1. Quality management Project Thorek Memorial Hospital Kristine Sullivan Hannah Lapkin

2. Identification of problem Problems Implications No forecasting/tallying system No standardization of recipes Portion sizes not monitored Waste not recorded Excess house diets Patient not consulted on menu preferences Diet clerk Cooks made uninformed guesses on food quantities Leading to unnecessary waste Cooks not following recipes Inconsistency in food taste Too little/too much food on patient trays Increased waste Difficult to determine over/underproduction of food Patients unsatisfied with tray May get items not asked for (added waste)

3. Production sheet Management project • Aramark standards require production sheet usage • Thorek out of compliance • Production sheets offer solutions to previously mentioned problems • Enforces a patient tally system • Diet clerks must tally according to patient selections • Requires use of standardized, quantified recipes • Clearly states portion sizes • Carefully monitors waste/leftovers • Preceptors solicited our help to oversee/supervise the implementation of system • Example of production sheet

4. Parameters and standards for outcome measurement • Minimal house diets • Goal rate: Less than 10% • Accurate and timely patient tallies • Limited food waste if accurate • Cooks receiving quantified recipes with adequate time for production • Cooks following standardized recipes • Accurate recording of waste • Patient satisfaction • Received desired items • Taste and temperature appropriate

5. Data collection • Collected production sheets from each day (B, L, D) • Investigated over/under food production • Helped to determine if tallying was completed accurately • Assessed accuracy of diet clerks tally • Ensured proper production prior to giving recipes to cooks • Helped identify when padding occurred • Determined if cooks adhered to recipes • Assessed amount served vs. portions made • Helped identify occurrence of padding Lots of paperwork! Created 3-ring binder to help organize

6. Employee supervision • Helped cooks learn to read/make recipes • Assisted with necessary tasks to ensure proper tray line timing • Taught diet clerks appropriate tallying procedures • Ensured diet clerks received actual patient selections • Minimize house diets • Ensured recipes were printed in a timely fashion • Monitored/confirmed recording of waste

7. analysis • After two weeks of supervising new system, findings were as followed: • Both diet office and cooks were padding • Due to fear of running out of food for patients/late trays • Waste still not being recorded • Cold production cook overwhelmed with new responsibilities • Poor employee morale/job dissatisfaction • Some employees not following portion sizes on production sheets • Lack of knowledge (scoop sizes) • Many needed corrections on production sheets • Recipe numbers and job responsibilities • Supervisors/clerks reluctant to embrace changes

8. Corrective action plan • Thorek audited by Aramark after production sheet implementation • Deductions for many items stated previously • Developed corrective action plan with RDs • Based on audit and data collection/analysis • Included: • Switch to forecasting from patient tallying • Education and increased supervision of waste tracking • Education and increased supervision of portion sizing • Education on adequate completion of production sheets • Ensure accurate standardized recipes for each menu item

9. In-services • To implement corrective action plan, in-services planned/executed to staff • Forecasting and waste logging • Forecasting: assessment of patient census, diet orders, and previous production sheets for determination of recipe quantification • Diet clerks • Waste Logging: accurate completion of production sheets • Specifically total prepared, total served, waste, leftovers • For use for future forecasting • Supervisors monitor the weighing and throwing out waste • Accurate portion sizing • Education on translating scoop numbers to portion size • Not over/under filling scoops • Educated on where to find portion size on production sheet • Difference between fluid ounces and weight

10. Summary • Production sheet management program to: • Minimize waste • Standardize recipes/menu items provided • Compliance with Aramark standards • Patient tally preferences to reduce house diets • Corrective actions • Made exponential progress, still room for growth/improvement • In-services • Lessons Learned