FSM EOT

knowledge of a food service dietitian

• nutrient requirements

• food legislation, regulation and standards

• food preparation (recipes)

• food service systems (menu ordering, procurement, preparation, plating, distribution and ware washing)

• methods of data collection (KPIs)

• change mment

Skills of a food service dietitian

• advocacy for pts through menu planning, procurement, mment

• translate knowledge into food safety and nutrition guidelines

• develop and assess recipes and menus

• utilise meal mment systems

• develop, implement and assess the results of quality audits

• adapt written and verbal communication to audiences

activities of a food service dietitian

• develop and analyse recipes

• develop and analyse menus

• monitor for the impact of changes

• monitor the quality of services

• develop training programs for staff

• lease with key stakeholders

• advocate for improved food services

dietitian as consultant

dietitian alongside

dietitian as manager

open vs closed system

• open - interacts w environment

• closed - do not interact w environment

systems thinking

key concepts of systems thinking

• holistic approach

• interconnectedness and interdependence

• systems and subsystems

• boundaries and environment

• feedback loops

aims/goals/purpose of food system

• produce safe nutritious meals of desired quality/quantity that meets client’s needs (social, cultural, medical)

• happy/productive workforce

• environmental sustainability

• meet organisational and financial goals

transformation

the processes that convert inputs unto outputs

• mment functions - planning, organising, staffing, leading, controlling

• functional systems - procurement/purchasing, preparation and production, distribution and service, hygiene and maintenance

• linking processes - decision making, communication, training

inputs

• human - labour, skills

• materials - food, supplies

• facilities - space, equipment

• operational - money, time, utilities (electricity, water), info

outputs

• meals - quantity (standardised recipes), quality (meets safety standards)

• client satisfaction

• client needs - cultural, social, medical, nutritional

• staff satisfaction and performance

• financial accountability

• sustainability - procurement, waste, donation

• financial - budget targets

control

• aims

• standards

• standardised menus

• policies/procedures

• programs

• contracts

• food control plans

• audits

external controls - contractor, laws, regulations, FSANZ

memory

records

• financial

• staff

• forecasting

• inventory

• procurement

• staff memory

• IT programs

• software - holds feedback, survey results, KPIs

feedback

assessment of food service system

• internal - client feedback, performance measures, plate waste, order frequency, audits

• external - food service regulators, supplier feedback, union

continuous quality improvement cycle

• plan - identify problem

• do - benchmarking, collect data

• check - compare to other FS and predictions

• act - what changes next?

external quality systems

food safety

• national food standards - FSANZ

• state legislation - food act (QLD) 2006

systems safety

• national safety and quality health service standards (accreditation standards)

internal quality systems

controls, memory, feed back

• production waste

• client feedback

• audits

• KPIs

inputs, transformation, outputs

• recruitment processes

• staff training audits

• staff surveys

• food procurement contracts

• food quality (ingredients)

• HACCP

• KPIs

• food safety standards

• budget

resources used in QLD to improve food services

• FS best practice

• FEEDS

food quality: what are you measuring

• patient acceptance of food

• quality of the food/meals

• efficiency of system

• safety of food - allergens, therapeutic, bacteria

how to test patient acceptance of food

• acute hospital foodservice patient satisfaction questionnaire

• resident foodservice satisfaction questionnaire

• hospital food experience questionnaire

• meal assessment tool

• meal quality audit tool

• plate waste there food o

other food service measures

accuracy and non-patient waste

• therapeutic diet accuracy

• meal accuracy

• production waste

quality and efficiency

• staffing efficiency

• cost per meal

• meals per hour or meals per FTE

• total cost of the system

nutrition care process

ADIME

CQI - NCP - assessment

plan, do and check

• data from surveys, admin data sets, epidemiological or research studies

• KPIs

CQI - NCP - Diagnosis

act

• dietitian identifies problem needing to be treated

CQI - NCP - int, M and E

occurs through change mment when you make int, plan for change, monitor change, evaluate outcome

CQI tools

• patient satisfaction

• resident satisfaction (aged care)

• meal assessment tool

• plate waste

• Meal quality audit tool

basic functions of management

1. planing

2. organising - determine objectives, work needed?

