Knowledge, Attitudes and Self-reported practices Questionnaire on Pureed Diet Preparation (KAP DYS Puree) among Food Handlers in Malaysian Hospitals for Dysphagia Management: Development, Validity, and Reliability Testing

@#Introduction: This methodological research study aimed to measure content validity and reliability of a newly developed questionnaire of knowledge, attitudes, and self-reported practices towards pureed diet preparation (KAP DYS Puree) among hospital food handlers for dysphagia management. Methods: The study was conducted through face validation, content validation, content reliability and construct validation. A cross-sectional design with convenience sampling was carried out involving 4 panels for face validation, 10 raters for content validity and 161 food handlers participated for Exploratory Factor Analysis (EFA), while 30 food handlers were involved for test-retest reliability. The questionnaire which consisted of 40 items distributed into 3 domains and was assessed and analyzed using modified kappa (k*) for reliability. Results: Content Validity Index revealed the following I-CVI values: knowledge = 0.915, attitudes = 0.922 and self-reported practices = 0.900 and modified kappa values (k*) knowledge = 0.983, attitudes = 0.9214 and self-reported practices = 0.899. The EFA was employed for two dimensions which were self-reported practices and attitudes based on principal axis of factoring with varimax rotation. The factor analysis yielded two factors with a total of 10 items in the attitudes domain and two factors with a total of 9 items in the self-reported practices domain that had satisfactory factor loading (> 0.3). The Kaiser-Meyer-Olkin (KMO) values for attitudes = 0.816 and self-reported practices = 0.776. Bartlett’s test of sphericity was significant at p < 0.0001 for attitudes and self-reported practices indicating the suitability of this data for factor analysis. Interclass Correlation Index (ICC) values for attitudes = 0.739 and self-reported practices = 0.789. Conclusion: This instrument can be used as a need assessment tool in the development of a comprehensive training module for pureed diet preparations in dysphagia management.

Development of a tool to measure patients’ satisfaction of hospital foodservice in a government hospital

@#Introduction: Dissatisfaction towards the quality of foodservice can affect several important aspects such as nutritional intake and financial burden. The effect of dissatisfaction towards nutritional aspect can be observed via a decline in dietary intake. Therefore, reliable and valid questionnaires are important to measure patients’ satisfaction with hospital foodservice. The main purpose of this study was to investigate the construct validity and reliability of a developed questionnaire in a local setting. Methods: A questionnaire adapted from previous studies and consisting of 27 statements from four dimensions, was administered to a total of 277 hospitalised patients in a government hospital. Factor analysis and reliability analysis were conducted using SPSS version 25. Results: Principal component of factor analysis revealed that the final questionnaire contained four main foodservice dimensions, namely food properties, staff and meal service reliability, customisation, and physical and social aspects. The reliability analysis revealed that the Cronbach’s alpha value ranged from 0.55 to 0.84 for these foodservice dimensions. The analysis showed that the alpha value differed from one dimension to another such as food properties (α=0.84), staff and meal service reliability (α=0.67), customisation (α=0.69) and physical and social aspects (α=0.55). Conclusion: Twenty-seven questionnaire items were retained because their factor loadings were greater than 0.35. Therefore, the questionnaire on patients’ satisfaction towards hospital foodservice was considered reliable and valid. The classification of the four dimensions provided detailed information of the satisfaction level, relationship and influence on the foodservice dimensions, which contributed to satisfaction towards hospital foodservice.

Effect of nutrition care process-based nutrition intervention on improvement of intake in the elderly in-patients with malnutrition / 한국영양학회지

PURPOSE: This study evaluated the effects of personalized nutrition intervention for increasing hospital meal intake by elderly patients with malnutrition. METHODS: The subjects were 30 elderly patients with malnutrition who visited a general hospital located in Daegu. An individual nutrition intervention such as change of meal types or special meal service was given to the patients according to nutrition diagnosis related to inadequate intake of hospital meals. Nutritional intake status of the subjects was assessed by analyzing energy intake, protein intake, index of nutritional quality (INQ), nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR). RESULTS: The causes of inadequate intake in the subjects were poor appetite or preference problems (46.7%), symptom-related problems (30.0%) and mastication problems (23.3%). The INQ of protein in the subjects was significantly increased from 0.81 ±0.17 to 1.41 ±0.25 after the nutrition intervention (p < 0.05). The NAR of protein (before 0.50 ±0.21, after 0.58 ±0.17), iron (before 0.72 ±0.30, after 0.84 ±0.29) and vitamin B2 (before 0.31 ±0.16, after 0.37 ±0.14) was also increased after the nutrition intervention (p < 0.05). The MAR of five nutrients, protein, calcium, iron, vitamin A and vitamin B2, was significantly increased by the nutrition intervention (p < 0.05). CONCLUSION: Personalized nutrition intervention according to nutrition diagnosis related to inadequate intake of hospital meals may improve the intake amount of elderly patients with malnutrition.

