Mountain Home VA Cares for Veterans One Meal at a Time

With hospital stays, Veterans expect great care at the Department of Veterans Affairs. At James H. Quillen VA Medical Center (JHQVAMC), the Nutrition and Food Service (NFS) team elevated the standard of care for Veterans by providing bedside service offering comforting, home-cooked meals right to patient rooms.

NFS embarked on its journey toward improved Veteran satisfaction with inpatient food services in 2014. This was in alignment with Veterans Health Administration’s Nutrition Field Advisory Board’s Strategic Goals.

"We decided we wanted to transition our service from retherm-style cooking, or cooking food items three to five days in advance, to ‘scratch-cooking’ (cook-serve)," said Sam Sisley, NFS chief. "We knew this was the way to go to have the best food and service, and to provide choices to our patients. We could potentially brighten a patient’s day by delivering them the best meals possible. Sometimes that is all patients have to look forward to."

The project included three phases requiring various renovations, equipment upgrades and innovating services, each necessitating an independent timeline to ensure no disruption to food services.

This was a major transition for NFS. Food preparation went from preparing meals three to five days in advance using retherm units, blast chillers and a food bank to NFS staff preparing meals for patients on the same day the meals are ordered.  The team no longer has days to make sure they get meal orders correct, because days suddenly turned into just a few hours. Meeting this challenge head on is what allows NFS to serve more meals using homemade recipes.

"Or as we like to say, "Mountain Home Homemade," said Sisley. "Foods are fresher and are much more appealing to the eye."  To improve Veterans’ experience with meal choices while admitted to JHQVAMC, NFS leadership understood the need to provide patients with more ownership in making decisions about their food and beverage choices. With the support of the medical center's Executive Leadership Team, NFS decided they would implement a bedside, spoken-menu style of room service and to change their meal production style from cook-chill-retherm to cook-serve.

"It's about the simple things that are making somebody's day a lot better," said Norman Faw, NFS production manager, whose efforts earned him the National VHA Food Service Excellence in Food Service by a Food Service Supervisor Award. "It’s about listening, caring and going that extra mile for that Veteran, and making sure their day here at the VA is the most fantastic day they can have."

NFS went through their fair share of obstacles to make this project happen, including establishing a culture of acceptance for change, hardware and connectivity issues, and staffing changes for key positions. Help came in many forms as NFS worked closely with Facilities Management, Logistics, Nursing, Human Resources, and the American Federation of Government Employees to make this project happen. Even the surgency of COVID-19 during this time did not deter NFS from making room service a realization.

"I am so proud of our staff in NFS for implementing this project," said Dr. Colleen Noe, JHQVAMC associative director.  "Moving to Cook-Serve with Bedside Select required staff to be in a state of constant change as they worked through each phase of the project. They have demonstrated professionalism, teamwork, resilience, and dedication to ensure the patient experience is enhanced during an inpatient stay. They truly own this initiative and have demonstrated all the principles of being a High Reliability Organization."

Phase one of the project began with implementing new software and developing Cook-Serve appropriate recipes that could be built into the software. The goal was a transition to cooking main entrees from scratch 80% of the time. The change required quicker orders for food from suppliers to meet the changing food production timelines.

"The patients can definitely see the difference from a frozen soup to a homemade soup, or from a reheated steak to a fresh steak off of the grill," said Sisley. "Our Veterans also love having the freedom to make their own choices at meals, which is much better than just having a meal provided to you."

Phase two, also known as Mountain Home HomeMade, required changes in staff and scheduling, and changing operational equipment to discontinue retherm and transition the tray assembly line to hot steam tables. NFS did a focus group patient satisfaction survey when they completed Phase two and it reflected a 59% increase in Veteran Satisfaction with the appearance of meals and a 41% increase in Veteran satisfaction with the quality of the meals. It also reflected a decrease in food waste by 39%.  

"Our friends in nursing are also very happy with this change because they feel that their patients are getting more of what they want and need, which makes for a better experience for our patients and our healthcare providers," said Holly Taylor, NFS assistant chief.

The final phase, called Mountain Home HomeMade to Order, or beside-spoken menu, implemented tablets, laptops, and carts for nutrition ambassadors to take meal orders bedside, one meal at a time.

"I decided to work here because of this project," said Taylor. "When I came onboard in 2016, I jumped right in and was able to help keep everything moving in the right direction and fill our key positions with great folks. I have been able to see the whole plan come together and could not be prouder to be part of it and to work with such great team members who have made it all possible."

"I love being a Veteran, serving our Veterans," added Faw. "It helps Veterans realize that we care about them, and we care about how we take care of them. And they are never forgotten. I couldn’t ask for a better job."