3. staffing - recruitment and retention

4. directing and coordinating - decision making, communication, follow up

5. reporting - inform everyone through records, research, reports, audits, inspections

6. budgeting - planning, accounting, controlling

why do we need change

• shift from hospital care to outpatient

• reduced lengths of stay in hospital

• aging population

• changes in gov

• improvement in tech, food ordering, equipment, delivery systems

• increasing costs of food and energy

• economic climate

• geopolitical events

• environment e.g. climate change

• pathogens and disease

• change to transport and infrastructure

• workforce changes

• regulation and legislation change - alleged labelling

key components of change mment

• communication - explain reasons and benefits of change

• training and support

• stakeholder engagement

• monitoring and feedback

Lewis model of change

unfreeze

• outline changes

• speak w mment

• develop presentation materials

• consider employee reactions

• connect changes to company goals

• emphasise your support

change

• determine how to measure progress

• allow for increased communication for staff questions

• contact staff who need more help

• create anonymous surveys to collect feedback

refreeze

• develop incentives and rewards

• implement training programs

• praise employees

kotter’s 8 step change mment framework

Prosci change mment

simple change management approach

phase 1 - prepare

• understand why of change

• plan for change

• commence stakeholder engagement

phase 2 - manage

• change resources

• delivery change

• monitor and adjust

phase 3 - sustain

• assess change

• embed change

• monitor change

leadership theory; 5 dimension theory of leadership styles

a leader that can be flexible in

1. degree of control

2. concern for productivity

3. concern for people - clients and employees

4. structure

5. risk taken in decision making

attributes of successful FS manager - technical expertise and knowledge

• standards, policies and procedures

• process paperwork

• manage work with resources allocated

• environmental protection laws

• political environment

• marketing

• CQI - surveys

• work redesign, productivity, benchmarking

• cost-containment measures

• sustainability

• disaster and emergency planning

• cultural/generational diversity

attributes of successful FS manager - interpersonal skills

• communication

• empathy

• understanding

• ethical conduct

• motivation

• mentoring

• trust

• intelligence

• share vision, goals, objectives

• self-confidence

• delegating

formal vs informal leader

formal - job title

informal - naturally forms

leadership styles

• autocratic - unilateral decision making. effective in quick decision making but can lead to low morale of overused

• democratic - e.g. participative leadership. encourages input from team members. fosters sense of ownership, can lead to higher job satisfaction, may slow down decision making

• transformational - inspires and motivates team through shared vision and enthusiasm. focus on change and innovation, often leading to high levels of engagement and performance

• transactional - system of rewards and punishments. effective in achieving short term tasks and maintaining routines. may not encourage creativity or long-term growth

• laissez-faire - hands off approach, gives team members high degree of autonomy. can be empowering for self-motivated employees but may lead to lack of direction/accountability

• servant - prioritises needs of team, focus on development and well-being. can build strong supportive relationships, can be less effective in high pressure situations

standard 3.3.3 for food premises and equipment

• div 1 - interpretation and application

• div 2 - design and construction of food premises

  • adequate space

  • can be cleaned and sanitised

  • reduces dirt, dust, pests

  • audit: windows sealed, self-closing doors, no holes for pests, storage space?

• div 3 - floors, walls and ceilings

  • can be cleaned

  • can’t absorb grease, food particles

  • no water ponding

  • no harbourage of pests

  • audit: cracks/chips, wall joints sealed, cleanable materials?

• div 4 - fixtures, fittings and equipment

  • no contamination

  • easily cleaned

  • no harbourage of pests

  • surfaces around can be easily cleaned

  • supply of hot/cold potable water?

• div 5 - miscellaneous

  • enough storage w no contamination

  • toilets - ‘hands-free’ hand washing

  • food transport - safe food, can be cleaned

Workflow and functional areas

understand why we have workflow, seperate clean and dirty e.g. GCUH

workflow issues in different sized kitchens

How are the menu, kitchen design and workflow related?

• menu

• standard recipes, production processes

• ingredients and storage (dry, cold, frozen)

• equipment

• task delegation/flow

• shift/break times

how does workflow influence food safety

• receiving/delivery

• storage

• preparation

• cooking

• holding/plating

• serving

• cooling - leftovers, bacteria

• reheating

• packaging

• distribution

equipment - cooking ovens

• convection - <40 meals

• commercial convection oven - smaller than combo

• combination/combi oven - steams, up to 40 trays

equipment - alternative cooking items

• induction heating/hob - like home stove

• bratt pan - tilting fryer: shallow pan, poach, stir fry

• oven w cooktop

• salamander - grill

• steam jacketed pans - like double boiler (soups, casseroles)

  

• blast chiller - extend product life

• plating equipment - warmers, chillers, shelves, bays for serving

• food delivery - carts/trollies (can have hot cold side), retherm trollies

• thermal dinnerware - keeps food hot for longer

• hostess trolleys - bur lodge and regethermic (decentralised, rolled to ward to self-serve/serve at ward)

