Food and Nutrition Champions in Residential Aged Care Homes Are Key for Sustainable Systems Change within Foodservices; Results from a Qualitative Study of Stakeholders

The role of foodservices in aged care is difficult to understand, and strategies to improve the nutritional care of residents are often unsustainable. In particular, food-first strategies such as food fortification are poorly executed in everyday practice and its execution relies upon the foodservice system in aged care homes. The aim of this study was to explore the perspective of staff on the role of foodservices in aged care and gauge the level of skills, education, access, time, and ability to deliver food fortification. Semi-structured interviews were conducted with foodservice managers, foodservice workers, dietitians, carers, and other managers who work in aged care homes across Australia. Participants were recruited purposively through email and through snowballing. Interviews (n = 21) were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Three themes and six sub-themes were identified. The three themes include the role of foodservices being more than just serving food, teamwork between all staff to champion nutrition, and workplace culture that values continuous improvement. These themes identify how staff perceive the role of foodservices in aged care and provide an important perspective on the long-term sustainability of food fortification strategies and how to improve current practice.     

Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review

BackgroundHospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal).ObjectiveTo systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice.MethodsEight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively.ResultsFrom 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients’ intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this.ConclusionThe literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.     

Planning for progress, productivity, and performance

A project is described for the interim renovation of a labor intensive existing foodservice facility. The renovated area will provide effective food management during the hospital's redevelopment period, including a new foodservice. Objectives of the interim project were to conserve labor while emphasizing control and centralization, provide economic foodservices with improved quality, and incorporate one tray distribution system throughout the hospital complex. Immediate measures were necessary in order to generate funds to proceed. Renovations had to occur without disrupting food-service to patients. The project was planned over a three year period and included an ingredient control area, two patient tray service centres, a renewed production kitchen and test kitchen facility. Each phase has been financed on the understanding that the costs of construction and equipment will be repaid within one fiscal year of operating the renovated facility. Positive results are being achieved, attributable to the support and encouragement received from staff during the change process.     

Resources,Barriers, and Tradeoffs: A Mixed Methods Analysis of School Pre-Consumer Food Waste

BackgroundFood waste is a global problem. School food waste before the point of purchase, pre-consumer waste, has been little studied.ObjectiveOur aim was to elicit a comprehensive assessment and understanding of pre-consumer food waste amounts, behaviors, policies, and attitudes.DesignThis study used mixed methods, featuring a convergent parallel design using key respondent interviews (n=20) and 80 hours of structured kitchen observations, including food waste measurement.Participants/settingSchool and district kitchens (n=14) using stratified random sampling to ensure school level and kitchen type reflected the population of three Colorado school districts in 2016-2017. Kitchen managers, district-level nutrition services directors, and sustainability staff were interviewed.Statistical analyses performedMean food waste volumes and percentages were calculated. Linear regressions were used to determine the relationship between school kitchen characteristics and food waste volumes. Interviews were coded to identify common themes.ResultsTrim waste and overproduction contributed the most to overall pre-consumer food waste; substandard foods and overproduction were the most common reasons for edible waste. Several competing priorities conflicted with schools’ and districts’ waste reduction efforts: food safety, promoting diet quality, food choice, and customer satisfaction. Batch cooking, production record use, shallow salad bar pans, and other inventory management techniques facilitated waste reduction. Staffing, space, and time constraints made it more difficult to implement these strategies. Increased food choice options were positively associated with pre-consumer waste volume (β=49.5, P=0.04), and this relationship remained significant once regression models adjusted for district, salad bar use, and new menu items (β=70.3, P=0.05).ConclusionsSchool nutrition programs are complex, and a systems approach is warranted to reduce overall waste in the context of existing food safety and nutrition policies. More research is needed to elucidate the impact of food choice on overall food waste of the school meal system.     

Costing Foodservices in Aged Care Is More Than Food Alone: The Development of the FCT

Foodservices in residential aged-care homes (RACHs) play a vital role in providing meals and maintaining residents’ health through good nutrition. However, foodservices are often required to work within a budget, and the costs involved in foodservices are often misunderstood and underestimated. The aim of this work was to design a costing tool that included all relevant costs of a foodservice. A systems approach was used to inform the development of the Foodservice Costing Tool (FCT). Eight domains were identified, including costs that are both directly and indirectly associated with foodservices. The tool was piloted and trialled in the Australian aged-care setting and compared to currently available national estimates of costs. Through four pilots and subsequent trials, the FCT was able to capture the costs of a foodservice system in a small sample of RACHs, although the low response rate may have biased the sample toward those homes that had fewer problems with the FCT. The results highlighted the limitations of currently reported estimates, which underestimate total costs, as they fail to encompass the complexity of foodservices and to recognise that costs extend beyond the kitchen. The FCT is a useful tool and has the potential to be used by RACHs to both measure and understand their costs at a more granular level to ensure cost effectiveness and accountability. Further research is required to validate the tool and investigate the implementation of the FCT on a larger scale.     

