EFFECT OF ABSENTEEISM AND TARDINESS 0N
INPATIENT MEAL SERVICE IN TWELVE MICHIGAN
HOSPITALS

Thesis for the Degree of M. S.
MICHIGAN STATE UNIVERSITY
AUFWIEDERSEHEN BROOKS AGBOKA, R. D.
1975

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J}i\/ ABSTRACT
‘1 EFFECT OF ABSENTEEISM AND TARDINESS ON

'\:N ‘ INPATIENT MEAL SERVICE IN TWELVE
~ MICHIGAN HOSPITALS

BY

Aufwiedersehen Brooks Agboka

This study consisted of an examination of hospital meal
service practices with major focus on the effects of employee
absenteeism and tardiness on patient meal service activities
(tray assembly, tray delivery and soiled tray collection) in
12 selected Michigan hospitals. The hospitals were nonfederally
operated, located within a 75—mile radius of Lansing, licensed
by the Michigan Department of Public Health and had an in-
patient bed capacity of not less than 125 and not more than 700.

The data for the study were obtained through on-site
interviews with 18 dietary administrative/supervisory per-
sonnel from the 12 selected hospitals. The guide used during
the interviews contained both highly structured and semi-
structured questions.

The information from this study provides some insights
as to a) the variety of techniques that are used in different
size hospitals for patient meal services, b) the strategies
used to maintain efficient inpatient meal delivery despite
employee absenteeism and tardiness and c) the similarities

and differences among personnel policies and procedures

Aufwiedersehen Brooks Agboka

established for handling the problems of employee absenteeism
and tardiness.

Findings of the study implicate that, regardless of
facility size, the policies and procedures pertaining to in—
patient meal-nourishment tray assembly, tray delivery and
soiled tray collection in Michigan hospitals are similar.
Dietary personnel have the ultimate responsibility for all
activities related to inpatient meal services. Most hospital
dietary departments use the centralized method to assemble
inpatient trays to enable dietary administrative personnel to
minimize labor costs and to have more precise control of the
personnel who participate in inpatient tray services. The
only meal service activities that nondietary personnel are
apt to be involved in are the delivery of service—ready foods
to and collection of soiled trays from patient bedsides.

Absenteeism and tardiness among patient tray service
employees are inevitable and bound to interfere with the
efficiency with which inpatient meal service activities can
be performed. Modifications which must be made to compensate
for or cope with poor attendance among employees are daily
problems that dietary administrative and supervisory personnel
are forced to deal with as effectively as possible. As long
as the human related problems of employee absenteeism and
tardiness exist new policies, procedures and regulations will
be formulated and/or existing ones revised in an effort to
minimize their occurences. Of all the service responsibilities
inherent in hospital dietary department operations, inpatient

meal-nourishment services must be given priority.

EFFECT OF ABSENTEEISM AND TARDINESS ON
INPATIENT MEAL SERVICE IN TWELVE
MICHIGAN HOSPITALS

BY

Aufwiedersehen Brooks Agboka, R.D.

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE

College of Human Ecology
Department of Food Science and Human Nutrition

1975

ACKNOWLEDGMENTS

Sincere appreciation is extended to my major professor,
Dr. Grace Miller, for her patience, understanding, encourage-
ment and guidance throughout this study and in the preparation
of the manuscript. A very special thanks goes to Dr. Gilbert
Leveille, Chairman of the Department of Food Science and
Human Nutrition, for financial assistance in conducting the
survey.

Appreciation is also extended to Dr. Wanda Chenoweth
and to Miss Jean McFadden for serving on my guidance committee
and for their helpful suggestions. Grateful acknowledgments
are also extended to the dietitians who assisted in the pre-
testing of the interview guide.

To the hospital administrators and the dietary admin-
istrative/supervisory personnel of the hospitals studied,
I express my sincere appreciation. Without their cooperation
and help, this study could not have been undertaken.

Thanks are also extended to my husband, Joseph, for
his support and encouragement during this research study
and to my parents, Espy and Grace, for their understanding,

love and moral support.

ii

LIST OF TABLES

TABLE OF CONTENTS

Chapter
I INTRODUCTION . . . . . . . . . . . . . . .
Statement and Significance of the

Problem . . . . . . . . . . . . . . .
Assumptions . . . . . . . . . . . . . .
Objectives . . . . . . . . . . . . . . .
Definition of Terms . . . . . . . . . .
II REVIEW OF LITERATURE . . . . . . . . . . .
Hospital Food Service System Components.

Trends in the Hospital Food Service
Industry . . . . . . . . . . . . . .

Effects of Absenteeism and Tardiness
on Hospital Food Services . . . . . .
Causes of Absenteeism . . . . . . . . .

Methods Used to Control Absenteeism
and Tardiness . . . . . . .I. . . .
III METHOD OF INVESTIGATION . . . . . . . . . .
The Survey Sample . . . . . . . . . . .
The Survey Instrument . . . . . . . . .
Pretesting the Survey Instrument . . . .
The Interview Procedure . . . . . . . .
Analysis of the Data . . . . . . . . . .
IV ANALYSIS OF THE SURVEY DATA . . . . . . .

Assessment of the Responses . . . .

Part 1. The Respondents . . . .

Part 2. Operational Characteristics-

Dietary Department . . .

Part 3. Manpower Needed to Provide

Patient Tray Services .

Part 4. Personal Characteristics and

Educational Background of

Dietary Employees who Assist

in Patient Tray Services .

iii

Page

(11pr

ON

ll
13

15
l9
19
20
23
24
25
26
27
28
34

46

63

Chapter

LITERATURE CITED

APPENDIX

Part 5. Absenteeism and Tardiness
Among Patient Meal Service
Employees . . . . . . . .

SUMMARY, CONCLUSION AND IMPLICATIONS . .

Summary of Findings . . . . . . . . .

The Respondents . . . . . . . . .
Operational Characteristics:
Dietary Department . . . . . .
Manpower Needed to Provide Patient
Tray Services . . . . . . . . .
Personal Characteristics and Educa-
tional Background of Employees
who Assist in Patient Tray
Services . . . . . . . . . . .
Absenteeism and Tardiness Among
Patient Meal Service Employees

Conclusions and Implications . . . .

iv

Page

69
92
93
93
94

97

100
102
114
118

120

Table

10

ll

12

l3

14

LIST OF TABLES

Hospitals Studied: Location, Size and
Dietary Personnel Interviewed . . . . . .

Professional Characteristics of Dietary
Department Administrators Interviewed . .

Professional Characteristics of Dietary
Department Supervisors Interviewed . . .

Operational Characteristics-Dietary

Department . . . . . . . . . . . . . . .
Menu and Food Purchasing Policies . . . .
Inpatient Tray Service Procedures . . . .

Dietary Department Manhours/lOO Beds:
Patient Tray Assembly . . . . . . . . . .

Dietary Manhours/lOO Beds: Patient Tray
Delivery to Patient Floors and to Patient
Bedsides . . . . . . . . . . . . . . . .

Dietary Manhours/lOO Beds: Soiled Tray
Collection From Patient Floors to Kitchen
and From Patient Bedsides to Kitchen . .

Dietary Department Manhours/lOO Beds: All

Patient Meal Tray Services Per Day . . .
Dietary Manhours/lOO Beds: Nourishments
Small Hospitals: Job Classifications,

Position Titles and Patient Meal Service
Duties of Dietary Employees . . . . . . .

Large Hospitals: Job Classifications, Posi-
tion Titles and Patient Meal Service Duties

of Dietary Employees . . . . . . . . . .
Dietary Labor Personnel: Personal
Characteristics . . . . . . . . . . . . .

V

Page

27

29

33

36
41

44

47

50

52

54

56

59

6O

64

Table

15

16

17

Page

Highest Educational Level Attained: Percent

of Dietary Labor Personnel . . . . . . . . . 66
Highest Educational Level Attained: Percent

of Administrative and Supervisory Personnel. 68
Modifications Made to Compensate for Absences

of Dietary Employees Normally Assigned to

Patient Tray Service Duties . . . . . . . . 78

vi

CHAPTER I
INTRODUCTION

The service component is a critical function of a
hospital food service operation and will demand increasing
emphasis as on-premise food production continues to decrease.
It is estimated that, as constituents of total hospital
food service,tflm3preparation of the facilities for meal
service and the portioning and assembling of service-ready
foods for distribution to inpatients, hospital personnel
and/or the public consume about nineteen percent of the total
direct work time of dietary employees who participate in
those activities [24].

As reported by Livingston [20], providing meal services
in hospitals is one of the most complex areas of food service
because of a) the requirement for an extensive variety of
foods to satisfy short term and long term patients and b)
the need to provide foods for patients on modified diets.
According to Merten [24], the fact that totally automated
food service systems have been tried but have been unsatis-
factory because of the lack of the "human touch" shows that
food service establishments cannot operate effectively without
the aid of human resources. Thus, the demand for capable
and available personnel who will contribute to the fulfillment
of consumers' needs and the attainment of the goals of the

l

food service department is imperative in the provision of
hospital food service. This is particularly true for

hospital food service employees whose duties include patient
tray assembly, tray delivery and soiled tray collection. If
such services are to be rendered effectively, techniques

must be developed for efficient meal delivery to all consumers
and, most importantly, the required number of personnel must
be present and available every day to provide patient tray

services as scheduled.

Statement and Significance of the Problem

 

According to Castillo [4], absenteeism is one of the
most serious problems facing hospital management today. On
the one hand, it leads to voluntary or nonvoluntary termina—
tion of employees. On the other hand, it results in ineffi-
cient meal delivery to hospitalized patients. From this
researcher's personal experience as Co-ordinator of Patient
Food Service in a 565 bed metropolitan hQSpital, it was
clearly evident that absenteeism and tardiness among dietary
employees responsible for patient tray services always
created severe operational problems in the service of
inpatient meals.

Keiser and Kallio [17] have also stated that employee
absenteeism and tardiness cause many problems in the food
service industry. Since most food service operations are
relatively small, the absence of even a few employees has
a severe effect on work schedules, duties of other employees,

volume of sales and the service efficiency of the operation.

The modifications which must be made to compensate
for or to cope with the problems associated with absenteeism
and tardiness among patient tray service employees become a
major task for hospital food service administrators and must
be given high priority. Whether the modifications made are
by the development and use of human resources to meet the
operational needs for efficient patient meal services or by
making temporary changes in the meal service procedures
themselves, the problem of choosing among the available
alternatives to maintain inpatient meal services as scheduled
is one of the most important continual responsibilities of
every hospital food service management staff member.

The purposes of this fact-finding survey were to exa—
mine the extent to which patient tray service efficiency is
affected by employee absence and tardiness in selected
Michigan hospitals and how the administrative and supervisory
personnel of these dietary departments deal with the problem.
The researcher believed that such knowledge would provide
insights concerning a) the strategies used to maintain
efficient inpatient meal delivery despite service employee
absenteeism and tardiness and b) the similarities and dif-
ferences among the personnel policies and procedures
established for handling the problems of absenteeism and

tardiness of patient meal service workers.

Assumptions

 

The assumptions for this study were:

1.

The

Policies and procedures used in patient tray
assembly, tray delivery and soiled tray collection
vary among dietary departments of Michigan
hospitals.

Absenteeism and tardiness among employees responsi-
ble for patient tray services in selected Michigan

hospitals are problems that dietary administrators

are facing with increasing complexity.

Objectives

 

Specific objectives for this investigation were:

To identify the methods used in patient tray
assembly, tray delivery and soiled tray collection
in 12 selected Michigan hospitals with bed capa-
cities ranging from 150 to 700 beds.

To examine the current job classifications and
specific work assignments of dietary employees

who are responsible for assisting in patient tray
assembly, tray delivery and/or soiled tray collec-
tion..

To identify specific work assignments of nondietary
department workers whose work responsibilities con-
sist of assisting in patient tray assembly, tray
delivery and/or soiled tray collection.

To ascertain the behavioral aspects and situational
factors of dietary department employees responsible
for patient tray services which may be associated
with employee absenteeism and/or tardiness.

To compare the perceptions of hospital dietary
administrative and supervisory personnel concerning
the effects of worker absenteeism and tardiness

on patient tray services in the hospitals selected
for study.

To identify and compare the personnel policies
concerning employee absenteeism and tardiness of
the 12 dietary departments studied.

Definition of Terms

 

Seven definitions were adopted for use in this study:

1. Absenteeism: The failure of an individual to report
as scheduled within a work day to his assigned
work area.

 

2. Tardiness: The behavior of reporting to an assigned
work area later than the time scheduled and/or
reporting as scheduled but not ready to perform
the assigned duties.

 

3. Dietary Administrative or Supervisory Personnel:
The person(s) who is (are) responsible for select—
ing and supervising labor personnel assigned to
inpatient tray assembly, tray delivery and soiled
tray collection.

 

4. Individual who assists in Patient Tray Service:
A dietary employee, or one who is employed by
another department, or a volunteer worker whose
work responsibilities include assisting in patient
tray assembly, tray delivery and/or soiled tray
collection.

 

5. Volunteer: An unpaid individual who works in the
hospital and whose responsibilities include assist-
ing in patient tray assembly, tray delivery and/or
soiled tray collection.

 

6. Patient Tray Service: The meal service system for
tray assembly, tray delivery and soiled tray col-
lection for hospitalized patients.

 

7. Tray Service Modifications: Changes made in worker
assignments and/or methods of patient meal service
when absenteeism or tardiness occur among individuals
responsible foriassistingin.patient tray services.

 

CHAPTER II
REVIEW OF LITERATURE

According to Doyan [8], about 14 million meals are
produced, transported and served daily to hospital patients
and employees by food service departments of United States
hospitals. In the View of Merten [24], the hospital food
service department which deals with patient menus, employees,
equipment, time and capital is complex and multifaceted.

All components of the hospital dietary department operate
within the constraints of the colossal structure known as
the health care delivery system.

The writings of Puckett [25] indicate that each hos-
pital food service department has its own unique operation.
Its policy and procedure manuals are adapted to meet the
needs of the hospital as well as the department. The number
of policies and the procedures differ according to the size
of the hospital, the administration and the philosophy of
the department. Furthermore, departmental organization,
community environment and the socioeconomic system of the
community also influence departmental policies and procedures.

Today, hospital food service departments along with
other mass feedings operations are experiencing the effects
of absenteeism and tardiness on labor cost, production and
efficiency of meal services. According to Halperin [13],

6

absenteeism among employees is a national disgrace and is a

problem that appears to be growing in intensity.

Hospital Food Service System Components

 

A hospital food service system is characterized by
objectives, resources and operational subsystems [3]. As
reported by Merten [24], all components of the food service
system are critical to its effectiveness. Much difficulty
would be encountered if one were to try to assign priorities
or designate one component as more important than another.
However, efficiency and effectiveness of the system are
improved if the interactions and interrelationships of
subsystems are integrated.

Of the components of a food service system, labor pro-
ductivity and effective and efficient layout and design are
of great importance to managers of hospital food services [3].
Managers must coordinate labor, food materials, facilities
(equipment and space), information (data), energy, time and
money to optimize the processing and service of high quality
food. Consequently, human capability is a critical resource
and an extremely variable one. In fact, Buchanan [3] has
indicated that the greatest untapped resource the managers
of food service departments work with may be human capability.
He also advocated that the productivity of individuals
depends primarily on their ability and motivation to perform
and is largely influenced by their working conditions. These

conditions usually fall into three general categories:

a) social conditions, b) work scheduling and c) the physical
environment in the work place.

Livingston [20] stated that study of the interactions
of the operational parts of a food service department
requires a "system analysis" approach. The goal of such an
analysis is the development of a successful "food service
system." He defines this system as "an integrated program"
in which the procurement, storage, preparation and service
of foods and beverages, and the equipment and methods
required to accomplish these objectives are fully coordinated
for minimum labor and optimum customer satisfaction, quality
and cost control. Bowman [2] and Donaldson [7] have empha-
sized that the service and distribution systems for patient
meals must be based on proper inputs of patient needs. The
delivery system must also be closely coordinated with the
pickup of soiled trays so that mealtimes do not overlap with
critical periods for other hospital services.

The system of personnel management is another one of
great importance in a hospital food service department.
Unionization, workman's compensation laws and regulations
from governmental agencies are encroaching upon the load of
administrative tasks. As the administrative tasks of dietary
departments increase, the managers of these departments
realize the need for an adequate impersonal system of
control [9].

Although the number of individuals needed to operate a

hospital food service department has never been well-defined,

Kotschevar [18, 19] reported that hospital dietary depart-
ments use too much labor in the production and service of
foods. He indicated that the production efficiency rate of
dietary food service labor personnel has been said to be
about 47 percent compared with a desired rate of 80 to 85

percent.

Trends in the Hospital Food Service Industry

 

In the latter part of the 1960's numerous authors in
the field were focusing upon the problems, concerns, and
developing trends of the food service industry. With the
rapidly rising demands for increased production, quality
and quantity of service and the maintenance of an optimal
balance among food cost, labor and space, Donaldson, Zolber
[7] and Greenway [11] reported that the hospital food service
industry was embarking on a vigorous search for methods of
sharply increasing worker productivity. In some instances,
labor-saving changes were proving effective in both the pre-
paration and service of foods. However, Donaldson warned
that the ability to change while achieving the objectives
of the department remains a grave responsibility of managers
of hospital food service departments.

In 1966 Livingston [20] cited three important emerging
trends in the operation of food service systems: a) the
separation of preparation from service (both in time and in
place), b) thecmmtralizednmss production of food items for

later reconstitution and service and c) the internal stress

10

forcmganizationalchange brought about by a new kind of
personnel, the knowledge worker, who has goals for personnel
achievement and whose social, physiological and psychological
needs must be more fully understood and satisfied. Two

years later (1968) Donaldson [6] further stated that certain
economic, sociological and political factors in the environ-
ments in which food service operations are managed were
bringing about a trend toward more precisely controlled
production, processing, assembly, distribution and service

of meals.

In 1970 Doyan [8] reported that major automated systems
for assembly, transportation and delivery of foods in hos-
pitals were the monorail, the automatic car system and the
automatic food supply system. He defined the monorail and
automatic car systems as material delivery systems that carry
all kinds of supplies besides food. In contrast, the auto-
matic food supply system is one designed especially for the
transport, assembly and delivery of food. Although the
systems are expensive, ranging from $1,000 to $10,000 per bed
and more, they present alternatives to the antiquated delivery
methods that contribute to the high cost of labor in hospitals.
In the opinion of Doyan, spiraling wages have made the use
of automatic food production, transport and delivery systems
not only desirable but necessary.

In his 1969 review Harris [14] indicated that, in
addition to concern for economic productivity, several reports

from European Countries emphasize improved mechanization and

11

automation of operations with automatic feedback. He reported
that at the University of Cologne Medical Center, some of the
traditional problems of food production, service and control
have been solved through the use of prepared frozen foods,
point-of-service finishing of foods, automatically dispatched
horizontal and vertical material handling systems and combined
sequential operations to reduce waste motion and time in
handling and transferring products during preparation, storage,
assembly, distribution and service. The Noss food service
system developed by Wasserle of Hanover, Germany incorporates
automatic preparation and handling of foods, continuous
processing equipment, streamlined material floors, efficient
distribution with electronically controlled guidance and data
processing for various functions. Computer-oriented manage-
ment information systems are also being designed to provide
specific information for management planning, decision making
and control.

