Facing hospital malnutrition: When will we understand that a precious ally lies in our catering service leading Chef?

Abstract

From its first official description, 1 Butterworth Jr., C.E. Malnutrition in hospital. JAMA. 1974; 230: 889 Crossref Scopus (42) Google Scholar hospital malnutrition has been many times pointed out as one of the major “health system scandals”. Unfortunately, apart from many surveys, aiming to quantify the dimension of such a problem, 2 Pirlich M. Schütz T. Norman K. et al. The German hospital malnutrition study. Clin Nutr. 2006; 25: 563-572 Abstract Full Text Full Text PDF PubMed Scopus (528) Google Scholar not much has been thought and even less has been done to avoid it. It looks as though we want to fight a war that we have already decided as been lost. But if the war against malnutrition, is what we are engaged in, we must try to find good alliances and struggle together. In this regard, the recent article by Donini et al. 3 Donini L.M. Castellaneta E. De Guglielmi S. et al. Improvement in the quality of the catering service of a rehabilitation hospital. Clin Nutr. 2008; 27: 105-114 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar has clearly highlighted the importance of catering services improvement and the role of both nutritionist and nursing staff. Particularly, when feeding must be personalized. A good example could be the dysphagia. How can a proper texture and homogeneity of our hospital food be achieved if we do not explain the fact that some patients can feed themselves by mouth rather than being fed by a tube depends on the two parameters? For this purpose, the role of different figures should also be emphasized and recognized, and a good example could be the leading Chef. Unfortunately, to the best of our knowledge, there was only an attempt to correctly evaluate this figure in hospital catering: the program “Better Hospital Food” inspired by the British NHS. 4 Better Hospital Food NHS estates department of health NHS. <http://www.betterhospitalfood.com>Date: 2002 Google Scholar The importance was so significant that the use of dishes studied by them was considered as compulsory for all England Hospitals. A very important proposal was to provide a recipe book in order to offer to all hospitals similar standards of catering, starting from simple statements: “…food standards…are variable…too much food is wasted…too much money is spent on food that patients do not eat…too many patients say they are dissatisfied with the services they currently receive…”. Therefore, what could be the proper role of a leading Chef? His role in managing the economic aspects goes without saying; he knows about food and he can give advice on which are the best at the moment, within hospital's budget. An important piece of advice is also how to prepare a good recipe, starting from the nutritional framework of the dietitian. He can also try to collect from the wards what is really found to be tasty and appearance, and to put them into practice. But a leading Chef must have a crucial role in training himself, the catering service staff and all hospital ward in nutritional education (Fig. 1), which is the key to overcome hospital malnutrition and a leading chef is one of our favourite allies to win this important war. In this regard, also recognising the Chef, as well as the other staff members, specific skills and goals may result in less repetitive and unchallenging work, higher levels of work motivation, job satisfaction and overall service improvement. 5 Lee-Ross D. An exploratory study of work motivation among private and public sector hospital chefs in Australia. J Manage Develop. 2001; 21: 576-588 Crossref Scopus (17) Google Scholar