Qualitative Analysis of the Implementation of a Hospital Room Service in a Large Metropolitan Hospital: Foundations for Transformation (2024)

Nine of the 13 potential participants were recruited. The interviewees comprised of a group of both clinical and non-clinical staff who had been involved on the local working party to implement room service. They included representation from food service management, dietetics, speech pathology, medical, nursing managers, education and training staff and an external project consultant who was engaged to assist with implementation. Interviewees had varying levels of engagement in the project from subject matter expert consultation to operationalising the implementation.

Three main themes were derived with reference to the study aims: (I) Foundations of transformation, (2) Navigating implementation, and (3) Embedding sustainable practices. The themes and sub-themes are outlined below and illustrated with representative quotes.

Theme one: Foundations of transformation

Foundations of transformation’s first sub-theme was (I) environmental and cultural assessment. It was acknowledged that consultation needed to happen early and widely. It was recognised this was “not a food service project, but a hospital project” and as such led to the conclusion that a broad organisation/ facility wide environmental scan or cultural assessment exploring local barriers and enablers would be beneficial for future sites’ room service roll-outs. Considerations of stakeholders extended from the proximal to more distal groups, including executive, food service, dietetics, medical, nursing, operations, speech pathology, pharmacy, administration, consumers, media/communications and information technology.

“she {Dietitian Team Leader Food Services} worked hard to get that buy in and building that case for change quite early so I think that’s why we were able to get those results because of that planning process, engaging people. I’ve seen it implemented in some other hospitals and unless you have that buy in, there’s a lot of nervousness around it and so there’s that desire to sort of go back to some of those old ways”(Participant 9)

Engagement with relevant unions to also be considered early on, from the outset and well prior to implementation, as well as apprising the needs of the patients and the community.

“talking about that community expectation, you know a lot of people don’t like to come into hospital, but if there is one less thing that they need to worry about, they don’t need to worry about the food anymore, like I wonder if that improves even coming into hospital.”(Participant 2)

Shortcomings in the process of consultation were noted to hinder a smoother implementation. It was felt that issues around menu planning could have potentially been overcome by ensuring the interdisciplinary steering committee had the correct stakeholder membership, with links to Executive and other decision makers for two-way information sharing. The interdisciplinary approach to the steering committee or working group also allowed the for the development of relationships and trust during the process.

The second sub-theme, (II) preparing for anxiety and tensions, acknowledged the expected trepidation that exists before any large change to a system,

“because it’s a change in culture, and people aren’t too flush with cultural change”(Participant 2)

“maybe I was expecting some of the points that I was apprehensive about, not really expecting, but I was a little bit unsure whether or not certain aspects of it would work. I work in a general surgical ward and diets are upgraded and down graded quite frequently, so ... I wasn’t sure how that was going to work, because you know you might see the patient and then 2 seconds later they want to order a meal through Room Service but yet we haven’t been able to change that in the system yet.”(Participant 7)

However, this sub theme also encompassed strengths, recognised with stories of problem solving in allaying fears and taking everyone on the journey.For example, participants said breaking down and addressing problems systematically, and recognising the evidence behind Room Service, were enablers for its implementation and uptake.

“When I first heard about it before I knew much about it I thought ‘oh my God they’re never going to be able to do this because it sounds too complicated’, but as I got to know it better I thought ‘this is going to be fantastic’ and ‘that’s a lot of work’, and then I wasn’t sure how successful it would be because you really need to get it to work right to make it successful, and then as we went along and broke all the problems down and fixed them.. and implemented it and then it worked and it was like ‘that was fantastic’ and then it was done.”(Participant 8)

“when I saw what had been learnt from .. other sites that had done it and when I heard about what the evidence .. I could see the potential. So, for instance, the lack of waste and the .. improved nutrition for the patients (because they were actually getting what they wanted) and {were} more likely to eat it, and I could see the logic behind that so I didn’t need much persuading once I saw the experience and the evidence.(Participant 5)

