Food Service Manual for Health Care Institutions / Edition 4

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The thoroughly revised and updated fourth edition of Foodservice Manual for Health Care Institutions offers a review of the management and operation of health care foodservice departments. This edition of the book—which has become the standard in the field of institutional and health care foodservice—contains the most current data on the successful management of daily operations and includes information on a wide range of topics such as leadership, quality control, human resource management, product selection and purchasing, environmental issues, and financial management.

This new edition also contains information on the practical operation of the foodservice department that has been greatly expanded and updated to help institutions better meet the needs of the customer and comply with the regulatory agencies' standards.

Topics covered include:

  • Leadership and Management Skills
  • Marketing and Revenue-Generating Services
  • Quality Management and Improvement
  • Planning and Decision Making
  • Organization and Time Management
  • Team Building
  • Effective Communication
  • Human Resource Management
  • Management Information Systems
  • Financial Management
  • Environmental Issues and Sustainability
  • Microbial, Chemical, and Physical Hazards
  • HACCP, Food Regulations, Environmental Sanitation, and Pest Control
  • Safety, Security, and Emergency Preparedness
  • Menu Planning
  • Product Selection
  • Purchasing
  • Receiving, Storage, and Inventory Control
  • Food Production
  • Food Distribution and Service
  • Facility Design
  • Equipment Selection and Maintenance

Learning objectives, summary, key terms, and discussion questions included in each chapter help reinforce important topics and concepts. Forms, charts, checklists, formulas, policies, techniques, and references provide invaluable resources for operating in the ever-changing and challenging environment of the foodservice industry.

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Product Details

  • ISBN-13: 9780470583746
  • Publisher: Wiley
  • Publication date: 11/27/2012
  • Series: J-B AHA Press Series , #150
  • Edition description: New Edition
  • Edition number: 4
  • Pages: 592
  • Sales rank: 488,178
  • Product dimensions: 8.50 (w) x 11.00 (h) x 1.20 (d)

Meet the Author

Ruby Parker Puckett, MA, FFCSI, is program director of dietary manager training in the division of continuing education at the University of Florida, Gainesville. She is president of Foodservice Management Consultants and president of the Foodservice Consultants Society International (FCSI) Educational Foundation.

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Read an Excerpt

Food Service Manual for Health Care Institutions

By Ruby Parker Puckett

John Wiley & Sons

ISBN: 0-7879-6468-9

Chapter One

Food Service Industry: An Overview

Health care is being met with increased public awareness associated with the cost of, and equal access to, high-quality care. The percentage of the national budget spent on health care is still rising at an alarming rate and will require persistent emphasis on cost-effective management. Past cost-control efforts include rightsizing the workforce by staff reductions, flattening management levels, using multidepartment management, heightening productivity, and participating in purchasing groups. Changes occurring within health care are affected by the economy and by business and industry trends. In addition to their effect on health care cost, these trends will affect methods of operation, especially as those methods relate to quality, customer satisfaction, and management style.

Hospitals of the future will experience increases in patient age and acuity level and a continued population shift from inpatients to outpatients. Responses to these changes have caused hospitals to add extended-care services such as rehabilitation units, skilled-nursing units, and behavioral health centers to increase inpatient census. Hospital-owned home care services now extend services for patients after discharge while they increase revenues. Once the primary health care facility, hospitals now face competition from a growing number of alternative health care facilities. These competitors include nursing homes, adult day care centers, retirement centers with acute care facilities, freestanding outpatient clinics, and independent home care agencies.

There is continuing concern about the millions of people who do not have any form of health insurance or access to health care, as well as for the millions of others who have severely restricted or inadequate protection. The health care field faces still other concerns. These include the growing number of persons affected with the human immunodeficiency virus (HIV), the increased number of people with tuberculosis (TB), the increased prevalence of child and spousal and drug abuse, the aging of the population, few medically trained personnel in geriatric medicine, and the emotional stress of daily living and working that takes its toll on health care providers.

