Interpretation based Bonnie Blaine, director of hospital operations case based dynamics

model using Venism PLE :

Using the model we understood individual roles involved in the problems which the hospital
dietary department is facing. The whole complex process of preparation of diet chart for patient,
,supply of food, food menus, preparation of food, arrangement of food tray ,distribution as per
the allotted list and the various loopholes in each step was analysed in detailed
The total full time & part time staff , working hours ,salary, distributions of jobs ,role of
supervisor was also scrutinised in detail based on the above model & following keys points how
this model helps in analysing the case :
 Able to find the Individual role of people, team, process, place, and variables which is a
general representation of a complex system otherwise.
 It allowed to understand the effect of supply on kitchen, effect of diet chart list and
preparation on food tray product, effect of staff on food distribution etc, how every
variables are interrelated and interdependent.
 The value chain system is easily modelled using data available in dynamics model.
 Helps to define & analyse problem which can in designing the method to improve the
process or to eliminate the steps creating the problem.
 Helps in time series analysis & simplifies extracting of data from the complex
phenomenon .
 Model is such developed that ,each department can be analysed in detailed also overall
department involved in dietary can also be analysed in meantime.
 Enhancing the Operational process , finding the delaying aspects & limiting it and
prospects of modification can be examined more easily using this model.
1. What are the problems facing the hospital’s dietary food service?
 Case of patient getting the wrong tray, which might risk the life of the patient
highlighting the inefficiency & incapability of dietary department of hospital.
 Dietary food service department is facing problem to analyse the complex
operation to investigate the origin of mistake, to find out which sub system has
not performed the job properly.
 Very difficult to conduct audit or trace if any mistaken happened such as giving a
wrong food tray to a wrong patient.
 All employee, of dietary are blaming each other rather instead of helping or
sharing the problems they are facing at workplace highlighting the lack of culture
& professionalism, Managers are also not able to raise issues they are facing on
practical basis.
 Some of the staff are inefficient to handle the job & leading to errors in task &
some staff are overloaded to make the process function resulting in poor service.
2. What is the cost to the hospital of a minor versus major service upset or failure?
Minor Upsets: Tray delivery on time, patient getting cold food , impolite behaviour of
staff towards patient ,tray pick up not on time, food tray is missed and not delivered to
patient ,poor service etc.
 Major Upsets : Patient getting tray which content ingredient which might be allergic
,risky to health can lead to severity such as death . Not only dietary department, but the
hospital whole health system will face problems can get involved in legal actions & may
lead to huge loss in terms of money & reputation .
3. What does the value chain look like? Describe features of each area. Provide examples of
opportunities for errors at each stage of the value chain.,
Supplier & purchasing Operation (cooking in Kitchen)

1.Frozen food stored in warehouse supplied to
kitchen
2.Private vendor supply refrigerated ,non refrigerated
& frozen food as per the order from purchasing
department
 Cooking process & types of recipes
 Diet food , soup ,salad, desserts, beverage
etc.
 Preparation breakfast ,lunch ,dinner
Key feature :

