Health Care Foodservice Research Articles

Conventional and digital technologies for measuring and monitoring food waste in the healthcare foodservice

ABSTRACT Monitoring and measurement are crucial activities in managing and reducing the impact of food waste. In Europe, the average food waste per person was estimated at 131 kg, with approximately 10% originating from restaurants and foodservice. Unfortunately, there is a lack of detailed information regarding food waste in hospital settings. Despite this, effective hospital food management plays a significant role in the environmental, social, and economic well-being of patients, and is closely linked to their nutrition and recovery prospects. This research examines key studies on hospital food waste management, focusing on practical implications and identifying strategies for improving sustainability in hospital foodservice through artificial intelligence technologies. It explores emerging trends, opportunities, and challenges in measuring and monitoring food waste while considering patient satisfaction and nutrition as critical factors for sustainable healthcare systems, through a semi-integrative literature review. Precisely, the amount of food waste per patient per day varies depending on the meal, with breakfast waste at about 0.08 kg, lunch waste ranging from 0.15 to 0.47 kg, and dinner waste between 0.11 and 0.48 kg, with the highest values recorded for lunch. Furthermore, considering the imperative to improve data precision, this study introduces current solutions that integrate artificial intelligence, 3D scanners, and digital scales to classify food categories, measure waste quantities, and assess the corresponding economic and environmental impacts. This research is intended for both academic and industry professionals in the foodservice sector, providing valuable insights into developing environmentally friendly strategies and achieving sustainability goals.

The Global Research Trends on Food Waste At Healthcare Setting: A Bibliometric Analysis Using Scopus Database

The issue of food waste has garnered much attention globally due to its adverse impacts on the economy, food security, natural resources, the environment, and human health. Despite this, the academic literature lacks systematic, historical, and synthesising investigations on healthcare food waste. This bibliometrics analysis study aims to summarise the growing trends of food waste publications and highlight common and potential research topics of food waste in healthcare settings. The Scopus database analysed 193 journal articles published between 1952 and 2022. We identified several common and potential research topics for future research in the area, including food waste and malnutrition, related intervention strategies, the impact of healthcare food service systems on food waste, and their economic and environmental impact. Healthcare food waste research in developing nations is still limited. Thus, it is recommended that policymakers support its development as one of the steps to encounter food waste.

Healthiness and sustainability of food service in healthcare settings in Germany

Abstract Background Current dietary patterns threaten individual and planetary health. Healthcare settings can set a positive example for dietary change, but data on the quality of food they offer is scarce. The aim of our study was to assess the environmental footprint and nutritional quality of food service in hospitals and nursing homes in Germany. Methods We collected 6-12 months of food procurement data and all available meal plans from three nursing homes and two hospitals in Germany. Procured food items were categorized into 50 food groups (e.g., potatoes, beef, apples), and the environmental footprint was calculated (i.e., land use, greenhouse gas (GHG) emissions, acidification, eutrophication, and water use) using life-cycle analysis factors based on a recent meta-analysis. Lunches from a representative week were broken down into their constituent ingredients and analyzed for adherence to the Planetary Health Diet (PHD) using an established dietary index (PHDI). Results Preliminary analysis of one nursing home and one hospital showed that animal-source foods (ASF) accounted for 70% of overall GHG emissions and land use and 76% of water use, primarily from beef, pork, milk, and cheese. Among plant-based foods, coffee disproportionately contributed to the environmental footprint. Red meat accounted for 30-45% of lunch calories consumed (13-25% of weight) and potatoes accounted for 20-24% of calories (31-35% of weight), whereas vegetables and legumes combined accounted for 11-15% of calories (33-35% of weight). Nursing home meals achieved 61 and hospital meals 71 out of 150 points on the PHDI. Conclusions Healthcare institutions in Germany have poor adherence to the PHD, with up to two-thirds of calories derived from red meat and potatoes. Unsurprisingly, ASF account for the majority of the institutions’ environmental food footprint. Policies to make healthcare foodservice more environmentally sustainable while ensuring nutritional adequacy are urgently needed. Key messages • Foodservice in German hospitals and nursing homes is neither healthy nor environmentally sustainable. • Policies are needed to improve healthcare food service for individual and planetary health.