Effects of Absenteeism and Tardiness
on Hospital Food Services

 

 

According to Halperin [l3], absenteeism causes many
problems in the food service industry. The absence of even
a few employees has a serious effect on work schedules,
duties of other employees, service efficiency and sales
volume. Generally management has a greater stake in absen-
teeism than labor. When employees are absent service
inefficiency results, there is a delay in production

schedules and subsequent grievances occur. A shortage of

12

help in any one area of a food service department may mean
assigning inexperienced personnel to the area in order to
try to keep production at its customary level or employees
will have to double up on jobs. When this occurs, touchy
situations may arise which can trigger many time consuming
grievances. Inevitably, absenteeism reduces the efficiency
of the total operation.

Smardon [26] believes that absenteeism and tardiness
can be contagious. Just as any contagious disease, if
absenteeism and tardiness are not checked other employees
are apt to take advantage of the laissez-faire attitude of
the responsible administrator and "follow suit." Hence to
minimize or at best to eradicate absenteeism and tardiness,
policies and guidelines relating to these problems must be
established and close adherence to these policies and
guidelines becomes a must.

A monthly absenteeism rate of more than 4 percent is
costly to management. For every twenty-five employees, an
extra employee is required to take care of the average
absence. There appear to be four types of employee absenteeism
that are very costly to management: a) Friday, Monday and
day after payday absences, b) the absences of the employee
who is not well over a relatively long time, c) the "vaca—
tioner" who takes a week off or repeated long weekends and

d) the moonlighter who is too tired to come to work [26].

l3

Causes of Absenteeism

 

The causes of absenteeism vary from place to place
and many authorities have tried to classify them under
different headings. One very simple way of classifying
absence can be based on the theory reported in 1963 by
Gaudet [10], which states that good attendance is found
where employees are able and willing to work. However, he
stated that many times this oversimplifies the case.

According to Gaudet [10], others have devised more
complex classifications. One researcher at Ohio State
University differentiated among types of employee absences
as follows: a) absences caused by conflicting motivations of
the worker, b) absences caused by physical incapability of
the worker, c) absences resulting from interfering personal
obligations and needs of the worker, and d) absences encouraged
by wage conditions. In another method of classifying
absences, those caused by conditions inherent in the job
have been segregated from others. These causes include
plant or departmental working conditions, methods of super-
vision and similar related factors, some of which are
clearly under the control of management. Other conditions
(external factors) may include such items as poor transpor-
tation or lack of other community facilities which top
management has tried to improve. However, most of the
external factors are related to the employee's ability and
willingness to come to work. Management can do little

about his "ability" to work, and the few research studies

14

which have been conducted in the area of "willingness" seem
to indicate that supervisory behavior is the single greatest
factor.

Many management specialists argue that illness absences
are more important than other types of absences because they
are likely to be preceded and/or followed by a day or two of
substandard work. Because this may be true, it is necessary
to check upon the productivity of workers preceding and
following all types of absences.

The relationship of sickness absence to other types of
employee absence varies greatly. These variations are
largely accounted for by the complete lack of agreement on
‘Uuadefinitionof sickness absence. However, several other
factors may also account for these variations. The type of
benefit plan, or changes in an existing benefit plan, will
affect the amount of the company's sickness absence as well
as economic conditions, male-female ratio, age of employees
and type of industry [5]. Climate will also affect statis-
tics on sickness absence; many studies support the wide-
spread belief that this type of absence increases in the
winter months.

A significant study by Mann and Sparling [23] dealt
with the relation between employee attendance and the
behavior of supervisors on the job. Their findings indicated
that both white and blue collar worker absences are related

to how the employees felt about their supervisor and the

15

other people in their work group. They also found that low
absenteeism was associated with better feelings toward
fellow employees and in some groups toward financial and
job status.

One of the few attempts to investigate the hypothesis
that high absence rates are associated with a fixed group of
employees was conducted by the New York telephone company
[15]. The results of this 1956 investigation indicated that
telephone employees who had many days of absence during their
early years of service continued to be problems in this
respect throughout their years with the company. Although
many additional factors might also have been involved, this
study does give some support to the concept of absence-

proneness.

Methods Used to Control Absenteeism and Tardiness

 

A 1960 survey of personnel executives in 160 companies
made by the Bureau of National Affairs, Inc. [27] indicated
that about half of these firms try to control or reduce absen-
teeism and tardiness in the traditional order: warning,
layoffs (sometimes) and discharge. Another approach to
company disciplinary practices was found in a study made in
1957 by Malott and Hass [22] of the American Management
Association in which 129 personnel officers were asked to
specify the reason(s) for firing their most recently terminated
employees. A surprising fact disclosed in this survey was

that excessive absence had been the most common single cause

16

for discharge. More than half the discharges were made
because the individuals "lost too much time."

Organized labor union attitudes toward employee atten-
dance changed during World War II. Unionized companies have
reported that they get help from unions. In the survey con-
ducted by the Bureau of National Affairs [27], it was found
that a vast majority of the unions actively assisted in
controlling employee absence. Such assistance was in the
form of admonitory talks by union representatives with
chronic absentees, refusal to defend habitual offenders,
investigation of the causes of absenteeism and working
cooperatively with management in the formation of disciplinary
procedures.

Gaudet [10] reported that in many companies, when par-
ticularly knotty problems of employee absence arise, they are
settled by precedents that are legal or, in any case, well
established. AccordinngOAhern's [l] findings, in order to
discharge an employee for habitual absenteeism and to have
the discharge upheld (in most arbitration situations), the
company may be required to supply answers to the following
questions: How often has this employee been absent? What
about the total number and the duration of the absences?
Over how long a period have they extended? What is the
overall rate of absenteeism in this company? What are the
absence records of the employees having the most absences?

Besides the usual three-step procedure (warning, lay-

off and discharge) there is a wide variety of techniques

I .f ‘ at I l II . I I IN [ t N l‘ in ‘1" l! I'lI. l‘ [I [l

[NI

17

used to discipline employees with poor attendance records
(absenteeism and tardiness). As reported by Smardon [26]
methods used to control absenteeism are to confront the
employee who is excessively absent and point out the expec—
tations of the organization. Kearns [l6] believes that a
realistic program which deals with the problem should be
developed and properly maintained. Other more specific
measures used by some organizations are suspension of pay
increases, decrease of seniority privileges, loss of benefits
for unexcused absences, loss of overtime, placing offenders
on probation, reduction of employee's paid vacation benefits
and holiday pay is not granted to employees who are absent on
the day before or after a holiday.

In other companies or institutions, the reward system
is used to control poor attendance among employees. Rewards
such as cash bonuses and/or additional paid time off for
good attendance are given to employees [12]. However, the
literature shows that more disadvantages have been cited for
rewards than for punishments. It appears that certain built-in
factors in bonus plans are responsible for some difficulties.
For instance, experience has shown that the length of the
period required for "good" or "perfect" attendance should
not be very long. If it is too long employees tend to lose
interest and resort to their past attendance habits. Another
criticism of rewards is that their effects are of short
duration.

Another technique, cited by Gaudet [10] and reported

18

with increasing frequency, is aimed at reducing off-the—job
accidents. The traditional devices that have been used are
posters on the company bulletin boards, prizes to school
children for essays on accidents, articles in the company's
paper and letters to the homes of employees. In another
situation reported by Castillo [4], special programs and
activities are provided to improve employee morale and

attitudes and to promote physical fitness.

CHAPTER III

METHOD OF INVESTIGATION

The method used to obtain data for this descriptive
study consisted of on—site interviews with dietary administra-
tive and supervisory personnel at the hospitals selected for
study. Note taking was the technique used for recording
the information gathered during the interview sessions. All

interviews were conducted by the investigator.

The Survey Sample

 

The sources used to identify the twelve Michigan

hospitals chosen for study were the 1974 Directory of Ho§:_

 

pitals, Nursing Care Facilities, Home for the Aged and the

 

October 1974 Statistical and Directory Issue of Michigan

 

Hospitals. Five primary selection criteria were established

 

to identify specific hospitals for consideration: a) facility
geographically located within a 75-mile radius of Lansing,

b) in-patient capacity of not less than 125 and not more than
700 beds, c) a minimum average daily inpatient census of

100, d) facility provides general medical and surgical care
for inpatients, and e) the hospital is nonfederally operated
and licensed by the Michigan Department of Public Health only.
This preliminary screening procedure identified 22 hospitals
which satisfied the primary selection criteria.

19

20

In order to obtain a representative study sample with
respect to hospital size, the preliminary list of 22 hos-
pitals was subdivided into five bed capacity ranges: below
200, 200 to 399, 300 to 399, 400 to 499 and 500 to 699 beds.
None of the 22 hospitals fell into the 300 to 399 bed classi-
fication. Therefore, on the basis of hospital size, three
hospitals from each of the four remaining classifications
were arbitrarily selected for study. Insofar as possible,
consideration was given to selecting the three facilities
with the same size classification from different geographical

locations.

The Survey Instrument

 

A seventeen-page interview guide was prepared to assure
collection of comparable data from the twelve hospitals
selected for study. The guide contained both highly struc—
tured and semi-structured questions. In each area of inquiry
one or more structured questions were introduced first.

Then, in order to probe more deeply, a series of open-ended
questions were used to obtain more detailed responses.

The interview guide was divided into five parts and
designed to obtain data relative to a) the respondent(s);

b) the operational characteristics of the dietary department;
c) the manpower needed to provide patient tray services;

d) the personal characteristics and job responsibilities of
dietary employees who assist in patient tray service activi-

ties (tray assembly, tray delivery and soiled tray collection)

21

and e) the modifications made in patient tray service pro-
cedures when there is absenteeism and/or tardiness among
individuals responsible for patient tray services. The
format of the guide was designed to enable the interviewer
to record the interviewee's responses directly on each page
and to minimize the amount of recording time required. A
copy of the interview guide developed for the study is

included in the Appendix, page 120.

Part I. The Respondents

 

This part of the guide contained two items of inquiry
concerning the interviewee's present position title and
professional experience. The experience component elicited
information pertaining to the respondent‘s years of employ-
ment in the food service field, length of employment in
his/her current position, and his/her area of educational

and/or training specialization.

Part II. Operational Characteristics-Dietary Department

 

The questions in this section sought to identify the
general operational policies and procedures of the dietary
department. The ten factors discussed with the interviewees
focused on:

1. the system of management

2. employee unionization

3. average daily inpatient census

4. types of inpatient meal services provided

5. inpatient meal service patterns and schedules

22

6. types of menus needed for inpatient diets
7. food purchasing policies
8. method(s) of patient tray assembly
9. method(s) of service-ready food delivery and
soiled tray collection
10. personnel responsible for delivering service—ready
food to the patient area(s) and to the patients

themselves.

Part III. Manpower Needed to Provide Patient Tray Services

 

The first question in this part of the interview guide
concerned the total number of full-time and part-time hos—
pital personnel needed to provide patient tray assembly,
tray delivery and soiled tray collection services detailed
according to worker departmental affiliation. The second
question pertained only to the dietary department employees
who assist in patient tray service activities and the number
of hours per day each employee participates in tray assembly,
tray delivery and/or soiled tray collections.

Part IV. Personal Characteristics and Job Responsibilities

of Dietapy Employees Assigned to Patient Tray
Services

 

 

The first question in Part IV dealt with six personal
characteristics of the dietary labor personnel: sex, age,
marital status, number and age range of children per house-
hold and the percentage of employees who had dependents
other than children at home. Information about the educa-

tional levels of the labor personnel and administrative staff

23

with regular patient tray service duties was also requested.
The second question sought information pertaining to the
major work assignments relating to patient tray service
activities performed by dietary employees and by nondietary
employees.

Part V. Modifications in Patient Tray Service Procedures
Due to Employee Absenteeism and Tardiness

 

 

The final section of the interview guide consisted of
seven questions which focused on the effects of employee
absenteeism and tardiness on patient tray services, the type
of procedural modifications usually made in order to cope
with and/or compensate for such irregularities in employee
attendance behavior, and the departmental and/or hospital

policies related to employee attendance irregularities.

Pretesting the Survey Instrument

 

The investigator's Faculty Guidance Committee members
reviewed the interview guide for clarity and completeness.
Recommendations of the reviewers were incorporated into the
final revision of the guide. As a pre-test, a) to determine
the length of time required to complete an interview, b)
to test the terminology and the logic of the sequence of
questions used in the guide, and c) for the investigator to
practice her interviewing technique, two professional dieti-
tians were interviewed. At the time of the study, one was
managing dietary personnel in a hospital in Cleveland, Ohio

and the other was formerly employed as a managing dietitian

24

in a hospital in Detroit, Michigan. Both professionals had
had considerable experience in the area of managing hospital
dietary personnel involved in patient tray services. Each

interview required approximately one hour to complete.

The Interview Procedure

 

The chief administrative officers of the twelve hos-
pitals selected for study were initially contacted by tele-
phone, informed of the nature of the research study to be
undertaken and their cooperation solicited. After the initial
contact by telephone, a follow-up letter detailing the
objectives of the study and requesting the participation of
the dietary administrative and/or supervisory staff in the
interview sessions and a complete outline of the proposed
project were mailed to each hospital. A week later, the
hospital administrators and their respective dietary depart—
ment heads were contacted by telephone to confirm their
willingness to participate in the project and to schedule
the interviews.

All personal interviews were conducted by the researcher
between March 13 and 27, 1975. At the beginning of each
interview, the interviewee was given an overview of the
content of the interview guide and the approximate amount of
time needed to complete it was indicated. Any questions the
participants had relative to the project were discussed
before the interview sessions began. At the conclusion of

the interviews, the interviewees were thanked for their

25

willingness to assist with the project and were promised
that, when available, a copy of the study results would be

sent to all participating hospitals.

Analysis of the Data

 

The interview data from the 12 hospitals studied were
hand tabulated. Factual response data were compiled and
compared for similarities and differences according to
hospital location, facility size and management responsi-
bility of the dietary department. Opinions of the dietary
administrators and supervisory personnel concerning the
behavioral aspects and situational factors related to absen-
teeism and tardiness of dietary department patient tray
service employees were summarized and compared within and
among hospital size categories, types of management control,
and organized labor status of employees. Personnel policies
relating to employer disciplinary practices for worker

absenteeism and tardiness were summarized and compared.

CHAPTER IV

ANALYSIS OF THE SURVEY DATA

This study concerned hospital meal service practices
with major focus on the effects of employee absenteeism and
tardiness on patient tray service activities (tray assembly,
tray delivery and soiled tray collection). The survey sample
consisted of twelve nonfederally operated hospitals, three
from each of four size ranges, located geographically within
a seventy-five mile radius of Lansing. Table 1 identifies
the five cities in which the selected hospitals are located,
the size of each hospital, and the numbers and positions of
dietary personnel interviewed at each facility.

With respect to community size, ten of the twelve
hospitals selected for study were located in cities with
populations of 100,000 or more. Of the other two, one hos-
pital was in a community of 45,000 and one in a community
of 17,000.

At nine of the hospitals surveyed the administrator or
manager of the dietary department was the only person inter-
viewed. At the other three hospitals the administrator or
manager was the primary interviewee with additional informa-
tion contributed by supervisory personnel. The inclusion
of supervisory personnel in these interview sessions was

initiated by the respective administrators or managers and,

26

27

Table 1. Hospitals Studied: Location, Size and Dietary
Personnel Interviewed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beds Hospital's Dietary Personnel Interviewed
Location —

Admin./Mgr. Supervisor Total

(No.) (No.) (No.)
Below 200 Flint l 0 1
Flint 1 0 1
Grand Rapids 1 0 1
200-299 Jackson 1 0 l
Lansing 1 0 1
Owosso l 3 4
400-499 Grand Rapids 1 0 1
Flint l 1 2
Lansing 1 0 1
500-699 Grand Rapids 1 0 1
Grand Rapids 1 2 3
Flint 1 0 1
Totals 12 6 l8

 

in these particular cases, was indicative of the policy of

team involvement in all departmental concerns and activities.

Assessment of the Responses

 

On-site interviews conducted with eighteen dietary
administrative and supervisory personnel in the twelve hos-
pitals studied sought information concerning selected pro-

fessional characteristics of the interviewees, the policies

28

and procedures used in serving meals to inpatients, the
classifications and duties of personnel assigned to patient
tray services, and modifications made in patient tray service
activities when there is absenteeism and/or tardiness among
individuals responsible for patient tray services. The
findings of the study are presented in the sequence used in

the design of the interview guide. (See Appendix, page 120).

Part 1. The Respondents

 

Part 1 of the interview guide was designed to ascertain
information about the respondent's administrative title and
professional experience. The experience component obtained
information pertaining to the respondent's years of employ-
ment in the food service field, length of employment in his/
her current position and his/her educational and/or training
specialization. For clarity of reporting the findings, per-
sonnel interviewed who were directing the activities of the
various dietary departments are referred to as administrators
and the other personnel interviewed are referred to as

supervisory staff.

Administrators Interviewed.-—A summary of the profes-

 

sional characteristics of dietary administrators interviewed
is shown in Table 2.

As shown in Table 2, Director of Food Service is the
title held by one half (6) of the persons who direct the
activities of the departments studied. The second most fre-

quently reported titles were Director of Dietetics and Food

29

Table 2. Professional Characteristics of Dietary Department
Administrators Interviewed

 

 

 

Professional Hospital Size (Beds)
Characteristics
Below 200- 400- 500- Total
200 299 499 699

 

 

 

 

 

 

Position Title

 

Director of

Food Service 2 3 1 - 6
Director of

Dietetics - - l l 2
Food Service

Manager - - l l 2
Chief Dietitian l - - - 1
Executive Dietitian - - - l l

 

Food Service

 

 

 

 

 

 

 

Experience
20 yrs. or more 1 1 3 2 7
15 to 19 yrs. 1 - - 1 2
11 to 14 yrs. 1 - — - l
6 to 10 yrs. - l - - 1
Less than 6 yrs. - 1 — - 1
Present Position
20 yrs or more - - l - l
15 to 19 yrs. 1 1 - - 2
11 to 14 yrs. - - - l l
6 to 10 yrs. - - l - 1
Less than 6 yrs. 2 2 l 2 7
Area(s) of
Specialization
On-the-job

Experience 2 - 2 l 5
Military

Experience - l - - l
Dietetics-Admin. - - l l 2
Dietetics-General - - - l 1
Hotel, Rest. &

Inst. Mgt. - 1 - - l
Inst. Mgt. &

Dietetics l - - - l

Inst. Mgt. - 1 — - 1

 

30

Service Manager. The remaining titles, Chief Dietitian and
Executive Dietitian, were each held by one respondent. Com-
parison of administrative titles of the respondents in this
study revealed that the title of Director of Food Service is
most often used for the person who directs the activities of
the dietary department in smaller hospitals (less than 300
beds). Persons who direct the dietary department activities
of larger hospitals (400 beds or more) are identified by a
variety of titles.

The length of time that the dietary administrators have
been in the area of food service ranged from less than 6 years
to 20 years or more. Nine Of the twelve administrators have
15 or more years experience in the field of food service, two
have more than 6 years but less than 15 and only one has less
than 6 years. These results show that considerable experience
in the food service field is a major characteristic of nearly
all dietary administrators interviewed.

