Practice paper of the academy of nutrition and dietetics: principles of productivity in food and nutrition services: applications in the 21st century health care reform era.

Food and nutrition services, along with the health care organizations they serve, are becoming increasingly complex. These complexities are driven by sometimes conflicting (if not polarizing) human, department, organization, and environment factors and will require that managers shift how they think about and approach productivity in the context of the greater good of the organization and, perhaps, even society. Traditional, single-factor approaches to productivity measurements, while still valuable in the context of departmental trend analysis, are of limited value when assessing departmental performance in the context of an organization's goals and values. As health care continues to change and new models of care are introduced, food and nutrition services managers will need to consider innovative approaches to improve productivity that are consistent with their individual health care organization's vision and mission. Use of process improvement tools such as Lean and Six Sigma as strategies for evaluating and improving food and nutrition services efficiency should be considered.

Current coding practices and patterns of code use of registered dietitian nutritionists: the Academy of Nutrition and Dietetics 2013 coding survey.

Coding, coverage, and reimbursement for nutrition services are vital to the dietetics profession, particularly to registered dietitian nutritionists (RDNs) who provide clinical care. The objective of this study was to assess RDN understanding and use of the medical nutrition therapy (MNT) procedure codes in the delivery of nutrition services. Its design was an Internet survey of all RDNs listed in the Academy of Nutrition and Dietetics (Academy)/Commission on Dietetics Registration database as of September 2013 who resided in the United States and were not retired. Prior coding and coverage surveys provided a basis for survey development. Parameters assessed included knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use, payer reimbursement patterns, complexity of the patient population served, time spent in the delivery of initial and subsequent care, and practice demographics and management. Results show that a majority of respondents were employed by another and provided outpatient MNT services on a part-time basis. MNT codes were used for the provision of individual services, with minimal use of the MNT codes for group services and subsequent care. The typical patient carries two or more diagnoses. The majority of RDNs uses internal billing departments and support staff in their practices. The payer mix is predominantly Medicare and private/commercial insurance. Managers and manager/providers were more likely than providers to carry malpractice insurance. Results point to the need for further education regarding the full spectrum of Current Procedural Terminology codes available for RDN use and the business side of ambulatory MNT practice, including the need to carry malpractice insurance. This survey is part of continuing Academy efforts to understand the complex web of relationships among clinical practice, coverage, MNT code use, and reimbursement so as to further support nutrition services codes revision and/or expansion.

Leadership: reflections over the past 100 years.

Leadership, viewed by the American Dietetic Association as the ability to inspire and guide others toward building and achieving a shared vision, is a much written-about topic. Research on leadership has addressed the topic using many different approaches, from a very simplistic definition of traits to a more complex process involving interactions, emotions, and learning. Thousands of books and papers have been published on the topic of leadership. This review paper will provide examples of the varying foci of the writings on this topic and includes references for instruments used to measure leadership traits and behaviors. Research is needed to determine effective strategies for preparing dietitians to be effective leaders and assume leadership positions. Identifying ways to help dietitians better reflect on their leadership experiences to enhance their learning and leadership might be one strategy to explore.

Dietetics students perceive themselves as leaders and report they demonstrate leadership in a variety of contexts.

A leadership survey was designed and administered to undergraduate dietetics students (n=283) at eight universities to examine leadership actions reported most frequently, the context of these leadership actions, and students' reported perceptions of themselves as leaders. The majority of students perceive themselves as leaders in all context areas. The leadership practice, "Enabling Others to Act," was the most frequently reported. There were no significant differences in leadership behaviors based on college classification status and supervisory experience. Leadership behaviors were more prevalent in students who had previous leadership coursework, were older, or who had previous leadership experience. Dietetics students perceive they demonstrate leadership and do so in a variety of contexts, most frequently in class. Therefore, classroom activities may help strengthen leadership abilities of future dietetics professionals.

Medical nutrition therapy provided to adult hematopoietic stem cell transplantation patients.

This study explored the current medical nutrition therapy (MNT) provided to adult patients undergoing hematopoietic stem cell transplantation (HSCT) and examined the current and desired role of registered dietitians (RDs) in providing MNT. A total of 60 RDs (57% response rate) responded to an electronic questionnaire. Descriptive statistics and χ(2) analyses (SPSS; version 18) were used. Results revealed the primary form of diet was oral, and for patients on nutrition support, parenteral nutrition (PN) was used more frequently (16%-31%) than enteral nutrition (EN) (5%-9%; P ≤ .05). Nutrition support decisions were based on patients' individualized needs rather than established protocol or policies. Mucositis was the most common reason for implementing PN (31%), and intubation or being in the intensive care unit was the most common reason for implementing EN (28%). The RDs had varying degrees of autonomy in order writing and were most often recommending MNT to the physician or writing the MNT order with a physician cosignature. Many RDs reported desiring higher autonomy than what they were currently practicing (P < .05). Those who held a certified specialist in oncology (CSO) or certified nutrition support dietitian/clinician (CNCD/C) certification were significantly more likely to have and desire greater autonomy in order writing than those without specialty credentials (P ≤ .05). No difference was found in current practice or desired autonomy based on the years of experience or educational degree.

Can patient-written comments help explain patient satisfaction with food quality?

This study identified themes in patient-written comments about meals served in a hospital and determined the relationship of those themes to patient food-quality satisfaction ratings among medical and surgical patients. Data from 2 years of quantitative Press Ganey patient-satisfaction ratings and qualitative comments related to meals by 1,077 patients discharged from a Midwest urban medical center were reviewed retrospectively. Themes in comments were identified. Results indicated that patient satisfaction with food quality did not differ based on sex or age, but did differ based on length of stay, perceived health status, and whether a patient provided written comments or not. The most common comments focused on the temperature of hot food, receiving what was ordered, and satisfaction with foodservice staff. The tenor of comments differed by food-quality rating given. Overall food quality rating was best predicted by food-related comments rather than comments about staff, or other issues not addressed in the Press Ganey quantitative questionnaire.

