Hospital food service: a comparative analysis of systems and introducing the 'Steamplicity' concept.
ABSTRACT Patient meals are an integral part of treatment hence the provision and consumption of a balanced diet, essential to aid recovery. A number of food service systems are used to provide meals and the Steamplicity concept has recently been introduced. This seeks, through the application of a static, extended choice menu, revised patient ordering procedures, new cooking processes and individual patient food heated/cooked at ward level, to address some of the current hospital food service concerns. The aim of this small-scale study, therefore, was to compare a cook-chill food service operation against Steamplicity. Specifically, the goals were to measure food intake and wastage at ward level; 'stakeholders' (i.e. patients, staff, etc.) satisfaction with both systems; and patients' acceptability of the food provided.
The study used both quantitative (self-completed patient questionnaires, n = 52) and qualitative methods (semi-structured interviews, n = 16) with appropriate stakeholders including medical and food service staff, patients and their visitors.
Patients preferred the Steamplicity system overall and in particular in terms of food choice, ordering, delivery and food quality. Wastage was considerably less with the Steamplicity system, although care must be taken to ensure that poor operating procedures do not negate this advantage. When the total weight of food consumed in the ward at each meal is divided by the number of main courses served, at lunch, the mean intake with the cook-chill system was 202 g whilst that for the Steamplicity system was 282 g and for the evening meal, 226 g compared with 310 g.
The results of this small study suggest that Steamplicity is more acceptable to patients and encourages the consumption of larger portions. Further evaluation of the Steamplicity system is warranted.
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ABSTRACT: 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.Journal of nutrition in gerontology and geriatrics. 01/2013; 32(3):175-212.
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ABSTRACT: OBJECTIVE: Patients often do not eat/drink enough during hospitalization. To enable patients to meet their energy and nutritional requirements, food and catering service quality and staff support are therefore important. We assessed patients' satisfaction with hospital food and investigated aspects influencing it. DESIGN: We conducted a cross-sectional study collecting patients' preferences using a slightly modified version of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ). Factor analysis was carried out to reduce the number of food-quality and staff-issue variables. Univariate and multivariate ordinal categorical regression models were used to assess the association between food quality, staff issues, patients' characteristics, hospital recovery aspects and overall foodservice satisfaction (OS). SETTING: A university hospital in Florence, Italy, in the period November-December 2009. SUBJECTS: Hospital patients aged 18+ years (n 927). RESULTS: Of the 1288 questionnaires distributed, 927 were returned completely or partially filled in by patients and 603 were considered eligible for analysis. Four factors (explained variance 64·3 %, Cronbach's alpha α C = 0.856), i.e. food quality (FQ; α C = 0·74), meal service quality (MSQ; α C = 0·73), hunger and quantity (HQ; α C = 0·74) and staff/service issues (SI; α C = 0·65), were extracted from seventeen items. Items investigating staff/service issues were the most positively rated while certain items investigating food quality were the least positively rated. After ordinal multiple regression analysis, OS was only significantly associated with the four factors: FQ, MSQ, HQ and SI (OR = 17·2, 6·16, 3·09 and 1·75, respectively, P < 0·001), and gender (OR = 1·53, P = 0·024). CONCLUSIONS: The most positively scored aspects of foodservice concerned staff/service, whereas food quality was considered less positive. The aspects that most influenced patients' satisfaction were those related to food quality.Public Health Nutrition 08/2012; · 2.25 Impact Factor
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ABSTRACT: This study investigated the generation of trolley food waste at the ward level in a hospital in order to provide recommendations for how practice could be changed to reduce food waste. Three separate focus group discussions were held with 4 nurses, 4 dietitians and 4 service assistants engaged in food service. Furthermore, single qualitative interviews were conducted with a nurse, a dietitian and 2 service assistants. Observations of procedures around trolley food serving were carried out during lunch and supper for a total of 10 weekdays in two different wards. All unserved food items discarded as waste were weighed after each service. Analysis of interview and observation data revealed 5 key themes. The findings indicate that trolley food waste generation is a practice embedded within the limitations related to the procedures of meal ordering. This includes portion size choices and delivery, communication, tools for menu information, portioning and monitoring of food waste, as well as the use of unserved food. Considering positive changes to these can be a way forward to develop strategies to reduce trolley food waste at the ward level.Appetite 08/2014; · 2.54 Impact Factor
Hospital foodservice: a comparative analysis of systems and introducing
the ‘Steamplicity’ concept
J.S.A. EDWARDS AND H.J. HARTWELL The Worshipful Company of Cooks
Research Centre, Bournemouth University, Talbot Campus, Poole, Dorset, BH12 5BB
Corresponding author: Heather Hartwell, Tel: 01202 595585 e-mail:
Key words: institution, satisfaction, wastage, food intake
Word count: 7,060
This manuscript has not been published elsewhere and it has not been submitted
simultaneously for publication elsewhere.
Patient meals are an integral part of treatment hence the provision and consumption of a
balanced diet, essential to aid recovery. A number of food service systems are used to
provide meals but recently, the ‘Steamplicity’ concept has been introduced. This seeks,
through the application of a static, extended choice menu, revised patient ordering
procedures, new cooking processes and individual patient food cooked at ward level, to
address some of the current hospital food service concerns.
