Improving Snack and Beverage Delivery in Acute Care
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- A wedge of lemon with a fish, chicken or pork entrée – this inexpensive garnish brightens up the taste of the food when a patient adds it right before eating and heightens the visual appeal of the tray.
- Adding pre-chopped fresh herbs – a little sprinkle goes a long way to amping up the freshness factor on your tray.
- Top a premade dessert with a fresh strawberry for a little pretty on the plate.
- Try adding lettuce back to sandwiches, it will be a negligible increase in cost and will make the sandwiches a little more like home – try using prewashed baby spinach or red leaf lettuce for that extra appeal.
- On days when French toast or pancakes are being served, add a few fresh blueberries to the plate or in a small dish on the cold side to dress up a favourite.
- Ask your distributor what other types of washed and chopped greenery or fruit they have that could be added to your trays; don’t be concerned with investigating a slightly higher priced fresh garnish since very little of it is used on each tray.
- See if you can find some great articles or information on what you are intending to change in your facility, maybe a group that has already implemented this shift with success and make this information available to your team in an informal way, on your staff bulletin board, as a slide in a staff meeting or through general conversations with your team.
- Once the idea has been floating around, let your staff know as a group that there is a desired outcome that needs to be achieved (maybe increase in patient satisfaction, infusing the menu with more exciting meal options, changing work loads to allow for other tasks to be accomplished) rather than suggesting that changes are coming down the pipe. This will allow people to wrap their heads around the idea that change is necessary but that it is occurring for a tangible reason.
- Now that your staff realize there is something in the current system that is not working, take the time to let them know how the changes will be taking place and what this means for them (make sure you have worked out all of the impacts of these changes prior to this meeting). People are going to have issues with these changes, some of them have been responsible for their current position for a long time and this request for change and flexibility triggers people’s stability in their work environment, maybe makes them feel less valued or that they have been doing something wrong all along. This is a great time to reassure them that the changes have nothing to do with any of these insecurities.
- Open up the dialogue within the group at this stage of the game, you don’t want people leaving the meeting feeling unsure or unheard and creating tension in the rest of the work environment. Make sure people feel heard and that their concerns are addressed in a real way and it is okay at this point not to have all of the answers but to reassure them that you will let them know when you do have them.
- If your change is a new meal item or a new process, have staff participate either in a food tasting, by providing them recipes of the item that they can prepare at home for their families or by asking for their feedback on a specific change in process; you won’t necessarily be able to incorporate all of their ideas but they are the people engaged directly in the work and may have interesting tricks to make this transition smooth.
- Try to have fun with this process; have a lunch or a yummy treat brought in for the meeting so your staff feel special and appreciated, we all like to feel valued and this will make the notion of change that much easier to swallow!
Apples, Peaches & Pears – Oh My!
August 10th, 2012Well it is that time of year again, the harvest begins and one of the sweetest treats that summer offers is tree fruit and it is out early this year; peaches, plums, pears, nectarines and apricots, oh my! Local tree fruit is a great addition to your menu and involves a simple switch from your distributor from the often-relied on imported fruit to local fruit.
Apples are an easy fruit to switch to local but much of Canada’s apple harvest has been devastated due to an early spring followed by a frost; killing most of the apple crop. Apples are a great shift to make from imported to local in your facility but this may be a hard shift this year. Have no fear; there are a lot of other types of tree fruit that you can switch in your facility to get more local produce onto patient trays.
Peaches are a great place to start; a whole ripe peach adds visual and taste appeal to any meal tray. Replace your canned peaches with a whole fresh peach. Work within your current labour pool, utilizing staff to wash the fruit instead of portioning canned fruit. This switch may actually free up staff to take on other responsibilities in the kitchen.
Pears are a staple on many hospital menus and can be easily substituted for imported. Take this opportunity to let your patients know that you have made a switch to your local, seasonal ripe fruit. Simply add a symbol or provincial name to your menus.
Work with your distributors to source locally produced fruit and take advantage of the short season that Canadian provinces enjoy.