Participants discussed ideas on preparation required to help support culture change, including appropriate staff training and equipping change champions in each area,

“and we had given them a lot of training beforehand about difficult conversations and resistance you know, people who are resistant to change and how to deal with those people, which at the time I think the department thought we were absolute crazy people, like you know, ‘why, why are you telling us all this?’ which was actually vindicated because someone said that they’d used all of those skills in the first hour”(Participant 1)

The final sub-theme related to (III) structural and strategic considerations prior to implementation. These focussed on issues suggested to be beneficial in preparing the service for the complex change. First and foremost was engagement of the executive.

“because it certainly helped and we needed exec to be pushed, you know, up to (Hospital and Health Service) exec to get the money, so without that, you know, whole hearted support it wouldn’t have been a success, so getting that super early I think is is key”(Participant 3)

This early engagement was thought to assist in securing essential support for resourcing the remodel of the kitchen facilities. Other early engagement that was noted to facilitate change was the engagement of an experienced external consultant, as well as a well-networked project officer for the project delivery. Participants also encouraged approaching the process with an “open mind and a positive attitude”in the lead up to the implementation, as well as ensuring the change process had adequate time given to it.

Theme two:Navigating implementation

The second key theme, Navigating implementation, contained the sub-themes of (iv) experiences and engagement and (v) the transition phase, and (vi) reorientation of the workforce. Despite the initial trepidation, the (iv) experiences and engagement were reported as overwhelmingly positive for patients, staff groups, personal satisfaction, and the system. Respondents reported feeling that patients were empowered and in control,

“because it’s about patients feeling in control. Patients often, particularly frail older patients in hospital, feel very out of control because they’re stuck in hospital, they can’t do anything, they can’t complete their own activities of daily living. It’s very disempowering. So to be able to have a menu and make choices and have some control is really good for them.” (Participant 4)

Interviewees reported that staff showed adaptability, ownership, and empowerment and felt proud, pleased and amazed at the results of the Room Service system and its outcomes.

“I think they feel quite proud serving this nice, new, fresh food and then I think they’re energised by the fact that the feedback they’re getting from the patients is just really positive.”(Participant 2)

“for me the best thing is the compliments, the amount of compliments that we get is amazing.“(Participant 6)

The positive feelings extended to staff’s pride in the significantly reduced waste and satisfaction with a more evidence based, patient focused approach.

“after my ward rounds, I see empty trays and it’s such a good thing to see empty trays”(Participant 4)

“at the end of the day it is about patient centred care, we have ideas as clinicians and therapists about how we want to do things but at the end of the day it’s the patient, the person’s in the centre”(Participant 4)

Minor negative comments were noted, mentioned as ‘hiccups’ or ‘glitches’ that were ‘ironed out’ through adaptability, further problem solving and collaborative decision making.

The second sub-theme in Navigating implementation was (v) the transition phase. The success of undertaking a mock trial prior to go-live was highlighted, with the benefits a simulation can bring,

“We actually did a mock trial where the nurses upstairs would order food and we would take it up, you know those sort of scenarios.. So we did that. All the cooks were involved in that, so well before going live they had a good understanding of how it would work. From reading dockets, to looking at allergens, to the cooking processes, all those sorts of things.”(Participant 6)

However, it was suggested that a more formal ‘transition phase’ during the commencement of the implementation of Room Service should occur. This was felt to be required to allow an ‘overlap’ or stock transition phase in the kitchen and ward imprest stores.When asked about their experiences of the actual go-live, participants said the extra staffing that was put on to allow for adjustment to the new system (with extra ‘bodies’ as runners and problem solvers) was essential to the smooth transition. A specific example noted was having all dietitians present and available on the wards and in the call centre to assist and problem solve during this go-live phase. This heightened teamwork and pressure was considered to be ‘team building’ and needed a ‘celebration’once it was implemented to acknowledge the work achieved.

