Implementing Culture Change in Food Service” Please respond to the following:
Implementing Culture Change in Food Service Contributed by Jullet A. Davis, PhD, and Paul W. Davis City Nursing Home (CNH) is a nonprofit, independent, 200-bed facility located outside a major city in the western United States. The community has a population of nearly 150,000 with a high rate of poverty. CNH has a current occupancy rate of 97%, which is significantly higher than the state and national averages. CNH is ranked highly on Medicare’s 19 quality indicators (Table CS7–1), but the facility had eight deficiencies cited on its certification survey when it was inspected about a year ago (Table CS7–2). The four-story building was opened 32 years ago and has maintained an excellent reputation for delivering high-quality patient care. Staff stability in a community that offers relatively few jobs has been one of the main factors that has contributed to the quality of care. The facility trains its own certified nursing assistants (CNAs). With less turnover compared with the industry, and having a pool of trained CNAs to fill vacancies, the facility maintains above-average staffing levels. The facility also takes pride in having its own in-house rehabilitation therapy staff. Ms. Morehouse has been the administrator of CNH for the past 12 years. For its current strategic plan, the governing board has approved adoption of culture change mainly through self-managed work teams in nursing services and the implementation of family-style dining. Implementation of this plan would require both structural and process changes. The existing kitchen is located in the basement of the building, and the main dining room is on the first floor. Using an elevator, food is transported in carts with hot and cold compartments. CNAs pick up the meal trays with preportioned food straight from the food carts, check the resident’s name against the meal card on each tray, and place the tray in front of the resident. Although the service is efficient, its appeal is very institutional. However, residents and families have been generally satisfied with the meals. One main issue in the past few years has been three leg injuries that the food service associates sustained while transporting the heavy carts. One of the injuries was serious enough to keep the associate away from work for 4 months. Shortly after returning to work, that associate resigned to take a job at the local McDonald’s. One year, the kitchen sustained some flooding after heavy spring rains and had to be closed down for almost 2 weeks. Food services were temporarily contracted out. Ms. Morehouse and the board worked together to engage the architectural firm of Caplin & Reese. The firm has had some experience with modern architectural designs for nursing homes. Considering the financial resources and other logistical issues, the facility would redesign its kitchen and dining areas in three to four phases. It is anticipated that over the next few years, each floor will have its own family-style kitchen and dining area. CNH is now in the early planning stage, having recently formed a Food Service Planning Committee. The Planning Committee met 2 weeks ago, and Ms. Morehouse is reviewing the minutes from that meeting:
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