Photo Credit: Thomas Hawk via Compfight cc
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Organic, Local, Sustainable: What is the difference and are any of these options realistic in healthcare?
July 17th, 2012Organic, local, sustainable, what do any of these food designations mean anyway? Well, organic has strict government guidelines, local is defined by an individual or organization and sustainable can have non-governmental regulating bodies to keep an eye on them.
Organic: this method of food production does not allow for the use of any chemical inputs in the form of fertilizers, pesticides or herbicides. This type of agricultural production focuses on a holistic method that pays attention to building health and nutrients in the soil which can translate up through the plant, protecting the biodiversity on the farm, while ensuring a natural environment for animals both wild and agricultural. Farms are inspected yearly by a third party auditor who adheres to the strict regulations enforced by the Canadian Organic Standards which was launched in 2009 and is referenced in the Organic Products Regulations which is a legal text (www.cog.ca). Farmers need to keep detailed records of all farm activities and go through a transition period during which they can’t use chemicals but are not allowed to use the organic designation as their farm rids itself of chemicals.
Local: this term refers to the location of the product rather than the production methods. Local is often associated with the 100 mile diet which was brought into the mainstream by 2 Canadian authors and food activists. Local can also refer to a specific regional food or provincial/state boundaries. If you are going to use local food procurement in your facility, make sure that you clearly define what local means to you and your organization so you can be clear as to what products do or don’t meet your needs when you are speaking with your distributor. Setting your boundaries larger as you venture into this type of procurement will increase your success.
Sustainable: often refers to people who are farming using similar principles to organic but are not certified or regulated. This is a harder category to focus on because you would need a relationship with the producer in order to ensure that they are standing by the production methods that they claim to use. Sustainability can also refer to products that come with less packaging, fish and seafood that is certified by an organization such as OceanWise (www.oceanwise.ca) or Marine Stewardship Council (www.msc.org) which is another great consideration for your organization. Other certification bodies include Local Food Plus (www.localfoodplus.ca) or Sustainable Farm Certification International (www.sustainablefarmcert.com).
Currently there is a lot of debate as to the viability of these “alternative” food production methods in healthcare but they can no longer be seen as a fleeting trend, they have a real foothold in the consumer market and that pressure is beginning to make its way into healthcare and public institutions. This can be seen by the new round of funding that was just announced through the Greenbelt Fund (www.greenbelt.ca) which is aiming to get more locally produced food into the broader public sector, evidence that the government, whom is footing the bill, was happy with the outcome of the first round of grants.
That said, how do big institutions get involved in these changes? Because of these grants, many larger processors and distributors are now offering prepared, chopped, cleaned and peeled varieties of produce and products through more traditional distribution channels; allowing you to maintain your current purchasing methods but begin to make small changes to increase your institution’s consumption of local, organic or sustainably produced food. Small changes make a big difference, allowing your organization to remain current with how the general public is beginning to look at the types of food they are offering. As well, this is an opportunity to work with your suppliers to find out ways that they can support you in getting more local food into the hospital when seasonally available.
Seasonality. There is a hard one, or so many North Americas think, but there are some simple solutions to reduce the amount of changes you need to make to your menu while offering your patients local food options. One simple solution is to switch an item, for example frozen broccoli for fresh. Once you have made this switch, speak with your distributor and ask them to let you know when local fresh broccoli is available, then rather than switching the whole item, you are just switching the origin of the product. But, make sure you let your patients know with a different label or symbol on the menu so they recognize the changes you are making!
Not interested in fresh produce or don’t have the facilities to make this a reality? Again, ask your distributor for any frozen options that are produced locally, this is a great switch and one that your patients will recognize as valuable to their wellbeing, the local economy and the farmers in your area.
Garnishing – Is There Space In Hospital Food Services?
June 29th, 2012Think back to your most recent satisfying meal experience. Was it in the company of your family or a treasured friend? Was it a simple meal in the comfort of your own home? Was it a celebratory dinner in a restaurant that paid attention to details and presented you with a thoughtful and decadently prepared meal? Do you remember the flavours, the textures and how this meal made you feel?