Effect of Dietitian's Perceived Organizational Culture on Organizational Commitment at Hospital Foodservices

This study was conducted to investigate the effect dietitians' perceived organizational culture has on organizational commitment at hospital foodservices. A total of 382 dietitians working at general hospitals with 500 beds or more participated in the survey from January 16 to February 8, 2017. The result of perceived organizational culture showed hierarchical culture, rational culture, development culture, and group culture scored to be 5.29, 5.25, 5.15, and 4.97 out of 7, respectively. Differences in the perception of organizational culture and organizational commitment were observed according to the general demographics of subjects, but no significant differences were shown according to the general characteristics of hospitals. For organizational commitment perception, affective commitment (5.14), normative commitment (4.41), and continuance commitment (4.21) were identified. There were differences according to age, work experience at the present job, position, and education level by type of organizational culture. In terms of organizational commitment, there were significant differences in age, work experience at the present job, employment status, and possession of clinical dietitian certificate, position by type of commitment. A positive correlation between dietitians' perceived organizational culture and organizational commitment such as overall organizational commitment, affective commitment, and normative commitment was observed (P<0.01). Group culture, development culture, and hierarchical culture positively affected overall organizational commitment (P<0.001). Development culture, group culture, and hierarchical culture had positive effects on affective commitment, whereas rational culture had a negative influence. Development culture (P<0.05), group culture (P<0.001), and hierarchical culture (P<0.01) positively influenced normative commitment. Results suggest that it is necessary to develop plans for the improvement of rational culture, group culture, and development culture at hospital foodservice organizations.

Case Study on Safety Situation and Awareness through Risk Assessment of Hospital Foodservice Kitchen Area

This study was carried out to provide a basis for the development of a safety manual for kitchen accident prevention by identifying the safety situation and awareness through risk assessment of kitchen areas. The study was conducted in two phases. First, kitchen accidents and area risk assessment were investigated from February 2014 to September 2014, after which safety awareness of hospital foodservice employees was assessed in a survey. The results of this study were as followes. All of the respondents were women. The evaluation point of kitchen area risk assessment was reduced by 14%. After improvement, an initial score of 108 points decreased to 93 points. The number of accidents was also reduced by 78%; 14 accidents were decreased to three. The most common area of accidents was the kitchen area (58.8%), and burns was the most common accident (35.3%). Most of the employees deemed "enough staff" as the most major factor for good foodservice. "High indoor temperature and poor ventilation in the kitchen area" was chosen as the most common problem in the foodservice workplace. Taken together, our study quantitatively evaluated safety issues in hospital foodservice kitchen areas and provides a basis for the development of a safety manual for kitchen accident prevention.

Evaluation on HACCP prerequisite-program performance within general hospital foodservice operations / 한국영양학회지

PURPOSE: This study was conducted to examine prerequisite-program performance of the hospital foodservice operation and develop measures for improvement of prerequisite-program performance. METHODS: Data were collected through surveys administered to 168 hospital dieticians in the Seoul, Incheon, Gyeonggi-do, Daegu, and North Gyeongsang areas. Out of total questionnaires, 65 questionnaires were usable and the response rate was 38.7%. Statistical analyses were performed using the SPSS program (ver 20.0) for chi2-test and one-way ANOVA. RESULTS: According to the result of the prerequisite-program evaluation, the percentage of 'appropriate', 'needs to be improved', and 'inappropriate' was 44.6%, 47.7%, and 7.7%, respectively. The score for the 'inappropriate' group was significantly lower than that of the 'appropriate' group or 'needs to be improved' group on the food safety management (p < 0.001), preparation facility management (p < 0.001), water management (p < 0.001), and storage.transportation management (p < 0.05) parts. Holding rate of foodservice facility and equipments in the 'appropriate' group were significantly higher than in the others on convection oven (p < 0.01), air conditioner (p < 0.01), three-compartment sink (p < 0.01), hot-holding equipment (p < 0.01), cold-holding equipment (p < 0.05), exclusive thawing refrigerator (p < 0.05), and sterilizer for sanitary shoes (p < 0.05) items. CONCLUSION: To improve the quality of hospital foodservice, foodservice managers and HACCP specialists should develop and implement a prerequisite-program and a HACCP plan considering the characteristics of the hospital foodservice operation.