Local food procurement by hospitals: a scoping review.

Local food procurement by hospitals is gaining traction as governments and advocacy groups seek to influence food systems and strengthen local communities, but there is little empirical evidence as to its practical application or efficacy. The aims of this review were to describe the extent, range and nature of local food procurement models in healthcare foodservices, and to understand the barriers and enablers to implementation, including from the perspective of stakeholders across the supply chain. A scoping review was conducted following the protocol published in the Open Science Framework Registration (DOI: 10.17605/OSF.IO/T3AX2). Five electronic databases were searched for the following concepts: 'hospital foodservice', 'local food procurement practices', 'the extent, range and nature' and/or 'the barriers and enablers of procurement'. Eligible peer-reviewed original research published in English from the year 2000 was included following a two-step selection process. The final library included nine studies. Most studies (7 of 9) were from the United States. Three studies used survey methods and reported high rates (58%-91%) of US hospital participation in local food procurement. Studies offered minimal description of local procurement models, but two models, conventional ('on-contract') or off-contract, were typically used. Barriers to local food procurement included restricted access to suitable local food supply, limited kitchen resources and inadequate technology to trace local food purchase thereby limiting evaluation capabilities. Enablers included organisational support, passionate champions and opportunistic, incremental change. There is a paucity of peer-reviewed studies describing local food procurement by hospitals. Details of local food procurement models were generally lacking: categorisable as either purchases made 'on-contract' via conventional means or 'off-contract'. If hospital foodservices are to increase their local food procurement, they require access to a suitable, reliable and traceable supply, that acknowledges their complexity and budgetary constraints.

აუთსორსინგის განვითარების პერსპექტივები სამედიცინო სფეროში

Outsourcing is an increasingly popular business practice of hiring a party outside a company to perform services and control the rising costs of providing different services. Outsourcing is a practice usually undertaken by companies as a cost-cutting measure. Companies use outsourcing to cut labor costs, including salaries for their personnel, overhead, equipment and technology. Outsourcing is associated to high quality lower cost services. The use of outsourcing is highly effective in healthcare. When properly managed, outsourcing helps improve patient care and maximize staff efficiency. But it is relatively new field, with some specific considerations; for example, security threats can amp up when multiple parties can access sensitive data as patients’ personal information. Outsourcing in the field of healthcare can be used in completely different directions, including the possibility of delegating certain key functions to specialized organizations. The advantage of outsourcing is primarily the economic benefits. At the same time, outsourcing services peripheral to the organization’s primary operations may also enable healthcare administrators and staff to concentrate more efficiently on their organization’s core business. The most significant reasons for outsourcing are to improve customer service, to reduce costs, to enable healthcare organizations to focus on core activities and to increase flexibility to configure resources to meet rapidly changing medical market needs. However, the most significant risks of outsourcing lie in the need to develop new management competencies, capabilities and decision-making processes. this task requires serious analysis and a comprehensive audit of the costs and revenues of a particular organization. Outsourcing laundry services, security, healthcare food service and nutrition, medical tourism accommodation and transportation are the most popular and well-developed in healthcare system, while clinical service outsourcing is relatively new field with specific considerations including high-quality patient care as well as many unintended results, such as, inconsistencies in standards of care.

