Gwen Friesen Introduction The purpose of this study was to establish an internal benchmarking system to provide a tool to continually

monitor and evaluate accuracy and efficiency of a hospital tray line assembly. Data was gathered November 6- ! "#$% at the &tratton '( )edical *enter located in (lbany! N+. ,enchmarking is -a continuous! systematic management tool for measuring work processes! products and services for the purpose of organi.ational comparison and improvement.- $ /nitially developed for the manufacturing industry! benchmarking has been shown to be applicable to other industries including food service." ,enchmarking has been utili.ed in the food service industry as a way to improve production! define performance standards and establish performance goals." /n selecting processes to benchmark! it is essential to select those that are central to the operation of the department.% 0uality has been identified as a critical performance element in a hospital tray line assembly! with accuracy and efficiency as measurable indicators of 1uality. "! %! 2! 6 (ccuracy and efficiency are vital for any foodservice operation! but in a healthcare setting they take on even more importance. /t is essential for the health and well-being of the patient that the meal delivered reflects the prescribed diet 3accuracy4 and that the assembly is done as 1uickly as possible 3efficiency4. 5nce the critical processes have been identified for benchmarking the metrics for each must be defined. This involves specifying what will be measured! establishing the units of measure! and the calculation method.6 /n a tray line assembly! the tray ticket contains information regarding the diet order! allergies and food preferences. The accuracy rate of the tray line is a measure of how closely the assembled tray reflects the information on the tray ticket.6 Tray line efficiency was defined as the number of trays assembled per minute. The fast paced environment in which hospital food service departments operate dictates that the tray line performs as efficiently as possible. ( large 1uantity of meals must be assembled within the time allotted for the meal service. The meals are $

Gwen Friesen also fre1uently assembled a distance from where the meals are served. To overcome these hurdles and still ensure that every patient receives the correct and a 1uality meal it is critical that tray assembly efficiency be ma7imi.ed. 5ne goal of an internal benchmarking is to establish realistic performance standards and goals based on the current level of performance.6 (ccuracy and efficiency data were collected from the tray line operation and utili.ed in the development of these performance standards. ( second ob8ective of internal benchmarking is to continually and systematically evaluate current performance data against these standards.6! 9 /f performance standards are not met a corrective action is implemented to improve performance. The benchmarking tool defines the process of implementing and documenting the corrective action! which includes identifying the problem! assigning a corrective action! establishing deadlines! and monitoring the effectiveness of the corrective action. Materials and Methods ( :rogram ;valuation and <eview *hart 3:;<T4 chart was developed to establish a timeline and coordinate the essential steps of the study 3(ppendi7 (4. Forms to record accuracy and efficiency data were developed to ensure data was collected accurately and consistently. The efficiency tool 3(ppendi7 ,4 documented the beginning and end times of the tray service as well as the number of trays processed. The formula for trays per minute was determined by dividing the number of trays processed by the total tray line operation time! in minutes.6 &pace was provided on the form to record observations made during the tray line assembly. :ertinent observations may include reasons for belt stoppages! food shortages! organi.ation of work stations! or any related action or behavior that may impact efficiency. The accuracy tool

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Gwen Friesen 3(ppendi7 *4 lists the total number of items on each audited tray as well as the number of discrepancies found between the assembled tray and the tray ticket. )issing=omitted items can be documented on the form to allow for more a detailed reporting of errors. For e7ample! if all discrepancies were associated with the beverage station! the station setup! as well as employee performance! could be investigated to determine the root cause of the error. Data was collected from five meal services! two breakfast and three lunch meals. (ssembled trays were audited at the end of the tray line prior to being loaded onto the delivery cart. ( total of 6# assembled trays were audited for accuracy! with ten trays selected randomly from each meal service. (ssembled trays were compared against the items listed on the tray ticket and the number of discrepancies recorded. /n addition! the duration of each meal service was recorded along with the total number of trays assembled. The start time of the tray line was designated

when the line supervisor turned on the tray line belt> the end time was when the last tray was loaded onto the delivery cart. :rior to each meal service the tray tickets were counted to determine the number of trays assembled. Results (t the completion of the data collection process! the data was sorted by the five meal service categories and analy.ed to determine the accuracy and efficiency rates for each breakfast and lunch serving. The tray line accuracy was determined to be ? .?@ 3%66 correct of %6? total items4. Figure $ contains the accuracy data collected for each of the five meals.

