Decreasing Time Burden of Plate Waste Studies in School Cafeterias

The QI project was implemented during a 5-day school week at one project site. PDSA was the key tool used. MCDPH staff used a simple one-page PDSA tracker to identify change theories and make predictions each day (Plan) before conducting the plate waste study using the previously identified process (Do). The time it took to complete the plate waste study was recorded along with staff assessments of the accuracy and amount of disruption to the students. The site team then reviewed this information; results, observations, and lessons learned were recorded on the PDSA tracker (Study), and changes or continuations for the following day were brainstormed (Act). This process was repeated each of the 5 days the plate waste study was conducted, resulting in five documented PDSA cycles. In cycle 1, students brought trays to an empty table, where pictures of each plate were taken to document waste, and milk was measured. This process created confusion among students, who were used to carrying their own trays to the trash. Consequently, not all trays were captured (accuracy score of 3), and it was determined that more table space and a better process for systematically capturing pictures of the trays were needed. In cycle 2, more table space and an additional staff member were used. This allowed the staff to document, measure, and dispose of the waste much quicker, so fewer trays piled up. Accuracy improved a bit (accuracy score of 4) with more staff attentively directing students. During cycle 3, it was decided to direct students to leave their trays at the table instead of having them bring them to the measuring station. This alleviated the students' confusion and made the process faster. An accuracy score of 5 was attained for the first time this cycle. Although the process of carrying trays to the measurement table after students had left them made the process go smoother, emptying the milk cartons proved to slow things down. For cycle 4, students were again instructed to leave their trays at the table, and a change to how the milk was measured was made; cartons were opened, and milk was deposited into the weighing can before the tray was transported to the measurement table. An accuracy score of 5 was maintained, and the time was slightly faster. For cycle 5, a slight adjustment to staff roles was made—having two people instead of one working on the milk cartons. This further improved the time while still maintaining the high level of accuracy.

A phone timer was used to record how long the study took to complete, and accuracy was self-assessed by implementing staff based on their recollections of student interaction and visual assessment of trash cans. These data were recorded daily during each PDSA cycle on the PDSA tracker sheet. Furthermore, during the reflection phase of each PDSA cycle, the implementing staff recorded qualitative observations about how students and school staff reacted to the process in order to gauge disruption. This was considered a balancing measure for the initiative.