Canadian hospitals are beefing up their meal programs, offering greater choice, personalized service and more local food optionsWhen many Canadians hear the words “hospital food,” they likely conjure up an image of a small tray of wilting broccoli, rubbery chicken, a cup of Jell-O and lukewarm milk, quickly dropped off at a patient’s bedside by a busy nurse. This may be the commonly held perception, but it’s a far cry from the reality at most Canadian hospitals today. As healthcare facilities work hard to keep up with patients’ increasing expectations, they’re offering more choice, personalized service, better-tasting food, a wider variety of cuisines and, most recently, an increase in locally sourced ingredients.
“It’s about bringing hospitality back into the hospital,” says Paul Gauntley, president of Brampton, Ont.-based Burlodge Canada, a supplier of institutional foodservice equipment. When speaking with hospital clients these days, he’s hearing a lot about “face time.” In simple terms, it means hospital staff are actually sitting with patients and discussing meal choices, then interacting with them in a more service- oriented way when bringing meals. This may include asking questions such as ‘Would you like another cup of coffee?’ or ‘Would you like to choose some bread from the bread basket?’ Face-to-face interaction increases the patient’s perception of the meal, says Gauntley. “Patients will report more satisfaction if they’ve had someone there, asking them questions and being involved with them.” Offering an array of choices also gives patients “a sense of control at a time when they’re vulnerable.” Of course, choice is only a good thing if the options are appealing. “Patients need to enjoy their meals and like the food they’re eating,” says Sharon McDonald, president of Mississauga, Ont.-based Compass Group Canada healthcare, which provides foodservice solutions for hospitals across the country. She adds that Canada’s diverse ethnic make-up requires that many Canadian hospitals today would be wise to provide a variety of ethnic cuisines. “There is a huge expectation that we provide meals to meet the diverse needs of Canada’s population,” she says.
Lately, there’s also an expectation that more food will be locally sourced. The local food movement, which is increasing in popularity across the country, has now hit the healthcare sector. Several months ago, Toronto’s St. Michael’s Hospital, for instance, embarked on a plan to bring more local foods into its facility. “We’re looking at our menu and saying here we have this apple, why don’t we make that a local apple?,” says Heather Fletcher, manager of Food Services at St. Michael’s. She’s already implemented a number of new menu items featuring local ingredients, including a popular blueberry crisp using local blueberries. When asked to explain why the hospital is going local Fletcher says, “It’s hard to find reasons not to.” She points to environmental sustainability, supporting the local community and perception: patients typically perceive local goods to be of higher quality. Though still in the early stages, Fletcher says the program is going well but admits she’s run into some logistical glitches. “The logistics of getting the product when you want the product — reliably — is a bit of a challenge,” she explains. “And we’re learning a lot about that — about how to plan so you’re not disappointed and to give yourself enough of a buffer so you can make sure that what you’re expecting is here when you need it.”
Leslie Carson, manager of Food and Nutrition Services at Guelph, Ont.’s St. Joseph’s Health Centre, was an early adopter of the local food movement. She’s been introducing more local items onto her facility’s menu for the past six years. Since Guelph is an agricultural community and many of the facility’s patients have a farming background, she felt it was crucial to go local. “It was not only about providing food our clients like and are used to, but it’s also about respecting their background and supporting local farmers and producers, because that’s something they would want to do,” says Carson.
One of the biggest barriers to adding more local food is its high cost. It’s a huge consideration when working within the tight budgets of our publicly funded healthcare system. But Carson was so passionate about using local ingredients, she structured St. Joseph’s entire foodservice model to support the initiative. “We have a very strict budget with the Ministry of Health, $7.33 a day (per patient) for raw food costs,” she explains. Unlike many healthcare facilities these days, St. Joseph’s places an emphasis on cooking from scratch rather than bringing meals in. Carson has found it’s the most economical way to provide the patients at the 331-bed facility with quality, local, healthy foods.
At St. Michael’s in Toronto, meals are mostly cold-plated and outsourced (from various companies). Fletcher admits the model works best at the large urban hospital. When introducing new locally sourced foods that might be more expensive, she’s simply finding ways to cut back on other food costs to stay within the hospital’s tight budgets. “We’re balancing those items that are a little bit more expensive — like the blueberry crisp, which is a bit of an indulgent item — with other items that are offering us great [economic] value.” Rather than seeing a tight budget as an obstacle, she views it as “an opportunity to be creative.”
In general, the budget constrictions faced by Canadian healthcare providers make operating facilities more challenging, and the shift toward increased “face time” is no exception. This type of personalized service requires more patient level staffing as opposed to kitchen/food prep staffing. In order to ramp up personal service levels, a hospital will have to shift its costs around. “If you find there’s an increase in the direct-care level you need, you can find the savings you need by [tightening up] the back of the house,” says Burlodge’s Gauntley. He points to the cold-plating method as one way to cut costs in back-of-the-house preparations and explains how streamlining tray assembly can also help.
