They started from the basement. Rock bottom. Back in 2019, patient satisfaction scores were in the basement for OhioHealth Riverside Methodist Hospital, a 1,000-bed hospital in Columbus, Ohio. The score? A thoroughly disappointing (and demoralizing) 2%, meaning 98% of other hospitals achieved higher scores. The foodservice team was also in the basement, literally and figuratively. More on that later. And also, more on how the team completely turned it around, to a score that’s currently an absolutely impressive 99%. Spoiler alerts: It wasn’t easy, and the “blame game” did not play a part.
Why the focus on these scores?
A couple questions to answer before we dive into the "how." Why are Patient Satisfaction Scores so important to hospital operations, including foodservice? Why does foodservice get blamed for low scores so often? There are a few reasons it matters so much, and a few myths to bust, as well.
First, a little history: Part of Centers for Medicare and Medicaid Services (CMS), the patient satisfaction score is a consumer-experience metric that can determine hospital reimbursement as well as compensation for senior health care execs. The metric represents the satisfaction levels of patients with the overall healthcare received. It’s measured using patient satisfaction surveys, enabling patients to rate how happy they were with different aspects of the care they received on a 1-5 rating scale.
A little more history: Notre Dame professors Irwin Press, PhD, a medical anthropologist, and Rod Ganey, PhD, a sociologist and statistician, (starting to sound familiar?) started Press Ganey in 1985, creating a new market for science-based analysis of patient care. The science? Survey design. The basic model is still in place, and after the federal government took notice of the scores in 2002, more and more hospitals took part, with a clear incentive (funding) to get them going.
What people get wrong about patient satisfaction scores
According to American Medical Association (AMA), there are some common misconceptions about these scores and what they mean for a hospital and its stakeholders.
In an article published in the AMA Journal of Ethics, one myth is “Very few patients fill out satisfaction surveys.” This may be true for most industries, but for healthcare, the response rates are “substantially higher, most likely due to the relative importance of the health care experience compared to experiences with non-health-related products or services.”
Another myth: The only patients who write comments in the surveys are either very happy or very unhappy. That’s also been proven false, according to the AMA Journal of Ethics. In fact, “Patient comments may be one of the most useful aspects of a patient satisfaction survey.” While numerical data is of course, vital, the qualitative aspects of patient comments should not be overlooked. According to a Press Ganey analysis of hospital data, almost half of responders took the time to add comments. The analysis found that 47% of patients who gave medium ratings did comment.
And now for the biggest myth: “You can’t improve patient satisfaction scores significantly in any reasonable timeframe.” That is false, but it certainly is far from easy. As the AMA Journal of Ethics explains, “It is clearly not easy … It requires a true commitment throughout the organization, constant attention to results and usually a big change in the organization’s culture. Yet, organizations have demonstrated that it can be done.”
How OhioHealth Riverside Methodist Hospital did it
The key players in pulling up the patient satisfaction scores from 2% to 99% at Riverside agree that a change in culture was key, along with better communication and the refusal to play the “blame game.” The goal of this new Morrison Healthcare team in 2019 was pulling both the scores and the employees’ pride out of the basement, and they’ll be frank: It was not an easy climb at all. But it’s obviously been worth it.
OhioHealth’s Senior System Director of Food & Nutrition Services Heather Buck has a background in commercial restaurants, and spent much of her career as part of Cameron Mitchell Restaurants, a Columbus, Ohio-based restaurant group with a founding principal of saying yes to guests as much as humanly possible. Cameron Mitchell actually penned an autobiography and business philosophy book called “Yes is the Answer! What is the Question?”
“I joined in April of 2019, and at that time [the score] was hovering around the 2%, and the organization took a typical view of food and nutrition,” Buck says. “It had really been overlooked, and the team was overlooked. We were basement dwellers.”
Although Buck did not have a background in dietetics or nutrition, she did have a ton of insight on the customer experience from her time with Cameron Mitchell Restaurants. So, her role was created to spark a paradigm shift in “what food and nutrition could and should be,” she says. “The organization recognized that what they had been doing with food and nutrition amounted to just a side hustle. It’s that way for many hospitals.”
To get a better patient experience (and in turn, better patient satisfaction scores, and in turn, more funding for more resources), “you have to have the right people and the right structure. With Morrison Healthcare, we are all in a partnership,” Buck says, adding that thinking of every individual in the hospital system as a partner is a good first step “up the mountain.”
