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Dietary Services
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Importance
Good food is important in the treatment of patient & is a part of his total careAdequate nutrition during hospitalization enables the patient to recover earlyReduces the “average length of stay” of the patientEconomic and “cost effective” for the hospitalTakes home a good impression of the hospital if the food is good and attractive ie helps in developing good “Public Relation”.
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Goals of Dietary Services
Optimum nutrition to patientsMaintenance of morale of patients through good & attractive foodDietary advice to patientsAchievement of goals with maximum efficiency at a minimum costMaintaining good public relations by quality food service in hospital
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Food Service Systems
It is a facility where large quantities of food intended for individual service and consumption are routinely provided, completely prepared. This is regardless of consumption, premises or whether or not there is a charge of food service
Conventional system followed in most hospitals– Menu items are prepared in a kitchen, on the premises,
where the meals are prepared and are held in a short time and maintained either hot or cold until serving time
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Conventional Food Services System
Advantages– Quality Control- More adaptable to regional, ethnic &
individual preference
Disadvantages– Because of menu differences it gives a stressful workday.– Skilled workers may be assigned tasks that could be done by
non-skilled workers– Needs two shifts of employees
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Commissary (Central Production Kitchen)
It has a large central production kitchen with centralized food purchasing & delivery of prepared food of satellite units located in separate remote areas for final preparation and serviceAdvantages– Saves on economy because of bulk cooking– Quality control is better because it has only one unit to superviseDisadvantages– Poor food safety in distribution- contamination– Needs high level equipment for mass production.
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Ready Prepared (Cook & Chill)
Foods are prepared in advance & stored
Advantages– No peak period pressure– No delay in preparation
Disadvantages– Need for cold storage and freezers
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Assembly/Serve
Advantage– No investment on equipment & space – absolute apportion control
Disadvantages– Limited availability of menus – Quality Control
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Functions of Dietary Servicesin Hospital
Procurement, storage & accounting of food items in all its formsProcurement of physical plant & equipments for the department.Issue of rations for daily cooking Menu planning & recipe standardizationPreparation & cooking foodDistribution of foodPreparation of modified dietsDietary education to patientsTraining of dieticians and under graduate studentsAssisting in research on metabolic disorders
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Delivery & Service Goals
Maintain quality characteristics including desirable temperature of foodEnsure microbial safety of the food to the consumerPresent attractive food in appearanceSave steps and energyReduce labor time and costsLessen worker fatigue
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Delivery System
Centralized System (into trays)
– Better quality control– Better portion size– Less equipment
Decentralized System (to the pantry)
– Quick service– Better temp. control– More labor system
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Planning ConsiderationsAverage number of meals served per day Type of food distribution systemHospital policy concerning meals, location of cafeteriaSample menu which will be usedEnumeration of modified diets which would be prepared.Number of qualified dieticians & subordinates which will be required.Ear marked storage spaceDelivery schedule for perishablesHousekeeping policies for proper cleaning & space allocation of different types of suppliesWaste disposal policy
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Physical Facilities
Site– Located on the ground floor– Should be in a place where the noise and smell from kitchen
is not disturbing to patients– Less cross trafficking in the route of food transport
Layout– 50 sq ft/bed in a 50 bedded hospital– 15 sq ft/bed in a 500 bedded hospital - McGibony– 8-10 sq ft/bed in the recommended space - UK Modil– Floors of concrete or terrazzo for easy washing – Running Floor Drains
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Physical Facilities (contd)Reception of supplies– Receiving area should be located where noise of trucks will not disturb the
patients– Door should be wide (5 ft)– Preferable to have a platform scale in the entrance of receiving areaStorage– Area should be dry & well ventilated for canned & non-perishable foods– Sufficient to hold stock for 15 days– Refrigerator for poultry etc– Separate storage space for linen, equipments, dishes and gas cylinders
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Physical Facilities (contd)
Refrigerator– Walk in Refrigerator- Advantages are
• More space• Convenient for handling large containers• Accessible and permits more careful examination of its contents• Easy to clean
– Reach in Refrigerator– Under counter reach in
Refrigeration space of 1.5 cu.ft. per person is enough to provide refrigeration, including zero storage facilities for frozen food -MacGibony
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Physical Facilities (contd)
Food preparation area– A double sink with drain boards for washing, soaking, sorting
and cutting– Table area of 4 linear ft/worker– Non- veg & veg section ideally to be separated.
