively impaired residents meeting inclusion criteria and living within each of 38 participating nursing homes were randomly sampled. The final sample of 263 residents was screened for risk of malnutrition, and a questionnaire on participants' dining experiences was completed by primary caregivers. Additional data came from participants' medical charts, and a written questionnaire was completed by each institution's foodservice manager. Logistic regressions were used to examine relationships between risk of malnutrition and foodservice characteristics. RESULTS: Close to 70% of participants were at risk of malnutrition. Foodservice factors, including tray food delivery systems, timing of menu selection, difficulty manipulating dishes, lids and food packages, as well as therapeutic diets were all significantly associated with risk of malnutrition. CONCLUSIONS: Our findings suggest that many nursing homes could modify certain aspects of foodservices that may affect risk of malnutrition among cognitively impaired residents.     

An Assessment of Potential Foodservice Organizational Development Within the Privatization Process of Eastern Europe

Abstract

This article is a review of current economic and development issues facing the Eastern European region (EE). The review is designed to highlight major points of interest for potential foodservice operators looking to invest in the economic developing region. Since 1989, the former Soviet Bloc has been opening its economic borders for foreign investment and growth. Foodservice organizations such as McDonald's and Pizza Hut have been aggressively expanding in the region to meet the labor force and infrastructure changes occurring in the region. This review of compiled data is designed future foodservice operators the current and future climate in the EE and provides such vital data for making investment decisions such as overall meat, chicken, fish, and pork consumption in each EE country, economic growth and development throughout the EE, and current trade relations amongst EE countries and the United States. Readers will be able to use this data to develop an understanding on how to invest and develop foodservice organizations in the EE.     

Emergency preparedness needs assessment of centralized school foodservice and warehousing operations

Managers of onsite retail foodservice operations, particularly those in centralized school foodservice operations, are called on to provide meals during emergencies, yet there is a paucity of research on their readiness to handle emergencies. Qualitative research and a cross-sectional survey design were used to conduct a needs assessment for emergency preparedness (emergency readiness, food recalls, and food defense) in centralized school foodservice operations, including warehousing. An open-ended written questionnaire was mailed to eight foodservice directors, and responses were used to develop a written questionnaire that was mailed to school foodservice directors in 200 districts identified as having centralized food production and warehousing. Directors from 78 districts responded (39% response rate). Most districts (n=72) had an emergency response team, and foodservice was included as part of 63 of those teams. Not all districts had written procedures for food recalls (47 of 73), natural disasters (37 of 74), or food defense (30 of 74). Barriers to implementing emergency preparedness policies and procedures included limited money, emergency equipment, and time. Most current training related to food safety with little training related to emergency preparedness. Training on the emergency preparedness plan was done in 61 of 78 districts. Training on emergency procedures was done by less than half of the districts during the previous year. This study identified best practices related to emergency preparedness that can be implemented in onsite retail foodservice operations. Results indicate a need to emphasize emergency preparedness, develop written standard operating procedures, and train employees to be prepared to respond to emergencies.     

Are registered dietitians adequately prepared to be hospital foodservice directors?

OBJECTIVE: To determine perceived importance of selected competencies for the role of hospital foodservice director and explore whether registered dietitians (RDs) are perceived competent in these areas. DESIGN: Data were collected through a mailed questionnaire. SUBJECTS: A random sample of 500 hospital foodservice directors and 500 hospital executives to whom the directors report. ANALYSIS: Chi2, Mann-Whitney, and Kruskall-Wallis tests were used to examine differences among ratings by and demographic characteristics of foodservice directors and the executives with whom they work. RESULTS: All competencies were perceived to be important for someone in the role of hospital foodservice director. RDs were perceived to be somewhat competent in all areas studied but were only perceived to be competent to expert in a few of the areas. Directors who were RDs and hospital executives who had worked with RDs rated the competence level of RDs higher than did non-RD directors and hospital executives who had not worked with RDs. CONCLUSIONS: Unique competencies appear to be important for those aspiring to become hospital foodservice directors. Hospital executives who had worked with RDs perceived the competency level of RDs to be higher than did executives who had not worked with RDs. Often, areas rated as most important for the role of hospital foodservice director were not areas in which RDs were perceived to be highly competent. Additional competency development may be needed to better prepare RDs to assume the role of hospital foodservice director.