Consumer evaluation of hospital foodservice quality: an empirical investigation

PURPOSE: The purpose of this article is to estimate the relationship between acute care consumers' satisfaction with hospital foodservices, foodservice characteristics, demographic and contextual variables. DDESIGN/METHODOLOGY/APPROACH: The acute care hospital foodservice patient satisfaction questionnaire was administered to 2347 patients in Queensland, Australia from 1996-2001. Regression analysis was conducted to measure the influence of 21 foodservice attributes and seven contextual/demographic items on overall foodservice satisfaction. FFINDINGS: Foodservice satisfaction was strongly associated with variety, flavour, meat texture, temperature, meal taste, and menu staff (p < 0.01). Consumers aged 70 years or more rated their overall satisfaction significantly lower than younger consumers (p < 0.01), but no statistically significant differences in overall ratings existed for other contextual or demographic groups. RESEARCH LIMITATIONS/IMPLICATIONS: This new foodservice instrument and the methods of analysis may be generalisable, but application is likely to be context-specific. Further applications of the instrument are required to produce greater confidence in its validity and reliability across different foodservice settings. PRACTICAL IMPLICATIONS: Global statements often used in health service satisfaction surveys (e.g. a single rating of "food quality") provide insufficient information to allow managers to adapt foodservices to suit consumers' preferences. ORIGINALITY/VALUE: Detailed information of the kind produced here is required for the formulation of managerial and sectoral policies to improve the quality of health and consumer nutrition care. The findings are noteworthy and, as far as the literature review showed, no previously published study has produced this level of detail on consumer preferences across foodservice attributes or their relationship to overall foodservice satisfaction.     

Computer use and undergraduate education for computer use in Canadian health care foodservices

Surveys were conducted to assess the computer use in 50 selected Canadian health care foodservice facilities and to determine the educational preparation for computer use in seven selected Canadian post-secondary education institutions which educate potential foodservice personnel. Both the foodservices and post-secondary educational institutions selected were represented at two workshops on computer-assisted foodservice management held in June 1980 and in May 1981. Only seven facilities used a computer for foodservice functions; nine foodservices planned to use a computer within the next two years. A list of applications in use, being planned and of future interest showed the priority areas for these foodservices. Only one post-secondary educational institution actually had an educational foodservice application for student use. The other six educational foodservice facilities covered the subject matter content by readings, lectures and discussions.     

A Systems Examination of Food Packaging and Other Single-Use Item Waste in School Nutrition Programs

ObjectiveIdentify types of food packaging used in school nutrition programs and competing priorities, barriers, and facilitators for sustainable packaging waste use and recovery.DesignQualitative interviews (n = 20) and structured kitchen observations were conducted.SettingData were collected from 3 school districts in Northern Colorado.ParticipantsThree nutrition program directors, 14 kitchen managers, and 3 sustainability staff.Phenomenon of InterestBarriers and facilitators for sustainable food packaging waste practices among school nutrition programs.AnalysisInterviews were recorded and transcribed, followed by inductive content analysis to identify themes.ResultsCommonly used food packaging included cardboard, aluminum, paper, plastic, and styrofoam. Four competing priorities were identified as impacting school nutrition programs’ ability to reduce or recover food packaging: serving line speed, labor, food quality, and cost. One key barrier was that school staff had difficulty understanding the total system impact of their food packaging use and recovery decisions.Conclusions and ImplicationsFood packaging is commonly used in school nutrition programs, and participants felt that its use offered key benefits, such as facilitating faster serving lines. More research is needed to quantify the direct and indirect impacts of packaging waste reduction and recovery in school nutrition programs.     

Computer use and educational needs in selected Canadian health care food services

A survey was conducted to assess the computer use in 27 selected Canadian health care food service facilities and the educational needs in computerization of the corresponding foodservice administrators. The foodservices selected were represented by foodservice administrators at a workshop on computer-assisted foodservice managements held in June 1980. Only three facilities used a computer for foodservice functions: seven foodservices planned to use a computer within the next two years. A list of applications in use, being planned and of future interest showed the priority areas for these foodservices. The foodservice administrators identified their educational needs in computerization and demonstrated that a one to two day workshop was their preferred educational program format.     

