Food-Service-Manual-for-Health-Care-Institutions

among professional staff whose members need less direction on a daily basis and may prefer to
work in self-directed teams. However, the need for less direction does not imply that structure
and control mechanisms are not necessary. Providing structure allows the manager to spend
less time on direct supervision and more time on the important function of planning and organizing
for the future.
In many health care facilities, the nutrition care manager’s leadership responsibilities also
include serving as a mentor and providing direction for students. Student education programs
may include internships for dietitians or practical experience in conjunction with programs for
dietitians or dietetic technicians. The nutrition care manager and the facility both benefit from
providing direction and leadership to students. While in the facility, these individuals can assist
with the nutrition care of patients and serve as a resource for future recruiting efforts.
In larger institutions, the nutrition care manager may be involved with research within the
facility. This may include supervision of the dietitians involved in coordinating and directing a
specific research project.
As always, providing leadership means communicating effectively, as outlined in Chapter
7. The nutrition care manager plays a significant role in establishing interdepartmental relationships
among the medical staff, nursing services, and the pharmacy, for example. Many of
the policies and procedures related to the nutrition care of patients require cooperation and
input from these various departments.
Controlling
Responsibilities assigned the nutrition care manager (evaluation and control, for example)
ensure that standards, policies, procedures, and budgets are followed as delineated by the leadership
function. Control mechanisms provide structure for evaluation and monitoring to assess
performance.
In that fiscal responsibilities continue as an overriding concern of food service managers,
the nutrition care manager must create and monitor the department’s budget and establish
standards for monitoring staff productivity. The nutrition care manager can improve the fiscal
situation by creating and marketing new programs that will provide revenue, as discussed in
the planning section. Information on determining needs and monitoring other financial indicators
is presented in Chapter 11.
Another controlling function of the nutrition care manager includes quality improvement
and assessment, that is, responsibility for ensuring that the standards of care and policies and
procedures related to patient care are followed as outlined. These standards are reviewed in
Chapter 4.
Measuring Productivity of the Nutrition Staff
Cost containment in nutrition management is focused on the best use of the professional staff,
as assessed here by the productivity of the nutrition staff. Three aspects must be considered in
the productivity review: determination of the time spent to provide services, assessment of
whether the skill level of the dietitian is appropriately used, and establishment of the benefit or
outcome of nutrition intervention.
First, the amount of time spent on each task performed by the R.D., D.T.R., and C.D.M.
should be carefully determined. This is best accomplished by asking the professional to keep
accurate records of the patients he or she sees, the amount of time spent, and the type of activity
completed. This can be facilitated by creating a department-specific form with the most
common tasks listed or by using one of the many accepted forms created by the American
Dietetic Association or other professional organizations. This type of record allows the manager
to assess the time spent on various tasks as a portion of the whole, as illustrated in Figure 9.3.
Clinical Nutrition Care Management
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