Special diet area– Should be located next to dietician’s room for effective control– Only minor cooking equipments are required here
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Physical Facilities (contd)
Formula Room– Adjacent to nursery– A bottle sterilizer, refrigerator & portable carrier to prepare
milk for babies
Serving Area– Two Systems
• Centralized• Decentralized
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Physical Facilities (contd)
Centralized Serving– Advantages
• Floor pantry is eliminated & therapy bed space is increased • No duplication of equipments• No duplication of personnel• Fewer mistakes in filling diet orders, trays more attractive• Food wastage can be checked• Better food distribution & reduced pilferage
– Disadvantages• More experienced personnel needed• Food becomes cold by the time tray reaches the patient• Not suitable for horizontal building
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Physical Facilities (contd)
Decentralized Serving– Advantage
• No need of trained personnel• Floor service enables the food to be served hot• Unused food returned in bulk to kitchen• Nurses receive a necessary part of their training in food servicing
– Disadvantage• Requires considerable space on each floor at the expense of patient care
area• Extra equipment on each floor• Extra staff needed• Lack of supervision leading to pilferage• Danger of contamination
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Physical Facilities (contd)Dining Room– Solution to curtail disadvantages of both the above food
distributions– Morale boosting for ambulatory patients– Increases interaction between patients & develops good relationsWashing Room– Requires 3 compartment sink
• One for pre rinse at 120° - 140° F temperature• One for washing at 120° - 140° F temperature• One for rinsing with water 180° F
– Facilities for sterilizing food containers of trolleys
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Physical Facilities (contd)
Doors & windows– Fly proof with 16 mesh wires/sq cm
Lighting– sufficient in working area
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Physical Facilities (contd)
Employees facilities– The employee who would prepare food should preferably take
a bath before doing so. Therefore, facilities should be available for the same.
– McGibony recommends• One locker for each employee• One washbasin for every 4 employees• One shower for every 8 employees• One toilet for every 8 employees
– Resting rooms for different categories of employees– Office for dieticians
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Standards
Joint Commission on Accreditation has laid minimum standards for – Organisation– Facilities– Personnel– Food handling practices– Records– Policies
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Standards (contd)
American Dietetic Association has laid standards for – Education of dietetic interns– Specified standard educational qualification for
qualified dieticians
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Organization
Number of staff is determined by– Average number of patients in wards– Number of modified diet– Type of service– Number of personnel served– Extent of educational programs– Physical capacity of Dept
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Responsibilities of Director Food Services
Plans, directs and coordinates activitiesEstablishes departmental regulations and SOPRecruitment and selection of staff.Selection, promotion and transfer of staffReviews records and reports on diet, cost & inventoryDelegates authority for smooth functioning Attends meetings and conferences to keep abreast with new knowledge
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Suggested Staff Structure (DGHS)– 300 to 600 Beds
Dietician
Catering OfficerAsstt. Dietician
Store Keeper Steward
Asstt. Store Keeper Cooks
Cook Mates Cooks
Cook Mates
Therapeutic Diets
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Policies
General – Dietician is the head of department– Department must operate 16 hours per day– Work schedule to be planned– Fixed service timings– Fixed charges to be levied– Dietician to supervise all activities in kitchen– She visits patients for making daily diet chart & opinions as
well
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Policies (contd)
Food Purchase– Dietician is responsible – Spot buying & seasonal purchases– Policy for source of purchase– Policy for method of purchase
Receipt and storage– Centralized control
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Policies (contd)
Menu Planning– Market trends is observed closely– Meals to meet physiological needs of patients & be palatable– Recipe to be standardized– Selected utensils & equipments used
Forms & Records– Diet chart for special & various diets– Daily records of cost to be maintained
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Policies (contd)
Safety– Employees to be trained to
• extinguish grease fire• report accidents• use of equipments guards• Know the hazards of slippery floors• Carry out waste disposal & understand infectious diseases
Sanitation– Periodic health check ups of employees – Proper handling and disposal of waste
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Sanitation Standards
Continuous education programme for personnelMedical check upsDress standardsCorrect work habitsCleaning and maintenance of equipmentRodent/insect controlClean premisesProper handling and disposal of waste
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Quality Food Production