Analysis of Operational Characteristics and Substantiality Plan of Inpatient Diets for Foreigners in Hospitals

The objectives of this study were to analyze the operational characteristics and to explore the substantiality plan of inpatient diets for foreigners in hospitals. Questionnaires were mail-delivered to 128 hospitals, and a total of 62 questionnaires were usable with a response rate of 48.4 percent. Statistical data analysis was completed using SPSS Win 11.0 for descriptive analysis, independent t-test, and χ2 test. Results can be summarized as follows. The average number of inpatient meals for foreigners in the last 6 months were 405 and 53 for general therapeutic diets and special therapeutic diets, respectively. The rates of hospitals with an exclusive department and exclusive staff for foreign inpatients were 48.4% and 53.2%, respectively. Major nationalities of foreign inpatients were China (37.5%) and Russia (31.3%), and their major medical departments were internal medicine (43.9%) and surgery (39.0%). The number of hospitals that provided inpatient diet only for foreigners was 42 (72.4%) and influencing factors were number of permitted beds (P<0.05), an exclusive department (P<0.001), and exclusive staff (P<0.01). The main type of menu was USA·European style (61.1%), and the price of inpatient meals for foreigners was mostly \10,000~\25,000 (62.0%). As 75.9% of hospitals did not possess dietary slip manuals for foreigners, the case of preparing inpatient meals for foreigners in the form of a general therapeutic diet partially-modified according to disease was the majority (55.4%). Dietitians felt the need for nutrition management guidelines and dietary slip manuals (47.3%) as a substantiality plan of inpatient diets for foreigners. There is a need for exclusive foodservice standards for foreign inpatients in the changing medical environment.

Case Study on Improvement of Hospital Foodservice by Introduction of FMEA Techniques: Focus on Food Delivery Service Quality and Customer Satisfaction

In this study, we attempted to improve hospital food delivery service quality and customer satisfaction by using FMEA (Failure Mode and Effect Analysis), which is applied to the quality control of products in manufacturing plants. Subjective food delivery service quality improvement was judged based on a 5-point likert scale. Traditional FMEA uses an RPN (Risk priority number) to evaluate the risk level of a component or process. The RPN index was determined by calculating the product of severity, occurrence, and detection indexes. In our results, total RPN value (P<0.01) significantly decreased after FMEA introduction, whereas customer satisfaction (P<0.001) and food delivery service quality (P<0.001) significantly increased. Specifically, foodservice errors (P<0.01) and loss cost (P<0.01) were significantly improved by FMEA introduction. Taken together, we suggest that FMEA reduces critical activities and errors in foodservice delivery caused by simple priority selection.

The Time Series Analysis of Standards and Results of Nutritional Domain in Hospital Evaluation Program