The purpose of this study was to directly compare selected aspects (food wastage at
ward level; satisfaction with systems and food provided) of a traditional cook-chill food
service operation against ‘Steamplicity’. Results indicate that patients preferred the
‘Steamplicty’ system in all areas: food choice, ordering, delivery, food quality and
overall. Wastage was considerably less with the ‘Steamplicity’ system; although care
must be taken to ensure that poor operating procedures do not negate this advantage.
When the total weight of food consumed in the ward at each meal is divided by the
number of main courses served, results show that at lunch, mean intake with the cook-
chill system was 202g whilst that for the ‘Steamplicity’ system was 282g and for the
evening meal, 226g compared with 310g.
Patient meals are an integral part of hospital treatment and the consumption of a
balanced diet, crucial to aid recovery (Stratton et al, 2006). Even so, it is well
established that up to 40% of patients may be undernourished on admittance to hospital;
a situation which is not always rectified during their stay (McWhirter and Pennington,
1994). The relevance and importance of patient meal service, when compared with
many clinical activities is not always appreciated and it is often seen as an area where
budgetary cuts will have least impact. This is particularly so as nursing staff are under
pressure to follow a medical/technical model of healthcare rather than one focused on
the fundamentals of nursing. Rapid turnover of patients also prioritises clinical
considerations. The provision of a foodservice system that optimises patient food and
nutrient intake together with minimising waste, in the most cost effective manner, is
therefore seen as essential.
Previous research has shown that food preference and acceptance constitutes 50% of the
variability in consumption (Cardello et al, 1996), and is not only a result of the intrinsic
quality of the food; but can also be related to consumer expectations and the degree to
which the food item matches them (Oh, 2000). Sensory characteristics, such as
appearance, flavour, texture and temperature have been found to be most important to
hospital patients when judging food quality (Clark, 1998). Temperature and texture are
key attributes of hospital food that have been shown to indicate patient satisfaction with
the food as served (Hartwell, 2004) with the temperature of hot food an area of patient
dissatisfaction and a regular cause for complaint (Stanga et al, 2003). It should therefore
be the goal of any hospital food service manager to prepare, distribute and serve safe
food of defined standards in respect of nutritional quality, balance, palatability and
temperature (Davis and Bristow, 1999).
Foodservice operations can be classified into three main styles (Jones and Lockwood,
1. Integrated foodservice systems: both food production and foodservice are carried
out as part of a single operation.
2. Food manufacturing systems: production of meals is separate from the service of
those meals, thus there is a decoupling of service from production, such as in
3. Food delivery systems: the operation involves little or no food production and
focuses only on the service of continuously assembled or regenerated meals.
Here there is decoupling and production lining.
This model can be developed and since the mid 1970s, a number of food production
system have been introduced which have sought to maintain current service levels but at
a reduced cost. These have included systems such as ‘Cook-Serve’, ‘Cook-Freeze’,
‘Cook-Chill’ and ‘Sous Vide’. More recently; the ‘Steamplicity’ concept has been
developed which has sought, through the use of a static, extended choice menu, revised
patient ordering procedures, new cooking processes and individual patient food cooked
at ward level, to address some of the current hospital foodservice concerns. Various
systems have been applied to increase profitability through bulk buying power, higher
productivity, better equipment utilisation and process control (Rogers, 2005). However,
selection is dependent on the environment and consumer profile, all physical, financial,
technological and operational issues need to be considered.
A cook-serve system is a ‘traditional’ catering operation where food is prepared and
cooked on site and distributed at the appropriate temperature to the wards, either already
plated or in bulk. This system allows for batch cooking which minimises hot-holding
and nutrient losses and optimises the food’s sensory characteristics as it can be prepared
close to the time required. However, in practice there can be a substantial time delay
between production and consumption as wards are often situated a long way from the
kitchens. The result is that many of the potential advantages are not realised.
In this system, food is cooked and held at a temperature of 70 - 750 C or more for at
least two minutes. Chilling occurs within 30 minutes of cooking and the temperature of
the food is reduced to 0-30C within 90 minutes. This temperature is maintained
throughout the storage and distribution cycle until regeneration occurs. Regeneration
can either be centrally controlled or carried out at ward level. However, a core
temperature of 70 - 750C must be reached for a minimum of 2 minutes for
microbiological reasons. In this system, dishes may be stored chilled for up to 5 days,
however, after reheating the food should be consumed immediately (Department of
Health, 1989). Advantages are higher efficiency and lower food costs based on bulk
buying and centralised purchasing while disadvantages number temperature control
which may compromise food safety and nutritional content (Hwang et al, 1999).
Sous vide is a variation of a cook-chill operation. Systems based upon large scale
production methods and the use of vacuum packaging, either before or after cooking, in
combination with the chilling techniques of cook-chill, were developed initially for the
institutional catering sector in Sweden (Schafheitle and Light, 1989).
Sous vide involves placing the food into heat stable, air and moisture high barrier plastic
bags or pouches. Air is then removed creating a vacuum with subsequent sealing of the
pouch. A pasteurising cooking process takes place followed by immediate rapid chilling
within 90 minutes to 0-30C. The product must then be stored within this temperature
range until required for consumption, but within five days of the date of production