Menu PlanningFactors affecting menu planningTarget marketing– Profile of the client– Nutritional requirements– Food habits– Meal pattern
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MenuTypes of Menu– Selective (choice)– Non-selective (non-choice)– Single use (for a day)– Cycle Menu (For seasons)
Purchasing & storage methods of purchasing – Informal (open market)– Formal (tender bid)
Quality for different food items is to be set up size, wholesomeness, colour, flavour, maturity etc
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Menu Planning
Cycle Menu- Defined as carefully planned menu which are rotated according to a definite pattern
Advantages– Minimises menu planning time– Coordinating preparation– Reduces repetition of menu items– Promotes standardization of preparation– Increased labour efficiency due to increased coordination – Simplifying purchase– Advantage of purchasing seasonal food– Improved inventory and cost control– Maximises utilisation of equipment
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Advantage of Selective Menu
Improved patient satisfactionImproved variety in menuReduced food wastage
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Advantage of Non-selective Menu
Food and labour costs minised to approx 15%Demand on skill and quantity of labour reduces due to decrease varietyTime is savedStorage and preparation area is reducedQuantity and type of equipment required is reducedReduces supervision
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Equipment & Furnishings
Factors affecting selection of equipment– Need determined by the menu plan complexity of the food
included– Number & types of a patient to be served– Form in which the food will be purchased– Style of service and length of serving period– Number of labor hours available– Abilities of employees to do the work– Accessibility & cost of utilities– Budget & amount of money allotted for equipment– Floor plans and space allotments
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Modernization of Kitchen
Automatic rice pressure cookerAutomatic chapatti makerVegetable choppersMixer-grinderElectrical and gas stoves with multiple burnersRefrigerator- walk in, reach in, under counter reachDish washersSteam sterilizers for sterilizing feeding bottlesMicrowaveDough Maker
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Labour CostLabour represents 50% of total food services cost
Depends on– Use of labour saving equipment– Size and design of work over– Use of disposable or re-useables– Selective or non selective menu– Number of food served– Working condition- temperature, humidity, lighting, noise– Personnel training programme & skills developed– Amount of supervision– Performance standard- employee morale
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Checklist for Cost Control
Cost accountability and budgetingMenu planningPurchasing and receivingLabour efficiencyFood preparation and service Energy efficiencyControl of pilferage
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Identify NeedsIdentify NeedsIdentify NeedsIdentify Needs
Write SpecificationsWrite SpecificationsWrite SpecificationsWrite Specifications
Develop Purchase OrderDevelop Purchase OrderDevelop Purchase OrderDevelop Purchase Order
Informal MethodInformal Method•Price quotationsPrice quotations•Select vendor & place orderSelect vendor & place order
Informal MethodInformal Method•Price quotationsPrice quotations•Select vendor & place orderSelect vendor & place order
Formal MethodFormal Method•Issue bid requestIssue bid request•Tabulate & evaluate bidsTabulate & evaluate bids•Award contractsAward contracts
Formal MethodFormal Method•Issue bid requestIssue bid request•Tabulate & evaluate bidsTabulate & evaluate bids•Award contractsAward contracts
Receiving & Inspection of DeliveriesReceiving & Inspection of Deliveries•Store in proper areaStore in proper area•Evaluate & follow-upEvaluate & follow-up
Receiving & Inspection of DeliveriesReceiving & Inspection of Deliveries•Store in proper areaStore in proper area•Evaluate & follow-upEvaluate & follow-up
Purchasing Process
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Layout of Kitchen Cold Storage
Cold Storage
Dry StoreDry
Store
Dry StoreDry
Store
Janitors Room
Janitors Room
Food Service Supvr
Food Service Supvr
DieticianDietician
Modified DietModified Diet
Preparation
Area
Preparation
Area
Chapatti preparation
Chapatti preparation
Cooking AreaCooking AreaCooking AreaCooking Area
Loading AreaLoading Area
Receiving AreaReceiving Area
Store KeeperStore Keeper
Salad Preparation
Salad Preparation
Washing AreaWashing Area
Trolley Washing Area
Trolley Washing Area
Employee FacilityEmployee Facility
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Functional Flow ChartReceivingReceivingReceivingReceiving
Day StoreDay StoreDay StoreDay StoreCold StoreCold StoreCold StoreCold Store Dry StoreDry StoreDry StoreDry Store
Meat & Veg Meat & Veg cuttingcutting
Meat & Veg Meat & Veg cuttingcutting
Store Keeper’s Office
Store Keeper’s Office Salad, Curd Salad, Curd
DessertsDessertsSalad, Curd Salad, Curd
DessertsDesserts
AttaAttaKneadingKneading
AttaAttaKneadingKneading
Rice, DalRice, DalPickingPicking
Rice, DalRice, DalPickingPicking
Food Service Supvr
Food Service Supvr
DieticianDieticianChapatti PrepChapatti PrepChapatti PrepChapatti Prep
Mod DietMod DietMod DietMod DietUtensilUtensilwashingwashingUtensilUtensilwashingwashing CookingCooking
Rice, DalRice, DalCookingCookingRice, DalRice, Dal
Employee FacilityEmployee Facility
Cooked food Cooked food loading arealoading area
Cooked food Cooked food loading arealoading area
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