The purpose of this study was to evaluate the current state of foodservice and clinical nutrition management in a hospital-based nutrition department. Nutritional guidelines and survey reports of hospital evaluation programs from 2004 to 2009 were analyzed. In total, 275 hospitals in the first period and 288 hospitals in the second period were evaluated. The division of knife and chopping board use decreased from 97.2% in 2005 to 89.7% in 2008, the maintenance of a proper freezer temperature (below -18degrees C) increased from 82.1% in 2004 to 97.7% in 2007 (88.9% to 97.4% from large hospitals and 69.8% to 86.5% from small/medium hospitals in 2005 and 2008, respectively). In tube-feeding management, the performance rate of material cold storage and the offer rate of tube-feeding were 65.9% and 94.2% in 2007, respectively. The cold storage of material, proper use within 24 hours after opening or production, and the use of an appropriate label were 47.3%, 71.2% and 67.2% in 2009, respectively. The rate of a management system for undernourished patients was 86.0% in 2007 (56.4% for large hospitals, 18.9% for small/medium hospitals) and 14.3% in 2009. In standards of nutrition support management, the performance rates of constructing a nutrition support team, the nutrition support team activity, and organizing multidisciplinary team were 66.7%, 43.6%, and 64.1% respectively, in 2004. For large hospitals, those rates were 61.1%, 36.1%, and 58.3%, in 2005, 93.0%, 62.8%, and 91.9% in 2007, and 69.2%, 43.6%, and 69.2% in 2008, respectively. The results of this study suggest standards on sanitary foodservice preparation, production, and tube-feeding production need to correspond with HACCP regulations for small/meidium hospitals in standards of a healthcare accreditation system. It will be necessary to understand the operating conditions of nutrition departments in convalescent hospitals, psychiatric hospitals, and geriatrics hospitals. As the application of accreditation is required from 2013, standards will need to be improved and continuously updated for healthcare accreditation.

Importance-Performance Analysis of Evaluation Indicators in Hospital Nutrition Department

This study has attempted to collect actual spot's opinions and analyze importance-performance of indicators for the evaluation of hospital nutrition department. The results of this research were as follows: first, the average score of self-estimated performance was 3.75 based on a 5-point scale. The degrees of importance of hospital foodservice and nutrition department management were in the range of 3.71~4.85 out of 5.0 and the mean importance degree score was 4.37. Second, the verage score of self-estimated performance in each category was significantly higher in the case of general special hospital compared to general hospital. Especially average performance score of nutrition management in the general special hospital was higher than that of general hospital (P<0.001). The average performance score of the hospital with more beds was significantly higher than that with less beds. Contract managed hospital's score was significantly higher than that of self-operated hospital in two categories, "facilities management" and "nutrition management" (P<0.05, P<0.01). In foodservice and nutrition management of task-separated hospitals, the average performance scores were significantly higher than those of not-separated hospitals (P<0.01, P<0.001). Third, according to the importance-performance analysis of recognition about indicators for the hospital nutrition department's operations evaluation, 'foodservice facilities management' and 'foodservice sanitation management' were in 'doing great', 'nutritional management' and 'operational management' were in 'low priority', and 'other foodservice management' was in 'overdone'. In conclusion, there's a need for institutional specific standards of sanitation for Korean hospital foodservice.

Importance and Performance of Dietitian's Task at Long Term Care Hospital Foodservice in Busan . Kyungnam Area / 대한지역사회영양학회지

The purpose of this study was to evaluate importance and performance of dietitian's task at long term care hospitals foodservices in the Busan.Kyongnam area. The research was performed through using questionnaires and conducted from June 11 to July 16, 2010 for 186 dietitians at 141 long-term care hospitals. Seventy-two percent of hospitals had two dietitians and 69% of them had a dietitian's office. Fifty-two percent of dietitians has worked for less than 2 years at long term care hospital, and 37.1% of them worked additional tasks. Seventy-three percent of hospitals conducted a therapeutic diet program and the therapeutic diets frequently provided were diabetic diet > tube feeding diet > dysphasia diet > sodium controlled diet. Mean score for the importance (4.36/5.00) and performance (3.91/5.00) of dietitian's tasks were significantly different (p < 0.001). The importance and performance grid showed that the purchase-inspection management and sanitation-safety management were high scores to the importance and performance (doing great area), menu-foodservice management and cooking-working management were low scores to the importance and high scores to the importance (overdone area), and nutrition management was low scores to the importance and performance (low priority). Forty-three percent of dietitians agreed with the needs for role separation between foodservice dietitian and clinical dietitian.

