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

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Food Service Manual for Health Care Institutions 258 Figure 9.3. Proportion of Registered Dietitian’s Time Spent on Various Tasks Research Education of Others 3% 7% 10% Self- Development 20% Indirect Patient Care Management Activities 5% 55% Direct Patient Care The second consideration in establishing cost-effective nutrition services is to ensure that the job responsibility is matched to the appropriate skill level of individuals on the team. For example, the dietitian should perform more complex nutrition intervention activities while dietetic technicians are available to conduct assessments and diet instructions. The dietitian and dietetic technician need not be used to perform the initial screening of patients for an existing or potential nutritional risk. This task is easily performed by a C.D.M. using a designated screening protocol. The third aspect the nutrition care manager should consider when assessing the costefficiency of staff utilization is determining the benefits associated with the nutrition intervention offered. Quality assessment must be done to determine whether patient outcome is improved by providing the service. Cost-benefit analysis is a method commonly used to assess whether the benefit of a particular product or program is greater than the cost of providing it. Although this technique works effectively for services with a direct charge attached, it is less effective in evaluating nutrition-related programs. Nutrition intervention should provide a positive outcome for the patient and improve the quality of life. Many nutrition intervention programs are being designed to prevent long-term illnesses and to keep individuals from using the health care system unnecessarily. To measure the benefit of these types of programs, a cost-effective analysis is needed. Conducting a costeffective analysis also identifies the cost of the service or program in monetary terms. The benefits, such as decreased length of stay or improved quality of life, are identified as outcomes for the patient and the organization.
Designing a Nutrition Services Payment System Services that could be provided for a fee by the nutrition and food service department include computerized nutrient analysis, computerized menu planning, inpatient and outpatient nutrition counseling, weight reduction counseling, diet and exercise programs, and other specialized nutrition programs. However, before these services are developed for distribution, a market analysis must be completed to determine whether the customer or other reimbursement agencies are willing to pay for them. Before the nutrition manager can initiate a charge directly for nutrition services, he or she will need to determine how dietitians spend their time and the dollar value of their services. The costs involved in providing the services and the price to be charged for them can then be determined realistically. All costs involved in providing the service must be included in determining the total cost per unit of service. Because a portion of all bills will be uncollectible even though the service has been provided, a provision for bad debts must be included in the overall cost. An example of such a cost calculation is illustrated in Table 9.2. Other authors have used other methods (see Jackson, Laramee, and Puckett [1997], and Hospital Food and Nutrition Focus [1996] in the bibliography). Table 9.2. Cost Calculation for the Services of a Registered Dietitian Variables Hours or Dollars Total number of work hours per year, hr a 2,080 Less: vacation time (10 days) (80) holidays (8 days) (64) sick leave (8 days) (64) education leave (8 days) (64) nonproductive time b (312) Actual number of work hours available per year, hr 1,496 Approximate number of units of service per yearc 600 Average yearly salary, $ Plus fringe benefits 40,000 d 12,800 Total yearly compensation, $ 52,800 Salary per hour ($52,800 ÷ 1,496), $ 35.30 Labor cost per unit of service (2.5 hours × $35.30), $ 88.25 Yearly indirect costs, $ e 22,000 Indirect cost per unit of service ($18,000 + 600), $ 36.67 Labor cost per unit of service, $ 88.25 Indirect cost per unit of service, $ 36.67 Profit (12 percent of labor and indirect costs), $ 15.00 Total cost per unit of service, $ 139.92 aThe number of work hours per year is based on a 40-hour workweek. bNonproductive time accounts for about 15 percent of the total work hours and includes coffee breaks, time spent waiting, and so forth. cThe standard amount of time allowed per patient referral, on unit of service (as determined by work analysis; includes evaluating the order, securing counseling materials, and performing counseling, charting, and the like), is 2.5 hours. 1,496 hours ÷ 2.5 = 598, or, for the sake of computation, 600 units of service per year. dFringe benefits are assumed to equal 32 percent of the average salary and include insurance benefits, Social Security payments made by the employer, and so forth. eIndirect costs include expenses for telephone service, postage, copying service, general overhead, allowances for uncollectible payments, and administrative expenses. Source: Based on J. C. Rose. Hospital Food and Nutrition Focus 2(3), Nov. 1985, revised in 2003 by R. P. Puckett, pp. 2–4. Clinical Nutrition Care Management 259
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Food Service Manual for Health Care
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Contents Figures, Tables, and Exhib
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Figures Figures, Tables, and Exhibi
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8.3. Excerpt from a Performance Eva
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19.1. Flow of Products in Food Serv
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6.2. Sample Job Description and Job
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Foreword It is truly an honor for m
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Preface The health care environment
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Acknowledgments The following indiv
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Introduction This edition of Food S
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Chapter 14 explains safety, securit
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Part One Management of the Food Ser
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Chapter 2 Leadership: Managing for
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oriented or people oriented and tha
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in an orderly manner, to manage the
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so as to anticipate and plan for fu
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Planning Through planning, the futu
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Reward or punitive power is the str
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• Building a team mind-set • Co
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of these three factors jeopardizes
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McClelland claims that “in some b
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• Define limits of what situation
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who have seen programs, processes,
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Leebov, W., and Scott, G. Health Ca
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Chapter 4 Quality Management A prim
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Figure 4.2. Deming’s PDCA Cycle A
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Move to CQI in Health Care The term
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care. Often these choices conflict.