There was an inverse relationship between the dietary
administrators' years in their present positions and their
total years of experience in the food service field. Nine of
the administrators had been in their current positions for
less than 15 years and, of these, seven for less than 6 years,
whereas 9 of the 12 administrators had worked in the field
of food service for more than 15 years and only 3 for less
than 15 years. Four of the persons who have been in their
present administrative positions for less than 6 years are

employed by Contract Food Service Companies which during

31

the past two years have acquired contracts for managing the
dietary departments of these hospitals. However, three of
these four managers have ten years or more experience in the
field of food service. Reasons why the three other managers
have been in their present positions for less than six years
were related to job promotions and/or transfers.

As shown in Table 2, one half of the dietary administra-
tors indicated that they had acquired their specialization
via on-the-job experience, either civilian or military. All
others developed their specialization through formal academic
training and work experience. Regardless of hospital size,
the results of the inquiry revealed that on-the-job experience
is a necessary route for dietary administrators to obtain
their area of specialization as well as formal academic
training.

Seven of the dietary administrators were males. Of
this seven, six gained their specialization through on-the-
job experience and only one by on-the-job experience plus
formal academic training. Four of these males were employed
by contract food service companies and were directing the
activities of the dietary departments in smaller (less than
300 beds) hospitals.

The remaining five dietary administrators were females
whose specialization developed through on—the-job training
plus formal academic training. None of the females were

employed by contract food service companies and three were

32

directing the dietary department activities in larger (more
than 400 beds) hospitals and two in smaller (less than 300

beds) hospitals.

Supervisors Interviewed.--Supervisory staff members

 

 

in three of the four bed size categories of hospitals estab-
lished for this study were interviewed. All who participated
were females and were employed in dietary departments that
were hospital operated. A summary of the professional
characteristics of dietary supervisory personnel is shown in
Table 3.

As reported in Table 3, four different position titles
were held by the six dietary supervisors interviewed. Food
Service Supervisor was the title held by three and the remain-
ing three were identified by different titles, namely Chief
Dietitian, Head Dietitian and Assistant Food Service Super-
visor.

One half (3) of the supervisory personnel had been in
the food service field for more than 11 years and the other
half less than 6 years. In contrast to dietary administrators,
extensive experience in the food service field was not a
major characteristic of all dietary supervisory personnel.
From observation by the researcher, it was apparent that
years of experience for persons in this job classification
were directly related to the individual's age and background.
One half of the supervisory personnel interviewed were re-
cent college graduates and have been in the labor market for

only a few years.

33

Table 3. Professional Characteristics of Dietary Department
Supervisors Interviewed

 

 

 

Professional Hospital Size (Beds)
Characteristics
Below 200- 400- 500- Total
200 299 499 699

 

 

 

 

 

 

Position Title

 

Chief Dietitian - - l - 1
Head Dietitian - - - l 1
Food Service

Supervisor - 2 - 1 3
Assistant Food

Service

Supervisor - l - - l

 

Food Service
Experience

 

 

20 yrs or more -
15 to 19 yrs. —
11 to 14 yrs. -
6 to 10 yrs. -
Less than 6 yrs. -

NII—‘I
I
Iran H
UJOFQCDH

|....I
I

 

Present Position

 

20 yrs or more - - - l
15 ot 19 yrs. - - - -
11 to 14 yrs. - - - -
6 to 10 yrs. - - - -
Less than 6 yrs. - 3 1 l

UTOOOH

 

Area(s) of
Specialization

 

 

Dietetics-General - - 1 l 2
Nutrition-General - 1 - - l
Home Economic-

General - l - - 1
ADA Supervisory

Training - - - l 1
On-the-Job Training - l - - 1

 

34

As with years of experience in the food service field,
years in their current positions were low for a majority of
the supervisory personnel. Five have been in their present
positions for less than six years whereas only one has had her
position for more than 20 years.

A majority of the supervisory personnel had developed
their specialization through formal academic training. Four
were college graduates and one completed a hospital food
service supervisory training program approved by a profes-
sional organization at a state university. Only one became
qualified for her position solely through on-the-job experi-
ence. Findings show that formal academic training is the
major route by which the supervisory staff members interviewed

achieved specialization.

Part 2. Operational Characteristics-Dietary Department

 

Part 2 of the interview guide identified the general
operational policies and procedures of the dietary department.

Information pertaining to the following factors was obtained:

1. the system of management

2. employee unionization

3. average daily inpatient census

4. types of inpatient meal services provided

5. inpatient meal service patterns and schedules
6. types of menus used for inpatient diets

7. food purchasing policies

8. method(s) of patient tray assembly

9. method(s) of service-ready food delivery and

soiled tray collection
10. personnel responsible for delivering service—ready

food to the patient area(s) and to the patients
themselves.

The information obtained is reported under three major

35

headings: Operational Characteristics, Menu and Food Pur—

chasing Policies and Inpatient Tray Service Procedures.

Operational Characteristics.--Data pertaining to the

 

operational characteristics of the hospitals studied are
summarized in Table 4 according to hospital bed capacity.
Comparison among hospitals indicated considerable variation
within and among hospital sizes for many of the operational
characteristics.

As shown in Table 4, eight of the dietary departments
are hospital operated and four are managed by contract food
service companies. Those dietary departments that are managed
by contract food service companies are all located in smaller
hospitals (299 beds or less) and each is managed by a male.
These departments have been operated by outside agencies for
less than three years. The dietary departments in the re-
maining two hospitals with 299 beds or less are hospital
operated with female registered dietitians as the administra-
tors. All six of the larger hospitals (400 beds or more)
operate their own dietary departments. Three are managed
by females and three by males.

Within the limits of these data it appears that, in
Michigan, hospitals with 299 beds or less are more likely
to employ the services of outside management companies to
operate their dietary departments than are hospitals of more
than 399 beds.

Table 4 shows that in seven of the twelve hospitals

36

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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37

 

 

 

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38

surveyed dietary employees are unionized. Of these, four are
hospitals with bed capacities of 400 or more and three are
hospitals with bed capacities below 300. These data suggest
only a slightly higher tendency toward unionization in

larger hospitals than in smaller hospitals.

Among the hospitals participating in this study, it
also follows that community size may be related to dietary
employee unionization. In the two hospitals located in
communities with populations of less than 45,000 the dietary
employees were not unionized whereas in 7 of the 10 hospitals
located in communities with populations of more than 100,000
the dietary employees were unionized.

Data pertaining to average daily inpatient census and
percent occupancy are detailed by ranges within hospital size
classifications (see Table 4). Among the 12 hospitals sel-
ected for this study, the average daily percent inpatient
occupancy in the six larger hospitals (400 or more beds)
varied less among hospitals than was true for the six smaller
hospitals (less than 300 beds). Within group comparisons
for the two size categories of smaller hospitals revealed
far greater differences in average percent occupancy among
the three facilities with less than 200 beds (34 percent)
than among the three facilities with 200-299 beds (13 percent).
Similar comparison between the two size categories for the
larger hospitals showed less variation among the three
hospitals in the 400-499 bed category (6 percent) than among

the three hospitals in the 500 or more bed category (9 percent).

39

Tray delivery to the patient bedside was the primary
type of meal service provided for inpatients in all hospitals
studied. In addition, one hospital provided floor trays for
group dining and, upon request, another served visitor trays
at the patient bedside. Both of these hospitals are located
in the same city and have bed capacities above 400. The
types of meal services that are provided for patients in the
hospitals studied are reflective of the many limitations
imposed by facility layout and design, per patient service
costs and the ratio of dietary and/or nursing personnel to
the number of patients requiring service.

Five different meal-nourishment service patterns were
found among the 12 hospitals surveyed. One hospital (477 beds)
provides 4 meals per day for inpatients while the other 11
provide only 3 meals per day. In addition, between meal
nourishments are provided for inpatients in all hospitals
although the scheduled number offered per day to all patients
and/or available only to patients on modified diets varies
among the hospitals surveyed. However, in all hospitals
studied bulk nourishmentsanxadelivered daily to the patient
divisions to provide for unscheduled supplements for patients
as ordered by their physicians or to accomodate permissible
patient requests. The patterns used are identified in Table
4, detailed according to hospital size-categories.

In the eleven hospitals which provide 3 regular meals,
the service periods begin between 7:00 - 7:30 a.m., ll - 11:30

a.m. and 4:15 - 4:30 p.m. for the morning, noon and evening

40

meals respectively. In the hospital which provides 4 meals,
the service period for the first meal (early breakfast) starts
at 6:00 a.m. with the 3 remaining meals following the same
general service schedule as found in all other hospitals
studied. Time allowed for each meal service period in the

6 smaller hospitals ranges from 45 minutes to 1 hour whereas
in the 6 larger hospitals meal service periods are from 1

hour 15 minutes to 2 hours.

The service time allowed for scheduled between-meal
feeding is 30 to 60 minutes. In hospitals offering 3
scheduled snacks, nourishments are served at 10:00 a.m.,
2:00 p.m. and 7:00 or 8:00 p.m. Hospitals offering 2
scheduled snacks serve them at 10:00 a.m. and 2:00 p.m.

In the three hospitals which provide only 1 scheduled snack

for all patients the service hour is 8:00 p.m.

Menu and Food Purchasing Policies.--Information regard—

 

ing the menu and food purchasing policies of the dietary

departments focused on two factors: a) the types of menus

used for inpatient meals and between-meal nourishments and

b) the percentage of 12 types of food items purchased partially

and/or fully prepared. Responses to these questions are

detailed according to hospital size and reported in Table 5.
Eleven (91.7 percent) of the dietary departments use

selective menus for all types of inpatient meals whereas only

one (8.3 percent) uses a nonselective menu. Nourishment

menus are either selective or semi—selective in nine (75

41

Table 5. Menu and Food Purchasing Policies

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Policies Hospital Size (Beds)
Below 200- 400- 500- Total Percent
200 299 499 699
(No.) (No.) (No.) (No.) (No.) (%)
Inpatient Menu Policies
Meals - Selective 3 3 3 2 11 91.7
Nonselective - - - l l 8.3
Nourishments
Selective l - 1 - 2 16.7
Semiselective 2 l 2 2 7 58.3
Nonselective - 2 - 1 3 25.0
Food Purchasing_Policy
Percent Service-Ready
Menu Items* 1-10 0.10 0-10 4—25
Percent Partially Pre-
pared Menu Items* 5-20 1-10 1-20 10-65
Percent Nonprepared Menu
Items* 79-94 80-89 70-99 31-65
Types of Fully/Partiallr_ (No.) (No.) (No.) (No.) (No.) (%)
Prepared Items
Appetizers 3 - 2 2 7 58.3
Soups 2 2 l l 6 50.0
Entrees 2 - 2 2 6 50.0
Potatoes 2 2 3 3 10 83.3
Vegetables 2 l 2 3 8 66.7
Salads - - - - 0 00.0
Sandwich Mixes - - — - 0 00.0
Desserts 3 l 3 3 10 83.3
Bread and/or Rolls 3 3 3 3 12 100.0
Beverages 3 3 3 3 12 100.0
Tube Feedings 2 l 3 2 8 66.7
Meal Supplements 2 3 3 3 11 91.7

 

*Range of percentages among three hospitals within facility size

classification.

42

percent) of the dietary departments studied. Within the
limitations of these data it appears that, irrespective of
hospital size, offering patients the opportunity to choose
their meals and nourishments is a relatively common practice.

Information concerning general practices with respect
to the market forms of food purchased is summarized in
Table 5. The extent to which service-ready (fully-prepared),
partially-prepared and nonprepared items are purchased is
expressed in percent of total food items needed. Percentage
variability among the three hospitals within each facility
size classification is reported by range. The number of
hospitals in each facility size classification which purchase
each of 12 types of menu items fully- or partially-prepared
is indicated.

Table 5 shows that among the 12 hospitals surveyed, 100
percent purchase pre-prepared breads and/or rolls and
beverages, 80-90 percent purchase prepared potatoes, desserts
and meal supplements, 50-70 percent purchase prepared
appetizers, soups, entrees, vegetables and tube feedings.
None of the hospitals studied purchase prepared salads or
sandwich mixes. Results show that there is a trend in all
of the hOSpitals studied to purchase a variety of prepared
menu items. Except for pre-prepared soups, a greater number
of larger hospitals use prepared menu items than smaller
hospitals. However, hospital size did not substantially

influence the variety of prepared menu items used.

43

Inpatient Tray Service Procedures.-—The data reported

 

under this heading pertain to: a) inpatient tray assembly;
b) service-ready food delivery and c) personnel responsible
for delivering service-ready foods to patient areas and to
patients. Table 6 identifies the procedures used for
inpatient tray services in the hospitals studied.

The major procedure used in assemblying patient meal
trays is the centralized method. The one dietary depart-
ment that, at the time these data were gathered, was using
the decentralized method for assembling patient trays will
be centralized by the time this report is written. This
department is in the process of centralizing its tray
service procedures in an effort to reduce per patient labor
and food costs. Three different methods are used in assem—
bling nourishments. Of the twelve hospitals surveyed, 4
use the centralized method, 4 use the decentralized method
and the remaining 4 use a combination of the centralized
and decentralized methods.

Since a majority of the hospitals are using the cen-
tralized method for assembling meal trays, preassembled
trays are delivered directly from the dietary departments
to the patient areas. In only one hospital, is it necessary
to send bulk food to the patient divisions.

Conversely, bulk supplies of nourishment items are
sent to patient floors in all of the hospitals studied.

In addition, in some cases preassembled nourishment trays

and an assortment of service-ready nourishments are also

44

Table 6. Inpatient Tray Service Procedures

 

 

Procedures Hospital Size (Beds)

 

Below 200- 400- 500- Total Percent
200 299 499 699

 

 

 

 

 

 

 

 

 

(No.) (No.) (No.) (No.) (No.) (%)
Inpatient Tray Assembly
Meals - Centralized 3 3 3 2 11 91.7
Decentralized - - - l l 8.3
Nourishments
Centralized 1 2 l 4 33.3
Decentralized l l l l 4 33.3
Combination 2 . l - l 4 33.3

 

Service-Ready Food Delivegy

 

Meals

Preassembled trays to

floors for direct delivery

to patients 3 3 3 2 11 91.7
Bulk-food carts to floor

pantries for assembly of

patient trays - - — l 1 8.3

Nourishments

 

Bulk-to nursing

divisions 3 3 3 3 12 100.0
Preportion to patient
bedside 1 2 l l 5 41.6

Preportion to patient
area (distributed to
patients upon request) 2 l 2 2 7 58.3

 

Service-Ready Food
Delivery Personnel

 

 

To Patient Floors

 

Dietary Personnel 3 3 3 3 12 100.0
Nursing Personnel — - - - _

To Patients

 

H
I—‘
N
U1
,5
I—“
O

Dietary Personnel 1 .
Nursing Personnel 2 2 2 l 7 58.3

 

45

delivered to the patient division. These nourishments are
then delivered directly to the patient by dietary/nursing
personnel at the scheduled times, as ordered by the physi-
cians, or if allowed, as requested by the patient.

In all 12 hOSpitals studied, dietary personnel are
totally responsible for delivering all service-ready foods
to the patient areas. The responsibility of delivering
meal trays and nourishments to patient bedsides differs
among hospitals. In 7 of the hospitals (4 smaller and 3
larger) nursing personnel deliver all scheduled meal trays
to patient bedsides whereas in 5 of the hospitals (2 smaller
and 3 larger) dietary personnel perform this duty. In all
hospitals, the scheduled nourishments are delivered to
patient bedsides by dietary personnel. Depending on time
requested, nourishments ordered for patients on modified
diets and those nourishments that are served to patients
ad lip may be delivered to patient bedsides by personnel
of eithertflmadietary or nursing departments.

The policy for the delivery of assembled trays to
patient bedsides (dietary versus nursing personnel) does
not appear to be related to hospital size but, rather to the
preferred practice of particular hospitals and/or the con-
cern of the dietary staff for more effective control of

all patient tray service activities.

46

Part 3. Manpower Needed to Provide Patient Tray Services

 

This part of the interview guide was designed to as-
certain information concerning the number of manhours re-
quired to perform the duties related to patient tray
services. Two questions were asked to obtain the needed
data. The first pertained to the number of employees
(dietary and nondietary) who participate in patient tray
service activities and the second concerned the amount of
time dietary employees of various job classifications spend
in performing duties related to patient tray services.

ReSponses to the first question are summarized and
presented in Tables 7 through 11. These tables show only
the number of dietary manhours/100 beds required to perform
patient tray service activities. The numbers of nondietary
manhours required are not included because the interviewees
were unable to supply definite responses relative to the
number of nondietary personnel that actually participate
in tray service activities. In most instances, it was
found that the number of nondietary personnel who partici-
pate in patient tray service activities depends on: a) the
number of available personnel on the patient division;

b) other activities on the division that occur around or
during meal service times; c) the time of the day that
meals and nourishments are served and d) the types of
patients on the division.

Dietary Manhours Required: Meals.--As shown in Table

 

7, the numbers of dietary manhours/100 beds required to

47

Table 7. Dietary Department Manhours/100 Beds: Patient

Tray Assembly

 

 

 

 

 

 

 

 

 

 

Hospital Size Tray Manhours/100 Beds
(Beds) Assembly
Method* Early Reg. Noon Even. Total
rft. Brft. Meal Meal Meals
Below 200
135 C - 2.78 4.44 4.44 11.66
182 C - 2.75 4.12 4.12 10.99
185 C - 3.38 4.05 3.38 10.81
200-299
213 C - 2.82 4.11 4.11 11.04
244 C - 2.05 3.69 3.69 9.43
258 C - 2.71 4.75 4.75 12.21
400-499
400 C - 3.44 3.66 3.66 10.76
401 C - 3.43 .4.34 4.34 12.11
477 C 0.15 4.09 4.77 4.77 13.78
500-699
504 C - 2.23 2.98 2.98 8.19
527 C - 2.56 3.42 2.56 8.54
680 D - 8.53 8.23 8.53 25.29

 

*Assembly Methods:
C Centralized
D decentralized

assemble patient trays for all meals differ somewhat within
and among categories of hospitals according to maximum facil-
ity size. In the 3 hospitals with less than 200 beds, a
decreasing number of manhours/100 beds per day is required
as the hospital size increases. Even though this decrease
is less than one, it appears that in this size category

the smaller the hospital the greater the number of manhours/

100 beds required per day to perform the sequential duties

48

involved in centralized tray assembly. In the second cate-
gory of hospitals (200-299 beds), a decrease in manhours/100
beds per day is observed in the hospital with 244 beds
(second largest).

In the larger hospitals (400-700 beds) manhours/100
beds per day decrease slightly as patient bed capacity
reaches 500 when the centralized method of tray assembly is
used. However, when the decentralized method of tray
assembly is used, the requirement of manhours/100 beds per
day is approximately tripled.

Among other reasons, the differences in dietary man-
hours/100 beds required among and within size categories of
hospitals may be due to more individualized attention to
each patient tray, the number of items for each tray, the
condition and design of the equipment used in the patient
tray assembly areas, and the employee skills and efficiencies
in assembling patient trays as well as the tray assembly
method.