Analysis of Hospital Foodservice Management and Health Insurance Coverage of Inpatient Meals in Seoul

The objectives of this study were to explore hospital foodservice management and to investigate conditions related to health insurance coverage of inpatient meals. A questionnaire was distributed to the nutrition departments of 44 hospitals in Seoul on July 2009. The average kitchen area was 0.5 m2, and centralized distribution systems were in place. Partition walls from contamination zones, separate work tables to prevent cross-contamination, exclusive areas for preparing tube feeding, and split carts with refrigerated and convection heat settings were largely used in tertiary hospitals. Most dietitians did meal rounds (93.2%) and surveyed for patient satisfaction (86.4%). The major theme of QI (Quality Improvement) was menu management (31.8%). The health insurance fees for meals were 4,938.9 won for a general diet, 5,199.8 won for a therapeutic diet, 4,067.0 won for tube feeding, 9,950.0 won for sterilized diet, and 18,383.4 won for diets not covered by health insurance. The prices for general and therapeutic diets were significantly lower in hospitals compared to tertiary or general hospitals (P<0.001). The cost composed of 48.3% food, 44.0% labor and 7.7% overhead for general diets and 47.9%, 44.5% and 7.6% for therapeutic diets. In the case of health insurance coverage for patient meals, the number of items applied to general diets averaged 2.8 out of 4 and for therapeutic diets it averaged 1.9 out of 3. To reform the health insurance coverage system for patient meals, it is urgent that the qualified level of patient meals is presented from a national viewpoint, and monitoring should be performed consistently by developing the evaluation tools.

The Importance-Satisfaction Study of Hospital Foodservice Encounters at the Elderly Health-Care Facilities

Institutional care is often necessary for the health and well-being of the elderly. Good quality foodservice provided at long-term care facilities not only includes patients satisfaction but also cares for good health, contributing to the stability of foodservice management. The purpose of this study was to assess the importance and satisfaction attributes of foodservice management by hospitalized elderly patients. The data were collected via questionnaire by a one-to-one interview with 194 hospitalized elderly patients in six different hospitals. According to the results of dependent t-tests, overall mean scores for the importance attributes (3.96) and satisfactory attributes (3.83) were significantly different (p<0.001). As indicated by the patients, the recognized importance attributes were the kindness of foodservice personnel (4.19), kind smiles by foodservice personnel (4.16), and kind speaking by foodservice personnel (4.12). The most recognized satisfaction attributes were kindness of foodservice personnel (4.36), bedside meal service by foodservice personnel (4.25), kind speaking by foodservice personnel (4.24), kind smiles by foodservice personnel (4.24), and sanitary uniforms worn by foodservice personnel (4.21). These results suggest that the above encounter attributes (importance-satisfaction) would be useful tools for hospital foodservices to adopt, in order to control foodservice quality and satisfy the nutritional needs of elderly patients.

Development and Verification of Indicators for a Foodservice & Nutrition Management Evaluation at a Hospital Nutrition Department

The purposes of this study were to develop the standard indicators to evaluate the food and nutrition systems in hospitals and to test the validity of those items scientifically. The results were as follows: First, the conceptual validity was examined with recognition degrees of importance from the hospital nutrition department managers. All of the hospital nutrition department's operation evaluation standards and the indicators' conceptual validity tested were in the range of 3.71~4.93 out of 5.0, and the mean score was 4.36. Therefore, the conceptual validity was verified. Second, to verify the factor validity of the items of the standards and indicators for the hospital nutrition department's operation evaluation, the standards and indicators were analyzed as key-factors. Key-factor analysis after vertical rotation showed that four factors appeared and were composed of (a) facilities management, (b) sanitation management, (c) operation & foodservice management, and (d) nutrition management. Third, the reliability of the standards and indicators for the hospital nutrition department's operation evaluation was analyzed and resulted in a score of 0.98, which showed good internal consistency. Fourth, the discriminative power of each item of the standards for the hospital nutrition department's operation evaluation was tested by checking the differences between groups with first quartile and forth quartile of total evaluation scores. The indicators having low distinction power were modified into obligatory items or eliminated for better differentiation.

Controle de perdas de carotenóides em hortaliças preparadas em unidade de alimentação e nutrição hospitalar / Control of carotenoid loss in vegetables prepared in a hospital foodservice