Dietary,Food Service,and Mealtime Interventions to Promote Food Intake in Acute Care Adult Patients

Malnutrition is common in acute care hospitals. During hospitalization, poor appetite, medical interventions, and food access issues can impair food intake leading to iatrogenic malnutrition. Nutritional support is a common intervention with demonstrated effectiveness. “Food first” approaches have also been developed and evaluated. This scoping review identified and summarized 35 studies (41 citations) that described and/or evaluated dietary, foodservice, or mealtime interventions with a food first focus. There were few randomized control trials. Individualized dietary treatment leads to improved food intake and other positive outcomes. Foodservices that promote point-of-care food selection are promising, but further research with food intake and nutritional outcomes is needed. Protected mealtimes have had insufficient implementation, leading to mixed results, while mealtime assistance, particularly provided by volunteers or dietary staff, appears to promote food intake. A few innovative strategies were identified but further research to develop and evaluate food first approaches is needed.     

Written Messages Improve Edible Food Waste Behaviors in a University Dining Facility

BackgroundSustainability and going green have become popular trends among foodservice organizations. Despite this interest, foodservice operations still produce large amounts of edible food waste and contribute significantly to waste management problems.ObjectiveThe purpose of this operational study was to determine how to introduce food waste behavior change into a dining facility using a simple message-type intervention that requires little sustained administrative support and can provide optimum effect.DesignThe population for this study was 540 university students living in residence halls and participating in a meal plan. This study assessed whether simple prompt-type message interventions had an influence or if the addition of more personally relevant feedback-based data elicited greater change in student beliefs and food waste behaviors. A written questionnaire and individual student tray waste tracking were used to gather data. Simple print-format messages were evaluated, allowing the effect of an affordable message campaign to be determined.ResultsStudents had a higher-than-neutral level of belief, but did not indicate a strong conviction toward environmental sustainability or food waste. The edible food items disposed of on 19,046 trays in this all-you-care-to-eat university dining operation were evaluated. On average, more than 57 g edible food was disposed of per tray, accumulating to >1.5 tons of food waste during the 6-week study. The simple to-the-point prompt-type message stimulated a 15% reduction in food waste. The addition of a more personalized feedback-based message did not stimulate an additional change beyond that of the prompt message.ConclusionsThese findings indicate that simply making university students aware of the topic of food waste may be useful in improving their behaviors and the sustainability of the foodservice facility.     

Repurposing Waste Streams: Lessons on Integrating Hospital Food Waste into a Community Garden

There have been increasing efforts in recent decades to divert institutional food waste into composting programs. As major producers of food waste who must increasingly demonstrate community benefit, hospitals have an incentive to develop such programs. In this article, we explain the emerging opportunity to link hospitals’ food services to local community gardens in order to implement robust composting programs. We describe a partnership model at our hospital in central Pennsylvania, share preliminary outcomes establishing feasibility, and offer guidance for future efforts. We also demonstrate that the integration of medical students in such efforts can foster systems thinking in the development of programs to manage hospital waste streams in more ecologically-friendly ways.     

How do the work environment and work safety differ between the dry and wet kitchen foodservice facilities?

In order to create a worker-friendly environment for institutional foodservice, facilities operating with a dry kitchen system have been recommended. This study was designed to compare the work safety and work environment of foodservice between wet and dry kitchen systems. Data were obtained using questionnaires with a target group of 303 staff at 57 foodservice operations. Dry kitchen facilities were constructed after 2006, which had a higher construction cost and more finishing floors with anti-slip tiles, and in which employees more wore non-slip footwear than wet kitchen (76.7%). The kitchen temperature and muscular pain were the most frequently reported employees'' discomfort factors in the two systems, and, in the wet kitchen, "noise of kitchen" was also frequently reported as a discomfort. Dietitian and employees rated the less slippery and slip related incidents in dry kitchens than those of wet kitchen. Fryer area, ware-washing area, and plate waste table were the slippery areas and the causes were different between the functional areas. The risk for current leakage was rated significantly higher in wet kitchens by dietitians. In addition, the ware-washing area was found to be where employees felt the highest risk of electrical shock. Muscular pain (72.2%), arthritis (39.1%), hard-of-hearing (46.6%) and psychological stress (47.0%) were experienced by employees more than once a month, particularly in the wet kitchen. In conclusion, the dry kitchen system was found to be more efficient for food and work safety because of its superior design and well managed practices.     