In all hospitals using the centralized method to
assemble patient trays, the manhour/lOO beds required to
perform this activity are less for breakfast than for the
noon meal. In 2 of these 11 hospitals manhours/100 beds
required are also less for the evening meal than for the
noon meal because it is the policy of these hospitals to
serve a larger meal at noon than in the evening. The
fewer number of manhours/100 beds required to assemble

breakfast trays is due to the smaller number and the types

49

of breakfast food items served. In the one hospital using
the decentralized method to assemble patient trays, the
number of manhours/100 beds required for the noon meal is
reduced slightly because for this meal tray assembly for
two patient divisions are combined, thereby requiring fewer
dietary employees overall.

Table 8 shows the increase in the number of dietary
manhours/100 beds required when dietary rather than non-
dietary employees deliver the trays to patient bedsides.
Among the 4 hOSpitals of 200 or more beds in which dietary
employees deliver service-ready trays to patient bedsides,
manhours/100 beds required to perform this service appear
to increase as hospital size increases. Another factor
that may influence the number of dietary manhours/100 beds
required to deliver trays to patient bedsides is the amount
of indirect assistance provided dietary employees by non-
dietary floor personnel. Such assistance may consist of
readying the patient for eating, clearing bedstands, and
notifying the dietary department in advance of patient
trays that are to be delayed or cancelled. Tray delivery
service is also affected by the structural design of the
patient floor areas and whether the rooms are arranged for
single or multiple occupancy.

The dietary manhours/100 beds required daily to
collect soiled meal trays from patient bedsides and patient
areas are summarized in Table 9. In the 5 hospitals where

dietary employees deliver the meal trays to patient bedsides

50

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51

they are also responsible for removing the soiled trays
from patient rooms and returning them to the dishwashing
area in the dietary department. In the 7 hOSpitals where
dietary personnel only deliver meal trays to patient floor
areas for distribution to patient by nondietary personnel
their responsibility is limited to transporting the soiled
trays collected by nondietary personnel from the patient
floor areas to theéfishwashingarea in the dietary department.
In these latter situations the numbers of dietary manhours/
100 beds required for soiled tray return to the dishwashing
area are the same as the numbers of dietary manhours/100
beds required to deliver service-ready meal trays to the
patient areas (see Tables 8 and 9).

For each of the 5 hospitals where dietary employees
are totally responsible for patient tray delivery, distri-
bution and collection, comparison of the dietary manhours/
100 beds required daily for all meals reveal that in all
cases the return of soiled meal trays to the dietary dish-
washing area (Table 9) requires fewer manhours/lOO beds
than does the distribution of service-ready meal trays
(Table 8). In the 4 hospitals using the centralized tray
assembly system, reductions in dietary manhours/100 beds
required for soiled tray collection and transport to the
dishwashing area range from 37.6 to 55.7 percent. In the
hospital using the decentralized tray assembly system the
reduction in dietary manhours/100 beds required is somewhat

less (24.8 percent).'

52

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53

Within and among the hQSpital size categories, differ-
ences in the dietary manhours/100 beds required to collect
soiled trays from patient bedsides and/or patient floor areas
may be due to several factors: a) the time required for all
patients on a floor to complete a given meal; b) the collec-
tion and transportation systems used in returning the trays
to the dishwashing area; c) the soiled tray capacity of the
carts used; d) the number of dietary and/or nondietary employ-
ees involved in the collection and/or transportation of the
soiled trays and equipment to be returned to the dietary
kitchen; and e) the location of the dishwashing area(s) in
relation to the patient areas of the hospital.

Of the total number of dietary manhours/100 beds
required daily to perform the duties related to patient
meal tray services, a greater number of dietary manhours/100
beds is required per day in those hospitals in which dietary
employees are responsible for all 3 steps (tray assembly,
tray delivery to patient bedsides and soiled tray collection
from patient bedsides) in the patient meal tray service
system (see Table 10).

Among the patient tray service activities, tray assem-
bly requires 50 percent or more of the total dietary man-
hours/100 beds in all hospitals studied. This activity
requires from 50.5 to 70.6 percent of the total dietary
manhours/100 beds in the 5 hospitals in which dietary
employees are responsible for delivering service-ready meal

trays to patient bedsides and collecting soiled trays from

54

Table 10. Dietary Department Manhours/100 beds: All Patient Meal Tray
Services Per Day

 

 

 

 

 

 

 

 

 

Hospital Tray Dietary Manhours/100 Beds - For Meal Tray Services
Size Assembly
(Beds) Method* Assembly Delivery Return Daily Total
to Patient to Dietary All Meals
Division Department

Below 200

135 C 11.66 1.29 1.29 14.24

182 C** 10.99 5.22 2.94 19.15

185 C 10.81 1.20 1.20 13.21
200-299

213 C** 11.04 3.18 1.41 15.63

244 C 9.43 0.96 0.96 11.35

258 C 12.21 2.34 2.34 16.89
400-499

400 C 10.76 0.93 0.93 12.62

401 C 12.11 1.11 1.11 14.33

477 C** 13.78 4.04 2.52 20.34
500-699

504 C** 8.19 5.37 2.67 16.23

527 C 8.54 0.84 0.84 10.22

680 D** 25.29 8.82 6.63 40.74

 

*Assembly methods:
C = Centralized
D Decentralized

**Tray transport to and from patient floor areas and to and from patient
bedsides by dietary department personnel.

patient bedsides. In the 7 hospitals in which dietary employ-
ees only deliver service-ready trays to and collect soiled
trays from patient areas the comparable manhour percentages
are even higher (from 72.3 to 87.5 percent).

The centralized method of tray assembly is used in all
7 of the hospitals in which dietary personnel only deliver

service-ready meal trays to and collect soiled trays from

55

patient floors. Among 6 of these hospitals (all less than 500
beds) differences in total dietary manhours/100 beds required
for tray assembly, and delivery to and from patient floors
appear to be due to variations in employee productivity

rather than to differences in the actual bed capacities of

the hospitals studied. In the 1 hospital with over 500

beds it appears that employee productivity (10.22 manhours/
100 beds) is greater than is true for any of the other 6
smaller hospitals.

When dietary department personnel are responsible for
all meal service steps (tray assembly, tray deliver to
patient floors and bedsides and soiled tray collection from
patient bedsides and floors), the difference in the total
daily dietary manhours/100 beds required for patient meal
tray service (irrespective of hospital size) appears to be
due primarily to the method used for patient tray assembly.
In the 1 hospital using the decentralized tray assembly
method more than twice as many total dietary manhours/lOObeds
are required daily than for any of the 4 hospitals which
centrally assemble their patient meal trays. Among these
4 hospitals which use the centralized method of patient
tray assembly differences in the total dietary manhours/100
beds appear to be due more to variations in dietary employee

productivity rather than to hospital size.

Dietary Manhours Required: Nourishments.--Table ll

 

shows that the numbers of total dietary manhours/100 beds

56

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57

required to assemble and deliver nourishments to patient
areas and to patient bedsides vary very little within and
among hospital size categories regardless of the number of
times nourishments are offered to all patients per day,
whether the nourishments are delivered to patient bedsides
by members oftflmadietary or nursing departments or the
method(s) used to assemble nourishments for distribution.

In all hospitals approximately 2 dietary manhours/100
beds are required per day just to assemble and deliver
nourishments topatient floor areas and/or bedsides. Since
these data do not include the dietary manhours/100 beds
required for the preparation of nourishment food items to
make them service-ready, the number of additional dietary
manhours/100 beds required to provide these supplemental
feedings in each hospital depends upon hospital policy
regarding the degree of pre-prepared convenience purchased
(fully-prepared, partially prepared, or basic ingredients).

No dietary manhours are required for collecting soiled
dishes that have been used for nourishments because all
hospitals studied use disposable ware for this service and
the removal of refuse from nourishment service is the assigned
responsibility of nondietary floor personnel only.

It is recognized that, if available, the total number
of manhours/100 beds (dietary and nondietary) required for
(a) the delivery of supplemental feedings and (b) the collec-
tion and disposal of refuse from this service would be

higher and more factually accurate than only the dietary

58

manhours/100 beds reported. However, because in all 12
hospitals studied the responsibility of delivering nourish-
ments to patient bedside areas are shared between dietary
and nondietary personnel and the collection and disposal of
refuse from nourishment service is done only by nondietary
personnel, and since all interviewees were unable to indicate
the number of nondietary manhours involved, the assessment
of manhours/100 beds required for nourishment service is,
admittedly, incomplete.

It is interesting to note that despite the interde-
pendence of dietary and nondietary personnel and the neces-
sity of team effort between the dietary department and the
nursing department in the service of meals and nourishments
to inpatients, the administrators of the 12 dietary depart-
ments of the hospitals studied, by their own admission,

did not know the additional manhours required by nondietary
personnel to provide these essential services to inpatients

in their respective institutions.

Job Classifications: Dietary Employees.--The job

 

classifications and variety of position titles used for the
dietary employees (labor and supervisory) who participate
in patient tray services are detailed according to hospital
size in Tables 12 and 13. Even though many of the labor
personnel who participate in tray service activities are
from employee groups of similar status (level of difficulty

and work responsibility), fourteen different job titles

59

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60

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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61

were identified among and within the four size categories of
the 12 hospitals studied. The job titles established are
either reflective of the accepted distinguishing terminology
denoting general skill levels for employees in all areas of
a particular hospital or the title describes the area the
employee is assigned to and/or the types of work responsi-
bilities the employee has. The job classifications and
position titles may also be related to hospital or depart-
mental organizational policies and/or management/union
agreements.

The job titles of similar terminology used for dietary
labor personnel in at least 1 hospital within each category
of hospitals studied are dietary aides and dietary porters.
Other job titles used for labor personnel which carry com-
parable job status in the smaller hospitals are general
dietary personnel, kitchen assistant, dietary technician
and therapeutic aide. Other titles used to describe similar
dietary labor personnel in the larger hospitals are food
handler, general dietary personnel and food service worker.
The title senior food service worker is used to describe one
of the labor personnel positions in l of the larger hospitals.
This title denotes a position which is one step above the
entry level position, food service worker. With the excep-
tions of dietary porters, all of these labor personnel
participate in patient tray assembly activities. Tables 12
and 13 also show that another group of labor personnel par-

ticipate only in patient tray assembly. This group consists

62

of 4 types of cooks (main course, vegetable, salad and
breakfast).

As hospital size increases, more members of the super-
visory staff with a variety of position titles participate
in tray service activities. In all twelve hospitals, pro-
fessional dietitians, dietary technicians and/or food service
supervisors participate in patient tray service activities.
These supervisory personnel primarily participate in patient
tray assembly (checking trays for menu accuracy, tray appear-
ance, food quality, etc.), although in some cases their
duties may also include the supervision of tray delivery and
soiled tray collection. In the larger hospitals there are
more vocationally and professionally trained supervisory
staff members, therefore many of the duties relating to
patient tray service supervision are delegated to them by
their respective dietary department administrators.

In the smaller hQSpitals, food service supervisor and
assistant food service supervisor are the titles given to
supervisory staff who participate in patient tray service
activities. In 2 of the smaller hospitals, the professional
dietitians are only employed on a consulting basis, in 2 others
the professional dietitians are also the department adminis-
trators and in the 2 remaining hospitals, the professional
dietitians are mainly responsible for therapeutic rather than
production and service assignments.

The amount of time each day that dietary personnel

from each of the job classifications spend in performing

63

duties related to patient tray services depends on whether
they are full-time or part-time employees and the specific
meal service duties assigned to them. Full-time personnel
usually participate in the tray service activities for 2
meals (Breakfast and Noon) and 2 nourishments (midmorning
and afternoon). Part—time personnel are usually involved

in 1 meal and l nourishment (midmorning or night).

Part 4. Personal Characteristics and Educational Background

of Dietarnymplpyees Who Assist in Patient Tray
Services

 

 

The fourth part of the interview guide sought informa-
tion pertaining to a) six personal characteristics of dietary
employees who participate in patient tray services: sex,
age, marital status, number of children in each household,
age ranges of children and the number or percentage of
employees with dependents other than children and b) the
educational background of the dietary administrative staff

and labor personnel.

Personal Characteristics.—-The responses to the inquiry

 

pertaining to the personal characteristics of sex, age and
marital status of the labor personnel assigned to patient
tray services are summarized according to hospital size and
reported in Table 14. In all hospitals studied except 1
(244 beds), 62 percent or more of the employees who parti-
cipate in patient tray services are females. Fifty percent
or more of the patient tray service employees are married

in 11 of the 12 hospitals studied. With the exception of l

64

 

 

 

 

 

 

 

 

 

 

 

Table 14. Dietary Labor Personnel: Personal Characteristics
Hospital Size Personal Characteristics
Sex Marital Status Age Range
Male Female Single Married
I (%) (%) (%) (%) (Years)

Below 200

135 5 95 50 50 40-45

182 6 94 11 89 21-60

185 12 88 50 50 17-55
200-299

213 0 100 50 50 17-64

244 61 39 50 50 17-40

258 10 90 400 60 19-50
490-499

400 12 88 50 50 16-65

401 38 62 50 50 18-70

477 10 90 85 15 16-55
500-699

504 17 83 50 50 18-55

527 17 83 30 ‘ 70 18-54

680 22 88 38 62 18-58

 

hospital (135 beds), a wide range of ages exists among
employees who participate in patient tray services. These
ages are from 16 to 70.

From the data gathered, it appears that hOSpital size
is not related to the employee personal characteristics of
age, sex and martial status. In both the larger and smaller
hospitals, a majority of the patient tray service employees
are females and married.

Data relating to the number of children in each house-

hold and their ages, and the percentage of employees with

65

dependents other than children are not reported because most
of the interviewees were unable to provide the information

requested.

Educational Background.--As indicated in Part 4, 15e

 

and 15f of guide (see Appendix) the responses to the question
concerning the highest educational level of dietary labor

and administrative personnel were placed in one of five
percentage (proportion) categories: 100% (all), 80% (nearly
all), 60% (more than half), 50% (half), 30% (less than half),
less than 30% (few) and 0% (none). The estimates obtained
from the interviewees were used to calculate the approximate
percentage of patient tray service workers who have completed
each of the educational levels listed in the interview guide.
The results are detailed in Tables 15 and 16 respectively.

As shown in Table 15, a higher percentage of the labor
personnel in larger hospitals have college level educations
than in smaller hospitals. The highest percentage (10%) of
the labor personnel with Bachelor Degrees are employed in
one of the larger hospitals. In this hospital, a majority
of the employees with the degrees are working under the
provisions of the Comprehensive Employment and Training Act
of 1973 (C.E.T.A.). This act provides job training and
employment for economically disadvantaged, unemployed and
underemployed persons. In order to assure that training
and other services lead to maximum employment opportunities

and enhance self-sufficiency, a flexible and decentralized

66

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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I m O OH mm on mm mm OH OH OOO
OH I I OH on OO OH OH e m 5mm
m I OH I mm mm I I I I vom
mmOIOOO
Om I I I on on I I I I new
ON I I I Om cm I I I I How
ON I I I om OO I I I I OOH
mmOIOOO
OH I I I mm mm I I I I Omm
OH I OH I OO OO I m m I «ON
m I me I ON ON I I I I mHm
mmmIOON
O m MH I me me I I I I OOH
v I mH I me me I O O O NOH
m I mm I OO Om OH I I I mmH
OON 30Hmm
.30m
.30m cmHm .30m .30m +.£om Omummo mmummo
.EOHH .HO .OO> Hmuoe anm anm Hmuoe .OOmm4 .Homm
«Hmsuo HO>OH Hoonom OHHbdm HO>OH OOOHHOU Ampmmv
ONHm
pmchpud HO>OH HmcoHumospm ummnOHm HMHHmmom
HOCCOmHOm HOOMH mumumHo mo unmoumm "pmchuua HO>OH HmcoHpmospm umOnOHm .mH OHQMB

67

system of federal, state and local programs was established.
Under this provision, employment opportunities were offered
to those employees in the dietary department with a Bachelor
Degree who would otherwise have been unemployed.
Fifty-five percent or more of the labor personnel in
11 of the 12 hospitals studied have completed high school
or high school plus vocational school. In the 1 remaining
hospital (213 beds), only 20 percent of the labor personnel
have completed high school. Some part-time employees from
each hospital who participate in patient tray services are
students, either in college or high school (4-30 percent).
The presence of well educated dietary labor personnel
within all categories of hospitals studied may be attributed,
in part, to the changing standards of employment and the
unavailability of jobs in the Michigan labor market. The
scarcity of employment opportunities allows employers to
select highly qualified individuals even for entry level
positions. This could account for the fact that people
with college training and those who have completed high
school plus vocational school have accepted jobs that hereto-
fore haverufi:required such high educational qualifications.
Table 16 shows that of the 12 hospitals studied only
4 have administrative and supervisory staff members with
Masters Degrees who participate in patient meal service
activities. The percentages of staff with these degrees
do not appear to be related to hospital size as indicated by

the 20 percent in l of the smaller hospitals and 5, 8 and

68

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NH I NH OO O OH Om ON OOO
ON I ON OS OO ON I I SNO
OO I OO OH I OH I I OOO
OOOIOOO
OOH OOH I I I I I I SSO
OO ON ON OO I O mm O HOO
SO. SO OH NO I O NO O OOO
mmOIOOO
ON ON I OO I OO I ON OON
mm mm I OO mm I MO I OON
OO OO I cm I ON ON I OHN
OONIOON
OO mO I SH I I SH I OOH
Om I mm SO SH mm SH I NOH
SO I SO mm mm I I I OOH
OON BOme
.cnmuaH
Hmuw NO Amy» OV .HOHQ
.nom .nom .oo> mwummo mmummo + OOHOOQ wmnmmo
HMHOB anm +.£Om anm Hmuoe .oommm .somm .nomm mumummz
HO>OH Hoocom OHHbdm HO>OH OOOHHOU Amvmmv
ONHO
OOGHmuud HO>OH HMGOHHOODOM ummHmHm HmuHmmom
Hmccomumm mnemH>ummsm
pew O>HumnumHeHEU¢ mo ucmoumm "pmchuu¢ HO>OH HmeoHumosom umwanm .OH OHHOB

69

25 percent in 3 of the larger hospitals. In 7 of the 12
hospitals studied from 17 to 42 percent of the members of

the administrative/supervisory staff have completed a dietetic
internship.

A wide range in the percentages of administrative staff
members with Bachelor Degrees and Associate Degrees exists
among the hospitals studied. The range of the percentages
of staff members with Bachelor Degrees varies from 5 to 60
percent with all size categories of hospitals represented
and from 6 to 50 percent with Associate degrees with only 3
of the size categories represented.

The remaining members of the administrative/supervisory
staff assigned to patient tray service duties from each of
the hospitals studied have only completed high school or
high school plus vocational school. Of these individuals,
more who have completed both high school and a post-high
school vocational training program work in the larger
hospitals (400 to 700 beds) than in the smaller hOSpitals
(less than 300 beds). Among the 12 facilities studied, 1
large facility has no member of the administrative/super-
visory staff assigned to patient tray services who has
completed formal education or training beyond the high
school level. I

Part 5. Absenteeism and Tardiness Among Patient Meal
Service Employees

 

 

Part 5 of the interview guide was designed to identify

a) the seasons and specific times of the year when absenteeism

70

and tardiness occur more frequently among patient tray
service employees, b) the number of individuals that can

be absent or tardy before inpatient meal service efficiency
is affected, c) the patient tray service activities that are
most affected by employee absenteeism and tardiness, d)

the types of procedural modifications usually made in order
to cope with and/or compensate for absenteeism and tardiness
among patient tray service employees, e) the assignment of
tardy employees upon their arrival, f) the effects of
absenteeism and tardiness among patient tray service
employees on the duties of other personnel and the patient's
meal and g) the departmental and/or hospital policies con-

cerning employee absenteeism and/or tardiness.

