Designing a Methodological Framework to Assess Meal and Food service Quality on Patient Satisfaction in Outsourced Hospital Settings: A Study Protocol
Keywords:
Meal Quality, Foodservice Quality, Patient Satisfaction, Plate Waste, Outsourced Hospital Foodservice, Study ProtocolAbstract
Introduction:
This study protocol addresses challenges in delivering patient-centred nutritional care in Malaysian public hospitals with outsourced foodservice systems. Despite reported patient satisfaction, persistently high plate waste indicates unmet expectations in both meal quality and service performance. The objective of this cross-sectional quantitative study is to investigate the influence of meal quality and foodservice quality on patient satisfaction, considering plate waste as a mediator with appetite and length of hospital stay as moderators.
Methods:
The study involves adult inpatients from three major public tertiary hospitals in Selangor, Malaysia, that have implemented outsourced foodservice systems. A validated structured questionnaire will evaluate meal quality, foodservice quality, plate waste, appetite, length of stay and satisfaction. Structural Equation Modelling (SEM) will be used to assess direct, indirect, mediation, and moderation effects, following a theoretical framework based on Expectation-Disconfirmation Theory and Patient-Centred Care Models.
Significance:
This study aims to provide actionable insights for healthcare administrators, dietitians, and policymakers by addressing both sensory and service-related aspects of hospital food to improve patient nutrition, reduce plate waste, and increase overall satisfaction in outsourced hospital foodservice settings.
References
Aminuddin, N. F., Kumari Vijayakumaran, R., & Abdul Razak, S. (2018). Patient Satisfaction with Hospital Food service and its Impact on Plate Waste in Public Hospitals in East Malaysia. Hospital Practices and Research, 3(3), 90–97. https://doi.org/10.15171/hpr.2018.20
Busra, N. N., Abdullah, S. N. D., Ngah, H. C., & Samsudin, A. (2017). Government Hospitals Food Quality and Patient Satisfaction. Journal of Tourism, Hospitality & Culinary Arts, 9(2), 593-602.
Chad Saus. (2020). Foodservice Satisfaction Levels Among Patients in Private Hospitals in Kwazulu-Natal. Faculty of Management Sciences at the Durban University of Technology.
Epstein, R. M., & Street, R. L. (2011). The Values and Value of Patient-Centered Care. The Annals of Family Medicine, 9(2), 100–103. https://doi.org/10.1370/afm.1239
Haerani, R. S., Jus’at, I., & Tahjoo, A. (2020). The Relationship Between Quality of Food and Nutrition Services and Patient Loyalty with Mediated Patient Satisfaction at X Hospital Bogor. Journal of Multidisciplinary Academica.
Hartwell, H. J., Edwards, J. S. A., & Symonds, C. (2006). Foodservice In Hospital: Development of A Theoretical Model for Patient Experience and Satisfaction Using One Hospital in The UK National Health Service as A Case Study*. Journal of Foodservice, 17(5–6), 226–238. https://doi.org/10.1111/j.1745-4506.2006.00040.x
Iqbal, M., Susetyowati, S., & Purba, M. B. (2017). The Effects of Room Service to Improve Patients’ Food Satisfaction and Food Acceptance. Gizi Indonesia, 39(2), 103. https://doi.org/10.36457/gizindo.v39i2.213
Justesen, L. (2014). Hospitable Meals in Hospitals Co-creating a passion for food with patients. Aalborg Universitet.
