How does the quality of food in hospital affect care?

The short answer would be that quality of food in hospital impacts on care in a variety of ways. Malnutrition (which in a hospital context generally means under rather than over-nourishment) affected 24% of adults on admission to Scottish hospitals according to a BAPEN (British Association of Parenteral and Enteral Nutrition) survey published in February 2014. While this was the lowest prevalence of all UK nations, it highlighted the necessity to make further improvements.

You can download the BAPEN Survey here.

Under-nourishment on admission is a particular problem, given nutritional status can often decline further during the hospital stay. Mainly, this is because acute illness or injury can impair appetite, swallowing and intestinal absorption. It is therefore highly important that patients receive effective, regular nutritional screening to identify their nutritional needs. They then must receive nutritionally appropriate food that incorporates any specific dietary requirements (e.g. allergies, texture modification, cultural preferences, personal preferences…) to deliver their needs. Food in Hospitals, published by Health Facilities Scotland (HFS), sets standards for nutrient and food provision for patients within hospitals, and provides practical guidance on how these standards can be met. Since 2009, HFS have published reports every six months on NHS Board’s mandatory compliance to their Food in Hospitals document. The first recorded compliance report (July to December 2009) showed 87.0% compliance. The last published audit (January to June 2015) revealed 96.5% compliance to standards across Scotland.

Palatability and aesthetics of hospital food are also of vital importance. When food is appetising, patients want to eat it, and this can then help improve their clinical condition. These qualitative components of hospital food are harder to define, and patient satisfaction is an important measure. The inpatient patient experience survey 2014 is one such example. This identified both areas for improvement and areas of strength. Recent events like Monklands Hospital’s food tasting allow patients, visitors and staff to sample the food served on wards each day, sample potential new menu additions and more generally give their views on what they want. This initiative is one example of the on-going work to support continued improvements in the quality of hospital food, at both a Board and national level.

The healthcare costs of managing individuals with malnutrition is more than twice that of managing non-malnourished individuals, due to higher use of healthcare resources. Malnutrition is complex and multi-factorial, and patients often present symptoms or are at risk prior to admission to hospital. However, NHS hospitals can aspire to mitigate this by providing food that is tasty and of high nutritional quality. Above anything else, food should be available, eaten and enjoyed. It makes prudent financial sense to address this issue, to help achieve and maintain a sustainable, value driven health service and eliminate food waste. Maximising opportunities for patients to eat, and maximising the quality and choice of food are seen as crucial to improving intakes. This necessitates adept, close collaboration between catering professionals and healthcare professionals, if all hospitals in NHS Scotland are to become exemplars of high quality food provision.

Guest author Kyle Malcolm – Policy Officer at the Scottish Government

How can your experience of cancer care be improved in the future?

We know that more people are being diagnosed with cancer and the number of new cases of cancer is projected to rise by 33% in the next 15 years.

  • How can we ensure that patients and their loved ones receive the information they need to make the right choices about their care?

Cancer

Several studies have documented substantial gaps between the outcomes patients prefer and the outcomes doctors ‘think’ patients prefer.

This study in the New England Journal of Medicine (NEJM) published in 2012 interviewed more than 1000 patients with terminal lung or bowel cancer and found that 69% (lung cancer) and 81% (bowel cancer) thought that their chemo was potentially curative.  This is never the case in these  scenarios as it is only ever palliative, rarely prolongs life compared to those who don’t opt for it, and it fact sometimes kills people quicker because it’s so toxic.

In an earlier guest post, Shaun Maher discussed the importance of a person centred approach to care and mentioned the navigator project – an abstract of which can be found here:

In essence the navigator project found that when we supported people with good information, in plain English, and built an agenda for consultation around the things that mattered to them, they had much less decisional regret and anxiety.  They also opted for less treatment.

You can find Shaun’s post here:

What should the future of hospital care look like in Scotland?

Patient Opinion is an independent site about your experiences of UK health services, good or bad. Patient Opinion was founded in 2005 and is now the UK’s leading independent non-profit feedback platform for health services.

When asked three questions about their experiences of hospital care throughout Scotland, some key themes emerged from the participants.

  • Have your say and tell us what you think Hospital Care in Scotland should look like in the next 10 to 15 years, in the comments section below.

The questions were:

1.How did you feel?

How did you feel

2.What could be improved?

What could be improved

3.What was good?

What was good

 

Care in Hosptial – Person Centred Care

Over the next three weeks we’ll be exploring our next theme ‘Care in hospital’. In week one we will be talking about Person-Centred Care.

To set the scene, we have a guest post by Shaun Maher – The Strategic Advisor for Person-Centred Care and Improvement at the Scottish Government.

  • Why isn’t a Person-Centred approach to care “business as usual” and what do we have to do to make sure that is?