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Supplier Partnerships A customer or
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analysis. Key benefits to having a
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Exhibit 4.1. Team Documentation For
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Figure 4.3. CQI Flowchart Quality c
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Exhibit 4.2. Inspection Criteria fo
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Once the departmental strategy is w
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Before hiring a consultant, managem
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selected for the issue in question.
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Figure 4.6. Cause-and-Effect Diagra
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not identical. CMS standards vary i
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the concurrent stay using critical
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Garvin, D. A. Managing Quality: The
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Chapter 6 Organization and Time Man
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Figure 6.1. Functional Organization
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Process departmentalization allows
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Characteristics of High-Performance
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outcome. Team building should conce
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necessary to assure that food servi
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Figure 6.4. Organization of a Small
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Figure 6.9. Organization of a Food
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skilled-nursing unit in the hospita
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service operations other than the c
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Distributing Authority Authority, t
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• What types of service does the
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Exhibit 6.1. (continued) Why? Which
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Exhibit 6.2. Sample Job Description
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equires, and the best means of moti
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Calculating FTE Needs Full-time equ
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Exhibit 6.3. Sample Productivity Fo
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Figure 6.10. Example of a Daily Sch
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Figure 6.12. Example of a Work Sche
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Figure 6.13. Example of a Manager
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Figure 6.14. Example of a Food Serv
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Lane, B. Managing People. Sunnyvale
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Page 277 and 278: Chapter 9 Clinical Nutrition Care M
Page 279 and 280: Planning As already shown, a manage
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Page 307 and 308: Elements of an MIS In addition to t
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Page 327: Bibliography Alexander, J. Selectin
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Excerpt from Annual Food Service De
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Sample Monthly Operating Statement
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Labor Cost Analysis 334 Figure 11.5
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336 Exhibit 11.6. Example of a Mont
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Part Two Operation of the Food Serv
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352 Exhibit 12.2. Selection of Wast
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354 Exhibit 12.4. Selection of Wast
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Figure 13.6. HACCPs for Cook-and-Ch
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Restaurant-Style Health Care Menu f
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Chapter 16 Product Selection Produc
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Figure 16.2. Procurement Subsystem
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The USDA organic seal appears on fo
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Figure 16.5. Grade Stamps and Inspe
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A carcass of good grade is blocky a
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e accomplished by scalping, which p
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Table 16.1. (continued) Meat Descri
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harvesting and processing. This tas
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Poultry Poultry products or domesti
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Weight and Size of Shell Eggs Shell
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Table 16.3. Manufacturing and Inspe
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Eggnog Eggnog contains milk product
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Natural, Processed, and Imitation C
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Table 16.4. Common Cheeses Cheese D
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• Bamboo shoots • Bean sprouts
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Celery Celery, mainly the Pascal va
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Size is another factor that affects
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Fruit and Vegetable Specifications
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Corn, , sunflower, and safflower oi
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Organic Flour Organic flour is from
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Relatively small quantities of wild
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Herbal Tea Herbal teas do not come
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alloy, the result is stainless stee
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Summary Food service purchasers mus
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U.S. Department of Agriculture, Agr
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Chapter 18 Receiving, Storage, and
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Figure 18.1. Receiving System Items
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Merchandise Receipt Receiving, Stor
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Receiving, Storage, and Inventory C
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disposed of promptly. The storeroom
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Issuing of Food and Supplies Receiv
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A perpetual inventory record alone
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Inventory Turnover Slow inventory t
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Figure 18.2. Comparison of Par Stoc
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Receiving procedures must ensure th
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Appendix 19.1 A Culinary Glossary
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Hors d’oeuvre Side dish or relish
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Chapter 20 Distribution and Service
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• What is the best type of servic
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Figure 20.1. Typical Tray Makeup Li
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Tray Delivery Because the point of
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quality. In recent years, food serv
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carrying their filled trays to thei
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plate is not used. Place coffee or
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minimized. The type of meal service
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Standards that should be monitored
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Exhibit 20.2. Sensory Assessment fo
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Herz, M. L. Analysis of Alternative
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Index A ABC method, 603 Absenteeism
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CDC (Centers for Disease Control an
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Delivery of products, 575-576 Deman
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Exit interviews, 239, 240e Exotic v
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described, 461; developing, 461-463
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Horizontal communication tract, 194
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Main-dish salads, 652 Maintenance-m
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Nutrient analysis, 296 Nutrition aw
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PERT (program evaluation and review
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(1993), 4, 203; Federal Employee Po
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Standing operational planning. See
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Waste audit, 349 Waste-handling equ
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