Gwen Friesen

Figure 1 - Tray Line Accuracy

)eal ,reakfast $ ,reakfast " Bunch $ Bunch " Bunch % Total Total A of /tems # 9$ 96 66 99 369 Total A of ;rrors # " $ $ # 4 Total A of *orrect /tems # 6? 96 62 99 365 (ccuracy <ate $##@ ?9."@ ? .9@ ? .2@ $##@ 9 !9"

The efficiency rate for the five meal services was ".$% trays per minute 36"6 trays assembled in "29 minutes4. Figure " contains the accuracy data collected.

Figure # - Tray Line $%%iciency

)eal ,reakfast $ ,reakfast " Bunch $ Bunch " Bunch % Total )inutes of 5peration 22 % 66 6# 6# #4& A of Trays 9 6 $"# $# $"2 5#5 Trays per )inute $.? "."6 ".$ ".$6 ".#9 #!13

Gwen Friesen 'iscussion and Reco((endations )easurable indicators of 1uality of the tray line assembly were indentified as accuracy and efficiency. /n a healthcare setting! accuracy is essential to ensure adherence to the prescribed diet order for each patient. The timeliness of meal delivery is largely dependent on the efficiency of the tray line assembly. (n internal benchmarking system was developed to establish a method for continually monitoring and improving 1uality of the tray line operation. The data collected served to establish baseline performance and was utili.ed to develop goals and benchmark performance standards for accuracy and efficiency. The tray line assembly was determined to operate at a ? .? accuracy rate for the timeframe studied. (lthough a high rate of accuracy was demonstrated! the benchmark goal was set at $##@ as any deviation from the tray ticket could have ma8or implications for the health and well-being of the patient. The study found the tray line efficiency rate to be ".$% trays per minute> this rate was adopted as the benchmark performance standard for efficiency. (n audit schedule 3(ppendi7 D4 was developed re1uiring that each meal service be audited for accuracy once every three months. ;fficiency data is gathered at every meal service. The data collected is entered into an electronic spreadsheet form 3(ppendi7 ;4 that calculates the rates for accuracy and efficiency and allows performance trends to be easily monitored. Chen baseline performance standards or goals are not met! the benchmark system provides a process for documenting the identified problem! assigning corrective action! establishing deadlines and reauditing to validate the effectiveness of the corrective action. ( ma8or component of benchmarking is the systematic collection of data to establish historical trends of performance. To accomplish this! data collection must occur at uniform time periods to

Gwen Friesen allow for consistent analysis and comparison of data. The timeframe between audits provides sufficient time for corrective action! when warranted! to be identified and implemented prior to the ne7t audit. /n this manner evaluation of the corrective action is built into the system. The audits also occur fre1uently enough to ensure there are not e7tended time periods of substandard performance. /t is through this process of monitoring performance trends that best practices! the ideal methods to complete a task! can be identified.2 &ince efficiency data is relatively simple to collect! an efficiency rate is calculated for each meal service. (s with accuracy data! performance trends are established and monitored to determine best practices. For e7ample! if the lunch service on Thursday is consistently below the performance standard an analysis can be conducted to determine the root cause and action re1uired to improve the efficiency. ;fficiency data allows for e7tremely timely feedback on performance. The tray line supervisor can utili.e this information as a tool to motivate employees and provide tangible evidence of performance. The data could also be utili.ed in performance evaluations as 1uantifiable measure of performance for kitchen workers! tray line supervisors! as well as the kitchen manager. /t is important to acknowledge that an over emphasis on efficiency can inadvertently cause a decrease in accuracy. ,est practices for efficiency must account for a balance between the two measures of 1uality. (lthough the benchmarking system was not implemented! the demonstrated accuracy rate of ? .?@ was below the goal of $##@! indicating the need for corrective action. ( potential problem source was identified as inade1uate setup of the tray line stations. ( corrective action plan was developed detailing the proper station configuration and minimum 1uantities re1uired for each meal service. The action plan also includes the development of an in-service training session to communicate the information to all employees! as well as a pre-meal service checklist 6