A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria.

The objectives of this study were to determine customer satisfaction with a healthful options food station offered in a worksite cafeteria and document the financial contribution of such a station. The healthful options station featured daily entrées with fewer than 500 calories and less than 30% of calories from fat. Questionnaires from 655 (24.5% response) employees and students provided data on satisfaction with and usage of the station. The majority of the respondents who had purchased from the healthful options station were female (77.3%), white (51.6%), aged 30 to 50 years (52.0%), and had annual incomes of $60,000 to $100,000 (29.3%) or $20,000 to $39,999 (22.2%). Sales and gross profit from the healthful options station were compared to those of the comfort station. Customers were satisfied with attributes of the healthful options station (means >3 on a 5-point scale). Results of paired t tests suggested that customers who had purchased from the healthful options station rated the station significantly (P<0.001) higher for healthfulness of entrées, food presentation, food quality, overall quality of the cafeteria, length of line, and food choices available compared to their ratings for the cafeteria in general. The healthful options station generated average daily sales of $458 and gross profit of $306. However, the sales and gross profit were significantly (P<0.05) less than the comparison comfort station.

Are registered dietitians adequately prepared to be hospital foodservice directors?

OBJECTIVE: To determine perceived importance of selected competencies for the role of hospital foodservice director and explore whether registered dietitians (RDs) are perceived competent in these areas. DESIGN: Data were collected through a mailed questionnaire. SUBJECTS: A random sample of 500 hospital foodservice directors and 500 hospital executives to whom the directors report. ANALYSIS: Chi2, Mann-Whitney, and Kruskall-Wallis tests were used to examine differences among ratings by and demographic characteristics of foodservice directors and the executives with whom they work. RESULTS: All competencies were perceived to be important for someone in the role of hospital foodservice director. RDs were perceived to be somewhat competent in all areas studied but were only perceived to be competent to expert in a few of the areas. Directors who were RDs and hospital executives who had worked with RDs rated the competence level of RDs higher than did non-RD directors and hospital executives who had not worked with RDs. CONCLUSIONS: Unique competencies appear to be important for those aspiring to become hospital foodservice directors. Hospital executives who had worked with RDs perceived the competency level of RDs to be higher than did executives who had not worked with RDs. Often, areas rated as most important for the role of hospital foodservice director were not areas in which RDs were perceived to be highly competent. Additional competency development may be needed to better prepare RDs to assume the role of hospital foodservice director.

Dietetics students perceive themselves as leaders and report they demonstrate leadership in a variety of contexts.

A leadership survey was designed and administered to undergraduate dietetics students (n=283) at eight universities to examine leadership actions reported most frequently, the context of these leadership actions, and students' reported perceptions of themselves as leaders. The majority of students perceive themselves as leaders in all context areas. The leadership practice, "Enabling Others to Act," was the most frequently reported. There were no significant differences in leadership behaviors based on college classification status and supervisory experience. Leadership behaviors were more prevalent in students who had previous leadership course-work, were older, or who had previous leadership experience. Dietetics students perceive they demonstrate leadership and do so in a variety of contexts, most frequently in class. Therefore, classroom activities may help strengthen leadership abilities of future dietetics professionals.

Leadership: reflections over the past 100 years.

Leadership, viewed by the American Dietetic Association as the ability to inspire and guide others toward building and achieving a shared vision, is a much written-about topic. Research on leadership has addressed the topic using many different approaches, from a very simplistic definition of traits to a more complex process involving interactions, emotions, and learning. Thousands of books and papers have been published on the topic of leadership. This review paper will provide examples of the varying foci of the writings on this topic and includes references for instruments used to measure leadership traits and behaviors. Research is needed to determine effective strategies for preparing dietitians to be effective leaders and assume leadership positions. Identifying ways to help dietitians better reflect on their leadership experiences to enhance their learning and leadership might be one strategy to explore.

A survey of perceived benefit and differences in therapy provided by credentialed and noncredentialed nutrition support dietitians.

BACKGROUND: Benefits of the certified nutrition support dietitian (CNSD) credential to clinicians, their patients, and healthcare administrators have not been defined. A study was designed to measure the difference in cost of therapy provided by credentialed and noncredentialed nutrition support dietitians and to measure the perceived value of the credential to those who hold it. METHODS: Using a modified Delphi technique, a questionnaire was developed to obtain demographic information, responses to statements of perceived benefit of the credential, and costs of therapy selected for patients in common clinical scenarios. RESULTS: Of the 691 questionnaires mailed, 314 (45%) were returned. For 8 of 10 statements of perceived benefit, mean response scores indicated agreement. Respondents did not agree that salary increases resulted from credentialing. There was no difference between groups in the type of monitoring selected or in the time to complete an initial assessment. Cost of therapy was significantly higher for credentialed versus noncredentialed dietitians (dollar 915.67 +/- dollar 241.73 versus dollar 851.78 +/- dollar 243.44; p = .035), although the survey was not designed to show that the most appropriate care was least expensive. CONCLUSIONS: The CNSD credential is of perceived benefit to practitioners except in obtaining salary increases. Credentialed dietitians selected more expensive therapy than noncredentialed dietitians, which would benefit healthcare administrators only if reduction of other costs resulted. More complex models are needed to fully assess the benefit of credentialed nutrition support dietitians to patients and healthcare administrators.