The most challenging time for hospital foodservice

By Yuen Ching Li (Cat), Ho Yee Leung (Chloe)

Can you imagine being the leader of a team responsible for providing more than three meals a day, every single day for more than 600 people? Feeding patients involves taking menu orders, cooking, heating, plating, checking and transporting meals to the ward by trolleys, so it takes a number of steps until a meal reaches the patient’s table. Now imagine doing this during the COVID-19 pandemic when balancing food and patient and staff safety is even more complex. This is what foodservice managers and dietitians are doing all the time in hospitals.

We conducted a study to explore how various aspects of foodservice in different hospitals within Victoria changed in response to COVID-19 and identify important lessons for improving foodservice plans in the future. We interviewed eleven foodservice managers or dietitians from nine Victorian hospitals and asked them about the impacts of COVID-19 brought to hospital foodservice, the actions that hospital foodservice has taken to cope with the impacts, and their positive and negative experiences during the pandemic.

We did this research in October and November 2020 when Victoria was at the end of a lockdown lasting 112 days, with cases peaking at 725 per day.1

How did foodservice operations change?

We found that food distribution and meal ordering were the two aspects most impacted by COVID-19. Foodservice staff were not allowed into wards with COVID patients to hand out meals, so nursing staff working in these wards had to do this job. Hospitals that had been using tablets to take meal orders from patients were forced to change to paper menus that can be discarded after use to minimise the risk of spreading viruses. Some hospitals also created meal-ordering applications for mobile devices or they would call patients on phones to take their meal orders without any face-to-face interactions. All the participating hospitals were concerned about the safety of kitchen staff during the dishwashing process, as there could be chances of catching the virus from contaminated crockery and cutlery. As such, some hospitals replaced real crockery and cutlery with disposable cutlery and crockery. However, it created a problem of increasing plastic waste.

Planning for a critical event

To overcome the impacts of COVID-19 on the hospital foodservice, contingency plans were developed for a variety of situations that were anticipated during the pandemic. These plans described:

  1. If the kitchen needed to close for deep cleaning, they would look for ready-to-eat meals from other food providers, rent extra food storage spaces and prepare emergency food at alternative kitchen places.
  2. If there was a staff shortage or spike in patients with COVID-19, they would develop a reduced menu with less food options, stock up pre-packaged and portion-controlled items requiring very little preparation, and ask clinical staff to help out the foodservice staff. They would also remove menu monitors to take meal orders directly from patients and use paper menus instead to reduce the risk of virus transmission.

Changes in the workforce organisation and methods of communication

All hospitals have initiated some basic COVID-related safety measures to make sure all foodservice staff were safe. There were strict unit allocations within the foodservice department and staff were splitted into teams, just in case one of the team members tested positive. Hospitals held a lot more meetings to provide regular COVID-19 updates to different staff, including the CEO, senior healthcare levels, foodservice staff and clinical staff. They also used various ways to communicate COVID-related announcements, such as face-to-face meetings, online meetings (MS teams and Zoom), emailing, and putting up messages on whiteboards and bulletin boards.

What are some challenges?

Keeping the hospital foodservice running during the COVID-19 pandemic presented many challenges. Most of the people we interviewed felt exhausted with the extra work and time required to rearrange foodservice operations and create contingency plans. Another difficulty was managing the stress and fear towards COVID-19 among the team. The constant change and uncertainty about the virus triggered anxiety and was even more challenging for the managers, as they had to keep the staff calm while busy maintaining normal operation.

“Coping with the staff’s anxieties and the unknown about COVID-19 was a challenge and having to constantly talk and communicate with staff to help drive down the anxiety”.

Any positive things?

With all the negative things that COVID-19 brought to the hospital foodservice, there were still some silver linings. The pandemic gave some hospitals an opportunity for quality improvement that they would not have otherwise had. For example, one hospital launched a mobile application as a new meal ordering method to reduce face-to-face interactions between staff and patients. It also reduced staff’s workload on manually entering meal orders, which greatly increased the efficiency of meal ordering and definitely helped the quality improvement of foodservice. Another benefit was that hospitals were prompted to develop new contingency plans, which helped improve the efficiency of foodservice operations while preparing them well in face of future crises. They also noticed an increase in communication and collegiality that resulted in better relationships and teamwork, while improving the understanding of different roles within the hospitals.

“Everyone was sort of thrown into working together as a team, especially in those COVID wards, the understanding of what the importance of food service role is, and what the importance of clinical role is”.

This research has given us an insight into how hospital foodservice have adapted so they can keep feeding patients safely during COVID-19. This pandemic is a once in a lifetime critical event, and provides a golden opportunity for us to reflect on the advantages and areas for improvement of hospitals’ response to be prepared for other events in the future.

More information:

This research was conducted by Yuen Ching Li (Cat) and Ho Yee Leung (Chloe) as part of their foodservice placement project for Master of Dietetics degree under supervision of Dr Jorja Collins from Monash University’s Department of Nutrition, Dietetics and Food.

Yuen Ching Li (Cat) and Ho Yee Leung (Chloe) are international students from Hong Kong that have graduated from Master of Dietetics at Monash University. They have completed a range of placements with hospitals, community organisations and commercial businesses in Melbourne and Hong Kong. Due to the pandemic, both Cat and Chloe were caught up overseas and were unable to complete their foodservice placements in person, which led to the rise of this remote research project. It was their first foodservice project and had given them the opportunity to connect with hospital foodservice staff to learn about the intricacies of feeding patients. They have thus developed a great interest in foodservice management and would like to explore patients’ experience with sustainable hospital foodservice in the future. 

Publication information:

This research was presented at the Dietitians Australia Conference 2021.

Oral presentation Abstracts. Nutrition & Dietetics. 2021;78(S1):6-59. https://onlinelibrary.wiley.com/doi/10.1111/1747-0080.12689 [ID:#71].

To access a copy of the full report, please contact Jorja Collins Jorja.collins@monash.edu