Abstract
Background: Malnutrition caused by poor food intake affects one in three hospital patients in New Zealand and Australia. Inadequate nutrition has an adverse impact on recovery, length of hospital stay, readmission rates and mortality. Over three-quarters of hospital patients rely on the foodservice as their sole source of nutrition. This makes malnutrition a major healthcare quality and safety issue. As nutrition is critical to patient safety, understanding patient expectations of and satisfaction of hospital foodservice is crucial to offering appropriate quality services. Perceived quality of a service provider is known to affect expectations and subsequent satisfaction levels. No published validated tool exists in New Zealand to measure patient expectations of or satisfaction with hospital foodservice. Understanding these factors is vital to offering patients high quality and safe foodservices.
Aim: To develop and validate a novel tool to measure patient expectations of and satisfaction with hospital foodservices.
Methods: A three phase mixed method study was employed in a private New Zealand hospital to measure expectations of and satisfaction with hospital foodservices. A literature review informed questionnaire design. Two versions of a single questionnaire with corresponding wording changes were used to capture expectations with and satisfaction of a hospital foodservice. The 19-item questionnaire measured four foodservice constructs, food quality, meal service quality, staff and service quality and hunger and satiety. The questionnaire underwent pilot testing and expert review before being administered to randomly selected patients booked for a surgical procedure requiring a minimum of one overnight stay. Descriptive statistics (mean, median, and interquartile range) were calculated for each matched question. Internal reliability of the foodservice constructs was assessed using Cronbach’s alpha and paired t-tests. Semi-structured in depth telephone interviews were conducted on a subset of participants after completion of the expectations questionnaire. Interviews allowed insights to factors that influenced participant’s levels of expectations. Phase one (expectations questionnaire) and phase two (expectations interview) were completed prior to hospital admission. Phase three (satisfaction questionnaire) was completed on the morning of a participant’s discharge.
Results: All foodservice constructs questions achieved a Cronbach’s alpha value showing strong internal reliability. Mean expectations score for each question was high, and satisfaction consistently met and exceeded expectations scores. Expectations scores were a key determinant of satisfaction levels. Statistically significant differences in satisfaction and expectations scores were seen in the foodservice constructs food quality (p=0.0002) and staff and service quality (p=0.0003). Semi-structured interviews identified an array of factors that influenced interviewee’s levels of expectations. Five themes emerged explaining expectation levels; private institutions, prior experience, meal quality, food accessibility and choice. A main finding supported by qualitative and quantitative results is that perceived quality of the service provider influences patient expectations and satisfactions of hospital foodservice.
Conclusion: To our knowledge the questionnaire validated in this study is the first tool assessing patient expectations of and satisfaction with hospital foodservices. The questionnaire is a valid and reliable measure of patient expectations of and satisfaction with private New Zealand hospital foodservices. Participants levels of expectations were significantly related to satisfaction levels, and affected by a number of tangible and intangible factors.