Seasons and Times When Absenteeism and Tardiness Occur

 

More Frequently.--Three seasons of the year (winter, spring

 

and summer) are identified by some administrators as being
particularly associated with absenteeism among dietary
employees who participate in patient tray services. In 4 of
the smaller hOSpitals (less than 300 beds) and in 2 of the
larger hQSpitals (400 beds or more) absenteeism is encountered
more frequently among dietary tray service employees during
the winter season. According to the dietary administrators
of these hospitals, absenteeism in this season is primarily
due to illness, especially colds and the flu.

Prevalence of absenteeism among patient tray service

employees during the spring was also reported by dietary

71

administrators of 2 of the larger and 2 of the smaller
hospitals. Dietary administrators of these hospitals
associated absenteeism among the older employees during
this season with more pleasant weather conditions and among
the younger (high school age) employees with the many
extracurricular school activities that are scheduled during
this time of the year. Summer was reported as a season in
which absenteeism occurs more frequently in only 1 of the
larger hospitals. The reason offered by the dietary admin-
istrator was that summer is the time of the year when
employees like to be outside enjoying themselves.

Monday, Friday, Saturday and Sunday were cited as
the days of the week patient tray service employees are
absent more frequently. Monday and Friday are the days
of the week indicated as being related to absenteeism in
some hospitals with bed capacities below 200 and in some
hospitals with bed capacities above 500. Saturday and
Sunday are the days when more absenteeism is encountered
among patient tray service employees in 2 of the hospitals
with bed capacities above 500 and in at least 1 hospital
from each of the other size categories of hospitals
established for this study.

Threeother times when there is increased absenteeism
ameng patient tray service employees in the larger hospitals

are: a) the day before and/or the day after an employee's

regular day off, b) around but not on specific holidays

and c) the day after payday. In one smaller hospital, a time

72

when absenteeism occurs more often among patient tray ser-
vice employees is the day after payday. It is evident from
these data that in most of the hospitals studied, frequency
of absenteeism among patient tray service employees is asso-
ciated with particular seasons and/or times of the year and
are usually due to personal causes rather than to on-the-job
causes.

With further questioning, additional data were obtained
for the calculation of the rate of absenteeism per week among
employees who participate in patient tray services for each
hospital. The formula1 used to calculate the rate of absen-
teeism is as follows:

Rate (%) of _ No. of absentees during period X 100

Absenteeism Avg. no. employees X no. working days

 

Comparisons among the percentages calculated revealed
that the rate of absenteeism among employees who participate
in patient tray service activities is low (3 percent or less)
in the six smaller hospitals studied. Of these 2 have an
absenteeism rate of 3 percent, 2 have an absenteeism rate of
2 percent and 2 have an absenteeism rate of 1 percent. Among
the six larger hospitals, a wider range is found in the rates
of absenteeism per week among patient tray service employees
than is true for the six smaller hospitals. Three of
these hOSpitals have absenteeism rates of only 1, 2 and
4 percent, respectively, but 2 have absenteeism rates of

10 percent and 1 has an absenteeism rate of 12 percent.

 

lJ. Keiser and E. Kallio. Controlling and Analyzing
Costs in Food Service Operations. (New York: John Wiley
and Sons, Inc., 1974), p. 40.

 

 

73

Neither marital status nor age of the employees were found
to be related to absenteeism in 10 of the hospitals studied.
However, in l of the smaller hospitals (182 beds) married
employees were found to be absent more frequently and in l
of the larger hospitals (527 beds), employees in the age
group of 18-21 were found to be absent more often.

It is evident from the results obtained that absenteeism
among patient tray service employees exists in varying
degrees among and within the categories of hospitals studied
and that higher rates of absenteeism are more apt to occur
in larger than in smaller hospitals.

The dietary administrators of the hospitals studied do
not consider tardiness a serious problem among the employees
who participate in patient tray services. Tardiness was
associated with the seasons of winter and spring in only
five hospitals. Of these five, three dietary administrators
from the larger hospitals associated winter with employee
tardiness and two from the smaller hospitals associated
tardiness with spring. Administrators from the other seven
hospitals responded to the inquiry relating to the seasons
and times of more frequent tardiness among patient tray
service employees in the following ways: a) tardiness is
not really a problem and it can occur any time of the year,
b) there is very little tardiness and c) it is not really
a problem and when it occurs it is usually related to

transportation methods.

74

Employee Absences and/or Tardiness Versus Meal Service

 

Efficienpy.--Responses pertaining to the number of employees

 

assigned to patient tray service duties that can be absent
before the efficiency of the meal service is seriously
affected were summarized according to hospital size. The
results show that in l of the smaller (less than 300 beds)
and in 5 of the larger (400 beds or more) hQSpitals, the
specific number of dietary employees assigned to inpatient
tray services for a particular meal must be present or the
meal service efficiency will be measurably affected. One
of the larger and 5 of the smaller hospitals can, if
necessary, function adequately with one or two fewer
employees than are usually assigned duties related to
inpatient tray services.

In each of the hospitals studied, the number of employ-
ees that can be tardy before inpatient meal service is
seriously affected is the same as the number of absentees.
However, the more tardy employees are the greater the
effects are on meal service efficiency.

Within the limits of this small study it is apparent
that the number of dietary employees that can be absent or
tardy before inpatient meal service efficiency is seriously
impaired depends upon three interrelated factors:

1. the specific steps in the inpatient meal service

process for which dietary department employees
have major responsibility (tray assembly, tray

delivery to floors and/or patient bedsides, soiled

75

tray collection from patient bedsides and/or
floors).

2. the relationship between the number of patient
trays to be processed per meal and the number of
available dietary personnel employed to provide
the required services as scheduled.

3. the expected productivity levels of dietary
employees assigned to patient meal service duties

under normal full-time conditions.

Inpatient Meals and Tray Service Activities Most

 

Affected by Absenteeism and/or Tardiness.--Breakfast is the

 

meal most affected by absenteeism among patient tray service
employees in 7 (3 larger and 4 smaller) of the hospitals
studied. Absenteeism during this meal usually results in
an insufficient number of employees who are familiar with
tray service procedures. Workers who substitute for the
absent employees may be less skilled in performing the
duties related to patient tray service activities. Combin-
ing the duties of the patient tray service employees may
lead to a delay in starting the meal service period and/or
require a longer time to complete all services for all
inpatients.

In 2 of the other larger hospitals, the evening meal
is the meal affected most by absenteeism among patient tray
service employees because these particular hospitals are

more dependent upon part-time workers for the service of

76

the evening meal. Of the three remaining hospitals, in 2

(1 smaller and 1 larger) no meal service is seriously
affected by limited absenteeism among patient tray service
employees because an absent employee is immediately replaced
by an employee from another area of the dietary department.
In 1 of the smaller hospitals, the service efficiency of all
three regular meals is usually affected by absenteeism

among patient tray service employees. Neither the noon

meal nor any of the in-between meals (nourishments) are
seriously affected by absenteeism among the patient tray
service employees in the 12 hospitals studied.

Of the 10 hOSpitals in which absenteeism among patient
tray service employees does affect meal service efficiency,
the specific tray service activities affected are either
tray assembly or all activities related to patient tray
services. Tray assembly is affected most by absenteeism
in 2 of the smaller and in l of the larger hospitals. In
3 of the smaller and in 4 of the larger hospitals all tray
service activities are equally affected.

Tardiness affects patient tray assembly for the
first regular meal (Breakfast) in 2 of the smaller hospitals
and all activities pertaining to patient tray services in 3
of the larger hospitals during the evening meals. None
of the tray service activities are measurably affected by
some tardiness among patient tray service employees in the

remaining hospitals studied.

77

Types of Procedural Modifipapipnngsually Made to

 

 

Cope with Emplpyee Absenteeism.--A number of modifications

 

are made in patient tray service procedures among the 12
hospitals studied to compensate for unexpected and/or
long-term departmental absences and for extensive absenteeism
due to emergency situations.

The eight different ways the dietary departments surveyed
cope with unexpected dietary tray service employee absences
are reported in Table 17 according to hospital size and
rank order of frequency among all hospitals studied. From
these limited data it is clear that, irrespective of hospital
size, the dietary administrators attempt to compensate for
missing workers by first utilizing the skills and services
of other on—duty dietary workers to maintain patient meal
services as scheduled without increasing payroll costs.

When the number of available workers is deemed inadequate
the next options pursued are a) to obtain the necessary
workers on a paid overtime basis (time and a half), b)
divide the duties of the absentees among the regular
patient tray service workers present and/or c) modify the
patient menus to simplify the meal service procedures
required. The dietary administrators of all hospitals
indicated that, although some unexpected absences are
inevitable, every effort is made to maintain both the
quality of patient meal service and the tray delivery
schedules expected from the department. The effects of

unexpected absenteeism on patient meal services ultimately

78

 

 

m I H H H HOHHHOO uuommu Ou Omxmm mum muanm
HOumH How pmHspmnom mmmmonEm SumuwHo

O H H I N mmuswmoonm OOH>umm
Smuu SOHHQEHO on OOHMHpoE mum mscmz

O H H I N Susw co HHOQOH

ou Omxmm mum mHmmH =HHm0IeO= am no name
Iunmmmp SumumHU may now xHOB 0:3 mmmonmEm

S m N H H OOOSOHQEO OOH>Hmm Smuu SuvacO macaw
meH>Hp mum mOmSonEm ucwmnm may no mmHuso

O N N N N Hummmxmmumv Heme umHHm OH» swap umauo

Hams m :0 usooo mmocmwbm may OH OEHH
IHO>O Hues Op wamm mum mmwmonEm SumumHQ

m N N N m Susw How unommu on Omxmm mum
mmmhoHQEO OOH>umm Snub HOHSOOH muszmmo

OH O N m N mOOSOHQEO pammnw Hem mHsuHumbdm
wmmum SHOOH>HOQDm\O>HumuumHGHEUO SumumHo

NH O m m m mOmSOHQEm uewmnm How OHSHHHOQDO mmmum
Huo3 umnuo ECHO mOOSOHQEO Sumume muspIco

OOO OOO OON OON
Hmuoe IOOO IOOO IOON 3OHmm

 

 

 

HmuHommmo Ummv ONHm HmuHmmom

 

mcoHHMOHmHOOE

 

 

mmHuso OOH>HOO mane ucmHumm on pwcmHmm¢
SHHmEHoz OOOSOHQEO SumuOHo mo mmocmwbm How mummemmeou on mum: OCOHHOOHMHUOE .SH OHHOB

79

depend on the resources available to management (human,
material, financial) and the ability of management to use
them to operational advantage to meet temporary worker
shortage.

The types of procedural modifications used to compen-
sate for long-term absenteeism among departmental patient
tray service employees are necessarily governed by a) the
accepted definition of "long-term absenteeism" and the
established rules for such absences in each operation, and
b) the availability of sufficiently skilled individuals to
permit work schedule adjustment for extended periods of
time. Among the 12 hospitals studied the type of dietary
department management (hospital operated versus outside
contracted services) appeared to be less of a determinant
in the worker replacement strategies used than the status
of the dietary department employees with respect to
unionization.

In the 7 hospitals where the dietary employees were
unionized four options appeared generally available to
management: a) hiring an additional worker as a temporary
replacement for the long-term absentee, b) temporarily
assigning a regular relief person to the position for the
period needed, c) increasing the number of working hours
of regular qualified part-time employee schedules temporarily
to provide adequate daily patient meal service coverage for
all scheduled meals. In nearly all cases the modifications

favor employees rather than management.

80

In the 5 nonunionized departments there appears to be
greater flexibility in making adjustments which favor manage-
ment by minimizing increases in labor costs during periods
of employee long-term absenteeism. The three types of
modifications generally used in these departments are a) di-
viding the duties of the absent worker among the other
regular patient tray service workers, b) temporarily assign-
ing a regular relief worker to the vacant position for the
period needed, and c) arranging with regular employees for
overtime work on a preplanned basis to provide adequate
coverage for the duration of the worker shortage.

In emergency situations such as walkouts, strikes and
disastrous weather and/or community situations the modifi-
cations made to compensate for absenteeism among patient
tray service workers are somewhat different from those
used to cope with unexpected and/or long-term departmental
absenteeism. When these extreme conditions occur absenteeism
usually becomes a hospital-wide problem and disrupts nearly
all patient services. Under such circumstances all hospital
and dietary administrative personnel work together and give
high priority to the provision of essential meal services
for inpatients and hospital personnel.

Even though not all of the dietary departments studied
had actually experienced the emergency situations noted above,
the concensus of the interviewees was that in addition to
their usual strategies more extreme actions would be under-

taken immediately. Depending on the severity and the

81

duration of the emergency, one or more of the following

adjustments would be made:

a.

All available hospital personnel (dietary, non-
dietary and volunteers) would work together to

see that all essential duties related to inpatient
and personnel meal services were completed.

Menu modifications would be made to simplify the
service of all general and special diets. Non-
selective menus would be used.

More pre-prepared food items would be used.

Insofar as possible disposable service items would
be used.

Public food service units of the hospital (cafe-
teria, snack shops, vending machines, etc.) for
which the dietary department regularly provides
food and services would be closed.

Types of Procedural Modifications Usually Made to Cope

with Employee Tardiness.--In all hopsitals studied, the types

of changes made when tardiness occurs among patient tray

service
cipated
missing

tive of

employees depends, in large measure, upon the anti-
extent of tardiness and the usual assignment of the
employee. All interviewees reported that, irrespec-

employee tardiness, patient tray service activities

are started as scheduled. In general the temporary adjust-

ments made include one or more of the following in rank order

of their practicability:

a.

Dietary employees who may be somewhat less
familiar with the tardy employee's duties are
asked to substitute.

Members of the dietary administrative/supervisory
staff fill-in for the missing employee.

The duties of the missing employee are temporarily
divided among the employees who are present.

82

Insofar as practical, in all hospitals tardy employees
are allowed to report to their regular positions upon arrival.
Situational factors which must be assessed at the time the
employee arrives in the work area include how late the employee
is in relation to his/her specific assign duties, how
advanced the patient meal service activities are and if the
additional shifting in personnel assignments will increase or

decrease meal service efficiency.

Effects of Employee Absenteeism and Tardiness on Other

 

Personnel and on the Quality of Patient Meal Services.--

 

Among the four size categories of hospitals studied, the
effects of absenteeism among patient tray service employees
on the duties of dietary administrative/supervisory staff
differ slightly according to hospital size. In the larger
hospitals (400 beds or more) one or more of the following
results occur: a) less supervision is given to department
employees who do not participate in patient tray service
activities, b) diet consultation with patients is limited,
and c) staff members must either work overtime to complete
their daily duties or work more rapidly and effectively to
complete their daily assignments in a shorter period of time.
With the exception of working overtime, the same results
occur when administrative/supervisory staff members from
hospitals with 200-299 beds substitute for absent employees
assigned to patient tray service activities. The daily

duties of the dietary administrative/supervisory staff

83

members in hospitals with less than 200 beds are not measurably
affected when staff members must substitute for absent
employees. Because of the smaller number of inpatients
requiring tray service per meal, there appears to be greater
flexibilityirlthetmxaofadministrative/supervisory work time

in smaller hospitals than is true in the larger hospitals.

When other on-duty dietary employees substitute for
absent patient tray service employees adjustments often
must be made to compensate temporarily for their absence
from their regular duties. In most cases the job responsi-
bilities of employees who are substituting for absent patient
tray service employees are either a) divided among the other
employees in the work units, or b) performance of less
essential duties of employees substituting in patient tray
service activities is delayed until the patient meal service
duties are completed or c) the least essential duties are
omitted entirely to permit the employee to complete his/her
work day as scheduled. Only when absolutely necessary are
employees asked to work overtime to complete all of their
regularly assigned duties.

Usually tardiness among patient tray service employees
does not measurably affect the daily duties and responsi-
bilities of other on-duty dietary employees or administrative/
supervisory staff members unless the employee is very late
in arriving. When extreme tardiness does occur, the effects
on other dietary personnel parallel those resulting from

absenteeism.

84

The effects of absenteeism among dietary patient tray
service employees on the quality of inpatient meal services
are usually more varied and often more severe in smaller
hospitals (300 beds or less) than in larger hospitals (400
beds or more). According to those interviewed, in the 6
smaller hospitals delivery of patient trays may be delayed
because of worker shortage with the result that some tray
items are undesirably warm or cold, some patients do not
receive all menu items as ordered because of last minute
changes in food items available for service and/or temporary
procedural changes are made to simplify the ways in which
particular items are served. In the 6 larger hospitals sur-
veyed the usual effect of absenteeism on the quality of
inpatient meal services reported by the interviewees is
generally limited to delayed or "behind-schedule" delivery of
meal trays to patients. Only under very extreme circumstances
are menu items or service procedures modified to compensate
for absences among patient tray service workers.

In each of the hospitals studied tardiness among
regular patient tray service employees results in the same
problems for management as does absenteeism. The severity
and duration of the effects depend upon the number of
employees tardy during a particular meal service period and
how late each one is in reporting for work.

Absences and tardinesses among patient tray service
workersvnnxfilcause substantial delays in the delivery of

meal trays to patients also often upset other scheduled

85

essential inpatient services for which other departments of
the hospital (nursing, x-ray, physical therapy, diagnostic
testing laboratories etc.) have primary responsibility.
Because of the possible undesirable multiple effects in the
provision of total health care for inpatients all persons
interviewed indicated that strict adherence to patient meal

service schedules must be maintained.

Personnel Policies Concerning Dietary Employee Absen-

 

teeism and Tardiness.--In the 12 hospitals studied policies

 

pertaining to absenteeism and tardiness for dietary employees
appear to be well-defined. In every case the departmental
regulations conform to the general policies of the hospital,
and, where applicable, to specific union contract conditions
covering dietary workers and/or to hospital-management
company contractural agreements. In some cases departments
have additional procedural rules regarding employee respon-
sibilities for reporting and justifying deviations in their
attendance behavior.

Thecxnxhijrxusunder which dietary employees may be
absent without loss of pay vary somewhat among the 12 hospitals
surveyed according to the particular regulations established
in each facility. From the data obtained it is apparent
that all departments annually provide a stipulated number of
paid leave days for regular full-time employees. The apparent
differences among hospitals are due to categorical variances

in the number of paid leave days that employees are allowed

86

per year and the extent of payment permitted. In some cases
all paid absences are credited against personal leave days
whether such absences are due to illness or to other personal
needs. In other facilities payment for days off due to
personal illness are differentiated from days off for other
reasons such as a death in the immediate family, illness of
a family member or othertaqusof personal matters. If an
employee has used all his/her earned personal leave days or
personal leave and sick days and is absent for an extended
period of time, he/she may be entitled to a percentage of
his/her regular wages if the employer feels the employee's
circumstances merit such consideration. Such cases are
individually considered and, if awarded, the reduced remun-
eration may range from 50 to 60 percent of the employee's
regular pay in some of these hOSpitals. If the employee

is absent for a long period of time due to work-related cir-
cumstances, in some situations, he/she may qualify for
workmen's compensation benefits.