Development, Validation, and Testing of a Self-Assessment Tool to Measure Food Safety Beliefs, Attitudes, and Behaviors in Health Care Food Service Operations

The neutropenic diet has long been a dietary prescription for immunocompromised patients. However, its effectiveness and consistency have been constantly challenged. Researchers and health care policymakers call for liberalization of the neutropenic diet, which shifts risk management strategies from excluding "high-risk" food items to focus on safe food handling. The responsibility of food safety falls on food service workers in a health care setting. The objective of the present study was to develop and conduct psychometric testing to determine the validity and reliability of a self-assessment survey instrument tool targeting beliefs, attitudes, and behaviors of health care food service workers regarding safe food handling practices. This survey validation study was conducted in four phases. First, the tool was developed based on the Theory of Planned Behavior. After the initial draft, the survey was tested to establish face validity and test-retest reliability to measure temporal stability. The 40-item survey was then pilot tested to assess internal consistency and construct validity. Pilot testing was conducted over a 16-month period on 211 health care food service workers across six acute care hospitals that serve immunocompromised people. The original survey comprised 46 items. Six items were removed due to low content validity scores and temporal instability. Pilot testing revealed acceptable internal consistency (Cronbach's alpha = 0.79). The linear regression model was a good fit (P ≤ 0.0001) after assumptions were tested and met to predict behavior from attitude. A reliable and valid self-assessment survey instrument tool was developed for use in a health care food service operation. Results of this tool can help organizations pinpoint areas in which they can improve food safety practices of food service workers who serve immunocompromised people.

Approaches to patient satisfaction measurement of the healthcare food services: A systematic review.

Monitoring consumer's satisfaction is important in ensuring effective foodservice improvements and to provide a patient-centred foodservice experience. The aim of this study is to systematically review available patient foodservice satisfaction survey instruments developed and validated within the acute and long-term care settings. A literature search of four scientific databases was performed to identify relevant studies with 50 participants or greater. Study characteristics, such as identifying information, contexts, and descriptive data regarding the tool and its evaluation study, were extracted and synthesised. Quality appraisal of individual studies was undertaken to assess the risk of bias during data collection. Majority of the survey instruments included utilised a quantitative research approach in the form of self- or interview-administered questionnaires. Tools within the long-term care settings were more likely to be administered via interviews using a shorter and even rating scale, potentially resulting in a higher degree of bias and reduced data sensitivity. Food quality was consistently shown to be the main predictor of the overall satisfaction in food services. Factors that are context-specific to the settings, opportunities to allow open-ended comments, and the involvement of patients' perspectives in instrument development were also critical in improving survey quality. The available validated survey instruments are generally valid and of acceptable quality, enabling effective foodservice satisfaction measurement in the healthcare settings. Nonetheless, gaps have been identified in the literature with limited evidence available for foodservice satisfaction measurement within the paediatric settings, supporting the value of future research in this field.

Impact of electronic bedside meal ordering systems on dietary intake, patient satisfaction, plate waste and costs: A systematic literature review.

AimHospital foodservices provide an important opportunity to deliver valuable dietary support to patients, address hospital‐acquired malnutrition risk and enhance patient satisfaction. Modifying the meal ordering process through the adoption of technology may actively engage patients in the process and provide an opportunity to influence patient and organisational outcomes. This systematic review was undertaken to evaluate the impact of electronic bedside meal ordering systems in hospitals on patient dietary intake, patient satisfaction, plate waste and costs.MethodsA systematic search following PRISMA guidelines was conducted across MEDLINE, CINAHL, EMBASE and Web of Science for randomised controlled trials and observational studies comparing the effect of electronic bedside meal ordering systems with traditional menus on dietary intake, patient satisfaction, plate waste and cost. The quality of included studies was assessed using the Quality Criteria Checklist for Primary Research tool.ResultsFive studies involving 720 patients were included. Given the heterogeneity of the included studies, the results were narratively synthesised. Electronic bedside meal ordering systems positively impacted patient dietary intake, patient satisfaction, plate waste and costs compared with traditional menus.ConclusionsDespite the increase in healthcare foodservices adopting digital health solutions, there is limited research specifically measuring the impact of electronic bedside meal ordering systems on patient and organisational outcomes. This study highlights potential benefits of electronic bedside meal ordering systems for hospitals using traditional paper menu systems, while also identifying the need for continued research to generate evidence to understand the impact of this change and inform future successful innovations.