These external factors affect the internal operation of health care organizations. Many of these organizations are faced with shorter lengths of stay, reduced census, fewer payers, shortage of qualified personnel, increased paperwork and verification of services, and competition for customers. They are also faced with meeting the increasing cost of providing quality service while still meeting the needs, wants, and perceptions of the customers. As a result, many health care organizations are engaged in cost-effective programs that downsize the number of personnel, implement cross-functional training for the realignment of job duties, and combine elementary functions that may not meet the mission of the organization (therefore reducing expense cost). This includes more outpatient procedures, less invasive procedures, and the increased use of technology. The aging of the population and the increased number of sophisticated older adults in residential health care services are additional causes for concern. The implementation of continuous quality improvement processes or improved organizational performance as required by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) is also tied in with cost-effectiveness.

Issues: Change

Changes are occurring almost minute by minute all across the world. Changes must happen for society to progress. Not all changes are due to the discoveries of scientists and advanced technology; some are due to the economic climate of the time and the desire for social equality. Change is the result of substitutions, disruptions, competition, or new developments; it is a difference in the way that things are done.

One change in health care organizations may be seen in the way that care has shifted from a hospital base to outpatient departments, home health care providers, and other outreach centers. As these changes in organization take place, specialists who deliver care in hospitals are refocusing the way they deliver this care. Many physicians are being trained to perform cross-functional job duties. Cross-functional training is the integration and progressive sequence of learning experience whereby employees are provided with the knowledge and skills needed to perform more than one function.

Socioeconomic changes are taking place on a worldwide basis. The Berlin Wall fell fifteen years ago. The eastern communist nations are still seeking not only independence but improved financial and technical assistance from the more prosperous nations. The war in Iraq has cost many billions of dollars and the deaths of many U.S. soldiers and civilians. Problems still exist in Bosnia and Afghanistan, and changes are occurring now in the former Eastern Bloc such as the Russian-Chechnyan war. Wars and rumors of wars that use technological advances in weaponry are ever present. Daily across the world, thousands of people die of malnutrition, natural disasters, and emerging pathogens. Transportation and communications are almost instantaneous. When an event happens on the opposite side of the world, we are able to see and hear about it as it is happening. The length of time it takes to transport goods and people to a different location has been reduced from weeks to days (even hours). It has become impossible for any nation to remain isolated. Every developed country has experienced twin problems: rapidly rising health care costs and a sluggish or failing economy.

Since the twenty-first century began, health care providers have been facing the following factors:

Consumer movements (protection of patient rights, informed consent, reporting, privacy)

Managed care (prepaid health care, reshaped health care)

Increased use of ambulatory centers (may be stand-alone centers)

Integration of health care organizations, departments within the organizations

Health maintenance organizations (HMOs)

The aging of the population

A prospective payment system based on classification of patients' diagnoses and the use of resources

Quality of care (the longer patients stay in the hospital, the higher the risk for serious slip-ups, rising 6 percent for each extra day in the hospital)

Worker's compensation laws

Financial woes (decreased profit margins)

Competition, mergers, and consolidations (especially of management teams)

Social litigation that includes Sexual equality Maternity leave Length of workweek Flexible scheduling Cultural diversity Increased technology Ethics Litigation Public health (domestic violence each year results in about 21,000 hospital admissions, 99,800 inpatient days, 28,700 emergency department visits, 39,000 physician visits, and about 212,000 new cases of breast cancer)

Other Changes in Delivery of Care

Other changes in the delivery of care have been labeled clinical pathways, empowering, restructuring, cross-functional training, decentralization, care paths, interdisciplinary team approach, and integrated systems approach. Regardless of the labels placed on these changes, all of these approaches have some of the following commonality:

Flattening of organizational structure, from the familiar pyramid-shaped organization with six or more levels of management to a structure with just three or four levels may not be necessary

Redesigning of technological content and services

Improvement of the admission and discharge procedures

Training people to do more than one function

Reducing the lengths of stay

Maintaining a stable, fiscally viable organization

Building high-performance teams that empower personnel to do their jobs and take necessary risks