Objetivou-se avaliar procedimentos de manipulação visando o controle de perdas de β-caroteno e licopeno em couve e tomate preparados em uma Unidade de Alimentação e Nutrição (UAN) hospitalar. Os critérios adotados não utilizados previamente pela UAN foram: armazenamento por 24 h sob refrigeração (10°C), sanitização por 15 min e distribuição logo após o preparo. As hortaliças foram coletadas após a recepção e depois de cada etapa de manipulação. A análise foi realizada por cromatografia líquida de alta eficiência (CLAE), usando como fase móvel metanol, acetato de etila e acetonitrila (50:40:10). A ANOVA (α = 0,05) foi utilizada para detecção de diferenças significativas. Não foram encontradas diferenças significativas quanto ao conteúdo dos componentes entre as etapas de manipulação, mas houve redução importante das taxas de retenção. Para β-caroteno em couve, verificou-se retenção de 68,2 por cento após 60 minutos de exposição para consumo, enquanto em tomate, 91,96 por cento do conteúdo desse composto foi preservado após 120 minutos de espera até a distribuição. Não foi observada redução importante na taxa de retenção de licopeno. Os procedimentos avaliados na UAN hospitalar contribuíram para controlar as perdas de carotenóides nas hortaliças, pois sua retenção foi elevada, sendo sugerida sua adoção em outras UAN.

The aim of this study was to assess the handling procedures of kale and tomatoes in a hospital foodservice (HFS) in order to control loss of β-carotene and licopene. The adopted measures, up to then not used by the HFS, were: 24-h storage under refrigeration (10°C), hygienizing for 15 min and distribution immediately after preparation. Vegetable samples were collected after reception and after each stage of manipulation in the HFS. The samples were analyzed using high performance liquid chromatography (HPLC) with a mobile phase of methanol, ethyl acetate and acetonitrile (50:40:10). ANOVA (α = 0.05) was used to detect significant differences. No significant differences in the content of the components were found between the different stages of manipulation but there was an important decrease in the retention rates. In kale a retention rate of 68.2 percent for β-carotene was verified 60 minutes after preparation whereas in tomatoes 91.96 percent of this compound were preserved for 120 minutes after preparation. No important decrease was observed in the retention of licopene. The high retention rates showed that the evaluated procedures contributed to control the loss of carentoids in vegetables and therefore these measures should be adopted in other HFS.

In-Patients' Food Consumption and Perception on Foodservice Quality at Hospitals

The purposes of this research were to investigate in-patients' perception on foodservice quality and to examine factors influencing their meal consumption at hospitals. Three general hospitals with over 400 beds in Seoul and Chon-An agreed to participate in the research. A total of 516 in-patients of the hospitals were surveyed on their meal consumptions, reasons of plate wastes, perceptions of foodservice quality, and demographic information. A response rate was 76% after excluding responses with significant missing data. On average the regular diet patients consumed 72%, 69%, and 68% of rice, soups, and side dishes served, respectively; the therapeutic diet patients consumed less than 70% of the meals they were served. The consumption rates did not differ significantly by diet type, gender, age, and hospitalization period. Among the therapeutic diet patients, those who had nutrition education consumed significantly more rice than the others (p<0.05). The main reasons why the patients did not eat all food served were 'lack of energy' and 'not tasty'. The patients' perception on foodservice quality was low; the therapeutic diet patients perceived more negatively than the regular diet patients in 'keeping hot food hot, cold food cold(p<0.05)', 'maintaining consistency of taste(p<0.01)', and 'providing nutrition information(p<0.01)'. To achieve the goal of the foodservice at hospitals, the dietitians can use the findings of the research in developing and implementing strategies to improve the patients' meal consumption. Recipe standardization, employee training, and production management will be useful for improving food quality and nutrition education on therapeutic diets for the patients will improve their meal consumption at hospitals.

A Study of Hospital Foodservice Management after Covering Hospital Foodservice in The National Health Insurance / 대한지역사회영양학회지

The purpose of this study is to investigate the overall operations of National Hospital Food service after it was benefited by National Health Insurance (NHI). The survey was conducted between July and August, 2007. Among questionnaires mailed to 2,558 medical care institutions, 2,090 returned (81%) questionnaires were analyzed by descriptive statistics, chi-square -test and ANOVA using the SPSS 13.0. The general foodservice characteristic of medical care institutions were as follows. The type of foodservice operations were 'self-operated' (86.9%), 'contracted' (10.5%) and 'Both' (2.6%). Only 6.4% of medical care institutions provided 'hospital food menu not benefited by NHI'. The number of dietitians and cook for medical care institutions were 1.1 and 1.0, respectively. The cost of a general diet meal was 4,205 won and therapeutic diet meal was 4,434 won. The overall operations of hospital foodservice were different depending on the types of medical care institution. After hospital foodservice was benefited by NHI, the overall quality of hospital foodservice including manpower, facilities, and environment was improved. The future direction of hospital foodservice should 1) differentiate the cost of hospital foodservice by the types of medical care institution, 2) increase in co-payment, and 3) provide same service with equal expenses in each party as medical aid or NHS beneficiary.