Conditions under which part-time employees may be
absent without loss of pay also vary among the 12 hospitals
studied. In 4 of the hospitals, regular part-time employees
receive no pay for absence due to illness whereas in the other
8 hospitals paid sick leave is awarded according to the
number of scheduled work hours missed. In each of these
latter hospitals the qualifying conditions for paid sick
leave for part-time employees are the same as for full-time

employees.

87

According to the dietary administrators interviewed,
many of the restrictions concerning employee absences such
as no pay for the first day off, no pay if absent the day
before and/or the day after a regular scheduled day off or
a holiday, and no pay for a designated number of consecutive
days absent without proof of illness resulted from employee
abuse of these benefits.

Procedures pertaining to paid compensation for time
lost due to employee tardiness are generally the same in all
of the dietary departments studied. Decisions as to whether
tardy employees are allowed to make up for the time lost by
a) working later than usually scheduled, b) reporting earlier
on another day or, c) having the tardy time deducted from
personal or sick leave allowance rest with the dietary admin-
istrative/supervisory personnel. Factors which influence
tjmzactionstaken usually include a) the amount of time involved,
b) the reasons for the employee's failure to report as
scheduled, and c) the tardiness frequency of the employee.

In all dietary departments the interviewees indicated
that the reasons employees usually give for their absences
are those forvHUIHIthey are most apt to receive pay for their
lost time. Only on rare occasions do employees indicate
reasons for absence which they know will result in loss of
pay. Although all hospitals studied require all employees to
notify the dietary department when they are unable to report
to work as scheduled, only 2 of the 12 hospitals require that

the call musthamade by the employee himself to qualify for

paid absent time.

88

In a majority of the hospitals studied all employees
(full-time and part-time) can accumulate unused sick days
up to stipulated maximum. Among the hospitals studied this
maximum varies from 5 days to 180 days. In one small
nonunionized dietary department employees are paid for
unused earned sick timean:the end of each operating year.
In one of thecfljmnrhospitals when the maximum number of
earned sick days is reached a portion of the time is
converted to additional vacation time at a rate of 2 hours
of earned sick time equals 1 hour of extra vacation time.

When employment is terminated (voluntarily or nonvol-
untarily) the procedures for accrued sick time compensation
differ among the 12 hospitals surveyed. In 7 hospitals
departing employees do not receive additional pay for unused
sick time; in 4 hospitals employees are paid in full for all
unused sick thma;and in 1 hospital only retirees are compen-
sated for accrued sick time and then for only half of the
tbme they have accumulated. In the 4 hospitals where the
job termination policy includes full monetary compensation
for unused sick time the administrators indicated that, as
a general rule, employees in the 3 smaller hospitals (less
than 300 beds) tend to take time off equal to their accrued
sick days before departing whereas in the 1 larger hospital
employees are more apt to ask for the additional pay at the
time they leave their job.

The steps taken when an employee returns after an

extended period of absence are principally the same among

89

the 12 hospitals surveyed. In all hospitals if an employee's
absence exceeds a designated number of consecutive days (as
few as 3 days in some hospitals) proof of the reason stated
for the absence must be provided before the individual can
return to his/her assigned work area. Such proof may be a
signed statement from the employee's personal physician or
from a physician who provides medical services for employees
of the hospital. In some situations the hospital physician
must also render judgment as to whether the employee is
sufficiently recovered to be permitted to return to his/her
assigned work area and resume his/her normal duties. In all
dietary departments employees are expected to call in
advance to inform the manager or their supervisor of the
anticipated day of their return so that work assignments

and schedules may be readjusted accordingly.

When the tolerance level for patient tray service
employee absenteeism is reached, the number of disciplinary
steps taken by the management staff differ somewhat among
the particular hospitals surveyed. In all hospitals the
first two steps are the same. Employees are first given a
verbal warning and if the employee's attendance record does
not improve the second step is to give the employee a written
warning.

Third step actions are the most varied. Among the 12
hospitals, failure to improve attendance behavior results in
dismissal in 3 hospitals, in suspension without pay for a

specific number of days in 5 hospitals, in a change in work

9O

assignment and/or conditional probation for a designated
period of time in 3 hospitals and a written final reprimand
in 1 hospital.

In the 9 hospitals who do not terminate employment at
the third step, the next or fourth step taken in 6 of the
hospitals is dismissal. In the 3 remaining hospitals the
employee is suspended from work without pay for a stipulated
period of timeand if upon return the individual's attendance
record does notshOWHmarked improvement he/she is then
discharged.

The particular disciplinary procedures used for
excessive absence in each dietary department are also used
for controlling excessive tardiness among dietary employees.
However, in the opinion of most of the dietary administrators
interviewed, excessive employee absenteeism and tardiness
can usually be corrected by verbal and written reprimand.
Only rarely must they resort to the more severe penalties
of unpaid suspension and/or dismissal.

When asked what the usual disciplinary actions are
for absenteeism and tardiness among supervisory personnel,
six dietary administrators indicated that the procedures
are the same for dietary employees of all levels. Among the
six remaining administrators five stated that they first
attempt tocxnnumfl.a supervisory staff member as to the
attendance behavior they expect from them as a member of the
management team. If such efforts fail to correct the

situation then the ensuing procedures parallel those used

91

for employees. One administrator indicated that he is less
lenient with supervisory personnel than with employees
because of their leadership roles and their responsibility
to set a positive example as a standard for employees to

follow.

CHAPTER V

SUMMARY, CONCLUSION AND IMPLICATIONS

This study pertained to hospital meal service practices
with major focus on the effects of employee absenteeism and
tardiness on patient meal service activities (tray assembly,
tray delivery and soiled tray collection). The 12 Michigan
hospitals selected for study were a) nonfederally operated,
b) located within a 75-mile radius of Lansing, c) licensed
by the Michigan Department of Public Health and d) had an
inpatient bed capacity of not less than 125 and not more than
700.

The data for the study were obtained through on-site
interviews with 18 dietary administrative/supervisory per-
sonnel from the 12 selected hospitals. The guide used
during the interviews contained both highly structured and
semi-structured questions (see Appendix, p. 120).

It was believed that the information obtained from
this study would provide some insight as to a) the variety
of techniques that are used in different size hospitals for
patient meal delivery, b) the procedural modifications that
are made when there is absenteeism and/or tardiness among
patient tray service employees and c) the variety of hospital

personnel policies and procedures that have been established

92

93

to deal with the problems of absenteeism and tardiness among
dietary employees assigned patient meal service duties.
The summarized findings are presented in the same

sequence as the major sections appear in the interview guide.

Summary of Findings

 

The Respondents

 

Of the 18 persons interviewed, twelve are dietary
administrators (those who manage the activities of the
dietary department), and six are supervisory members of the
department staff. Five different position titles were
identified among the dietary administrators and four were
identified among the supervisory personnel. Director of
Food Service is the title most frequently held by administra-
tors and the title of Food Service Supervisor is the most
common one used for supervisory personnel.

Nine of the dietary administrators interviewed have
considerable experience (15 years or more) in the area of
food service, 2 have less than 15 but more than 6 years and
only 1 administrator has less than 6 years experience. In
contrast, extensive experience in the food service field is
not as characteristic of the 6 supervisors interviewed.

Three have been in the field for less than 6 years, 2 for
more than 10 years but less than 15 years and only 1 for more
than 20 years. Employment in their present positions for
both dietary administrators and supervisory personnel was

less than 6 years for the majority from both position levels.

94

On-the-job experience or formal academic training plus
on—the-job experience are the major ways the administrators
surveyed prepared themselves for their present positions; 6
by experience only and 6 by a combination of academic study
and work experience. For the supervisory personnel, pre-
paration for their current positions was primarily through
formal academic training and, for the most part, they are
younger and have had relatively few years of on—the-job
work experience in the food service field.

Of the 12 hospitals surveyed, 5 of the dietary depart-
ment administrators are female and 7 are male. Four of the
7 male administrators are employed by contract food manage-
ment companies and assigned to hospitals of less than 300
beds. Of the 8 dietary departments which are hospital-

operated, 5 are managed by women and 3 by men.

Operational Characteristics: Dietary Department

 

The dietary departments of 8 of the 12 facilities
studied (6 with more than 400 and 2 with less than 300 beds)
are hospital operated. The remaining 4 (all with less than
300 beds) are managed by contract food service companies.

All of the hospitals in the latter category have been operated
by an outside agency for less than 3 years. The labor per-
sonnel in 7 of the 12 dietary departments are unionized.

All of the hospitals with unionized labor personnel are
located in communities with populations of more than 100,000.

Greater differences in the average daily percent

95

inpatient occupancy were found among the three smaller hos-
pitals with less than 200 beds (34 percent) than among the
three facilities with 200-299 beds (13 percent). Similar
comparison between the two size categories of larger hospitals
showed less variation among the three hospitals in the 400-499
bed category (6 percent) than among the three hospitals in

the 500-699 bed category (9 percent).

Delivery of trays to patient bedsides is the only type
of meal service regularly provided for inpatients in the 12
hospitals studied. However, two additional types of meal
service are provided in 2 of the larger hospitals. In one
floor trays for inpatient group dining are provided and in
the other, upon request, visitor trays are delivered to
patient rooms.

Five different meal-nourishment service patterns were
found among the 12 hospitals surveyed. All of the patterns
consist of 3 or 4 regularly scheduled meals plus one of 4
nourishment schedules. Regular meal services in all of the
hospitals begin between 7:00 - 7:30 a.m., 11:00 - 11:30 a.m.
and 4:15 - 4:30 p.m. for the morning (regular breakfast),
noon and evening meals, respectively and at 10:00 a.m.,

2:00 p.m. and 7:00 or 8:00 p.m., respectively for the 3
regularly scheduled nourishments. In the one hospital which
provides 4 meals, the service of the first (early breakfast)
begins at 6:00 a.m. Approximately 45 to 60 minutes are
allowed for the service of each meal in the smaller hospitals

whereas 60 to 95 minutes are allowed for this function in

96

the larger hospitals. The service time required for each

of the scheduled nourishments ranges from 45 to 60 minutes

in all 12 hospitals. Patient meal menus are selective in 11
of the 12 hospitals surveyed and nonselective in only one.
Nourishment menus are either selective or semi-selectiVe in 9
of the hOSpitals and nonselective in only 3.

With the exception of soups, a greater number of larger
hospitals (more than 400 beds) than smaller hospitals (less
than 300 beds) purchase a wide variety of prepared menu items.
Of the 12 hospitals studied, 100 percent purchased prepared
tneadsand/or rolls and beverages, 80-90 percent purchased
prepared appetizers, soups, entrees, vegetables and tube
feedings. None of the hospitals purchased prepared salads
or sandwich mixes.

Two methods (centralized and decentralized) are used
in the 12 hospitals to assemble patient meal trays and 3
methods (centralized, decentralized and a combination of
centralized and decentralized) are used to assemble nourish-
ments. Of the two methods used for tray assembly, 11 of the
hospitals use the centralized method and only 1 uses the
decentralized method. When assembling nourishments, 4 of
the hospitals use the centralized method, 4 use the decen-
tralized method and the remaining 4 use a combination of
the centralized and decentralized methods.

In the 11 hospitals where the centralized method is
used to assemble patient meal trays, preassembled trays

are delivered directly from the dietary department to the

97

patient areas. Bulk food (to be used in tray assembly) is
sent to the patient division in the one large hopsital in
which the decentralized method is used to assemble inpatient
trays. In some of the hospitals preassembled nourishment
trays are delivered to patient divisions and in some an
assortment of service-ready nourishments are also delivered
to patient divisions. In addition, bulk supplies of nourish-
ment items are delivered to the patient divisions in all
hospitals. The responsibility of delivering service-ready
foods to patient areas (meals and nourishments) is that of
dietary labor personnel in all 12 of the hospitals studied.
Delivery of assembled meal trays and nourishments to patient
bedsides may be the responsibility of either dietary labor
personnel or personnel of the nursing department and varies
among hospitals according to the individually established
work assignment policies of the hospitals surveyed. Among
the 12 hospitals studied, facility size did not appear to

be a factor of influence in this regard.

Manpower Needed to Provide Patient Tray Services

 

The number of dietary manhours/100 beds required to
assemble inpatient trays varies within and among the 4
categories of hospitals studied. In the category of smaller
hospitals with less than 200 beds, a decreasing number of
manhours/100 beds is required per day as hospital bed capacity
increases. Among the 3 hospitals with 200-299 beds, fewer

manhours/100 beds are required per day in the hospital with

98

244 beds (second largest) than in the other two hospitals.
When considering the daily manhours/100 beds required for
tray assembly in the 2 categories of larger hospitals (more
than 400 beds), a slight decrease is found as hospital bed
capacity reaches 500 and the centralized method of tray
assembly is used. When the decentralized method is used,
the manhours/lOOIxxksrequired per day triple. In all hospitals
in which the centralized method is used to assemble inpatient
trays, the manhours/100 beds required to assemble trays for
breakfast (first regular meal) are less than for the noon
and evening meals. In the one hospital in which the decen-
tralized method of tray assembly is used, the manhours/100
beds required per day for the noon meal are less than for
breakfast or for the evening meal.

Dietary manhours/100 beds required per day in the 5
hospitals where dietary employees deliver service-ready
trays to patient bedsides increase as hospital size increases.
In these 5 hospitals, the return of soiled trays to the dish-
washing area requires fewer manhours/lOO beds than the dis-
tribution of the service-ready meals. In the 7 hospitals
where dietary employees only deliver trays to and collect
them from patient areas, the return of soiled trays to the
dishwashing area from the patient area requires the same
number of dietary manhours/100 beds daily as required to
deliver the service-ready meal trays to the patient areas.

A greater number of dietary manhours/100 beds is

required per day in those 5 hospitals where dietary employees

99

are responsible for all tray service activities; tray assembly,
tray delivery to patient bedsides and soiled tray collection
from patient bedsides. Of the tray service activities, tray
assembly requires 50 percent or more of the total dietary
manhours/100 beds per day.

The differences in the total dietary manhours/100 beds
required for all meal service activities appear to be due
primarily to the method of patient tray assembly used. More
than twice as many total dietary manhours/100 beds are required
daily for tray service activities in the one hospital using
the decentralized method of tray assembly than in any of the
11 hospitals using the centralized method.

Regardless of the number of scheduled nourishments per
day, the personnel (dietary or nursing) responsible for
delivering nourishments to patient bedsides or the method
used to assemble nourishments for distribution, the total
number of dietary manhours/100 beds required to assemble
and deliver nourishments to patient bedsides and areas is
approximately 2 per day. Because all hospitals studied use
disposable ware for nourishment services and the removal
of refuse from nourishment services is the responsibility of
nondietary personnel, no additional dietary manhours are
required in this part of the service procedure.

Fourteen different job titles were identified among
the dietary workers assigned to patient tray service activities
in the 12 hospitals studied. The job titles of similar

terminology used for dietary labor personnel in at least one

100

hospital within each hospital size-category are dietary aide
and dietary porter. Other job titles used for labor personnel
which carry comparable job status in the smaller hospitals

are general dietary personnel, kitchen assistant, dietary
technician and therapeutic aide. Other titles used to
describe similar positions in larger hOSpitals are food
handler, general dietary personnel and food service worker.

In one of the larger hospitals, senior food service worker

is a title given to a dietary employee to denote a position
one step above the entry level.

In all 12 hospitals, professional dietitians, dietary
technicians and/or food service supervisors or assistant food
service supervisors participate in patient meal service
activities. Of these position titles, professional dietitian,
dietary technician and food.service supervisor are the ones
given to the supervisory personnel who participate in patient
tray service activities in larger hospitals. In the smaller
hospitals supervisory staff who participate in patient tray
service activities have the title of either food service
supervisor or assistant food service supervisor.

Personal Characteristics and Educational Background of
Employees who Assist in Patient Tray_Services

 

 

In general, the majority of the dietary labor personnel
in 11 of the 12 hOSpitals studied are female (62 percent or
more), married (50 percent or more) and vary widely in age
(16 to 70 years). Exceptions among hospitals include 1

smaller hQSpital (244 beds) which has 61 percent male employees,

101

1 larger hosptial (477 beds) in which 85 percent of the
dietary employees are single and 1 smaller hospital (135
beds) in which all dietary employees are between 40 and 45
years of age.

The presence of well-educated dietary labor personnel
was found within all size categories of hospitals studied.

In 11 of the 12 hospitals studied, 55 percent or more of the
labor personnel have completed high school or high school
plus vocational school. In the 1 remaining hospital (213
beds) only 20 percent of the labor personnel have completed
high school.

Among the hospitals studied, a higher percentage of
the dietary labor personnel in the larger hospitals have a
college level education than is true in the smaller hospitals.
The highest percentage of the labor personnel with baehelor
degrees (10 percent) was found in one of the larger hospitals.
In this hospital, a majority of the employees with these
degrees are working under the provisions of the Comprehensive
Employment and Training Act of 1973.

Irrespective of hospital size, both college and high
school level education are characteristic of the dietary
administrative/supervisory staff members in the 12 hospitals
studied. In only one hospital all administrative/supervisory
staff members who participate in patient tray service
activities have only a high school education. Among the 12
hospitals studied, the percentage of administrative/super-

visory staff members regularly participating in patient meal

102

service activities who have completed college range from 17
to 88. Percentages for those who have only completed high
school range from 12 to 100. The higher percentages of
persons who had not completed a college degree were found
in smaller hospitals (less than 300 beds) rather than in

larger hospitals (400 beds or more).

Absenteeism and Tardiness Among Patient Meal Service Employees

 

The dietary administrative/supervisory personnel
interviewed associated the seasons of winter, spring and
summer with frequent absenteeism among dietary employees
who participate in patient tray service activities. Accord-
ing to these staff members, absenteeism during the winter is
primarily due to illness (colds and flu) and in the spring,
absenteeism among the older employees (those who are not of
high school age) is related to their practice of taking time
off to enjoy the pleasant weather conditions and among the
younger employees (those who are attending high school) with
their desire to participate in the extracurricular school
activities. Absenteeism during the summer is related to the
employee's desire to be outside enjoying themselves.

Monday, Friday, Saturday and Sunday are the days of the
week associated with absenteeism among patient tray service
employees by the personnel interviewed. According to these
staff members three specific times when there is more absen-
teeism among patient tray service employees in the larger

hospitals are: a) the day before and/or the day after an

103

employee's regular day off, b) around but not on specific
holidays and c) the day after pay day. The Specific time
when absenteeism among patient tray service employees occurs
more frequently in smaller hospitals is the day after pay day.