Implementing standards and rewards to give control of care back to patients

Benchmarking internally and with competitors

Many of these changes will also dovetail with the implementation of the JCAHO's and other regulatory agencies' mandated improvement of organizational performance. Some of the changes need to be defined:

Empowering personnel. Giving authority and responsibility to personnel to define problems and identify solutions that may involve resource allocation or interdepartmental coordination; giving employees the power to set their own work standards, rotate jobs, and have a larger measure of control over the job-a greater sense of responsibility and authority. W. Edward Deming, who is credited with bringing quality control to Japan in the 1950s, is generally regarded as the intellectual father of total quality management. His concept of total quality is based on the 14-point system. These points were such that, when implemented, they improved quality, provided on-the-job training, broke down barriers between departments, and focused on zero defects.

Empowerment provides employees with the tools, authority, and information to do their jobs with greater autonomy. It also broadens the knowledge base, causing a shift in power; encourages creative open communications; and provides for access to data, the ability to cut through corporate bureaucracy and to communicate with shareholders, and the ability to implement solutions.

Clinical pathways. This is a method or approach to improve care of patients from preadmission through inpatient stay and after discharge, with delineation of nutrition service for each practitioner involved. Information is provided among other providers such as physicians, home health care providers, and long-term care agencies. It is a multilevel, multidiscipline, multidimensional, long-term approach to care that "flattens" the organization, eliminates redundancy of bureaucratic functions, redesigns work, allows for creativity, allows empowerment of personnel, and gives employees the ability to take the initiative and, if needed, take risks. The facility environment must be one of support for change.

Interdisciplinary health care providers who have been cross-functionally trained. These are personnel who have been educated or trained to provide more than one function or job duty, often in more than one discipline. They are multiskilled, competent, and cross-trained. The day of the generalist has come, as has the "preventive" approach to health care. Health care institutions are focusing on the interdependence of the various functions that must be completed to meet their organizational goals. Cross-functional training will also result in "broad-banding" (that is, combining multiclassifications of jobs under one occupational category). These changes will alter the roles of nutritional care providers. The director will assume more of the responsibilities of middle managers. Employees will play an increased and more visible role in the organization. Clinical registered dietitians will be involved in more nontraditional health care jobs, including entrepreneurial activities and consultation with pharmaceutical companies and home health care agencies as nutrition support directors, educators of the public, and major players in the critical pathway of care to patients. In-service teams can work together to cut cost and increase quality.

Political Issues

The future direction of health care will be influenced by political and governmental intervention as a direct result of increased public awareness and demands. Regulation of the health care industry is likely to continue, even intensify, as access to care becomes a concern of politicians and consumers alike. Health care food service departments will feel the effects of the political environment as it shapes and regulates the way service is delivered. In addition to regulation, managers will see the effects of more emphasis on environmental safety while they struggle to provide accurate nutrition information to consumers.

Regulation and Legislation

The nature of this text precludes a comprehensive discussion of legislation as it pertains to health care nutrition and food service delivery. Even so, legislative effects and subsequent regulations must be taken into account when food service directors plan the direction of their departments. This section briefly reviews various governmental and private sector regulations that affect food service delivery. In addition to those covered, the twelve-week family leave legislation (Family and Medical Leave Act of 1993) should be scrutinized closely to determine what, if any, modifications are required in work methods and staffing patterns (discussed in full in Chapter 8).