A Study of Hospital Foodservice Satisfaction after Covering Hospital Foodservice in the National Health Insurance / 대한지역사회영양학회지

This study aimed to evaluate the amount of patients' satisfaction with hospital foodservices among those who were benefited from national health insurance during theirhospitalization. A total of 3,094 inpatients from 191 medical institutions were enrolled in this survey. The survey was carried out from July 23 to September 14, 2007 through the face-to-face interview method. All analyses were made using the SPSS software (version 13.0). The mean age of the participants was 53.3 years, 57.0% were women; 34.7% were high-school graduates. Among the respondents, 30.9% stayed in the hospital for 7~14 days long, and 52.0% were hospitalized in multi-patient rooms for six persons. The 87.7% of total population had a general diet, and 9.6% selected the food menu that was notcovered by health insurance. In addition, 38.3% of patients regarded the fee of foodservice as inexpensive. Overall, the satisfaction score with hospital foodservice was 3.63 on a Likert-type scale ranging from 1 (extremely dissatisfied) to 5 (extremely satisfied). However, the limitations were indicated including the lack of providing nutritional information and quality of taste. In conclusion, the quality of hospital foodservice might not deteriorate even after enforcement of national payment of medical insurance. Further efforts are required for the diversification of menus and legislative work for improving quality of food service for a successful hospital foodservice policy.

The Study of Patients Satisfaction and Expectation of Hospital Foodservice

The purpose of this study was to measure patients satisfaction and expectation with hospital foodservices, and thereby identify areas for improvement and provide basic data for the introduction of total quality management with hospital foodservices. This survey was carried out on 383 hospitalized patients of 7 hospitals in Deagu, Busan, Changwon with 350 beds to determine the quality satisfaction with foodservices. The subjects were 50.5% male and 49.5% female. 62.6% of the subjects were over 40 age, 31.4% were only educated to middle school or below, 28.3% were hospitalized for 7 - 14 days. The mean score for taste of diet was 2.79, temperature 3.23, appearances 2.96. Most subjects agreed with following foodservice characteristics that meals of movement (4.03 ), dress of employees (3.84 ), kindness of employees and meals arrived exactly the same time every day (3.47 )and cleanliness of foods (3.34 )and dishes (3.33 ). The unsatisfied quality attributies were information provide (2.82 ), variety of the meals (2.91 ), mixing of meals (2.95 ), the opportunity to meet with a dietitian (2.97 )and prompt dealings with meal complaints (3.01 ). Most subjects expectation that the decrease the multiple of menus, increase provide of fruits in hospital meals and selective menus in hospital foodservices operations. In conclusion, it would seem to be desirable that hospital foodservices departments introduce selective menus, quality assurance, and increase the meal rounding of dietitians in the patient foodservice.

The Evaluation of Hospital Foodservice with Patients' Condition

The purpose of this study was to measure hospitalized patients' satisfactions with hospital foodservices, and thereby identify areas for improvement and provide basic data for the introduction of total quality management with hospital foodservices. This survey was carried out questionnaires by 382 hospitalized patients into 7 hospitals in Deagu, Busan, Changwon. The subjects were 50.5% male and 49.5% female. Sixty-two percent of the subjects were over 40age, 31.4% were only educated to middle school or below, 28.3% were hospitalized for 7~14 days. The result of evaluation for hospital foodservice during the length of hospitalization are as follows : Taste, seasoning, temperature, apperance of foods were higher in the short hospitalized patients than in the long hospitalized patients, especially kind and combinazation of food were significantly higher(p<0.001). The result of the foodservice with appetite status was significantly higher score(3.33) in the good appetite patients than in the bad appetite patients score(2.00)(p<0.001). As the hospitalization rooms were the significantly difference in the taste(p<0.05), seasoning(p<0.001), apperance(p<0.01) of the foods, amount of service(p<0.01), variety of menu(p<0.05), combinazation of foods(p<0.01) and opinion of patients(p<0.05).