A Novel Model for Flexible Staffing in Unionized Healthcare Foodservice Departments

develop a flexible staffing model for foodservice operations in both unionized and non-unionized healthcare facilities.

Comparing Food Provided and Wasted before and after Implementing Measures against Food Waste in Three Healthcare Food Service Facilities

The aim of the study was to reduce food waste in a hospital, a hospital cafeteria, and a residential home by applying a participatory approach in which the employees were integrated into the process of developing and implementing measures. Initially, a process analysis was undertaken to identify the processes and structures existing in each institution. This included a 2-week measurement of the quantities of food produced and wasted. After implementing the measures, a second measurement was conducted and the results of the two measurements were compared. The average waste rate in the residential home was significantly reduced from 21.4% to 13.4% and from 19.8% to 12.8% in the cafeteria. In the hospital, the average waste rate remained constant (25.6% and 26.3% during the reference and control measurements). However, quantities of average daily food provided and wasted per person in the hospital declined. Minimizing overproduction, i.e., aligning the quantity of meals produced to that required, is essential to reducing serving losses. Compliance of meal quality and quantity with customer expectations, needs, and preferences, i.e., the individualization of food supply, reduces plate waste. Moreover, establishing an efficient communication structure involving all actors along the food supply chain contributes to decreasing food waste.

【ミニシンポジウム報告】／日清医療食品の事業戦略とメニュー開発

Nissin Healthcare Food Service Co., Ltd., as a leading company of health care food service business, has provided meal services to medical, welfare, and child-care facilities, and has expanded its scope of business into home-delivery meal services. The outsourcing of food supply services has proceeded for the purpose of service improvement, operational efficiencies, and cost reduction, and the customers' demands have stretched to menu development, foodstuffs procurement as well as management of human resources. The company offers meals prepared with both cook-chill and cook-served systems with proper balance, and is planning to start providing high eating-quality soft food prepared with the cook-chill method to the elderly.

Farm-to-Hospital Research Findings Point to Opportunities for Extension

Extension has a history of local foods programming around farm to institution. But connections with hospitals, an industry sector with significant potential for increased local food purchasing, appear limited. Hospital outreach could provide inroads for patient and employee education around healthy eating. But does Extension know how to engage healthcare foodservice? Do hospital foodservice directors have knowledge of Extension? This article focuses on intersections at which Extension can approach hospitals to help improve health and the economy through local foods. It is based on findings excerpted from a comprehensive Ohio hospital foodservice director study (n=155) conducted in late 2014.

Dysphagia

Purpose – The purpose of this study was to survey current culinary, hospitality and nutrition students to determine their level of knowledge about dysphagia, or swallowing impairment, and the dysphagia diet. In addition, the study provided a means by which to gauge current students’ awareness of health-care foodservice as a career option. Design/methodology/approach – A pilot study conducted in 2009 indicated that health-care foodservice workers were unaware of many of the risks associated with the dysphagia diet. A second study was conducted in 2012 to obtain an idea of the perceptions and knowledge levels of culinary, hospitality and nutrition students about dysphagia. Subjects included students across the three disciplines at two large universities in the Midwestern USA, and a private culinary school on the east coast of the USA. The instrument consisted of a traditional paper survey containing 18 questions. A total sample size of n = 139 surveys was collected and analyzed. Findings – Results of the survey suggests that current university students are lacking in some areas of knowledge concerning dysphagia patients and their dietary needs. Education and training are indicated, as the number of patients suffering from some degree of dysphagia is only going to increase as the US population ages. Findings also indicate that many introductory-level students are unaware of health-care foodservice as a viable career choice in industry. Research limitations/implications – The primary limitations to this research were the relatively small sample size, and the fact that most students surveyed were not interested or aware of health-care foodservice as a viable industry career choice. This study would be greatly enhanced by contacting professors/instructors at several universities representing the Northeast, Midwest, and east and west coasts of the USA. Educating future foodservice professionals at the introductory level would allow industry leaders to make students aware of this large and necessary sector of the foodservice industry. Likewise, there is no doubt that food preparers, food deliverers and foodservice managers in health care will come in contact with a patient with some level of dysphagia as our population ages. More research to strengthen this body of data is indicated, as are similar studies across broader ranges of the population. Practical implications – The occurrence of dysphagia is growing as the US population ages. That fairly little research has been done is somewhat alarming. There is a need for standardization of recipe formulas, benchmarking viscosities of dietary liquids and solids and training of food preparers. The symptom is found in very large populations in the USA, as well as in Europe. Also, the fact that dysphagia has so many potential causes makes the symptom that much more of a health issue. More research is certainly called for to better prepare potential institutional foodservice employees for the next 20 years. Originality/value – Millions of Americans currently suffer from at least some degree of dysphagia. This number is expected to increase as the Baby Boomer generation reaches retirement age. The USA will be populated by more elderly people than ever before, and will thus host more individuals suffering from swallowing impairment. Health-care foodservice, including hospital and long-term care foodservice will certainly become a viable career choice for current students of culinary arts, nutrition and hospitality.

