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Hospital kitchen cuts hospital expenses, but not food expenses

For a long time we have seen that hospitals cut costs through centralizing food production for a lot of patients and achieve economies of scale in cooking and distribution.

Einar Risvik

Food constitutes a few thousandths of the budget of a hospital, but still is the food budget under constant pressure. Probably this happens because food is seen only to be an expense in hospitals, an issue that can be turned on its head if one considers the possibilities of using food actively in treatment.

Food is a source of well-being for both patients and staff at a hospital. Patients thrive when treated by a staff that also thrive. They recover faster when the food is eaten because it tastes good, as opposed to when the food is too cold or the portions are too large or look un-appetizing. When food constitutes the cost for 6-8 minutes per day it is not difficult to understand that increased wellbeing among patients and staff can reduce average stay in hospital with more, and thus make food investments profitable for the hospital. This is something we have learned in practice through the two largest hospitals in Denmark, where the food supply was altered back from a central kitchen to an a la carte restaurant.

Food taste better when it looks good, this is simple psychology. Nurses do a better job when they spend the most time on their patients. Today food service takes a fair proportion of working time for nurses, so great that it goes out over the rest of care. Of course there are patients who also need the nurse to bring their food, but it is a very large majority who do not need nurses to handle their food. In fact it is so that food can be advantageously handled by persons other than nurses, for several reasons. A nurse reminds a patient that they are sick, something many have benefited from not having to think about. A major reason why it may be wise to employ staff who have food service and enjoyment, and not disease as their main occupation. Nurses also have a good deal of duties that are not necessarily associate with food, such as wound care and handling of secretions and excretions from the human body. Just for this reason one would think that it was difficult in practice to create routines good enough to manage the switch between wound care, help with personal hygiene and food many times each day. Besides, it is also a mental block for many. To eat food brought by a person who comes straight from bandages, wound and feces can be perceived as repulsive. The third perspective is economic and should be of interest to management at a hospital. Serving staff cost averaging 100,000 NOK less in wages than the average nurse per year. Compared with a specialist nurse the difference is much bigger. One would therefore think that the pressure on economy had made this positive change implemented long ago.

Many countries have today acute shortage of nursing staff in hospitals and institutions and the lack appears to be significantly worse in the coming years. Only in Norway it is registered 145 ooo nurses. If 10% of the capacity of these could be released to the care and not the catering, it would in itself constitute a great resource that society desperately needs. This is such a great resource that it is actually quite strange that the discussion has been totally absent.

Environmentally, it is also much to be gained. The Central Kitchen idea takes very little account that all patients have individual needs, desires and expectations. Servings in hospitals where "one size fits all" is common, this implies throwing away very much food. Food that has been out on a department or to a patient cannot be reused for other patients, while food that has not left the kitchen does not have the same restrictions. It is therefore opportunities to reduce wastage both by adapting portion size to the wishes and needs and by avoiding sending out too much food to the departments.

It costs more, however, to have a good cook than the cheapest and unskilled people in a central kitchen. In Denmark, they nevertheless found that the value of waste, ie the price of food thrown away, compensates for the difference in price of labor. The environmental benefit comes as a bonus, which also applies to increased satisfaction among patients and staff, reduced hospital stay and reduction in risk of infection related to food handling.

Last, but not least, we see big gains in getting a positive food and nutrition expertise into the hospital departments. It is known that several risk groups of patients are reducing their nutritional status during a hospital stay because they do not eat enough. Through simple measures related to pleasure, satisfaction and positive mood, these patients are often enticed to eat more and to make choices that are better for them. The foundation for this is that food tastes and looks good. Beautiful presentation of food and the ability to create a positive atmosphere require people with positive attitudes, and it is an advantage that they are not too greatly associated with disease. 
The sum will be positive for the hospital in many ways, but not in terms of cuts on the food budget. Food is the investment that the hospital does to keep secondary and larger expenses down. The total provides a larger profit for the whole.

In the autumn of 2014, the Nordic Council of Ministers invited a group of leading players from across the Nordic Region to discuss their visions for the future of Nordic food. This essay formed part of this initiative #Nordicfood2024