Food production and wastage in relation to nutritional intake in a general district hospital--wastage is not reduced by training the staff

BACKGROUND AND AIMS: To assess the amount of food produced in a hospital kitchen and the amount wasted. To assess the amount of food eaten by patients in relation to their energy needs. To assess whether the food production and wastage could be reduced by training members of the staff. METHODS: The study was carried out in a general district hospital in Denmark. The amount of food produced in the hospital kitchen and returned uneaten (wasted) was determined. In a representative sample of patients, the energy expenditure was calculated and in the same patients, the energy and protein intake was determined. Following training of the hospital staff the first part was repeated. RESULTS: On average, 11.1 MJ and 112 g of protein were ordered per patient per day. From these amounts on average 3.1 MJ and 33 g protein were wasted per patient per day. The total average energy expenditure was calculated to be 7.5 MJ per patient per day; however, on average, the daily energy intake was only 4.5 MJ and daily protein intake 46 g per patient. Sixty percent of the patients showed evidence of malnutrition as judged from the hospital notes. However, the staff only drew attention to this in 20% of the cases. Following training of the hospital staff, a new investigation showed no significant changes in the amount of food ordered and wasted. CONCLUSION: Despite a supply of food, which was much higher than the patients' needs, the patients have only approx. 60% of their energy need covered. We suggest a reorganization of nutrition in hospitals, so that this is made the responsibility of specific staff members.     

Obstacles to Nutrition Labeling in Restaurants

Objective This study determined the major obstacles that foodservices face regarding nutrition labeling.Design Survey questionnaire was conducted in May 1994. In addition to demographic questions, the directors were asked questions addressing willingness, current practices, and perceived obstacles related to nutrition labeling.Subjects/setting Sixty-eight research and development directors of the largest foodservice corporations as shown in Restaurants &. Institutions magazine's list of the top 400 largest foodservices (July 1993).Statistical analyses performed P tests were used to determine significance within a group for the number of foodservices that were currently using nutrition labeling, perceived impact of nutrition labeling on sales, and perceived responsibility to add nutrition labels. Regression analysis was used to determine the importance of factors on willingness to label.Results Response rate was 45.3%. Most companies were neutral about their willingness to use nutrition labeling. Two thirds of the respondents were not currently using nutrition labels. Only one third thought that it was the foodservice's responsibility to provide such information. Several companies perceived that nutrition labeling would have a potentially negative effect on annual sales volume. Major obstacles were identified as menu or personnel related, rather than cost related. Menu-related obstacles included too many menu variations, limited space on the menu for labeling, and loss of flexibility in changing the menu. Personnel-related obstacles included difficulty in training employees to implement nutrition labeling, and not enough time for foodservice personnel to implement nutrition labeling.Applications Numerous opportunities will be created for dietetics professionals in helping foodservices overcome these menu- or personnel-related obstacles. J Am Diet Assoc. 1997; 97:157–161.     

基于不同外包模式的医院后勤服务人员工作嵌入评价研究

目的比较独家外包和多家外包两种模式下上海市三级公立医院后勤服务人员工作嵌入水平,为提升医院后勤服务管理水平提供参考。方法对上海市17家三级公立医院的第三方公司管理者和保洁人员进行问卷调查,应用R4.0.3软件进行数据分析。结果多家外包模式下,公司管理者和保洁人员的平均年龄、保洁人员税后月收入均高于独家外包模式,女性占比高于男性;两种模式下管理者工作嵌入水平均高于保洁人员;管理者和保洁人员对医院和公司工作嵌入水平整体上差异无统计学意义。结论建议独家模式在工作中引入良性竞争机制,以激发工作人员主观能动性,进一步提升其工作嵌入水平;多家模式加强外包人员工作冲突管理,提高其对医院的依附感;管理者激励应注重促进职业发展和专业能力提升,保洁人员管理应重点关注薪酬的绝对水平和公平性。     

Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost

Background

Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs.

Exploring patient satisfaction with foodservice through focus groups and meal rounds

The purpose of this study was to investigate adult patients' perceptions of hospital foodservice through focus groups with patients postdischarge and with nurses. The focus group themes included an emphasis on health, quality, freshness, and appropriateness; variety, selection, and choice; inability to provide feedback; menu errors; accessibility to food on the units; service; tray layout; and waste. The themes emerging from the focus groups were further explored through meal round interviews with patients (n=116) to determine areas for improvement. Patients thought food served in the hospital should be a model for a healthy diet. Ongoing education and communication with patients and nurses is important in improving satisfaction with foodservice.