Dietary Services

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 Importance
Good food is important in the treatment of patient &
is a part of his total care
Adequate nutrition during hospitalization enables the
patient to recover early
Reduces the “average length of stay” of the patient
Economic and “cost effective” for the hospital
Takes 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 patients
Maintenance of morale of patients
through good & attractive food
Dietary advice to patients
Achievement of goals with maximum
efficiency at a minimum cost
Maintaining 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
service
Advantages
– Saves on economy because of bulk cooking
– Quality control is better because it has only one unit
to supervise
Disadvantages
– 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
Services
in Hospital
Procurement, storage & accounting of food items in
all its forms
Procurement of physical plant & equipments for the
department.
Issue of rations for daily cooking
Menu planning & recipe standardization
Preparation & cooking food
Distribution of food
Preparation of modified diets
Dietary education to patients
Training of dieticians and under graduate students
Assisting in research on metabolic disorders

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 Delivery & Service Goals
Maintain quality characteristics including
desirable temperature of food
Ensure microbial safety of the food to the
consumer
Present attractive food in appearance
Save steps and energy
Reduce labor time and costs
Lessen worker fatigue

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 Delivery System

Centralized Decentralized
System (into System (to the
trays) pantry)
– Better quality – Quick service
control
– Better temp.
– Better portion
size control
– Less equipment – More labor system

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 Planning Considerations
Average number of meals served per day
Type of food distribution system
Hospital policy concerning meals, location of cafeteria
Sample menu which will be used
Enumeration of modified diets which would be prepared.
Number of qualified dieticians & subordinates which will be
required.
Ear marked storage space
Delivery schedule for perishables
Housekeeping policies for proper cleaning & space
allocation of different types of supplies
Waste 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 area
Storage
– 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 relations
Washing 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 activities
Establishes departmental regulations and SOP
Recruitment and selection of staff.
Selection, promotion and transfer of staff
Reviews records and reports on diet, cost & inventory
Delegates 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 Officer
Asstt. Dietician

Store Keeper
Steward

Asstt. Store Keeper

Cooks
Therapeutic Diets
Cooks
Cook Mates
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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
personnel
Medical check ups
Dress standards
Correct work habits
Cleaning and maintenance of equipment
Rodent/insect control
Clean premises
Proper handling and disposal of waste
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 Quality Food Production

Menu Planning
Factors affecting menu planning
Target marketing
– Profile of the client
– Nutritional requirements
– Food habits
– Meal pattern

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 Menu
Types 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 satisfaction
Improved variety in menu
Reduced 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 variety
Time is saved
Storage and preparation area is reduced
Quantity and type of equipment required is
reduced
Reduces 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 cooker
Automatic chapatti maker
Vegetable choppers
Mixer-grinder
Electrical and gas stoves with multiple burners
Refrigerator- walk in, reach in, under counter reach
Dish washers
Steam sterilizers for sterilizing feeding bottles
Microwave
Dough Maker

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 Labour Cost
Labour 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 budgeting

Menu planning
Purchasing and receiving
Labour efficiency
Food preparation and service
Energy efficiency
Control of pilferage
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 Purchasing Process
Identify Needs

Write Specifications

Develop Purchase Order

Formal Method Informal Method

•Issue bid request
•Price quotations
•Tabulate & evaluate bids
•Select vendor & place order
•Award contracts

Receiving & Inspection of Deliveries

•Store in proper area
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•Evaluate & follow-up
 Layout of Kitchen Cold
Storage
Dry
Store

Receiving Area Dry

Preparation Store
Store Keeper Area Janitors
Room
Salad Chapatti
Preparation preparation Food
Service
Washing Area
Cooking Area Supvr
Trolley Washing
Dietician
Area
Loading Area
Modified Diet
Employee Facility 43
 Functional Flow Chart
Receiving
Cold Store Dry Store Day Store

Meat & Veg Atta Food

cutting Kneading Service
Supvr
Store Keeper’s Rice, Dal
Salad, Curd Picking
Office
Desserts
Chapatti Prep
Dietician
Utensil Mod Diet
washing Cooking
Cooked food Rice, Dal
Employee Facility loading area 44
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