Exploring Patient Foodservice Experiences with a New Zealand Public Hospital Population

Abstract

Background: Recently, patient experience tools have been preferred by hospitals over patient satisfaction tools. This is because patient experience is seen as providing more meaningful feedback, allowing service providers to more easily identify where improvements are needed. While the focus is on patient experiences with health services, very few established tools include questions about hospital foodservice experience, including the New Zealand Health Quality and Safety Commission’s Adult Inpatient Experience Survey. Hospital foodservices in NZ currently use satisfaction questionnaires, none of which appear to be validated. Validated questionnaires are important to ensure responses are interpreted correctly therefore resulting in appropriate quality improvements. In 2016, a foodservice expectations and satisfaction tool was developed and validated in a NZ private hospital by Lowerson S. Aim: To explore factors that influence patient foodservice experience and refine and adapt the 2016 foodservice questionnaire to assess patient foodservice experience in a NZ public hospital. Methods: A mixed method study was undertaken in a NZ public hospital to measure patient foodservice experiences using an adapted version of the 2016 foodservice questionnaire. Adaptations were made to the questionnaire to capture patient experiences and make it suitable for a public hospital population. The questionnaire consisted of two sections: six questions on patient demographics and 21 questions categorised into four foodservice constructs: food quality, meal service quality, staff and service quality and hunger and satiety. On the day of patient discharge, participants were invited to complete the written questionnaire and one of two semi-structured interviews: a usability interview on the day of discharge or a five-day post discharge telephone interview about their foodservice experience. Questionnaire responses and usability interview data was analysed with descriptive statistics and Cronbach’s alpha internal reliability values were calculated for the four foodservice constructs. Experience interview data was analysed using thematic analysis to identify themes and subthemes that capture the factors influencing patient foodservice experiences. Results: Overall, patients rated their foodservice experience highly on the written questionnaire. The food quality construct showed high internal reliability for Cronbach’s alpha, while the other three constructs produced lower reliability scores. Themes from the post discharge experience interviews showed consistency with the foodservice experience questionnaire results. The semi-structured experience interviews identified five major themes of influences on hospital foodservice experiences: clinical condition, individual preferences, experienced meal quality, public hospital, foodservice staff and hospital food importance. Usability interviews revealed a high level of usability for the questionnaire. Conclusion: To our knowledge, this study is the first to explore the factors influencing patient foodservice experience. Five major themes capturing influences on patients’ foodservice experience were identified. Use of quantitative and qualitative research methods assisted in adapting an existing questionnaire for a NZ public hospital population. Interviews confirmed the usefulness of the questionnaire however the addition of a clinical conditions construct warrants further investigation to ensure the validity of the tool. Participants communicated the value of hospital food and the reasons for its importance to them, confirming the importance of measuring foodservice experience in NZ hospitals.