Gwen Friesen to be completed by the tray line supervisor. The checklist provides a method for the supervisor to systematically verify that each station is ade1uately prepared for the meal service! as well as identifying workers who may need to be retrained in appropriate station set-up. The kitchen manager would be tasked with the final responsibility of implementing this corrective action! but drafting the instructions would be assigned to multiple supervisors. ,enchmarking is clearly more than 8ust a data collection tool. The implementation of an internal benchmarking system provides the means for a food service department to continually monitor performance! and when necessary! take action to ensure the desired tray line accuracy and efficiency rates are maintained. /n addition to responding to declines in performance standards!

best practices for achieving 1uality can be established. These best practices are based on performance statistics and represent methods of operation that consistently result in high performance standards and the achievement of desired 1uality goals. The benchmarking system develop here should be viewed as a template for implementing a comprehensive benchmarking system for the food service department. The system could be e7panded to include other critical elements such as food waste! food temperatures! food cost! and patient satisfaction.

Gwen Friesen (ppendi7 (

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(ppendi7 D

Benchmarking System
$. 5nce a month audit for both efficiency and accuracy. a. Dtili.e observational tools developed for study b. *omplete tally sheet to determine accuracy rate and trays per minute. c. <otate the meal service audited each month so every meal is audited four times a year. EanuaryF ,reakfast (prilF ,reakfast EulyF ,reakfast 5ctoberF ,reakfast ". FebruaryF Bunch )ayF Bunch (ugustF Bunch NovemberF Bunch )archF Dinner EuneF Dinner &eptemberF Dinner DecemberF Dinner

/nput data from tally sheet into benchmarking tracking spreadsheet

%. <eview the data and observational notes. 2. *orrective action is warranted when a decrease in either rate is recorded or when observational notes indicate behaviors not in adherences with operational guidelines. 6. Dtili.e corrective action form toF a. Develop action plan

b. (ssign ownership c. Determine deadlines d. Document specifics of corrective actions

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Gwen Friesen (ppendi7 D

Corrective Action Form

Problem:

Correction Needed:

Action Plan: )T$* 1+

Assigned To: )T$* #+ Assigned To: )T$* 3+ Assigned To:

Due Date:

Due Date:

Due Date:

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Gwen Friesen <eferences $. Eohnson ,! *hambers ). Foodservice benchmarkingF practices! attitudes! and beliefs of foodservice directors. E. (m. Diet. (ssoc. "###>$##3"4F$96G$ #. ". Eohnson!,! *hambers ). ;7pert panel identifies activities and performance measures for foodservice benchmarking. E. (m. Diet. (ssoc. "###>$##364F6?"G6?6. %. Eackson <. ,enchmarking food costs. Hosp. Food Nutr. Focus. $??6>$"364F$G6. 2. &awyer *! <ichards! <. *ontinuous 1uality improvement in hospital foodservice. Food Technol. $??2>&eptemberF$62G$6 . 6. &troud E. Dnderstanding the purpose and use of benchmarking. i si7 sigma. "#$#. (vailable atF httpF==www.isi7sigma.com=methodology=benchmarking=understandingpurpose-and-use-benchmarking=. (ccessed November "?! "#$%. 6. :uckett <. Food service manual for health care institutions. %rd ed. &an Francisco! *(F Eossey-,ass> "##2. 9. )ahalik :. ,enchmarkingF ten practical steps with review points. i si7 sigma. "#$#. (vailable atF httpF==www.isi7sigma.com=methodology=benchmarking=benchmarking-tenpractical-steps-review-points=. (ccessed November "?! "#$%. . &chuster I. ,enchmarkingF how do you measure up. Food )anag. $??9F2"G2?.

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