Keller, H., Allard, J., Vesnaver, E., Laporte, M., Gramlich, L., Bernier, P., Davidson, B., Duerksen, D., Jeejeebhoy, K., & Payette, H. (2015). Barriers To Food Intake in Acute Care Hospitals: A Report of the Canadian Malnutrition Task Force. Journal of Human Nutrition and Dietetics, 28(6), 546–557. https://doi.org/10.1111/jhn.12314
Lai, H., & Gemming, L. (2021). Approaches To Patient Satisfaction Measurement of The Healthcare Food Services: A Systematic Review. Clinical Nutrition ESPEN, 42, 61–72. https://doi.org/10.1016/j.clnesp.2020.12.019
Manimaran, S., Razalli, N. H., Manaf, Z. A., & Shahar, S. (2025). Challenges And Strategies to Reduce Food Waste in Malaysian Hospitals from The Perspective of Multidisciplinary Professionals: A Qualitative Descriptive Study. BMC Health Services Research, 25(1), 224. https://doi.org/10.1186/s12913-025-12365-w
Moorthy, J. M., Ruzalee, R. S. binti, Hafizon, D. M. P. binti, & Razalli, N. H. binti R. (2024). Therapeutic Diet Plate Waste and Satisfaction Among Adult Patients. Malaysian Journal of Nutrition, 30(2). https://doi.org/10.31246/mjn-2023-0128
Osman, N. S., Md Nor, N., Md Sharif, M. S., Hamid, S. B. A., & Rahamat, S. (2021). Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review. Nutrients, 13(10), 3649. https://doi.org/10.3390/nu13103649
Osman, N. S., Md Nor, N., Md Sharif, M. S., Rahamat, S., & Abdul Hamid, S. B. (2022). Barriers and Challenges of an Outsource Hospital Foodservice Operation: A Narrative Thematic Analysis. Malaysian Journal of Medicine and Health Sciences, 18(s15), 97–107. https://doi.org/10.47836/mjmhs.18.s15.14
Osman, N. S., Md Nor, N., Mustafa, N., Rusali, R., & Ishak, R. (2023). Hospital Food Service Quality Improvement Questionnaire (HFSQIQ): Development, Translation and Validation of a Questionnaire. Journal of Health and Translational Medicine, sp2023(1), 196–211. https://doi.org/10.22452/jummec.sp2023no2.22
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL A Multiple-item Scale for Measuring Consumer Perceptions of Service Quality. Journal of Retailing.
Razalli, N. H., Cheah, C. F., Mohammad, N. M. A., & Abdul Manaf, Z. (2021). Plate Waste Study Among Hospitalised Patients Receiving Texture-Modified Diet. Nutrition Research and Practice, 15(5), 655. https://doi.org/10.4162/nrp.2021.15.5.655
Safarian M, Alinezhad-Nameghi M, Vafisani F, Asadi Z, & Seyedhamzeh Sh. (2019). Patient Satisfaction with Hospital Food in the Hospitals Affiliated to Mashhad University of Medical Sciences, Iran. Nutrition Fasting Health. 2018; 6(4): 191-197. DOI: 10.22038/JNFH.2019.32579.1141.
Sarstedt, M., Hair, J. F., Cheah, J.-H., Becker, J.-M., & Ringle, C. M. (2019). How to Specify, Estimate, and Validate Higher-Order Constructs in PLS-SEM. Australasian Marketing Journal, 27(3), 197–211. https://doi.org/10.1016/j.ausmj.2019.05.003
Sathiaraj, E., Priya, K., Chakraborthy, S., & Rajagopal, R. (2019). Patient-Centered Foodservice Model Improves Body Weight, Nutritional Intake and Patient Satisfaction in Patients Undergoing Cancer Treatment. Nutrition and Cancer, 71(3), 418–423. https://doi.org/10.1080/01635581.2018.1506490
Schiavone, S., Pistone, M. T., Finale, E., Guala, A., & Attena, F. (2020). Patient Satisfaction and Food Waste in Obstetrics and Gynaecology Wards. Patient Preference and Adherence, Volume 14, 1381–1388. https://doi.org/10.2147/PPA.S256314
Setiawan, F., Antonio, F., Marsaulina, R. P., Hadinata, V., Utomo, A. L., Alexandra, C., Ramadhana, R., & Catharina, C. (2024). Navigating Hospital Foodservice Satisfaction: Insights from Importance-Performance Map Analysis. AcTion: Aceh Nutrition Journal, 9(2), 270. https://doi.org/10.30867/action.v9i2.1572
Wright, O., Capra, S., & Aliakbari, J. (2003). A Comparison Of Two Measures Of Hospital Foodservice Satisfaction. Australian Health Review, 26(1), 70. https://doi.org/10.1071/AH030070
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