Most of us can remember back to a special meal or more importantly, get to routinely enjoy dinners that leave us feeling satiated physically and emotionally.
For many people in hospitals or long term care, the pleasure of meal time is greatly diminished because they are often alone, they may not have family that come to share in mealtime, their spouse and friends are not likely with them and they have no control over the types of meals they are offered and no opportunity to help prepare them. For people, many of them women, who have spent much of their lives caring for their loved ones through food, this can be a very hard transition.
Now I am not trying to say that we should have residents and patients in the kitchen helping on the beltline, what I am suggesting is that the care and attention to detail around meal time from ingredient selection to plating and finally through to the delivery of the tray to the patient, is vital in increasing the patient’s experience at your facility and is important in their overall well-being. Budgets are tight, staffing is limited, meal selections are dependent on what is available in the market and through your distributors, but kitchen staff are a vital piece of the puzzle and the last people to have contact with the plate and the food before a patient receives their tray; this final step can make a world of difference.
Garnishing a plate provides the opportunity to infuse an item with colour and freshness even when the item is not made in your facility. It speaks to attention to detail, thoughtfulness and care all of which are present in home cooking which is often not possible in a hospital or long term care facility.
Some simple ideas to dress up your plate and liven up mealtime for your patients:
The next time you are eating out at a restaurant, pay attention to the small details, how do they increase the satisfaction you get from your meal, does it improve the taste and texture of your food?
Take these ideas back to work with you and share some of your favourite mealtime traditions and experiences with your patients; they are sure to appreciate it.
Engaging Staff in Change: Headache or Team Builder?
June 22nd, 2012My natural tendency when I hear about team decisions, large group meetings and engaging staff is to shy away; this could be due to my type A personality of wanting to make decisions, my dislike of conflict (I hate when people don’t feel heard in a meeting) and my frustration with wasted time trying to consider ideas that just don’t make sense, all of which inevitably come up in this type of engagement process. That said, I have seen the incredible results that come from staff engagement in food service and how the folks on the front line really can help an initiative gain a solid foothold, more so than any top down implementation.
Let me clarify, I am not suggesting that these meetings become a free for all of endless opinions and minute details but I am however suggesting that there is an appropriate time and place to engage your staff and it usually comes before the project is ready to launch. Asking for feedback, conducting focus groups (make sure you are careful of how you divide the group making sure your pro change staff and change averse staff are evenly dispersed to keep the morale high), trying to make the change visible (ask a senior staff member to come in and visit with the group while they are working or send a letter to the staff letting them know how important their work is to the hospital and that they are “seen” by the higher levels of the organization) are all ways to make your staff feel included in the change versus having change forced upon them.
Here are a few steps to ease your team through change:
It’s Strawberry Time!
June 8th, 2012Well it is that time of year again one that many of us have been waiting for with anticipation; to some a sign that summer is here, warm days and fresh simple meals. It is indeed strawberry season and nothing beats a fresh locally produced ripe seasonal strawberry! We have all had the imported varieties that lack flavor and colour and yes they may help us through a long winter of soups and stews but nothing beats a truly ripe strawberry! Plump and juicy, red and ripe through to the middle and all the way up to the top, there are no white cores or white shoulders on these local delights. With farmer’s markets brimming with the berries, you-pick berry facilities galore, there is no doubt that your fruit and vegetable producer whether a broadliner or a distributor specifically focused on produce, will begin to carry locally produced berries (whether they are sourced in the immediate vicinity of your facility or within provincial or national boundaries, they are going to be full of flavour). If your distributor is not currently carrying locally produced strawberries, take this as a great opportunity to begin a discussion with them about sourcing more fresh locally produced food or frozen local berries, many of which end up with a close to fresh taste and texture even after they are thawed.
