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Hospice Niagara: Fishbone
Equipment Staff/Volunteers Process Residents Policies Paid staff and volunteers have inconsistent & varying expectations of one another Some Volunteers do not take meal orders when Resident appears to be sleeping (Staff know status and will wake them) The kitchen is located far from the Residence. So many people are involved in meals, which causes lack of consistency in presentation Equipment is not always available, due to use, elsewhere, breakage, theft, etc. Within Residential Staff, only PSWs typically prepare meals, according to JDs We often don’t have enough Staff/Volunteers for every shift There has been a decrease in client satisfaction with the meal experience at The Stabler Centre. Cultural needs/expectations of some families have regarding food creates a challenge for us.. There are no set meal times. Not every meal is fresh (e.g. re-heating) Residents have never been formally asked about their meal experience Staff/Volunteers have varying expectations/understanding of their role It takes a lot of time to prepare individual food needs Length of stay varies Not everyone is trained in health and safety Staff/volunteers follow the posted menu for the week Diagnosis and medications change food tastes Some Family Members wish to assist with meals preparation, however, they are not allowed in the kitchen. Health status and preferences change hourly
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Hospice Niagara: 5 Whys 1. Residents have never been formally asked/surveyed about their meal experience. Why? Process has been to survey the caregiver, several months after their loved one’s death. Why? Felt Residents are too fragile; don’t want to interrupt or bother them with surveys at end of life. Why? Staff/Volunteers focused on Resident’s physical health (e.g. pain, meds, etc.) as a priority, with less emphasis on meals. Why? Resources (Staff/Volunteer time) are limited to conduct formal feedback. Why? Informal (verbal) feedback from Residents was consistently positive.
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Hospice Niagara: 5 Whys 2. There is an inconsistent approach to meals.
There is a wide array of people (Staff/Volunteers) who are involved. Why? We are a 24/7 operation with rotating schedules/multiple shifts. Why? Staff/Volunteers have varying understanding of the expectations of their job/role. Why? Communication regarding roles/expectations is not continuous (reminders/checkpoints). Why? The roles and expectations provided to Staff/Volunteers are not clearly understood/reviewed on an ongoing basis.
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We needed to become more practical in our approach.
Hospice Niagara: 5 Whys 3. Staff/Volunteers have different standards of meal preparation and presentation. Why? We have strayed away from our original philosophy/approach (e.g. fine china, flowers in vases). Why? Staff/Volunteers have varied approaches to meals, based on their individual preferences/expertise. Why? There is a lack of formalized meal preparation/presentation standards. Why? We needed to become more practical in our approach. Why? We have limited resources (money for equipment/people/time).
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Hospice Niagara: 5 Whys 4. There is a lack of understanding of the dying process, which conflicts with the Resident’s abilities, preferences and needs related to nourishment. Why? There is an emotional attachment to food. Why? Individual traditions/beliefs regarding nourishment are set early-on in life and within families. Why? It is typically the one thing that the family can do for their loved one. Why? Resident’s health status changes continuously, which directly impacts how and what they eat. . Why? There is often a lack of readiness to accept pending death among Residents and their families.
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