Each year, the Canadian healthcare system spends more than $4 billion on food, $745 million in Ontario alone. And yet of this, up to 54 per cent of the food ends up as waste. Add to this Canada’s increasingly diverse and aging population, the demands imposed by the pandemic and fixed per-day funding model, Canada’s healthcare foodservice operators, dietitians and suppliers to innovate to respond to this ever-growing challenge.
Limited Resources, Unlimited Opportunity
“With only $11 per day food cost available for three meals and two snacks a day, Canadian hospitals need to continue to adapt their foodservices operations to meet the changing needs of their patients,” states Doug Feltmate, principal consultant, Planned Foodservices Solutions in Ottawa.
The recent pandemic put increased pressure on overstretched budgets and staffing levels. In an effort to balance budget demands and quality patient foodservices, many hospitals turned to bulk purchase of frozen, fully prepared meals. Healthcare operators then use ‘re-thermalization’ to thaw, cold plate and then re-heat/chill foods prior to service. This allows operators to assembly patient trays well in advance of meal service, resulting in labour savings of upward of 30 per cent.
In July 2021, Cambridge Memorial Hospital, a 174-bed acute care facility moved to a brand-new ‘kitchen’ equipped with a new tray assembly system, dishwasher and removal of other equipment. All food arrives frozen and then is thawed and cold plated.. Once assemble and trayed, Cambridge uses re-thermalization to heat or cool food which is then transported to patient wards. “We are working in conjunction with CBord to launch a patient-ordering app in September 2022 to increase patient choice. Cambridge is excited to be the first hospital in Canada to utilize an app to provide this service,” explains Nicole Evans, manager Food and Environmental Services.
Annette Giffen, RVP at Compass Group, one of Canada’s leading contract healthcare contract caterers’ states, “While many of our newer hospitals are using re-thermalization, others are incorporating steam technology — something Compass provides through our Steamplicity Model. We also see a trend back to cook from scratch and on-site production.”
Looking Across Canada
Across Canada, patient food production varies. “More facilities across Canada, expecially in British Columbia are interested in reusable trayware. For the last 26 years,most hospitals used cook-chill plating. However, we are now seeing a movement back to hot plating with B-Pod, RTS and now Logiko. There is also a growing movement to fresh and local on-site food production to stimulate the local economy,” explains Paul Gauntley, president of Burlodge Canada & U.S.A., Canada’s leading provider of patient meal assembly and delivery systems.
In Alberta and Saskatchewan, there is a mixture of hot and cold-plating assembly being used, while Ontario predominately uses cook chill and cold plating due to its efficiency. An increasing number of the province’s hospitals, including Sunnybrook Health Sciences in Toronto, Royal Victoria Hospital in Barrie and Ontario Shores in Whitby, use their own kitchens for food production then blast chill food onsite.
“In recent years, we’re seeing a shift back to on-site freshly prepared and plant-forward menus particularly in Ontario and B.C.,” explains Donna Bishop, senior director of Growth Enablement and Business Process for Aramark Canada.
Quebec’s focus on gastronomy continues in the healthcare setting, while Eastern Canada is similar to Ontario and B.C. Nova Scotia, however, is also experimenting with mixed hybrid models based on patient mix.
Change for the better
Just as in restaurants, patient menus are also experiencing significant change. Hospitals are shifting to a light continental breakfast with coffee or tea, while lunches are also lighter with wraps, salads and cold options increasingly available. Hospital food is also becoming more culturally diverse, including incorporating various ethnic and Indigenous menus and ingredients.
Meal preparation that supports being able to eat food with minimal assistance is also a major trend. “In recent years, we’ve seen a trend to more patient-friendly, finger and hand-held foods as the more patients can eat independently, the better it is for their mental and physical health,” explains Bishop.
Local Foods, Sustainable Practices
“There’s also a major trend towards sustainability and bringing more local food to patient dining. With fixed budgets, hospitals are serving less but better-quality meats and more plant proteins,” explains Jen Reynolds, co-executive director, Nourish Leadership, a non-profit network of leaders who work collaboratively to build better health for both people and the planet.
Amy Ford of St Joseph’s Health Care in London, Ont. and Nourish Anchor Collaborator adds, “Sustainability has now been added as one of our foodservice pillars in our menu-development process. In recent years, we’ve moved from 20 to 40 per cent of food production onsite and continue to focus on this.”
As part of its partnership with Nourish, St. Joseph is making plans to break ground on a 12,000-sq.-ft. greenhouse in the near future. which will hopefully grow up to 50 per cent of the produce they purchase for the 1,000 patients and residents they feed daily. “Our goal in the first year is to focus on one crop — tomatoes — then add in heirloom carrots, fresh herbs and onions,” explains Ford.
Nourish has also developed a Sustainability Menu Guide for healthcare providers, which is built on six values, including health, social and environmental priorities.
Hospitals are also looking for ways to reduce packaging waste. “We have moved from single use plastic domes, bowls and cutlery, reducing our single-use plastic by 1.2 million units a year, often replacing them with re-usable cups,” says Helen Van de Mark, director, Patient Support Services at St. Joseph’s Healthcare in Hamilton, Ont. “Using less packages reduces barriers to eating and saves money, which we re-invested in higher protein foods and a snack program.”
Where to next?
When asked what’s ahead, directors of Nutrition Services agree — innovation will be driven by their patients’ evolving needs. “Ask yourself what it would be like to not be able to open a juice container or wait hours for a meal because of the time of day you were admitted. Patient stories like that drive innovation,” says Van der Mark.
As in other industries, technology will become increasingly critical in nutrition services. “While we are seeing some robotics in delivery of tray carts to wards, individual trays still need to be carried to patients,” explains Gauntly.
Dramatically increasing food prices and supplier shortages have also plagued patient-foodservice operations, forcing them to be even more nimble. “As we continue to see rising inflation and labour shortages, we anticipate there might be a move to increase outsourcing,” adds Giffen.
There is no doubt that technology will continue to play a role. Facial recognition software is almost ready to use, whereby patient’s food preferences, diet restrictions et cetera are automatically identified.
“How healthcare operators will create menus and produce and serve food will also continue to adapt,” explains Feltmate. “Menu ingredients, portion and plate size and even how food is plated will become much more integrated. Menus will be designed for cost and efficiency around each of these issues in addition to taste and nutritional value.”
By Morag McKenzie