Key feature :  Careful with the food items &Timely

preparation
1. Quality of food : fresh food or expired
 Correct proportion ,quantity & quality of
2. May prefer low cost food items.
food
3. Delay in delivery & transportation of food
 Overloaded with 18 hours a day
4. Condition of food storage, order accuracy
 Controlling wastage of food
5. Food items getting damaged while loading.
 Cleaning , sanitary & other kitchen utilities
Operation (Diet chart & food menu )
Operation (Tray assembly )
1. Clerk filling the die chart ,Checking the prescribed
 Arranging tray in rotating oval track
diet by clinical nutritionist or head nurse.
 8 persons arranging each food items,1
2. List preparation of Menu for each patient in
supervisor,1 covering the food tray ,2
different room & floor number.
helpers.
3. Manging new patient & recording old history of
discharged patient. Key feature :
Key feature :
1. Accuracy of information while filling diet chart  Arranging each food item as per the list
2. Coordination with kitchen, dietician, nurses etc.  Managing loading docks
3. Handling last minutes changes  Accurately placing the food
4. Skilled & Effective communication channels  Product mixing
5. Proper data collection of discharges, new  Not skilled & trained workers (max PT)
admittance ,pre & post-surgery ,emergencies.
Operation (tray distribution)
6. Precision in sequence of room & floor number
 Team captain with delivery Aides for
Services & Feedback distributing food tray to patient
Patient : taste ,timely getting the meals, behaviours of delivery person  Following the list correctly based
order ,room & floor number
Doctors & Nurses : Monitors the food quality ,receives complains Key feature :
Medical staff takes the complains regarding & verify cases of wrong  Timely delivery & pick up
delivery, quality of food from the patient & family .  Accuracy in following the list while
delivery
Key feature : Patient & family monitors the food quality & timely
 Tem captain needs skilled while
delivery ,Dieticians check food as per doctor’s instruction (Occasional
),Complaints are informed to dietary department .
The dietary department provides food services begin with raw materials and food supplies
Providing item such as refrigerated, non-refrigerated, or frozen, and it uses intermediate
Process for order taking, cooking, and final assembly ending with order delivery. It expects
patient & their family members are satisfied with the service & food quality .The doctors, nurses,
Medical staff receives the feedbacks or complains if any regarding the food from the patient side
and deliver it to dietary department so that they can improve their services based on the
feedback.
Examples of opportunities for errors at each stage of the value chain
 The suppliers may be using old raw material, expired food ,damaged food .
 Since delivery is once a week delivery dietary department there is a probability that the
items ordered by services manager , as it uses intermediate process for ordering maybe
wrong when taking patient’s menu.
 Clerks while filling the diet chart might do errors & not provide diet chart to the kitchen
prescribed by doctor, due to last minute changes in diet .
 Cooking at breakfast, lunch and dinner continuously without much break may lead food
not finished or uncooked , food take over in the night to save time leading the degrading
the quality of food.
 No proper coordination & in accurate information flow between the clerk ,cook
,dietician & tray production team during rush hours.
 During final assembly, the food is assembled on each patient tray on a large rotating oval
track. Maybe the food contaminated, placing wrong food items in tray not as per the list
& diet chart.
 In correct placement of food tray in the cart during the transition between tray
production to delivery team
 Delivery team don’t follow the list in sequential manner and misplaced the order
 3 teams manging the delivery of 20 floors may delay the timely delivery & pick up &
rude behaviour of delivery aides .
Due the complex phenomenon & continuous flow of information everyone involved in
the operations of value chain are responsible for errors.
4. Who is responsible for quality?
 Dietary personnel in food service department is responsible for food quality &
main duty is to check poor quality food is not supplied to kitchen.
 Also the cooks in kitchen are also responsible to provide good quality food for the
patients.
5. Define the patient’s wants and needs, and associated processes ?
Patient’s wants & needs Associated process
Good quality food interns of taste ,hot & Supplier –purchasing process
cold food & beverages ,administrative services ,food production
team process & kitchen staff
Timely arrival & pick up of food tray Food production, tray assembly &
delivery process
 Food should match with the prescribed All process involved in the supply chain &
diet value chain ,Primary management
processes ,technical process (by clerk)
Food is properly checked by dietician Supporting process of management
Friendly behaviour of delivery Aides Training process involved in delivery
Neat & clean food tray & delivery person Training process of Tray assembly &
delivery Aides & management supporting
process to provide clean uniforms.
 The patient ultimate requirement is dietary department being systematic with the
arrangement of their system without mistaken giving a wrong food tray & giving good
quality food & services satisfying their needs .
 To fulfil the tangible & intangible product & services demands of patient for value
proposition
 Creating a positive feedback loop between the patient & dietary department in terms of
value & cost.
Key process involved
Effective Value chain Process – focused on primary product or services such as good, food
quality of food, on time delivery & pickups, getting the food as prescribed by doctors.
Supporting process in value chain –Secondary activities providing proper training to staff for
being well behaved & well dressed.
Technical Process –Skilled & efficient staff for clerical post in service department as the filling
diet chart ,preparing of final list ,allotting trays to correct room numbers & floor being the prime
duties & most volatile point of errors.
Managements Process – Coordination between the team, relationship with nurses & doctors,
Occasional audits & checks, Role of supervisor .
6. Select a process and discuss how to mistake proof it and improve process performance?