“The hospitality that has to take place is where the nurse loves our food and the lab tech loves our food, and everybody else does, too,” Buck says. “If we can bring people in on the journey, they become part of it. Every time someone hits the call button [to complain], we’ve lost something we could have managed.”
It doesn’t happen overnight
Senior Director of Food & Nutrition Services Erica Hamilton added her skill set—15 years of experience at a large medical center—to the team around the same time as Buck. Hamilton also remembers the time as “a very tough transition period for sure.”
In fact, the problems seemed so big that traditional fixes just wouldn’t do the trick.
“In 2019, there was no, ‘Throw something at the wall and see what sticks’ approach,” Hamilton says. Instead, “we needed to really see where we were broken.’ We had nowhere to go but up. Heather would have a lot of different ideas that I had never thought of before, from a creativity standpoint.”
From her managerial standpoint, Hamilton was quick to get down to what she calls “the nitty gritty” with the team. “It’s about accountability and expectations, and then taking these ideas and implementing them bit by bit, not making the team swallow the changes whole and making the team feel like part of it.”
“As leaders, we need to be part of the team, not just telling them what to do,” Hamilton adds. “We have folks who have been here for 40 years. How do we get the cook who’s been in the basement for 30 years to feel like they’ll have an impact on someone upstairs they’ve never met?”
Some cooks had never even set foot on a patient floor in decades. So, chefs and cooks started visiting on patient floors regularly so they could see who was eating their food and how it impacted them.
“Now, chefs and cooks can go up and say, ‘I made this.’ And the patients, nurses and staff feel that and they all feel like it’s part of something bigger,” Hamilton says. “It was a big investment and adjustment to that culture.”
Make friends with the nurses
Having every hospital employee feel like part of the bigger mission sounds great, but it takes time and trust. Hamilton sees the nurses as a “make it or break it” component to foodservice’s success or failure.
“The nurses are the ones who are giving the patients they menu, and they can be a roadblock if they sigh or groan and say, ‘Here’s what you gotta do,’” Hamilton says. When foodservice builds a strong relationship with nurses on the other hand, “If there is a problem, the nurse can say, ‘I know who to call to fix this for you, we’ll make it right.’”
“We’ve been able to flip the script [with nurses] and it’s been a snowball of positivity in helping each other,” Hamilton says. “It’s been a long journey and it doesn’t change overnight. It’s slow and steady.”
Buy-in allows great results to happen
Morrison Healthcare’s Regional Director of Operations Bill Dodson is another part of the team that overhauled the culture at OhioHealth Riverside.
His role includes “getting the right folks in the right places, making sure I can deliver on the needs of our partnership and ensuring the team has the resources and tools and training,” he says. “And then I stand back and let them succeed.”
“The culture here takes care of its staff and its team members,” Dodson says. “There’s a lot of wisdom in defining the ‘why.’ Giving team members a voice is always a tremendous win. When you’ve got the buy-in from the teams and the organization, when they trust the vision and the plan that allows great results to happen, then you’re getting those results and not having dozens and dozens of misses each and every shift.”
99 is a great number
Now that all the hard work has resulted in a new Patient Satisfaction Score of 99%, the team has been validated in that hard work, and celebrated with an event for staff that included a donation to an Ohio food bank.
“From 2019 to 2024, it’s great to sit on this side of it,” Hamilton says. “There were some really tough days … and months, in 2019, 2020 and 2021. But having that partnership, we didn’t feel like we were in an ocean treading water. If any of us feel that we’re going off course, we can get bumpers to get readjusted. We can get together and share feedback; sitting down and hearing you need to look at something differently or share a perspective and be vulnerable. Instead of getting defensive, saying, ‘I may have messed this up. How would you do it differently?’”
“It’s an easy blame game,” Buck adds. “Before, there was a very heavy blame culture, and at times, the culture transformation was painful.”
Hamilton has found that “emotional safety” is critically important to make the culture change happen. “It’s not easy what we do, but it’s a different level of what we do. [The patient satisfaction score] means almost every single patient had a food experience that was beyond their expectation. You can put your head on the pillow and say, ‘I changed someone’s life for the better today.’”
Buck sums it up nicely: “It doesn’t happen alone and being able to call a team member and instead of saying ‘no,’ they say ‘how?’ We are a ‘yes’ group of people. When you make each decision with the patient in mind, it becomes really simple.”