What am I going to do with these delectable treats you ask? Well the possibilities are endless. These yummy treats can be made into a thick compote which can be added to your breakfast menu or as a dessert on its own. Simply wash the berries and remove the (hull) stem and add the berries to a large pot or cooking kettle. Heat the berries on medium heat until they are broken down and resemble a jam like texture. Add brown sugar to the desired level of sweetness and chill or plate hot, depending on your facility. This gooey mixture works really well with pancakes or French toast, as a topper to your hot cereals or in a lovely small dish as a dessert (place on the hot side of the cart for a sensational dessert). If you are using a Novaflex, this mixture could also be placed in your smallest container and served on the cold side as jam for toast or placed in a larger serving container and added to trays if you are using the Multigen system for bulk meal delivery.
Additionally, you can simply wash the berries and place three or four berries in a small dish and place on the cold side of the cart for a fresh simple dessert. Fresh whole or roughly chopped berries can be added to your oatmeal or hot breakfast cereal to add flavor and colour to your breakfast items. To save on preparation time simply wash and hull the berries and place in a food processor, pulse a few times to get a roughly chopped consistency and top your cold oatmeal or cereal options and place on the hot side of your tray.
Because local berries have been picked closer to their peak of ripeness, their impact will be far greater than that of imported berries so you will be able to serve fewer berries and still have a big impact. Sometimes local berries can seem costlier than the imported version but reducing the serving size will allow you to have a big impact item without blowing your budget. Take this opportunity to add summery freshness, flavor and colour to your menu!
Tender Spring Shoots
June 2nd, 2012Early spring shoots of asparagus make for a delicious addition to your menu, that said, they are not around for very long so make sure to capitalize on them while you can.
The bright green shoots are a welcome addition to many meals and the inclusion of a small amount of asparagus amps up your regular menu and provides patients with the feeling of high-end menu selections. While many vegetables freeze quite well, asparagus is not at the top of the list, so make sure to choose fresh asparagus from your distributor to get as much freshness as possible from your menu changes.
Asparagus can be enjoyed in a variety of ways depending on the cooking facilities that you have in your organization. A few spears of asparagus can be a great side with your dinner entrée, gently steamed and served alongside a breakfast omelet for a fancy breakfast item or chopped raw and served with a prepared bean salad or a salad plate for a hearty lunch option.
To get the most from your asparagus, ask your distributor for fresh local asparagus and make sure that when it arrives the spears are firm, bright green and that the tips are tight. Wash asparagus in cold water or soak in a container of cold water for a few minutes to remove any sand or debris. Holding the top and bottom of the asparagus in your hands, gently break the bottom of the asparagus off of the rest of the stem. The asparagus will naturally break in the place where the spear starts to get woody (the bottom of the asparagus is tough and not good eating). Now you are ready to lightly steam the spears or serve them raw. Fresh asparagus is so flavourful you won’t need to add any fat or salt to the spears and you will have a fresh delicious addition to your spring menu.
Attention to seasonality allows you to provide a fresh and innovative menu which will be exciting for all members of the food service team as well as your patients!
Ring in Spring with Rhubarb!
May 18th, 2012What is tart, pungent, flavourful, refreshing and a sure sign of spring? Well it is rhubarb of course.
Rhubarb is the first fruit to grow in Canada in the spring and a welcome change from the apples and pears that make up our local diets in the winter months. Rhubarb is an interesting way to inject some fresh food onto your menus and demonstrate seasonal awareness and menu innovation to your patients, through additions such as rhubarb; the season for rhubarb is relatively short so make sure you capitalize on it as soon as it becomes available to you through your distributor. That said, I think you will be hard pressed to find prepared products through your distributor that incorporate rhubarb, so for those of you with some, even minimal cooking facilities, this is a chance to offer your patients fresh seasonal fruit that will liven up their palates and provide them with a little bit of spring sunshine in their meals.
Rhubarb can be offered to your patients in the form of a rhubarb upside down cake, rhubarb crisp or stewed rhubarb, the latter of which will allow this tart fruit to go across as many of your diets as possible. For facilities with cooking equipment simply wash and chop the rhubarb into chunks and heat with a small amount of water; add brown sugar, honey or maple syrup to sweeten the mix. If you don’t have any cooking facilities, you can heat the rhubarb, water and honey mixture in a covered microwave safe dish until you have a soft texture. This mixture can be served in a covered soup bowl and offered as a hot dessert on your dinner trays for the Novaflex or created and served in larger pans suitable for the Multigen. The stewed rhubarb can be added to oatmeal for a seasonal spin on a common menu item or topped with vanilla yogurt and served on the cold side of the tray for a lunch dessert. The rhubarb mixture can easily be made a day ahead and stored cold to ease the workload on the day of service and to ensure it is a safe temperature if you are in a cold plate/ retherm environment.