Operational process in Value Chain creation : full range of activities in the dietary
department needed to create a food or service are involved , which comprises the steps
that involved transformation activities that change inputs into outputs to provide value to
customers such as Supply & purchasing raw materials ,placing orders ,production and
deliveries & other intangible services .
Mistakes is process :The department of dietary always late timely delivery and pick up
of trays, the accuracy of menu orders and the medical staff is most concerned about the
accuracy of prescribed diets for obvious patient health reasons.
 1 manager handling 51 staff in administrative service including kitchen, tray
production & cafeterias may lead mistakes and handling such huge number of
staff is tough where the most crucial part is involved food productions & tray
assembly.
 26 out of 30 part time staff belongs to tray delivery, food productions & assembly
who are unskilled there is high probability of misplacements.
  Only 8 clerks handling all the patient list in 20 floors assuming 25 rooms in each
floor which is 500 rooms .Suppose 300 patients are there in that case each clerk
has to manage 38 patient(300/8) 3 meals each day i.e 115 meals (3x38) per day
.Which certainly involves human error .
 Kitchen staff are working 18 hours a day which is very tiring & high probability
of wrong ingredient in food & compromising with the quality of food.
 Since the food supply is only once a week in case of shortage quality of food may
be compromised .
 Just 3 teams handling delivery of 20 floors (300 patient approx.) which shows
they are overburdened along with doing error in misplacing the order they might
get irritated & may not behave properly .
Methods of Improvements:
1. Adding more staff & additional supervisors under the manager of
administrative services to monitors the food production & tray assembly.
Adding additional cooks & kitchen staff and shift changes such that no
body works beyond 10 hours .
2. Arranging frequent meeting with the manager ,conducting audits in all
process involved & Surprise food checking by dietician .
3. Adding more benefits & appraisal based on performance for motivating the
staff .
4. Adding more trained & skilled staff in delivery & production who can
understand diet chart and electronic copy of each patient meal must be pasted
in room so that during final delivery food tray can verified with prescribed
diet.
5. Adding Floor representative to help the delivery & checking of diet chart of
respective patient with the food tray .
6. Automation methods & technical tools ,scanner must be used by clerks to
prepare diet chart & final list ,last moment changes should be updated in
system so that in gets automatically updated in the diet chart ,also adding
automated methods for collecting diet chart history of discharged patient
instead of calling & manually doing the task.
7. Hiring more staff & helpers for the clerks and dividing into teams for
manging new admittance ,emergency cases ,discharged patient ,meals for
visitors etc.
8. Each food tray should have a chip matching with patient room no after
scanning the same food should be delivered.
9. Proper quality checks & scanner controlling the supply chain so that food is
never out of stock.
10. Collecting feedback forms from all patients .
7. How do we turn this dietary food service around? What are your recommendations?
Short term actions:
  Arranging meeting with the managers of food service manager, patient service &
administrative service to scrutinise the process and push the mangers to share the
problems & issues which might lead to errors.
 Hiring more staff patient services team and for clerical support. Adding low
payed helpers in kitchen and adding shift so the kitchen staff are not overburden.
 Adding separate supervisor & mangers for taking care of kitchen staffs & tray
assembly & production team.
 Conducting immediate frequents Audits for every process involved.
 Getting weekly feedback & report from mangers of every team about the
problems & issues occurring during the respective process.
 Arranging Quality checks for food supply.
 Adding well skilled & trained floor representative at every floor for verifying the
food tray & final checking with the patient’s diet chart before handing over to
patient.
 Adding additional supervisor during tray assembly to monitor all the 8 activities
in the oval track.
Longer-term actions
 Add more funding to automate the systems, RFID tags, automatic scanner & chips
connecting patient name, room number & diet chart with food tray.
 Conducting Meeting & adding continuous methods for improving the process
 Recognising & rewarding staff based on performances
 Adding more benefits for the staff & managers based on their performance.
 Training programs for the delivery Aides for faster & effective deliveries of food
trays.
 Scrutinising the organisation chart regularly ,hiring staffs based on works
allocation & distribution whenever required.
Name : Arpita Sahu
Student Number : 425409