Review Case Study 7: Implementing Culture Change in Food Service, located on page 408 of your textbook. Next, examine the main structural and process changes that will be required to design and implement family-style dining at this facility. Then address the following:

• Suggest a plan of action to address Miss Laird's concerns from the Planning Committee meeting regarding noise, security, and other potential disruptions expected during the construction of the new kitchens and dining areas
• Provide a rationale for your response.

408 Part V Case Studies Table CST CASE 7 Measures Implementing Culture Change in Food Service Long-stay Contributed by Jullet A. Davis, PhD, and Paul W. Davis vaccination City Nursing Home (CNH) is a nonprofit, preportioned food straight from the food carts, check Long-sta independent, 200-bed facility located outside a major the resident's name against the meal card on each tray, and giver city in the western United States. The community and place the tray in front of the resident. Although has a population of nearly 150,000 with a high rate the service is efficient, its appeal is very institutional. Long-st of poverty. CNH has a current occupancy rate of However, residents and families have been generally with dail satisfied with the meals. 97%, which is significantly higher than the state and Long-s national averages. CNH is ranked highly on Medicare's One main issue in the past few years has been three leg injuries that the food service associates severe 19 quality indicators (Table CS7-1), but the facility sustained while transporting the heavy carts. One of had eight deficiencies cited on its certification survey the injuries was serious enough to keep the associate High- when it was inspected about a year ago (Table away from work for 4 months. Shortly after return- press CS7-2). The four-story building was opened 32 ing to work, that associate resigned to take a job at Low years ago and has maintained an excellent reputation the local Mcdonald's. One year, the kitchen sustained pres for delivering high-quality care. Staff stability in a some flooding after heavy spring rains and had to be community that offers relatively few jobs has been one closed down for almost 2 weeks. Food services were Lon temporarily contracted out. rest of the main factors that has contributed to the quality of care. The facility trains its own certified nursing Ms. Morehouse and the board worked together Lor to engage the architectural firm of Caplin & Reese. assistants (CNAs). With less turnover compared with de The firm has had some experience with modern ar- the industry, and having a pool of trained CNAs to chitectural designs for nursing homes. Considering fill vacancies, the facility maintains above-average the financial resources and other logistical issues, the staffing levels. The facility also takes pride in having facility would redesign its kitchen and dining areas its own in-house rehabilitation therapy staff. Ms. in three to four phases. It is anticipated that over the Morehouse has been the administrator of CNH for the next few years, each floor will have its own family- past 12 years. style kitchen and dining area. CNH is now in the early For its current strategic plan, the govern- planning stage, having recently formed a Food Service ing board has approved adoption of culture change Planning Committee. mainly through self-managed work teams in nursing The Planning Committee met 2 weeks ago, and services and the implementation of family-style din- Ms. Morehouse is reviewing the minutes from that ing. Implementation of this plan would require both meeting: structural and process changes. The existing kitchen Following the meeting, Ms. Morehouse jotted is located in the basement of the building, and the down a list of things to do. As she pondered over it main dining room is on the first floor. Using an el- further, she was convinced that culture change was nec- evator, food is transported in carts with hot and cold essary, but wondered whether alternative plans should compartments. CNAs pick up the meal trays with be explored. Dr. Davis is associate professor of Health Care Management, Management and Marketing Department, University of Alabama. Mr. Davis is vice president of operations, Nutrition Management Services.Measures Table C57-1 Medicare Quality Measures for City Nursing Home City Nursing Case 7 Long-stay residents given influenza Home (%) 409 vaccination during the flu season 100 State Average (%) | National Average Long-stay residents who were assessed 97 Quality (%) and given pneumococcal vaccination 100 90 Long-stay residents whose need for help 94 with daily activities has increased 19 Long-stay residents who have moderate to 12 severe pain 0 15 High-risk long-stay residents who have 4 pressure sores 15 14 Low-risk long-stay residents who have 12 pressure sores 0 2 Long-stay residents who were physically 2 0 restrained 3 4 Long-stay residents who are more depressed or anxious 10 14 Low-risk long-stay residents who lose 50 control of their bowels or bladder 52 50 Long-stay residents who have/had a N 4 catheter inserted and left in their bladder 6 Long-stay residents who spend most of O N 4 their time in bed or in a chair Long-stay residents whose ability to move 17 11 12 about in and around their room got worse Long-stay residents with a urinary tract W infection OO Long-stay residents who lose too much 8 weight 80 Short-stay residents given influenza 100 84 vaccination during the flu season 80 87 Short-stay residents who were assessed 100 2 and given pneumococcal vaccination 1 0 19 Short-stay residents with delirium 15 0 Short-stay residents who had moderate to 16 severe pain 19 21 Short-stay residents with pressure sores410 Part V Case Studies Table CS7-2 Survey Deficiencies Survey Date One Year Ago Two Years Ago Complaint Current Complaint Complaint Reporting Period: Reporting Period: Reporting Period: Deficiency Category July-September July-June July-June 2 0 0 Mistreatment 2 3 - Quality care 1 0 Resident assessment 1 0 Resident rights 2* 1 * * O Nutrition and dietary 0 0 Pharmacy service 0 - N Environmental O N W Administration O 0 Reported between inspections 00 Total number of health deficiencies for this nursing home Average number of health 6 deficiencies in the state Average number of health 19 9 9 deficiencies in the United States * Inspectors determined that the nursing home failed to: 1. Provide food in a way that meets a resident's needs. 2. Store, cook, and give out food in a safe and clean way. * Inspectors determined that the nursing home failed to: 1. Store, cook, and give out food in a safe and clean way. Minutes from the Planning Committee Meeting Present: Ms. Morehouse, administrator; Mr. Hassan, finance and admissions coordinator; the governing board had authorized a long- Mr. Washington, food services director; range plan to implement certain structure and Ms. Laird, director of nursing; Ms. Smith, process changes. Modification of current dining rehabilitation supervisor; Mr. Keith, construction arrangements was part of this long-range plan. representative; Mr. Morgan, designer; Mr. Ms. Morehouse then opened the meeting for Welbourne, contractor; Ms. Reese, architect. The meeting started at 9 a.m comments and questions from those present. aved at Ms. Moreh