Medicare and Medicaid

The regulations that currently have the greatest effect on health care are those dictated by Medicare and Medicaid, the largest managed care providers in the United States. Reimbursement rates for services have been set by Medicare and embraced by other managed care systems. Although most food service managers recognize their responsibility to provide a high-quality and safe food delivery system, Medicare regulations continue to ensure these entitlements for consumers. Medicare regulations affect the nutrition services offered, those services for which a fee is charged, and the quality of care delivered through meal service. Emphasis is on adherence to medically approved diets, written prescriptions, and the service of wholesome food. Medicaid coverage continues to be an ongoing problem, with various bills awaiting action in both the House and the Senate. By 2012 Medicare spending will exceed $425 billion, with 69.3 million beneficiaries. Part A spending will grow 86 percent, reaching $267 billion, and Medicare spending will grow nearly 110 percent, reaching $216 billion. Medicare budgets will increase more than 44 percent. Medicaid is the largest and fastest growing part of the state budgets, comprising 20 percent of all state expenditures. The number is expected to grow as the population ages, the need for long-term care increases, and older people enter nursing homes. Medicaid is the largest purchaser of nursing home services and maternity care in the nation. Much of the anticipated increase in spending will go to purchasing prescription drugs.

Omnibus Budget Reconciliation Act of 1987

Food service departments that serve hospital extended-care units and long-term care facilities also must comply with the Medicare and Medicaid Requirements for Long-Term Care Facilities. These requirements, finalized in September 1992, implement the nursing home reform amendments enacted by the Omnibus Budget Reconciliation Act (OBRA) of 1987, as published by the Health Care Financing Administration. It is estimated that nearly 50 percent of the OBRA regulations relate directly or indirectly to nutrition and food service departments. The OBRA standards pertain to dignity and independence in dining, initial and annual nutrition assessments, nutrition care plans, and participation of a dietitian in family conferences. Discussions of how to maintain compliance with these regulations are covered in chapters 9 and 20.

Joint Commission on Accreditation of Healthcare Organizations

Medicare and Medicaid regulations are government imposed, but some facilities choose to further their compliance efforts by following standards set by independent organizations. The JCAHO is one such organization. Standards set by the JCAHO are similar to those set by Medicare; however, JCAHO surveys tend to place more emphasis on the systems, processes, and procedures that influence quality of patient care and outcomes. More recently, publications by the JCAHO report that future emphasis will be on the education and training of patients and their families; orientation, training, and education of staff; leadership roles of directors; and approaches and methods of quality improvement. They also have announced increased standards for safety, infection control, pain management, and emergency readiness. They will no longer announce the date or time of the surveys. Because JCAHO guidelines are updated and published annually, they must be reviewed annually to ensure compliance.


Excerpted from Food Service Manual for Health Care Institutions by Ruby Parker Puckett Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Tables, Figures, and Exhibits iv

Foreword vii

Preface ix

Acknowledgments x

The Author xi

Introduction xiii

CHAPTER 1 Foodservice Industry: An Overview 1

PART ONE Management of the Foodservice Department 19

CHAPTER 2 Leadership: Managing for Change 21

CHAPTER 3 Marketing and Revenue-Generating Services 37

CHAPTER 4 Quality Management 51

CHAPTER 5 Planning and Decision Making 71

CHAPTER 6 Organization and Time Management 95

CHAPTER 7 Communication 127

CHAPTER 8 Human Resource Management: Laws for Employment and the Employment Process 145

CHAPTER 9 Human Resource Management: Other Needed Skills 169

CHAPTER 10 Management Information Systems 189

CHAPTER 11 Control Function and Financial Management 207

PART TWO Operation of the Foodservice Department 237

CHAPTER 12 Environmental Issues and Sustainability 239

CHAPTER 13 Microbial, Chemical, and Physical Hazards: Temperature Control 261

CHAPTER 14 HACCP, Health Inspections, Environmental Sanitation, Food Code, and Pest Control 285

CHAPTER 15 Safety, Security, and Emergency Preparedness 311

CHAPTER 16 Menu Planning 343

CHAPTER 17 Product Selection 367

CHAPTER 18 Purchasing 405

CHAPTER 19 Receiving, Storage, and Inventory Control 429

CHAPTER 20 Food Production 447

Appendix 20.1 A Culinary Glossary 486

CHAPTER 21 Distribution and Service 489

CHAPTER 22 Facility Design, Equipment Selection, and Maintenance 507

References 541

Index 553

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