Healthcare foodservice workers' knowledge of the dysphagia diet

PurposeThe purpose of this paper is to survey current nutrition/foodservice‐related healthcare professionals to determine their level of knowledge about dysphagia, and their perceptions of dysphagic patients and their needs.Design/methodology/approachA data collection instrument in the form of a questionnaire was developed to obtain an idea of the perceptions and knowledge‐level of diet/foodservice‐related healthcare workers about dysphagia. Subjects included foodservice workers, including food preparers and food deliverers at a large healthcare facility in the Southwestern United States. A total sample size of n=51 surveys was collected and analyzed.FindingsGiven the means from this sample group, healthcare foodservice workers are lacking in some areas of knowledge concerning dysphagia patients, and their dietary needs. Education and training seem indicated, as the number of patients suffering from some degree of dysphagia is only going to increase as the US population ages.Originality/valueMillions of Americans currently suffer from at least some degree of dysphagia. This number is expected to increase as the Baby Boomer generation reaches retirement age. The USA will be populated by more elderly people than ever before, and will thus host more individuals suffering from swallowing impairment. This paper adds insights to the subject.

Influence of Nutrition Information Pre- and Post-Purchase in Retail Healthcare Foodservice Operations

Influence of Nutrition Information Pre- and Post-Purchase in Retail Healthcare Foodservice Operations

Environmentally Friendly Health Care Food Services: A Survey of Beliefs, Behaviours, and Attitudes

There is increasing global interest in sustainability and the environment. A hospital/health care food service facility consumes large amounts of resources; therefore, efficiencies in operation can address sustainability. Beliefs, attitudes, and behaviours about environmentally friendly practices in hospital/health care food services were explored in this study. Questionnaires addressed environmentally friendly initiatives in building and equipment, waste management, food, and non-food procurement issues. The 68 participants included hospital food service managers, clinical dietitians, dietary aides, food technicians, and senior management. Data analysis included correlation analysis and descriptive statistics. Average scores for beliefs were high in building and equipment (90%), waste management (94%), and non-food procurement (87%), and lower in food-related initiatives (61%) such as buying locally, buying organic foods, buying sustainable fish products, and reducing animal proteins. Average positive scores for behaviours were positively correlated with beliefs (waste management, p=0.001; food, p=0.000; non-food procurement, p=0.002). Average positive scores for attitude in terms of implementing the initiatives in health care were 74% for building and equipment, 81% for waste management, 70% for non-food procurement, and 36% for food. The difference in food-related beliefs, behaviours, and attitudes suggests the need for education on environmental impacts of food choices. Research is recommended to determine facilitators and barriers to the implementation of green strategies in health care. As food experts, dietitians can lead changes in education, practice, and policy development.

Hospital Foodservice and Patient Experience: What's New?

