ALTERNATIVES ANALYSIS

The Westinghouse Study Team concentrated on a systems analysis

of those improvement areas which affect the construction, space
requirements, and operating costs of the reference hospital. The eleven
functional areas analyzed in this study are called "functional subsystems,"
although these areas often relate to management options which cross many
functional lines. The eleven areas considered are:

Private Rooms versus Conventional Bed Mix.

With the exceptions of construction and private rooms versus the conventional bed mix, the analysis methodology is given for each functional subsystem in the portion of this section devoted to the various subsystems. Construction and bed mix are analyzed as potential improvement alternatives to the improved hospital and are discussed in the Improved Hospital Design

and Construction section.

Dietary System

Technical Approach

Each dietary alternative was evaluated by the following criteria:
Life-cycle cost. Investment and equipment costs were derived for
the investment costs of each system. Operating costs considered
were personnel by skill level, food, maintenance and operations,
and supplies. To account for the cost of money and inflation, all
costs during the 25-year life cycle of the system were discounted
to net present values.

• Ability to provide an acceptable quality of food. Each system was

judged on its ability to provide quality in terms of patient acceptability and sufficient variety to make possible a three-week menu cycle.

The following baseline data were collected at the reference hospital and were used to determine costs for both the reference and the improved hospital:

In the reference hospital, 35 percent of all inpatient meals served are special diets. The percentage of special diets for extended care patients averages about 40 percent.

The number of inpatient meals will increase by three meals per day per additional occupied bed. For cafeteria meals, the increase will be proportionally the same as now, or approximately .35 cafeteria meals per inpatient meal. For this analysis, the total annual meals served is:

The percentage of special diets will be assumed to remain constant. • The average annual costs of the four levels of personnel

required in the dietary department are:

Total Annual Per
Person Cost

$13,569

10,443

8,510

Costs per square foot of construction, as determined by MDA,

are $55.51. Twenty to thirty square feet of space per bed is

considered adequate for a hospital in the bed-size range considered

(410 beds expanding to 530 in 1981).

Maintenance and operations costs are 4.7 percent annually of

equipment and construction costs combined.

Supplies costs are $.040 per meal.

Existing Dietary System

The following quantitative description of the reference hospital's con-
ventional dietary system is based on an interview with the chief dietitian
at the reference hospital and from financial, operating, and inventory
reports:

Food Costs -- the current total food cost for the reference hospital was
reported at $228,046, which is the actual yearly food expenditure.
This results in the following per meal costs which will be used in the analy
Food Cost/Meal

5

Using the current food cost per type of meal at the

reference hospital, the projected total food cost is $317,316 in 1971, $451,380 in 1980, $464, 689 in 1981, and $597,457 in 1996.

Floor Space

-

the initial design of the dietary system

allocated 32.35 square feet of dietary space per bed for a
hospital of 410 beds (244 acute care, 128 extended care,
38 rehabilitative). Since the planned hospital expansion will
yield a ratio of 25 square feet per bed, this space is adequate
to handle the increase in workload projected through 1996.
The total space allocated to the dietary department is
13,262 square feet. This space is used as follows:

5

An additional 4,800 square feet are available for eating areas in the extended care facilities. This area does not affect the food system chosen and is not included in the analysis.

Total construction cost, based on $55,51 per square foot, is

$736,173.

Equipment Costs

-

$209,180 is the reported present value of

equipment at the reference hospital.

Equipment costs would increase for additional ward, food preparation, and cleaning equipment. However, the increase will probably be only half the initial investment rate, or $255 per new bed, totaling $30,600.

Maintenance Costs

-

These costs are not specifically documented for the food service department. The following

are costs allocated in proportion to the department area, actual costs:

Equipment maintenance and mechanical

operations

Plant maintenance

not

$31,488 per year

$12,979 per year

The total annual cost of maintenance and operations is thus $44,467, or 4.7 percent of the cost of equipment and construction costs combined. This will be used for the analysis.

Personnel Costs A total of 45.6 full-time equivalents (FTE) work in the food service department of the reference hospital: five dietitians or supervisory personnel with an average annual salary of $10,560; seven cooks, including two head cooks, with an average annual salary of $8,127; and 33.6 kitchen helpers, dishwashers, and pantry helpers, with an average annual salary of $6,623.