Compass Group Canada’s McDonald agrees that in order to provide more personal service and better food without exceeding budgets, a hospital has to be smart about shifting costs around. Her company has a new food delivery system called Steamplicity, whereby food is freshly prepared and sealed using a patented valve. When heated in a microwave, food is cooked by steam from the natural waters in the food. The food is first prepared offsite at Compass’s “cuisine centre,” then “steamed” in microwaves in each unit of the hospital, rather than at a central hospital kitchen. The Steamplicity model is riding the wave of the patient-focused dining trend: staff will sit down and ask patients what they want to eat approximately an hour and a half before meal time, presenting a restaurantstyle menu offering diverse options. Overall, the costs involved with this system are no higher, says McDonald, “Hospitals have had to move around costs. So instead of having staff in the main kitchen preparing the meals, the staff are now up on the patient units.”
Toronto’s North York General Hospital implemented Steamplicity last year. The hospital’s chief planning officer, Tony Humphries, is thrilled with it. The hospital made the change because its large central kitchen, which was originally built in 1968, was in need of an overhaul. Completely redoing the kitchen would have required a huge capital outlay, but when the hospital investigated Steamplicity, it found the cost of implementing the model (including the construction of a small preparation pantry in each unit) is a small fraction of the cost of a new kitchen system. It was admittedly a challenge to find the space for each pantry, but a solution was found, and the team hasn’t looked back since. Humphries says the food quality has greatly exceeded everyone’s expectations, and there’s significantly less waste because patients choose their own food. Overall, Humphries thinks outsourcing foodservice was a smart move, as it allows his hospital to focus on what it does best — taking care of patients.
When it comes to the latest foodservice trends, it’s important to remember each hospital must evaluate its needs and decide which trends fit best with its own culture before making major changes. St. Joseph’s Carson compares foodservice to the fashion industry with regard to its propensity to jump on the latest fad. But she cautions hospitals to “make intelligent decisions based on a long-term vision. Trends are good, but they are trends. They do change.” That said, once a hospital does decide on a particular change or initiative, budgetary constraints shouldn’t hold anyone back if they’re willing to work at coming up with creative solutions. As St. Michael’s Fletcher notes, hospital foodservice administrators “are very good at managing budgets, and we always find a way to make things that are important to us happen. If you’re willing to try something different, if you’re willing to take something apart and put it back together again, you can end up with something really fantastic in the end.”
HEALTHY FOOD FOR ONE AND ALL
When it comes to serving patients, providing healthy, nutritious food is a priority at all hospitals. But what about the hospital visitors, or doctors and nurses, who grab lunch in the cafeteria? This June, the Alberta Health Services launched a Healthy Eating Environment Policy aimed at promoting health and wellness in all aspects of the hospital environment throughout the province. “What we’re trying to do is have an environment within our healthcare facilities that makes healthy eating the easy choice for all. We want to go about doing this in an all-encompassing manner,” says Susan McKay, vice-president of Nutrition and Food Services for the Edmonton-based government organization. This includes vending machines, cafeterias and anywhere else within a healthcare facility where food is sold.
“We’ve seen a lot of this sort of movement in schools,” says McKay, pointing to the recent efforts across North America to offer healthier options in school cafeterias. “But the public is quite naturally saying, ‘What about healthcare? Why is it when I go into a healthcare facility, all I can get to eat is a chocolate bar or chips from a vending machine?’”
As part of the initiative, Alberta Health Services, which oversees 400 facilities throughout the province, including hospitals, clinics, continuing care facilities, mental health facilities and community health sites, is working closely with its vending machine suppliers to make healthier options available. This means providing lower-sodium snacks, bottled water instead of just pop or juice and smaller portions of everything. It isn’t easy. They’ve encountered numerous challenges along the way, including finding smaller-portioned packages of food for the machines and finding items that have the proper packaging requirement for Canada (most items from the U.S. don’t have the required French text, for instance.) It’s an ongoing process, and they’ll continue to work on improving the healthful content of their vending machines.
Cafeterias are also a major focus, but McKay admits some Albertans are worried about a total nutrition overhaul in the cafeterias. Some have argued it’s emotionally draining to visit friends or family in the hospital, so shouldn’t they be able to get their fix of greasy fries when they’re feeling stressed? “It is a high-stress environment, so people do have different opinions on how much we should push [healthy eating] and risk becoming ‘the food [police].’ We certainly don’t want to go too far in that direction either,” says McKay. “We just want to make healthy eating the easy choice.” To that end, plans are in motion to make healthy choices more front-and-centre in the cafeteria — not having the salads hidden behind the chips, for instance — and simply making healthy options more appealing. “We need to make healthy food easy, make it so it doesn’t break the bank, and, most of all, make it yummy,” says McKay.
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