In 2003, hospital food quality ranked lowest of 10 items measured on a scale of satisfaction, according to a Press Ganey survey of 1.8 million patients ( 1 Press GaneyPress Ganey survey shows patients see room for improvement in hospital quality. Health Care Strategic Management. 2003; 21: 6 Google Scholar ). Since then, hospital foodservice has dramatically remade itself, employing chefs, using more fresh and seasonal ingredients, offering cook-to-order room service, and increasing the number of choices for each meal ( 2 Hill M. Hospitals try cooking up better food for patients. http://news.yahoo.com/s/ap/20110310/ap_on_re_us/us_fea_food_hospital_cuisine_1 Google Scholar ). At California-based Kaiser Permanente, for example, the menu includes citrus-marinated pork loin and barley pilaf, grass-fed beef, and fresh produce straight from farmers' markets ( 2 Hill M. Hospitals try cooking up better food for patients. http://news.yahoo.com/s/ap/20110310/ap_on_re_us/us_fea_food_hospital_cuisine_1 Google Scholar ). Grilled salmon, tilapia, quesadillas, stir-fry, pot roast, and roasted vegetable lasagna are some of the menu items offered at hospitals in Baystate Health in Springfield, MA; Hendricks Regional Health in Danville, IN; and Saint Francis Health System in Tulsa, OK. “There has definitely been a big change from your two-entrée selections to more of a restaurant-style menu,” says Lisette Coston, MBA, RD, LD, director of nutrition and foodservices at Saint Francis Health System in Tulsa, OK, for the last 13 years, and a member of the board of directors for the Association for Healthcare Foodservice. “It follows what we see in our society, with the trend toward much more eating at restaurants. At hospitals patients expect to see the same choices and quality.”

Time-varying production efficiency in the health care foodservice industry: A Bayesian method

Abstract Cost containment, budget control, and improvements in efficiency are key drivers of the way health care foodservice operations (internal hospital foodservice departments that produce/reheat food and deliver them to patients) will respond to emerging economic and population trends. These factors are the motivation for this study, which aims to assist health care policy makers in identifying operational strategies for efficiency improvements. The study applies a Bayesian method in deriving to efficiency estimates, using panel data on key Australian hospitals. The results show that the model satisfies the theoretical economic requirements. Important relationships are identified between the level of meal production and other input and environmental variables. The efficiency results indicate that the performance of health care foodservice operations is improving over time and reached its highest level in the operating year 2007. The paper identifies some factors related to efficiency improvements, and offers some suggestions for future improvement strategies.

‘Going Green’ in Food Services: Can Health Care Adopt Environmentally Friendly Practices?

Sustainability and the environment are issues influencing individual and organizational choices on purchasing, waste management, and energy-saving practices. The food service industry and related stakeholders have reported active pursuit of initiatives to reduce environmental impacts. We examine reported environmentally friendly practices being implemented in the food service industry and consider ways in which health care or hospital food services can adopt some of these programs. Building and equipment, waste management, food, and non-food supplies and procurement are considered. Suggestions are made for small changes to start the green initiative in each of these areas. A health care food service department is a large consumer of resources, and therefore food service workers, managers, dietitians, and administrators can make a significant difference by supporting and adopting environmentally friendly practices. Further studies are needed to determine which practices are currently being implemented in health care facilities in Canada, as well as perceived facilitators and barriers to these practices in the food service area.

Improving the accuracy of DEA efficiency analysis: a bootstrap application to the health care foodservice industry

This article analyses the efficiency of health care foodservice operations and its determinants using a Data Envelopment Analysis (DEA) bootstrapping approach. The purpose of using the bootstrapping approach is two-fold: first, to obtain the bias corrected estimates and the confidence intervals of DEA-efficiency scores and second, to overcome the correlation problem of DEA-efficiency scores and to provide consistent inferences in explaining the determinants of health care foodservice efficiency. The approach was implemented on a sample of 89 health care foodservice operations. The results showed the presence of inefficiency in the sample, with an average efficiency level of 72.6%. Further, the results from analysing the determinants of health care foodservice operations provided policy implication regarding the factors that might improve the efficiency of health care foodservice operations.