The rate of absenteeism per week among employees who
participate in patient tray service activities showed less
variation (1-3 percent) among the 6 smaller hospitals (less
than 300 beds) than among the 6 larger hospitals (1-12 per-
cent). Of the smaller hospitals, 2 have an absentee rate
of 3 percent, 2 have an absentee rate of 2 percent and 2 have
an absentee rate of 1 percent. Among the larger hospitals
(more than 400 beds), 3 have absentee rates of l, 2 and 4
percent, respectively, but 2 have absentee rates of 10
percent and 1 has an absentee rate of 12 percent. Neither
marital status nor age of the employees were found to be
related to absenteeism in 10 of the hospitals studied. Of
the other 2, in 1 smaller hospital (182 beds) married
employees are absent more frequently than single persons and
in 1 larger hQSpital (527 beds) employees in the age group
of 18-21 are absent more often than those over 21 years of
age.

Tardiness is associated with specific seasons of the
year in only 5 hospitals. Of these five, the three dietary
administrative/supervisory members from the larger hospitals
associated winter with employee tardiness and the two from
the smaller hospitals associated tardiness with spring.

Administrative/supervisory personnel from the other 7

104

hospitals stated that tardiness is not really a serious
problem. There is very little tardiness and when it occurs
it is usually related to transportation methods.

The number (1 or 2) of patient tray service employees
that can be absent or tardy before inpatient meal service
efficiency is seriously impaired depends on: a) the specific
meal service activity for which dietary employees have major
responsibility (tray assembly, tray delivery to patient
floors and/or patient bedsides, soiled tray collection from
patient bedsides and/or floors), b) the relationship between
the number of patient trays to be processed per meal and the
number of dietary workers normally available to provide the
required services as scheduled and c) the expected produc-
tivity levels of dietary employees assigned to patient meal
service duties under normal full-time conditions.

Absenteeism affects breakfast (first regular meal)
service most in 10 hospitals (5 larger and 5 smaller) and
tardiness seriously affects this meal service in only 5
hospitals (2 smaller and 3 larger). The Specific meal
service activity affected most by absenteeism and/or tardi-
ness in these hospitals is patient tray assembly. In some
of these hospitals, however, all activities related to
patient tray services are impaired when employees are absent
or tardy.

Of the different adjustments made to cope with unexpec-
ted absenteeism, irrespective of their size, in all hospitals

the first adjustments consist of attempts by the dietary

105

administrative/supervisory staff to compensate for the missing
worker(s) by first utilizing the skills and services of other
on-duty dietary workers to maintain patient meal services

as scheduled without increasing payroll costs. If this type
of adjustment is deemed inadequate the next options are:

a) to obtain the necessary workers on a paid overtime basis
(time and a half), b) divide the duties of the absentees
among the regular patient tray service employees present
and/or c) modify the patient menus to simplify the meal
service procedures required. The effect of unexpected
absenteeism on patient services ultimately depends on the
resources available to management (human, material, financial)
and the ability of management to use them to operational
advantage to meet worker shortage.

Among the 12 hospitals studied, the types of proce-
dural modifications used to compensate for long-term absen-
teeism among patient tray service employees depend on the
prevailing definition of "long-term absenteeism" and the
availability of sufficiently skilled individuals to permit
work schedule adjustments for extended periods of time. The
options usually available in unionized hospitals are: a)
hiring an additional worker as a temporary replacement for
the long-term absentee, b) temporarily assigning a regular
relief person to the position for the period needed, c)
increasing the number of working hours of regular qualified

part-time employees temporarily to provide adequate daily

106

patient meal service coverage for all scheduled meals.
Modifications generally used in nonunionized hospitals
generally are: a) dividing the duties of the absent worker
among the other regular patient tray service workers, b)
temporarily assigning a regular relief worker to the vacant
position for the period needed and c) arranging with regular
employees for overtime work on a preplanned basis to provide
adequate coverage for the duration of the worker shortage.

Absenteeism caused by emergency situations such as
walkouts, strikes and disastrous weather and/or community
situations are cooperatively handled by both dietary and
hospital administrative personnel. Even though not all of
the hospitals studied have actually experienced an emergency
situation, the concensus of the interviewees was that in
addition to their usual strategies one or more of the follow-
ing adjustments would be made: a) all available hospital
personnel (dietary and nondietary) would work together to
see that all essential duties related to inpatient and
personnel meal services are completed, b) menu modifications
would be made to simplify the service of all general and
special diets, c) nonselective menus would be used, d) more
pre-prepared food items would be used and e) insofar as
possible disposable service items would be used.

The daily duties of dietary administrative/supervisory
staff members are measurably affected by absenteeism among
patient meal service workers in 3 of the 4 size categories

of hospitals studied. In the two categories of hospitals

107

with more than 400 beds, one or more of the following results
occur: a) less supervision is given to department employees
who do not participate in patient meal services, b) diet
consultation with patients is limited and c) staff members
either work overtime to complete their daily duties or work
more rapidly to complete their duties in a shorter period of
time. In the 1 remaining category of hospitals (200-299
beds) in which absenteeism among patient meal service
employees affects the duties of dietary administrative/
supervisory personnel, except for working overtime, the
same results occur as stated for the two categories of
larger hospitals.

When other on-duty dietary labor personnel substitute
for absent patient tray service employees, dietary adminis-
trative/supervisory personnel must make adjustments to com-
pensate for their absence from their regular duties. The
adjustments usually made are: a) to divide the regular
duties of the employee who is substituting for an absent or
tardy employee among other employees in that work unit, b)
to delay the performance of less essential regular duties
of the employee substituting in patient tray service
activities or c) omit the least essential duties of the
employee who is substituting in order to permit the employee
to complete his/her work day as scheduled.

Unless an employee is very late in arriving, tardiness
does not measurably affect the duties of other dietary

personnel. When extreme tardiness does occur, the effects

108

on dietary personnel parallel those resulting from
absenteeism.

According to those interviewed, the effects of
absenteeism among dietary patient tray service employees
on the quality of inpatient meal services are usually more
varied and more severe in smaller hospitals (less than 300
beds) than in larger hospitals (more than 400 beds). The
effects that result in smaller hospitals are a) patient
trays may be delayed because of worker shortage with the
result thatsome tray items are undesirably warm or
cold, b) some patients may not receive all menu items as
ordered because of last minute changes in foods available
for service and/or c) temporary procedural changes are made
to simplify the ways in which particular items are served.

In the larger hospitals surveyed the usual effect of absen-
teeism on the quality of inpatient meal services is generally
limited to delayed or "behind schedule" delivery of meal
trays to patients.

Tardiness among patient tray service employees usually
causes the same types of problems as absenteeism. However,
the severity and duration of the effects of tardiness depend
upon the number of employees tardy during a particular meal
service period and how late each one is in reporting to work.

Scheduled essential inpatient services for which other
departments of the hospital (nursing, x-ray, physical therapy,
diagnostic testing laboratories, etc.) have primary respon-

sibility are often upset if absenteeism and/or tardiness

109

among patient tray service employees cause substantial delays
in the delivery of meals to patients. All persons inter-
viewed indicated that strict adherence to inpatient meal
service schedules is maintained as much as possible because
of the compounding effects resulting from off-scheduled
patient meals.

In all 12 hospitals, policies pertaining to absenteeism
among dietary patient tray service employees were well-
defined. These regulations conform to the general policies
of the hospital and, where applicable, to specific union
contract conditions covering dietary workers and/or hospital-
management contractural agreements. Additional procedural
rules regarding employee responsibilities for reporting and
justifying deviations in their attendance records were found
in some hospitals. All 12 hospitals annually provide a
stipulated number of paid leave days for regular full-time
employees, however, the situation for part-time employees
differs among hospitals.

The differences among hospitals in relation to
policies regarding absenteeism among full-time employees are
due to categorical variances in the number of paid leave
days that employees are allowed per year and the extent of
payment permitted. In some cases all paid absences are
credited against personal leave days whether such absences
are due to illness or to other personal needs. In other

hospitals, payment for days off due to personal illness are

110

differentiated from days off for other reasons such as a

death in the immediate family, illness of a family member or
other types of personal affairs. If an employee who has

used all of his/her sick time is absent for an extended

period of time, in some of the hospitals studied he/she

may be able to collect a percentage (50-60 percent) of his/her
regular pay. In other hospitals, employees who are absent

for a long period of time due to work-related circumstances,
may qualify for workman's compensation.

For part-time employees, conditions under which they
can be absent with pay vary among the 12 hospitals studied.
In 4 of the hospitals, regular part-time employees receive
no pay for absence due to illness whereas in the other 8
hospitals paid sick leave is awarded according to the number
of scheduled work hours. In these latter hospitals the
qualifying conditions are the same as for full-time employees.

Decisions as to whether tardy employees are allowed to
make up for the time lost by a) working later than usually
scheduled, b) reporting earlier on another day or c) having
the tardy time deducted from personal or sick leave time
allowance rest with the dietary administrative/supervisory
personnel of the particular hospital.

The reasons that employees usually give for their
absences are those for which they are most apt to receive
pay for their lost time. Seldom do employees indicate
reasons for absenceIWhichthey know will result in loss of

pay. Even though all hospitals require that employees

111

notify the department when they are unable to report to
work as scheduled, only 2 of the 12 hospitals require that '
the call reporting the absence be made by the absent employee.

Employees can accumulate unused sick days up to a stip-
ulated maximum in a majority of the hospitals studied. This
maximum varies from 5 days to 180 days. In one of the small
nonunionized hospitals, dietary patient tray service employees
are paid for unused earned sick time at_the end of each
operating year. In one of the larger hospitals when the
maximum number of earned sick days is reached a portion is
converted to additional vacation time at a rate of 2 hours
of earned sick time for 1 hour of extra vacation time.

The procedures for accrued sick time compensation also
differ when an employee is terminated (voluntarily or
nonvoluntarily). In 7 hospitals departing employees do not
receive additional pay for unused sick time; in 4 hospitals
employees are paid in full for all unused sick time; and in
1 hospital only retirees are compensated for accrued sick
time and then for only half of the time they have accumulated.
In the 4 hospitals where the job termination policy includes
full monetary compenstaion for unused sick time the adminis-
trators indicated that, as a general rule, employees in the
3 smaller hospitals (less than 300 beds) tend to take time
off equal to their accrued sick days before departing whereas
in the 1 larger hospital employees are more apt to ask for

the additional pay at the time they leave.

112

In all hospitals if an employee's absence exceeds a
designated number of consecutive days (as few as 3 days in
some hospitals) proof of the reason stated for the absence
must be provided before the individual can return to his/her
assigned work area. Such proof may be a signed statement
from the employee's personal physician or from a physician
who provides medical services for employees of the hospital.
Along with the proof of illness, in some facilities the
hospital physician must also render judgment as to whether
the employee is sufficiently recovered to be permitted to
return to his assigned work area and resume his/her normal
duties. In all dietary departments employees are expected
to call in advance to inform the manager or their super-
visor of the anticipated day of their return.

When the tolerance level for absenteeism is reached
among patient tray service employees, the disciplinary steps
taken by management vary from 3 to 5 in the 12 hospitals
studied. The steps are as follows:

a) The first two steps are the same in all hospitals.

First employees are given a verbal warning and if
the employee's attendance record does not improve
the second step is to give the employee a written
warning.

b) Third step actions vary considerably among the 12

hospitals studied. Failure to improve attendance
results in dismissal in 3 hospitals, in suspension

in 5 hospitals, in a change in work assignment and/or

113

conditional probation for a designated period of
time in 3 hospitals and a written final reprimand
in 1 hospital.

c) In the 9 hospitals where employees are not ter-
minated at the third step, the next or fourth step
taken in 6 of these hospitals is dismissal. In
the 3 remaining hQSpitals the employee is suSpended
from work for a stipulated period of time, and if
upon return the individual's attendance record
does not show marked improvement, the fifth step
taken is dismissal.

The particular disciplinary procedures used for ex-

cessive absence in each dietary department are also used
for controlling excessive tardiness among dietary employees.
However, in the opinion of most of the dietary administra-
tors interviewed, excessive employee absenteeism and tardi-
ness can usually be corrected through verbal and written
warnings.

Six dietary administrators indicated that they follow
the same procedures for supervisory personnel as for labor
personnel when the tolerance level of absenteeism and tardi-
ness is reached. Among the 6 remaining administrators, five
stated that they first attempt to counsel a supervisory staff
member as to the attendance behavior they eXpect from them
as a member of the management team. One administrator
indicated that he is less lenient with supervisory personnel

than with labor personnel because of their leadership roles

114

and their responsibility to set a positive example as a

standard for employees to follow.

Conclusions and Implications

 

Although it is acknowledged that the scope of this

investigation is quite limited, the findings from the study

lend credence to eight general conclusions regarding the

operational aspects of dietary departments and the proce-

dural elements involved in the provision of inpatient meal

services in nonfederally operated hospitals in Michigan.

1.

Irrespective of facility size, community size,

type of dietary department management or employee
unionization status, the operational characteris-
tics and inpatient meal service procedures of
hospital dietary departments are generally similar.
Each department is obliged to service the individual
needs of patients, personnel and visitors within
the constraints imposed by the policies and
practices of the hospital of which it is an
essential part. Differences in departmentally
established procedures for inpatient meal-nourish-
ment services (tray assembly, tray delivery and
soiled tray collection) are due, primarily, to
variations in the extent of responsibility assigned
to the respective dietary departments to provide
for the dietary needs of inpatients throughout
their periods of confinement.

Hospital dietary departments are managed by per-
sonnel with various levels of academic training
and/or experience in the food service field.
Employment of a contract food management firm to
operate the dietary department is practiced more
by smaller hospitals (300 beds or less) than
larger hospitals (400 beds or more).

The majority of dietary labor personnel who parti-
cipate in patient meal service activities in Michigan
hospitals are married females from a wide range of
ages (16-70 years). More than half of these
employees have completed high school. Positions

of dietary labor personnel regularly assigned to
patient meal service activities are described by

many different titles whereas the positions of

115

of dietary administrative/supervisory personnel
regularly involved in patient meal services are
identified by relatively few different titles.
Unionization among dietary labor personnel is
related to and influenced more by community size
than by hospital size or type of dietary department
management.

In nearly all hospitals dietary employees are
responsible for all functions related to the pre-
paration of service-ready meal trays and nourish-
ments (assembly and/or delivery to patient areas)
and the collection of soiled meal trays from the
patient areas. Responsibility for meal tray and
nourishment distribution to patients and the col-
lection of soiled meal trays from patients varies
according to hospital policy and may be assigned
to either dietary or nondietary personnel.

In the provision of inpatient meal-nourishment
services the two major determinants of dietary
manpower needs and the associated labor costs are
the extent of service responsibility assigned to
the dietary department and the method(s) used to
assemble meal trays and nourishments for distribu-
tion.

Higher rates of absenteeism among patient tray
service employees in Michigan hospitals are more
prevalent in larger hospitals than in smaller
hospitals. Absenteeism among patient tray service
employees is more likely to be associated with
particular seasons of the year, days of the week
and specific times of the week and of the year
than tardiness. In most instances employee
absences are due to personal needs and situational
factors rather than to on-the-job causes. Tardi—
ness among patient tray service employees is
neither frequent nor a problem of great concern to
dietary administrative/supervisory personnel.

Modifications made to compensate for absences
(uneXpected, long-term and those cause by emergency
situations) and tardinesses among patient tray
service employees are similar in Michigan hospitals.
Regardless of the number of employees absent or
tardy or the situations which cause the absences,
all dietary administrative/supervisory personnel
work together to see that meal service schedules,
the quality of patient meals, and the adequacy of
patient meal service are maintained. In addition,
when excessive absences occur, such as those caused
by extreme situations, hospital nondietary personnel

116

also participate in patient meal-nourishment
service activities to see that meal services for
patients are adequately maintained for the
duration of the emergency.

8. Hospital and dietary department policies and prac-
tices pertaining to employee absenteeism and
tardiness are well-defined and designed both to
treat all employees fairly and to assist manage-
ment in the control of operational procedures
essential for success. When employees abuse or
fail to follow the established rules regarding
work attendance, the number and successive severity
of the mandatory steps for management before an
employee can be discharged are specifically
detailed in the regulatory practices established
by each hospital. In general, the more steps
required the more chances the employee has to
correct his/her attendance behavior.

From this study it is apparent that, regardless of
facility size, the policies and procedures pertaining to
inpatient meal-nourishment tray assembly, tray delivery and
soiled tray collection in Michigan hospitals are similar.
Dietary personnel will continue to have ultimate responsi-
bility for all activities related to patient meal services.

Dietary departments use the centralized method for
assembling inpatient trays to minimize labor costs and enable
managers of dietary departments to have more precise control
of the personnel who participate in patient tray services,
the assembly of prescribed food items and the system used
for patient food distribution. The only meal service acti-
vities that nondietary personnel are apt to be involved in
are the delivery of service-ready foods to and the collection
of soiled trays from patient bedsides.

Absenteeism and tardiness among patient tray service

employees are inevitable and bound to interfere with the

117

efficiency with which patient meal service activities can

be performed. The number and types of modifications that
need to be made to cope with or compensate for poor atten—
dance among employees are daily problems dietary administra-
‘tive/supervisory personnel are forced to deal with as
effectively as possible. As long as the human related
problems of employee absenteeism and tardiness persist,

new policies, procedures and regulations will be formulated
and/or existing ones revised in an effort to minimize their
occurences. Of all the service responsibilities inherent in
hospital dietary department Operation, inpatient meal-

nourishment services must be given priority.

LITERATURE CITED

10.

ll.

12.

13.

LITERATURE CITED

Ahern, E. "Discharge for Absenteeism Under Union Contracts."

Personnel Journal, L11 (October, 1973), 95.

 

Bowman, J. "Distribution as a Subsystem." Hospitals,
XLVI, (July-September, 1972), 63-68.

 

Buchanan, R. "College and University Food Service" in
The Anatomy of Food-Service Design I, by John Wiley.
Boston: Cahners Publishing Company, Inc., 1975.

 

Castillo, M. "How Providence Memorial Hospital Cut
Employee Absenteeism." HOSpital Topics, LI (November-
December, 1974), 2-4.

 

Dekar, A. "Absenteeism: A Fact of Life." Personnel
Journal, XLVIII (November, 1969), 21.

 

Donaldson, B. "Managing Changes in Food Service Opera-
tions." Journal of American Dietetic Association,
LVII (October, 1970), 335-337.

 

Donaldson, B. and Zolber, K. "Distribution of Work

Functions in Hospital Food Systems." Hospitals,
XLVI (August, 1972), 39-44.

 

Doyan, P. "Automated Food Delivery Systems." Hospitals,
XLIV, (February, 1970), 109-112.

 

Drake, R. "Control as a System Function." Hospitals,
XLVI (July-September, 1972), 73-79.

 

Gaudet, F. Solving the Problems of Employee Absence.
American Management Association, Inc., 1963.

 

Greenway, D. "An Overview of the Food Service Industry."
Cornell Hotel and Restaurant Administration Quarterly,
V (February, 1964), 10-13.

 

Grove, B. "Attendance Reward Plan." Personnel Journal,
XLVII (June, 1968), 119-121.

 

Halperin, J. "Absenteeism." Personnel Journal, XLII,
(November, 1963), 499-502.

 

118

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

119

Harris, P. "Facing the Realities of Change." Manage-
ment Reviews, LVIII (July, 1969), 43.

 

Hinkle, L., Pinsky, R., Bress, J. and Plummer, N. "The
Distribution of Sickness Disability in a Homogenous
Group of Healthy Adult Men." The American Journal of
Hygiene, LXIV (September, 1956), 220-242.

