By Marissa Trout

The world is shifting into a post-pandemic era, as many refer to it. What does this mean for hospital and healthcare food service operations? Families are facing challenges at home in their kitchens, and it is no surprise that hospital kitchens face the same challenges but on a much grander scale. 

Product availability, product substitutions, labor shortages, supply chain issues and declines in customer service from vendors are a few of the issues that have a bearing on the patient and family experience. If the local grocery store is out of avocados, there is no guacamole for dinner. Instead, people pivot and make salsa or pico de gallo. 

The effect is far more significant in healthcare operations and impacts the patient’s experience. Hippocrates, the Greek founder of western medicine, said, "Let food be thy medicine and medicine be they food." This could not be a more valid statement for patients in hospitals. In another quote by Hippocrates, “de alimento”, a word about food creatively translated as, "Some foods provide a cure while other foods can make you sicker. The effect can vary." 

Focus on accuracy 

Food is prescriptive in acute care hospital settings. A physician's order drives a patient's diet order. Just as a physician prescribes medications and treatments, physicians prescribe patients' diet orders. 

The food and nutrition services (FNS) department is responsible for ensuring patients receive the proper food allowed on their diets. Conversely, this means the FNS team is to ensure patients do not receive foods not allowed on their diets. Just as a pharmacist must not dispense the incorrect medication, kitchens must not serve the incorrect food. 

Managing this process takes extreme attention in FNS operations. For example, a vendor omits details when a product substitution is made because it is unavailable but does not notify the FNS department. Such an oversight can create issues. Therefore, added allocated labor is needed because the food-receiving process takes additional time, and flow charts are developed to ensure patient safety as the product-substitution trend continues. In addition, our teams have adjusted food receiving standard operating procedures (SOP) and when a product substitution arrives. 

Substitution issues 

Chefs and registered dietitian nutritionists are working even more closely to discuss recipes and menus and enhance training material to ensure patient safety. We rely heavily on innovative technology to drive outcomes, ensure safety, and ensure operational efficiencies. The diet office software is critically important in the success of our food and nutrition programs and operates at the ingredient level. 

For example, if a recipe calls for ketchup, ground beef and onions, they know there are many more than three ingredients, since ketchup contains tomatoes, brown sugar, vinegar, etc. Software is continually updated and maintained as the product substitutions keep arriving and are vital in keeping patients safe. 

The primary concerns with product substitutions are ensuring patients receive the foods ordered for their diet order and are not served an allergen-containing food. 

Collaborative tactics 

Facility managers need to work closely with supply chain partners to find creative solutions for unavailable products or equipment. The average cost of a piece of kitchen equipment is up 30 percent, and the delivery of replacement parts — if available — is extremely delayed. Therefore, chefs need to play critical roles in retraining staff on techniques and equipment and adjusting recipes for the equipment that is available. 

Labor shortages have impacted operations nationwide, according to the U.S Chamber of Commerce. As of mid-May 2022, the United States has lost millions of workers and has 62.2 percent labor force participation rate, and three million people have left the workforce since February 2020. As a result, conducting efficiency studies help determine how to do more with less. Technology vendor partnerships have been instrumental in driving efficiencies and automating processes otherwise handled with an FTE complement. 

Salad bars are reopening to the dismay of many infection preventionists. It’s important to encourage the use of hand sanitizer before building salads. Many of the best practices implemented are continuing, such as a redesign of sneezeguards and repeated changes in serving ware. These changes lessen potential infection touchpoints for customers desiring the salad bar experience. There has also been an increase in the use of equipment to accommodate grab-and-go salads. 

Purchases of food away from home — restaurants — increased by 4.5 percent in 2021, according to the U.S. Department of Agriculture’s Economic Research Service. In addition, the predicted Consumers Price Index forecasts costs to rise 5-6. These are historical averages as the inflation rate of food prices increases for 2022. Food costs and the demand for increased wages have led executive chefs to critically evaluate current menus and plan expanded product trials for the applicability of similar ingredients at a lower price point that produce the same quality product. 

Such solutions to these challenges are working closely with food and technology vendors, revising SOPs, enhancing training and keeping the patient experience at the core of our work. These collaborative efforts are critical and ensure the success of keeping patients safe, happy and well-nourished on their journey to improved health and healing.  

Marissa Trout is food and nutrition services project manager and subject matter expert with ABM’s business and industry healthcare division. She has more than 15 years of experience in food and nutrition services in healthcare with extensive experience in operations, clinical nutrition and implementing evidenced-based leadership systems and practices to elevate and improve the patient and family experience.