Reflecting on the effectiveness of communication strategies the Hospital and Health Service utilised during the covid-19 pandemic, it was suggested that short videoconferences (town hall-style) with executive could be utilised for future rollouts as an effective information and update tool for all staff.

Interviewees also highlighted the process of managing (vi) reorientation of the workforce. In addition to the positive benefits that came from having a dedicated project officer, it was noted that there were more permanent staffing changes needed and early planning is required for this.

“The workforce changes and having enough time to recruit and train and work out the rosters, and, I think HR seemed to sort of drag their feet a bit on that. Um I mean we went live end of April, it was a year yesterday, and said to them we need early February, we need all the stuff signed off and they were really dragging the chain. I don’t think they understood the complexity and the severity, even though they had been involved in the key stakeholder meetings quite early on, I don’t think they really got the breadth of the scope of the impact from a workforce point of view. ItI is a significant impact”(Participant 9)

As well as adequate resources, particularly in regards to some of the key food service roles, consideration of timely back up support or backfill of people undertaking key roles was recommended. Suggestions included requiring higher level workforce to be able to reorient to higher duties as well as restructuring the workforce and shift coverage (for example, having two people making sandwiches at busier times). Earlier recruitment of staff for the new roles was also recommended to occur to allow plenty of time for training.

It was also noted that the implementation could also have been enhanced by continuing the Project Board meetings for a longer period post go-live,

“I suppose since the project board and the project officer didn’t continue on as long as they should have …probably in the end it probably just didn’t happen as quickly and as smoothly as it could have I think. And there are you know there are little things that crop up in those three months you know, with equipment and menu and those sorts of things probably could have been ironed out a bit easier. Yeah, if it had been yeah, for that kind of month longer really and the board in particular I think as well”(Participant 1)

Participants noted the potential benefit of having dedicated time allocated post implementation to review the changes and support any further problem solving that was required before resuming business as usual,

“And then I’ve tried to do my normal role, I couldn’t go in there and fine tune a lot of stuff.. I couldn’t sort of evaluate it, like where are we going right, going wrong. We didn’t have any time to reflect, you know what I mean”(Participant 6)

Theme three:Embedding sustainable practices

The final theme was Embedding sustainable practices for future success. Types of ordering systems that allow families to assist patients to order were acknowledged as possibly helping to take the burden off staff,

“the patient’s family can order for them, they can order remotely, plus the nurses can order by {the alternate system} so it just means that from a workload point of view there’s less demand on the workflow”(Participant 9)

On a larger system scale, considering the potential rollout across several sites within a Hospital and Health Service, the possible benefits of utilising a central call centre with a core, shared menu was noted,

“to streamline the job, use similar menus, you know and in the end too you know, looking at we could have one call centre in the middle of {theHospital and Health Service}, they don’t have to be on-site here, and then we have one call centre that you know does that does every meal order, it’s just a phone number.”(Participant 6)

The importance of remembering to engage new staff at orientation was highlighted,

“engaging people on day one at their orientation program to let them know it’s coming …what it’s going to look and feel like so they can expect it, so there is no surprises … I’ll get staff that that have been to an orientation program, come to me and say wow, you know. You advised us of this and you asked us to be open minded and and to embrace this and I’ve never seen anything as amazing as this in a hospital”(Participant 2)

Finally, comments addressed ward and unit areas in which room service was not considered suitable as part of this rollout (such as rehabilitation wards with shared dining rooms), and suggested undertaking patient-centred problem solving to facilitate its adoption into the future.

Qualitative Analysis of the Implementation of a Hospital Room Service in a Large Metropolitan Hospital: Foundations for Transformation (2024)


What are qualitative research methods in health services? ›

Qualitative research helps to understand the patterns of health behaviors, describe illness experiences, design health interventions, and develop healthcare theories. The ultimate strength of the qualitative research approach lies in the richness of the data and the descriptions and depth of exploration it makes.