Additionally, you can source frozen rhubarb or simply wash and freeze the fresh rhubarb that you purchase through your distributor; then add it to fresh local strawberries when they become seasonally available. You can easily add a few fresh strawberries or frozen berries to any of the above recipes to add extra flavor and flare, reduce the amount of sugar required, and to offer your patients a fresh seasonal berry dish without the higher cost of a dessert made entirely from strawberries. With the rejuvenation that comes with spring, it is a great time to familiarize yourself with local seasonal items that are offered through your distributor. Patients will surely notice and appreciate the thoughtful, spring addition to their meal trays!
An Apple A Day
May 11th, 2012From the glorious sunshine to the moist rain sodden air to the earthy smell that envelops us, it is safe to say that spring has sprung. Spring conjures up feelings of excitement; promising sun filled days, lighter less sluggish bodies and great local seasonal food! As much as I love the heavy root vegetables, stews, meats and soups that comprise many winter menus, it is the local fresh fruit and vegetables that allow for exciting menu options both at home and on patient meal trays. The plethora of crops that is about to descend upon us is limitless and can allows you to include seasonal delights on your menu to provide your patients with new menu options, which freshens and revitalizes your menu and can lead to an increase in patient satisfaction.
Over the past 10 years there has been a steady and unrelenting increase in the awareness, demand and volume of local and/or organically sourced food which has taken a strong foothold to become a wide spread movement rather than a fleeting trend. While this movement has been alive and active in the general public, it is more recently starting to make its way into the healthcare sector and there are simple changes that you can make to participate in this growing food movement.
I am going to be focusing this first menu change on apples. You are right in thinking that it is strange to start a conversation about spring menus with apples, a fall crop, but apples have staying power on your menu that makes this small change worthwhile and can provide a year round item that punctuates your menu with freshness and the local options that people are now looking for. Because of the humble apple’s wide popularity, most hospital menus have either fresh whole or sliced apples on the menu and many of these apples make a long journey from far beyond the reaches of North American borders. Many of the apples on hospital menus are making the trip from South America and South Africa; but this import heavy food system takes a toll on patient satisfaction (food is less fresh or sometimes even arrives under ripe) and the environment (on average imported food travels 45 times farther than its locally sourced counterpart [1] ). Simple switches to fresh local food can have a great impact on patient satisfaction, which is the goal for all of us involved in the hospital food system.
Many of the large broad-line distributors are beginning to increase the amount of local food on their product lists as the demand from hospitals and the broader public sector increase and as the supply from farmers begins to meet this demand. Have a conversation with your distributor(s) and ask them what local apple varieties they carry; versatile well-loved apples varieties in hospitals are the gala or empire (macs are also widely available but can be slightly more tart than the other two options). If your distributor is not currently stocking any local apples, ask them if this is something that they could consider and let them know that you would be happy to purchase locally procured foods when they are made available to you. There are also many smaller distribution companies that are focusing exclusively on local foods across Canada and North America. These companies are a great resource for understanding the seasonal availability of your products, where the product is coming from (right down to the farm level) and providing lead time as to when they product will need to be switched to imported (you will likely need to rely on imported apples for about one month in the late summer once you have made your switch to local apples!).
If you are looking for new and innovative ways to stay in line with leading food trends and increase or maintain your patient satisfaction, sourcing food for patients locally is a great way to start.
[1] Xuereb, Marc. 2005. Food Miles: Environmental Implications to Food Imports to Waterloo Region. Region of Waterloo Public Health.
Retrieved from http://chd.region.waterloo.on.ca/en/researchResourcesPublications/resources/FoodMiles_Report.pdf