 

Kearns, J. "Controlling Absenteeism for Profit."
Personnel Journal, XLIX (January, 1970), 49.

 

Keiser, J. and Kallio, E. Controlling and Analyzing
Cost in Food Service Industry. New York: John Wiley
and Sons, Inc., 1954.

 

 

Kotchevar, L. "Staffing Dietary Departments." Hospital
Progress, LIII (January, 1970), 49.

Kotchevar, L., Owens, L. and Sawyer, B. "Dietary
Operations in State Mental Hospitals." Hospitals,

 

XLV (October, 1971), 17.

Livingston, G. "Food Service Systems." Food Technology,
XX, (May, 1966), 76-80.

 

Livingston, G. "Design of a Food Service System." Food
Technology, XXII, (January, 1968), 35-40.

 

 

Malott, J. and Hass, G. "Why Employees Are Fired:
A Survey of Recent Discharges." Management News, XXX
(January, 1957), 7-8.

 

Mann, F. and Sparling, E. "Changing Absence Rates."
Personnel, XXXIV, (March, 1958), 392-408.

 

Merten, W. "Service is a Critical Process." Hospitals
XLVI, (July-September, 1972), 69-72.

 

 

Puckett, R. "Policies and Procedures for the Dietary
Department." Hospitals, XLIV (February, 1970), 112.
Smardon, R. "Some Cures for Chronic Absenteeism."

Supervisory Management, XIX, (November, 1974), 12.

 

Survey No. 57. Personnel Policies Forum, Bureau of
National Affairs, Inc. Washington, D.C. 1960.

APPENDIX

INTERVIEW GUIDE

SURVEY: EFFECTS OF ABSENTEEISM 5 TARDINESS 0N PATIENT MEAL SERVICE
IN MICHIGAN HOSPITALS

 

 

 

 

 

 

INTERVIEWEHS)
DATE OF
II. MT, nrs, Ms, INTERVIEW TIME
0:. Mr, Mrs, Ms, HOSPITAL
#3 Mr, Mrs, Ms, SIZE-RANGE (beds)

 

PART I: THE RESPONDENMS)
I
I. ADMINISTRATIVE TITLE ;

#1 #2 #3 TITLE
Director's? Food Service
Director of Dietetics

Chief Administrative Dietitian
Chief Therapeutic Dietitian
Administrative Dietitian
Therapeutic Dietitian

Food Service Manager
Dietary Technician

Food Service Supervisor
Chief, Head, or Charge Narse

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Staff Nurse
Other
2. PROFESSIONAL EXPERIENCE
a) Years in area of food service #1 #2 #3
b) Years in present position #1 #2 #3
c) Area(s) of Specialization
#1 #2 #3 AREA

 

Hotel S_Restaurant Management
Institution Management(Admin.)
Food Service Management(Admin.)
Dietetic-Administrative
Dietetic-Therapeutic
Dietetic-General

Dietary Technician

Business Administration

Home Bconomics(identify area)
Fd. Ser. Supervisory Training

 

 

 

 

 

 

 

 

 

 

Other
‘INOne-EXperience only

 

 

 

 

 

 

 

   

 

 

 

   

u. .,

. ,-.
~v.-
O

..

 

5.

PART II: OPERATIONAL CHARACTERISTICS--DIETARY DEPARTMENT

MANAGEMENT OF THE DIETARY DEPARTMENT: ___Hospita1 operated
___Contract Fd. Co. (Total)
___pontract Fd. Co. (Mgt. only)

ARE THE EMPLOYEES OF THE DIETARY DEPARTMENT UNIONIZED? yes
no

AVERAGE DAILY IN-PATIENT CENSUS.

 

WHAT TYPES OF PATIENT MEAL SERVICES ARE PROVIDED?

patient tray (bedside)
cafeteria (on patient division or in another area)
family style (patient division or in another area)

other (identify)

 

 

WHAT MEAL SERVICE PATTERN(S) ARE USED? WHAT TIME IS EACH MEAL SERVED?

 

 

 

Pattern(s)
a) ____3 meals
b) ___5 meals ______ ._____ ._____
c) ___3 meals + 2 snacks ______ _____
d) ___3 meals + 3 snacks _____. _____
e) ___pther (describe)

WHAT TYPES OF MENUS ARE USED FOR PATIENT DIETS?

 

 

 

 

 

 

 

 

 

a) Types selective semi-selective non-selective
General Diets 1
Special Diets I
Nourishments I
b) Are the same policies used on holidays? ___yes ___po
weekends? yes ___po

c) If not, what types are used on:

Holidays?

 

 

Weekends?

 

 

9.

10.

11.

12.

FOOD PURCHASING POLICIES

a) What percentage of the menu items you serve are purchased:
% fully prepared (service-ready or reconstitute and serve)
% partially prepared (additional preparation required)

b) What types of prepared fOOds do you buy?

appetizers
soups

entrees
potatoes
vegetables
salads
sandwich mixes

WHAT METHOD(S) OF PATIENT TRAY ASSEMBLY ARE USED?

desserts

bread and/or rolls
II'-_beverages

tube feedings
special nourishments I
meal supplements ‘-I
other (identify)

 

 

 

 

 

ASSEMBLY METHOD

MEALS

NOURISHMENTS

 

 

centralized

 

de-centralized

 

combinaEion: Eentralized

 

and de-centralized

 

 

 

 

HOW IS THE SERVICE-READY FOOD DELIVERED FROM THE MAIN KITCHEN TO THE

PATIENT AREA?

BulE-Food carts to pantries on each floor
Bulk-Food carts to pantries in one central area fOr tray assembly
and distribution to patients on more than one floor

Preassembled trays sent to each floor for direct delivery to patients

Other (describe)

 

 

WHO IS RESPONSIBLE FOR DELIVERING SERVICE-READY FOOD?

a) Tolpatient areas

 

Patient Pd. Ser. Aides
Dietary Aides (kitchen helper)

 

 

Dietary Porters
Dishroom Aides

 

 

 

Volunteers
Others (specify)

 

 

Nurses (charge, staff, aide).

b) To patients

 

 

PART III--MANPOWER NEEDED TO PROVIDE PATIENT TRAY SERVICES

13. HOW MANY FULL:TIME AND PART—TIME PERSONNEL ARE NEEDED EACH MEAL TO PROVIDE:
a)_TRAY ASSEMBLY, b) TRAY DELIVERY and_g1 SOILED TRAY COLLECTION? (INCLUDE
WORKERS INVOLVED IN ALL LOCATIONS WITHIN TH§;SYSTEM.1

MEAL SERVICE STEPS
a C
MEALS SERVED I TRAY ASSEMBLY 2 TRAY DELIVERY SOILED TRAY TOTAL
' - . ' COLLECTION

'T DE ND ‘V T

#1 Full Time
Part Time
Total

 

Full Time
Part Time
Total

Full Time
Part Time
Total

Full Time
Part Time
Total

Full Time
Part Time
Total

Full Time
Part Time
Total

Total Meals

 

1-6
1 . 2
#1-6=consecut1ve meals from T=total number
12:01 am - 12:00 pm DE=dietary dept. employees
Full time=30 or more hours/day ND=non~dietary dept. employees

Part time=less than 30 hours/week V=volunteers

 

 

O. 1.. -- .

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onusou can:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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mzommum

 

 

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Amuuoxnoz mofl>nom

 

8o". 253m...

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Amvaafiuwenooe
xnmpofio
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mzHH onhumgqoo 1 onh<uHmHmm<qu
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ficwsefiucouU mone<oHaHmm<so mow

.vH

PART IV--PERSONAL CHARACTERISTICS AND JOB RESPONSIBILITIES OF
DIETARY EMPLOYEES WHO ASSIST IN PATIENT TRAY SERVICES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. EMPLOYEE CHARACTERISTICS
a) 0f the Dietary Depg. Labor Personnel assigned to patient tray services,
how many are males "How many are fEmales? How many are under 18?
18-25? 26-55? 41-55? over 55? How many are married? 35w many are
single? (Record according to sex.)
AGE RANGES s}
SEX TOTAL ' un or oveiFLMARITA STAN
18 18-25 26-40 41-55 55 married single }
Male
Female
Total
Labor
b) On the average, how many children do these employees have living at
home?
c) What is the general range 2; children's ages per household?
d) What proportion of these employees have other dependents at home?

(Spouses, parents, other relatives, friends.)

 

15. EMPLOYEE CHARACTERISTICS (continued)

0) Among the Labor Personnel of the Dietary Department assigned patient
tray service duties, what preportion (or percentage) have completed
the following levels of education?

 

EDUCATIONAL

PROPORTION OR % OF EMPLOYEES

 

Half

All Nearly More Less Few one
LEVEL 100% All Than 50% Than -30% 0%
80% Half Half
60% 30%

 

Bachelor Degree
(4 yrs. College)

 

Associate Degree
(2 yrs. College)

 

High School +
Vocational
School

 

High School

 

VOcational
School

 

Jr. High
School
(Middle School)

 

Elementary
School

 

 

Other-

 

 

 

 

 

 

 

 

 

 

16. WHAT ARE THE MAJOR WORK ASSIGNMENTS PERTAINING TO PATIENT TRAY SERVICE

 

 

 

 

 

 

 

 

 

ACTIVITIES PERFORMED BY DIETARY DEPT. EMPLOYEES? NON’DIETARY EMPLOYEES?

DIETARY DEPT. EMPLOYEES "ON‘DIBTARY

EMPLOYEES

WORK Admin. Ther. Pt. Fd. Main Nurses Volun-
ASSIGNMENTS Staff Staff Serv. Kitchen (aides, teer
Emp. Emp. staff,
charge);
Tray assembly-
main Kitchen

 

 

Tray assembly-
patient area

 

 

A.T-_h

Deliver bulk
feed--pt. area

 

 

Deliver service-

ready food (pt. area)

 

Deliver service-

ready fbod (pts.)

 

Deliver nour. +
snacks (pt. area)

 

Deliver nour. +
snacks (pt.)

 

Check trays
befbre serv. (pt.)

 

Collect soiled
trays (pt . bedside)

 

Collect soiled
trays (pt. area)

 

Return soiled trays
(dishwashing area)

 

Isolation tray
assembly

 

 

Deliver + Collect
Isolation trays

 

 

Other

 

 

 

 

 

 

p-m--qr.“ o.‘k

 

 

 

“v-

 

17.

18.

PART V--MODIFICATIONS MADE IN PATIENT TRAY SERVICE PROCEDURES WHEN
THERE IS ABSENTEEISM AND/OR TARDINESS AMONG INDIVIDUALS
RESPONSIBLE FOR PATIENT TRAY SERVICES

DURING WHICH_§§ASON OR TIMES OF THE YEAR DO YOU ENCOUNTER MORE ABSENTEEISM
AND TARDINESS FROM PATIENT TRAY SERVICE EMPLOYEES?

 

 

SEASONS & TIMES ABSENTEEISM TARDINESS

 

HOW MANY INDIVIDUALS CAN BE ABSENT(?), (TARDY), FROM PATIENT TRAY ASSEMBLY,
TRAY DELIVERY AND SOILED TRAY COLLECTION BEFORE THE EFFICIENCY OF MEAL
SERVICE IS AFFECTED? (give the number for each meal)

 

 

 

  
   
 

SOILED TRAY
COLLECTION

TRAY ASSEMBLY TRAY DELIVERY

 

 

 

Meals* Meals Meals
l _2 .5 4 5 6 Al 2 3 4 5 5 1 2 3 ,4 .5 .5

 

ABSENT

 

 

 

 

 

 

 

TARDY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*1-6 No. of meals served

 

 

l9.

WHICH MEAL(S) AND WHICH TRAY SERVICE ACTIVITY(ES)7ARE MOST AFFECTED BY
ABSENTEEISM AND7OR TARDINESS? .

AMEALS

 

(dietary employees)

TRAY SERVICE ACTIVITIES

 

ASSEMBLY

DELIVERY

COLLECTION

 

ABS. TARD.

ABS. TARD.

ABS. TARD.

 

lst

 

2nd

 

3rd

 

4th

 

5th

 

6th

 

Other

 

 

 

 

 

 

 

 

 

“I

L.‘

20. WHAT ARE THE ADJUSTMENTS MADE IN PATIENT TRAX‘SERVICE ACTIVITIES IN ORDER
TO COMPENSATE FOR UNEXPECTED ABSENTEEISM AND TARDINESS?

 

TRAY ASSEMBLY TRAY DELIVERY SOILED TRAY
COLLECTION

 

TYPE OF ADJUSTMENT
ABS. r TARD. ABS. TARD. ABS. TARD.

 

Dietary workers who are
less familiar with tray
service activities are
assigned to area

 

Obtain help from non-
dietary department emp.

Menu modifications made
to simplify service
requirements

Admin. and/or Supv. Staff
substitute for missingempL

Vol. are asked to work in
service area

Pt. tray serv. emp. who
are on-call are asked to
report on duty

Pt. tray serv. emp. who
are scheduled-off are
asked to come in

Emp. are asked to work
overtime if abs. or tard.
is on a shift later than
the first

Work is divided among ind.
present F

 

 

 

 

 

 

 

 

 

Emp. is assigned to check
trays

 

Other

 

 

 

 

 

 

 

 

 

b) IN THE CASE OF TARDINESS, HOW LONG DO YOU WAIT BEFORE YOU MAKE
ADJUSTMENTS IN THE WORK SCHEDULED?

 

20.

(continued)

C)

d)

e)

f)

ARE THE SAME ADJUSTMENTS MADE FOR LONG TERM ABSENTEEISM?

yes no

 

 

IF NOT, WHAT ADJUSTMENTS ARE MADE TO COVER LONG TERM ABSENTEEISM?

Relief person is placed in position
A replacement is hired to cover schedule
Employees are asked to work overtime in advanced
Work is divided among present employees

Other

 

 

 

 

 

DO THESE SAME ADJUSTMENTS APPLY TO ABSENTEEISM IN SITUATIONS SUCH AS
STRIKES, WALKOUTS, AND DISASTROUS WEATHER WHEN MORE THAN HALF OF THE
EMPLOYEES MAY BE ABSENT 0R TARDY?

 

es no

L

 

IF NOT, WHAT HAPPENS UNDER THOSE CONDITIONS?

<_Hospital Administrative Staff is in charge of making adjustments
Additional public volunteers are called in (Red Cross)
Other

 

WHAT IS THE COMPENSATION POLICY FOR EMPLOYEES WHO ARE ASKED TO WORK

OVER??? 7'

 

 

 

regular rate
regular plus 1/2
d0‘ 15' .i. e
equal time-off
_______other

 

 

 

 

 

I§_THE TARDY EMPLOYEE GIVEN A NEW WORK ASSIGNMENT WHEN HE REPORTS ON
DUTY OR IS HE GIVEN HIS REGULAR ASSIGNMENT?

 

es no
depends on employee's regular assignment

depends on employee's seniority

according to statement in union contract or to a departmental policy
other

 

 

 

 

 

 

 

20.

'21.

(continued)

g) WHEN ADMINISTRATIVE OR;§UPERVI§ORY PERSONNEL SUBSTITUTE IN TRAY SERVICE
ACTIVITIES, WHAT ARE THE EFFECTS ON THEIR DAILY ACTIVITIES?

 

 

 

None

Less supervision is given to employees who do not participate in
tray service activities

Patient diet consultation and dietary education limited because
of time shortage

Others

 

WHAT ARE THEéEFFECTS OF PATIENT TRAY SERVICE EMPLOYEES ABSTENEEISM AND
TARDINESS ON THE PATIENTSi MEAL?

none

meal served later than usual
food not received as ordered
food slightly cold

other

 

 

 

 

 

 

b) WHAT SPECIFIC AREA(S) OF THE HOSPITAL IS/ARE AFFECTED BY OFF-SCHEDULED
MEALS? HOW IS/ARE THE AREA(S) AFFECTED?

EFFECTS

 

Housekeeping

 

Nursing

 

x-Ray

 

Laboratory

 

(Specific lab)

 

Other

 

 

 

 

 

 

22. WHO OR WHAT ESTABLISHES THE EMPLOYMENT RULES REGARDING ABSENTEEISM AND

 

 

 

 

 

N R I E E
ABSENTEEISM TARDINESS
Written Hospital
Policy 4.
‘Written Departmental
Policy

 

Admin. Personnel
Dietary Department
posItIon

 

Other

 

 

 

 

b) UNDER WHAT CIRCUMSTANCES ARE ABSENT AND TARDY EMPLOYEES PAID?
(Include part-time, full-time and Administrative and SuperviSory

Staff-Dietary Department Employees)

 

22. (continued)

c) ARE THE REASONS EMPLOYEES STATE FOR ABSENTEEISM AND TARDINESS USUALLY

d)

e)

g)

11)

TIES E"wH"'I'C"'H"'"AR“E""CO'1~P" "“SEN AT 730 mfi PAY

yes no
THEN, WHAT ARE THE REASONS?

/

 

 

 

DOES PAY FOR ABSENTEEISM OR TARDINESS DEFEND ON WHETHER THE CALL THAT
REPORTED THE ABSENTEEISM OR TARDINESS IS MADE BY ~——N'_T—T—__THE ABSE R TARDY
EMPLOYEE?

 

es no

L

 

CAN AN EMPLOYEE ACCUMULATE PAID SICK LEAVE? yes no

 

WHAT IS THE MAXIMUM AMOUNT OF PAID SICK LEAVE TIME THAT EMPLOYEES CAN
ACCUMULATE?

 

 

 

IF THE SICK LEAVE IS NOT TAKEN BEFORE THE EMPLOYEE RETIRES OR LEAVES
THE DEPARTMENT FOR OTHER REASONS, IS HE COMPENSATED WITH PAY FOR

 

none
1/2
all
other

 

 

 

 

 

DO YOU OFTEN FIND EMPLOYEES USING ALL OR SOME OF THEIR SICK TIME WHEN
ANTICIPATING A LEAVE OR RETIREMENT?

yes no
WHEN AN EMPLOYEE IS ABSENT FOR AN EXTENDED PERIOD, DOES HE

 

 

call the day befbre he returns and notify supervisory personnel
of his anticipated return

if out fOr illness of others, report to physician and bring in a
statement of validation

if out fOr personal illness, report to his physician and bring a
statement of validation plus report to employee's health clinic
in order to obtain a work clearance

other

 

 

 

23. WHAT ACTION IS TAKEN WHEN THE LEVEL OF DEPARTMENTAL TOLERANCE IS REACHED
FOR ABSENTEEISM AND TARDINESS? (dietary employees)

 

ACTIONS ' ABSENTEEISM TARDINESS

Change shift if person has
problems in reporting on duty
at his scheduled time

 

 

Re-assign person to another
area of hospital if it is
found that absenteeism or
tardiness is due to lack of AA
job satisfaction

 

oral warning

 

 

written warning

 

suspension

 

length

 

dismissal

 

others

 

 

 

 

 

b) IS THE SAME TYPE OF ACTION TAKEN FOR DEPARTMENTAL ADMINISTRATIVE AND/OR
SUPERVISORY PERSONNEL?

 

 

yes no
IF NO, WHAT ACTION IS TAKEN FOR ADMINISTRATIVE 0R SUPERVISORY PERSONNEL?

 

 

 

COMMENTS:

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