How a qualitative research may help the hospital organization? ›

Qualitative research in healthcare provides detailed and contextualized information on product development, patient satisfaction, doctor and physician perceptions, and more. The most common types of qualitative research include focus groups, in-depth interviews, and phone surveys.

What is an example of qualitative research in the medical field? ›

Another area where qualitative research is being used in health care is to identify obstacles and barriers to practice change by exploring the reasons behind certain behaviours. A good example of this is the study of patients' decisions about whether or not to take anti-hypertensive drugs.

What are the three most common qualitative methods used in health research? ›

The three most common qualitative methods, explained in detail in their respective modules, are participant observation, in-depth interviews, and focus groups. Each method is particularly suited for obtaining a specific type of data.

What are the 5 methodology of qualitative research? ›

Approaches to qualitative research

Common approaches include grounded theory, ethnography, action research, phenomenological research, and narrative research. They share some similarities, but emphasize different aims and perspectives.

What are the limitations of qualitative research in healthcare? ›

Limitations of Qualitative Research

Rigor is more difficult to maintain, assess, and demonstrate. The volume of data makes analysis and interpretation time consuming. The researcher's presence during data gathering, which is often unavoidable in qualitative research, can affect the subjects' responses.

What are the disadvantages of qualitative research in healthcare? ›

Qualitative research does not promise a clear or direct and orderly method of tackling research problems in health studies. It does not provide researchers with a set of rules to be followed or give them a comforting sense of security and safety backup against possible mistakes on the road to knowledge.

How does qualitative research improve patient care? ›

Qualitative research is important because it helps nurses to understand their patients better. By understanding their patients, nurses can generate information that can help to inform clinical decisions. This ultimately results in enhanced patient care.

How is qualitative and quantitative research used in healthcare? ›

In general, quantitative research seeks to understand the causal or correlational relationship between variables through testing hypotheses, whereas qualitative research seeks to understand a phenomenon within a real-world context through the use of interviews and observation.

How do you use qualitative research methods? ›

Qualitative research uses several techniques including interviews, focus groups, and observation.[1][2][3] Interviews may be unstructured, with open-ended questions on a topic and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked.

What is an example of quantitative research in a hospital? ›

An example of a quantitative research study is the survey conducted to understand how long a doctor takes to tend to a patient when the patient walks into the hospital.

How do you Analyse qualitative data examples? ›

You could, for example, use narrative analysis to explore whether how something is being said is important. For instance, the narrative of a prisoner trying to justify their crime could provide insight into their view of the world and the justice system.

What type of data is used in qualitative research? ›

Qualitative data describes qualities or characteristics. It is collected using questionnaires, interviews, or observation, and frequently appears in narrative form. For example, it could be notes taken during a focus group on the quality of the food at Cafe Mac, or responses from an open-ended questionnaire.

What is a quantitative research method in healthcare? ›

Quantitative research, as the name suggests, quantifies a problem by generating numbers. Quantitative data, often informed by qualitative data, can answer questions such as how many, how often, who and where. It is used to quantify attitudes, opinions, experiences, behaviours and other defined variables.

What are quantitative methods in healthcare? ›

Types of quantitative data sources include: Surveys and questionnaires: Surveys and questionnaires gather information from respondents through open- and close-ended questions. For example, patients, providers, or other organizations may participate in surveys about their experience or satisfaction with the program.

What is an example of a quantitative research method in healthcare? ›

Quantitative instruments may include self‑reporting tools, questionnaires, observation, and biophysical measures (Polit and Hungler 2013). Commonly used methods in nursing research also include focus groups and interviews that are qualitative in nature (Moxham 2012).

What are the qualitative research methods in nursing? ›

Examples of qualitative methods employed in nursing research include grounded theory, phenomenology, ethnography, and qualitative description. Each method has its own assumptions and purposes and an appropriate method is chosen based on the research question.

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