The hospital food service environment has radically changed over the past decade. One key factor is the focus on the financial picture, with an increased emphasis on the catering department to operate as a profit centre rather than as a cost centre. Another key trend is a customer-oriented food service where the meal follows the patient rather than the food served at a set time on a given ward. Patients should also be provided with a reasonable choice and increasingly be informed about the dietary value and composition of the meals. Over the past few years, several strategies have been developed about how best to bring together multi-disciplinary approaches to food and food service in hospitals. Nurses, physicians, dietitians and facility managers - caterers looked for synergies between their work areas to improve productivity. This was to ensure that patients would experience a seamless service from the different departments involved in providing high-class, modern hospitality-oriented meal services in hospitals. In 2003 already the Council of Europe resolution emphasised the developing focus on the patient food experience.
But nutrition in hospitals has been a subject of concern for many years now, and constitutes the core function of hospital food services. According to Kowanko (1997), patient outcome can be improved and costs reduced if appropriate nutrition is ensured in hospital. The cost of treating a malnourished patient developing complications is two to four times greater than treatment of a well-nourished patient with no complications (Edwards and Nash, 1997). Despite an increased awareness of the issue, there is little evidence of general improvement in Belgium and The Netherlands. The lack of status afforded to the whole area of food and nutrition in hospitals has been highlighted in the literature, together with a blurring of roles concerning responsibility for nutrition and overall service to patients. It would seem that there is potential for operational tension unless roles are clearly defined and communicated. This appears to apply in a situation where food services are outsourced, as well as in a situation where food services are contracted internally.
While significant research focusing on the patient experience has been conducted in the past, little is known about the perceptions and goals of various stakeholders such as the management, dietitians, medical staff and the (external) caterer regarding hospital food services. The aim of this research is therefore to explore the perception of these stakeholders in 7 acute care hospitals in Belgium and the Netherlands, leaning on a qualitative multiple-case study. The hospitals are clustered in 4 Groups (A, B, C and D). This research aims to highlight the importance and relevance of hospitable food services in the context of acute hospitals in both countries. The project is done in collaboration with a major private caterer operating in the healthcare sector, as well as with CELTH (Centre of Expertise in Leisure, Tourism & Hospitality). Two Dutch Universities of Applied Sciences have collaborated on this research project, in interaction with the field:
NHTV University of Applied Sciences - Academy of Hotel and Facility Management
Stenden University of Applied Sciences - The Academy of International Hospitality Research (AIHR)
The demand of the industry partner (private caterer) was very specific as from the start of the research: pretty often the caterer experiences the lack of recognition towards food services when working for healthcare institutions in the Benelux. In order to help overcome this hurdle, the company asked for an academic piece of work that would help placing food services high on the agenda of hospitals in Belgium and The Netherlands. Although this research can be considered as an industry report and provides concrete guidelines for operational practices, the theoretical underpinning and methodological approach is explored in detail for the (academic) reasons mentioned here above.
Considering the results of this research, it is relevant to note that, across hospitals involved, food services is given more importance in The Netherlands than in Belgium. In The Netherlands, food services form a way to achieve differentiation from competitors and enable positioning in an increasingly competitive marketplace. The goals and visions of the different foodservice stakeholders in The Netherlands do display higher levels of alignment and concurrent achievability, when compared to the goals and visions of the Belgian hospitals. All Groups involved in this research illustrate there is room for improvement with regards to elements pointed at in the literature: a lack of coordinated approach between nurses, dieticians and practitioners, lack of interdepartmental communication and lack of shared responsibility when it comes down to food services. The output of the research leads to a set of recommendations for operational practices, tackling 6 elements:
1. The importance and relevance of improving interdepartmental communication when it comes down to food services.
2. The relevance of involving all stakeholders concerned when redesigning food processes, at an early stage of the process already.
3. The need to further educate all stakeholders about the importance of nutrition in acute hospitals.
4. The need for (external) caterers to highlight their technical skills, taking into account the specificities of developing and producing menus for the healthcare sector.
5. Clarifying the task division related to food is imperative, specifically when it comes to assisting patients with eating.
6. Understanding that the healthcare sector is moving towards customization of food services, almost on individual bases and eventually integrating pre-and post-hospital stay. Such (surgical) diets may reduce the costs in healthcare, enabling patients to enter surgery directly after admission to the hospital and ensure earlier dismissals.
Overall, the quality of the foodservice provided is influenced by the relationships and interactions that take place between the various stakeholders. Therefore, ensuring that each stakeholder is able to perform in alignment with other stakeholders can be valuable to any hospital – and this research’ aim is to further develop awareness of the importance in ensuring food services of high quality.
Keywords: healthcare, food (services), hospitality, nutrition, goal alignment, communication, dietitians, facilities management.