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Person-Centred Care

When people think about person-centred care they often equate it with the principles of good customer service, and whilst there is some truth in this, when it comes to the world of healthcare there is much more to being person-centred than smiling and saying “have a nice day!” Really good customer service comes about when the provider of the service or product has a good understanding of what provides value to their customers. If they fail to understand what provides value then experiences and quality will be variable. These same principles apply to healthcare. Coupled with this the common description of relational elements of care as “soft skills” can demean their importance and reinforces the view of some that these skills are nice to have, but not essential. The pressure and pace of work can often cause us to lose sight of the important fact that our work is all about people, our fellow human beings. How we, and the systems we operate in, relate to the people we come into contact with is at the heart of our work and critical to its quality.

What is person-centred care?

Person-centred care is at the heart of the NHS Scotland quality strategy, which defines it a “providing care that is responsive to individual personal preferences, needs and values and assuring that patient values guide all clinical decisions”.

How can a person-centred approach help?

One of the principle objections to adopting a truly person-centred approach is that there is simply not enough time. This objection may seem reasonable at first glance, especially in the current climate. This is worth exploring a little more deeply and in doing so we need to return to the point about good customer service being at the heart of high quality.

Failure to understand what really matters to the people who use your service and what provides value, at best results in variable quality and at worst, leads to poor clinical outcomes, harm and poor financial performance.

Where patient experiences are good, safety, effectiveness and financial performance are good. Where experiences are variable and poor, so are safety, effectiveness and financial performance. In light of this relationship we could perhaps argue that we should always start with “what really matters” and the rest will follow. The reality is perhaps that we cannot afford to neglect any of these elements and they are at least of equal importance, but perhaps person-centred approaches have been somewhat neglected until now and therefore, need some remedial attention. We cannot afford not to make time to focus on person-centred approaches to care.

Person-centred care in action

There are a number of exciting and innovative examples at home and abroad demonstrating the potential transformative power of this approach.

Swedish gastroenterologist Jorgen Tholstrup and his team adopted a person-centred approach starting with asking whether routine return visits to the outpatient clinic following treatment were good value to patients. Unsurprisingly people didn’t value sitting for half a day in his late-running clinic! Amongst other interventions, the new approach simply involved a direct phone line to a senior nurse that people could call if they had any concerns or questions following treatment. The nurse would triage the calls, deal with the ones she could and refer on to medical staff those that she couldn’t. The results were significant.

By focusing on what provided value to the people using the service capacity was released in the outpatient clinic. This in turn resulted in waiting time for referral from primary care being reduced by two thirds from around 70 days to a little over 20 days. There was also a 50% reduction in waiting time for gastroscopy; 18 days to 9 days. Because people were seeing a specialist more promptly emergency admissions to the ward reduced along with a 25% reduction in length of stay. In the new system patients achieving set physiological improvement goals increased as well as improved quality of life and satisfaction with the service.

Belinda Hacking and colleagues developed a person-centred approach with a “navigator” supporting people who had breast or prostate cancer through the decision making process about treatment options. The intervention had a number of elements, but mainly focused on ensuring that people were primed with clear understandable information by means of a personal phone call and discussion prior to a major consultation with their oncologist. They were supported to set an agenda for the meeting based on the things that mattered to them. Immediately following the consultation with the oncologist a recording of the conversation was provided to take away and reflect on. Participants were randomised to standard care or the navigator intervention.

Patients who had the support of a navigator reported less regret about their decisions than the control group, but interestingly also chose less treatment opting for less chemotherapy and less surgical intervention than the control group. Another interesting finding was that those in the navigator group who did choose intervention experienced less side effects than those in the control group undergoing the same treatment. The reasons for this were not explored.

The final example is from the USA and involves people who presented with stage IV lung carcinoma. There is no curative treatment with advanced disease of this nature and life expectancy is around 12 months, often much less. Standard care focuses on palliative chemotherapy and various other pharmacological interventions aimed at symptom relief.

The intervention in this study was “a good conversation about the things that really matter to you” as soon as possible after diagnosis. The technical description of the intervention was “early palliative care” which involved a semi-structured conversation with the individual about their personal goals and fears, as well as some of the more usual aspects of care. One half of the participants in the study were assigned to standard care and the other half received the “what matters to you?” conversation.

The intervention group fared significantly better than the control group, experiencing less anxiety and depression and fewer hospital admissions. They also opted for less chemotherapy and only 16% of them died in hospital compared to a little over 30% in the control group.   There is one final finding to ponder. This group of patients had less medical intervention, less time in hospital and yet they lived 25% longer than the control group. Food for thought.

Final thoughts

These examples, and many more besides, are telling us that modern healthcare is lacking something important. When person-centeredness is at the heart of everything we do, our core purpose if you like, then improvements in safety, effectiveness and efficiency follow on naturally. It’s not that we can’t improve without being person-centred, but we will never be as good as we could be if we fail to recognise the benefits that this crucial element of quality can contribute.

The evidence supporting the benefits of a person-centred approach is so powerful that if a good conversation about the things that matter to you was a drug I’m certain we would prescribing it for everyone by now!

  • So, why isn’t this way of working “business as usual” and what do we have to do to make it happen?

Guest post by Shaun Maher – Strategic Advisor for Person-Centred Care and Improvement at the Scottish Government.