Exploring Patients' Expectations of a New Zealand Public Hospital Foodservice

Abstract

Background: Malnutrition caused by sub-optimal food consumption is an alarming and ongoing issue in hospitals worldwide. The consequences are significant including; increased complications, length of stay, mortality and costs. Hospital food has shown to be important in the prevention and treatment of malnutrition. Food also has the potential to improve patients’ wellbeing through enhancing interpersonal communication, autonomy, choice, familiarity and comfort. Given the importance of hospital food to both the patient and hospital management, understanding patients’ expectations of and experiences with hospital foodservice is vital in meeting patient needs and encouraging food consumption. In New Zealand (NZ) there is no validated tool to measure patient expectations of or experience with public hospital foodservices. In 2016, the Patient Foodservice Expectations and Satisfaction Study developed and validated a tool for NZ private hospital patients.

Aim: To explore factors influencing booked patients’ expectations of public hospital foodservices and to refine and adapt the 2016 Patient Foodservice Expectations and Satisfaction Questionnaire for a public hospital population.

Methods: The three-phase, mixed method study was undertaken at a 230-bed hospital in a main centre to measure elective orthopaedic surgical patients’ expectations of and experience with the foodservice. The expectation and experience questionnaires used were adapted from the 2016 study tool. The questionnaire comprised of twenty-one questions measuring four foodservice constructs; food quality, meal service quality, staff and service quality, and hunger and satiety. Participants (n=38) completed an expectations questionnaire prior to hospital admission (phase one) and an experience questionnaire (n=26), on the day of discharge (phase three). Semi-structured telephone interviews (phase two) were conducted with a subset of participants (n=19) after they completed the expectations questionnaire, before admission, to explore factors influencing their expectation levels.

Results: Mean expectations scores for each question were high, and mean experience scores were either similarly high or higher. Overall scores for staff and service quality, and hunger and satiety constructs were significantly higher (p<0.05) on the experience questionnaire than on the expectations questionnaire. Food quality and meal service quality measures in the expectations questionnaire had Cronbach’s alpha of >0.7, indicating strong internal reliability. In the experience questionnaire, food quality was the only measure to produce a Cronbach’s alpha of >0.7. Cronbach’s alpha for the hunger and satiety measures in both questionnaires indicated weaker reliability (<0.7). Thematic analysis of semi-structured interviews conducted with half of the study participants indicated six main factors influenced their expectations of the foodservice; public health system institution, previous hospital experience, healthcare facility, meal quality, intangible aspects of food and other influencers.

Conclusion: To our knowledge this is the first study to explore patients’ expectations of public hospital foodservices in NZ. Findings show that patients’ high expectations are fulfilled in their overall experience with the foodservice. This illustrates the importance of measuring and understanding patient expectations, particularly given the importance of hospital food to the patient and to hospital management. Qualitative data highlights important tangible and intangible factors influencing interviewees expectations. This study has contributed to developing a valid tool to measure patient expectations of and experiences with NZ hospital foodservices.