• robotic trolley delivery

• pot washer

• dishwasher - pass through (short cycle times), flight (high volume, magnets for cutlery, different compartments)

production, plating and distribution systems table

production systems

• central - meals prepared for multiple facilities and transported

• convenience - bought from supplier, heated etc. on site

• cook-fresh - cooked fresh, served immediately

• cook-chill - cook fresh, rapidly chilled <3C, can be held fro 5 days

• long-life cook-chill - cook fresh, vacuum sealed before chilling. shelf life 20-45 days

• cook-freeze - cook fresh, blast frozen to -20C. shelf life 12 months

• therapeutic - big hospitals have seperate area - allergens, cultural, religious

• mid meal

  • bought in preprepared - supplement w things on site

  • special diets maybe prepared on site

  • drinks prepared in ward pantry’s (tea, cordial…)

• fluid

  • clear/full - portion packs cheaper

  • special reqr - e.g. ONS - purchased

  • instant formula - made in dedicated room (cross contamination)

plating systems

plating

• hot - food cooked or reheated and put on plates hot

• cold - plated cold, need cold environment, retherm trolley

distribution systems

• centralised - food is plated in central area

• decentralised - plated from bulk trolleys or servers onto plates in ward/ding room

• semi-centralised - plated centrally, finished at ward (e.g. add toast so not soggy)

• self service

• mid meal - usually de centralised, from trolleys at ward pantry

• room service - always hot-plates, could be cook-fresh, cook-chill or cook-to-order, centralised distribution

factors to consider when planning menu

• external environment - gov, budget, laws, availability, seasons, suppliers, sustainability

• internal - mment, labour changes, standards, size, staff

• people - pt demographic, nut reqr, cultural

why plan menus

• improve nut intake

• predictability

• labour

• costs

• budget

• purchasing

• maximise efficiency

• variety, less repetition

types of menus

• a la carte (restaurants, room service, cafeteria)

• cyclic

  • week/fortnight

  • non-selective

  • selective - choice every meal

  • semi-selective - some choice, some fixed

• single use - ramadan Christmas

menu standards - aged care

• 14 day min menu

• 35 choices
  14 x full
  21 easy to chew (at least 1 vegetarian choice every day)

• hot, cold and fortified breakfast every day

• protein at all 3 meals

• supplementation available

• finger food available

• fortified soup

• moulds where possible

• HPLE for wt mment residents

• fish 3x per week

• 25-35g/d of fibre

• allow input from residents

menu standards - acute long stay

• min 35 hot main meals

• choice of 3 main meals and 3 mid meals each day (at least 2 mid meals are substantial)

• fortified hot cereal and soup

• hot protein breakfast for all texture levels - full, easy to chew, minced moist, pureed

minimum menu choice - long stay adult acute (QHNSMM)

per cycle

• 7 soups

• main hot protein

  • 35 minimum

  • 14 x full

  • 21 x easy to chew

  • (at least 1 veg choice every day)

  • 4 starchy veg (sweet/potato/mash) & 2 alternatives (rice, noodle, pasta)

  • 3 orange veg

  • 4 green/brassica veg (cauliflower, beans, Brussel, peas, broccoli)

why plan integrated menus

(includes common therapeutic diets w/in general menu)

• more available for those w restrictions

• supplies - less waste, storage

• efficiency - less items, less time

• less cost

assessing a menu

3 steps

1. verify info about menu and FS

2. verify info about people you are feeding

3. use appropriate tools to assess menu that meets standards/policies

   • QHNSMM

   • QH menu assessment tool

   • AGHE

   • therapeutic diet guidelines

   • menu analysis software - e.g. foodworks

   • DA food allergy intolerance menu assessment tool

standardising recipes - advantages/disadvantages

standardising recipes - integrated vs non-int menus

int combines multiple diets - no added sugar, no added salt, HPHE, low fat (KJ), tex mod, high fibre, veg, gluten, lactose

steps to developing bulk standardised recipes

1. yield

2. weights (g) or measures (cup)

3. use easy figures - whole or half

4. standard abbreviations tsp, tbsp

5. list ingredients in order used

6. concise method

7. directions for serving

OR

1. watch cook

   • ingredients, quantity

   • procedures

   • equipment

2. go over w cook, change if needed

3. others cook w recipe, change if needed

mid meal groups

1. HPHE

2. LPHE

3. healthy snack

food safety program

• hazards HACCP

• food safety program needs to be audited

• control reqr

• storage, processing, packaging, distribution, disposal, recall

standard - food premise and equipment

• layout reduces contamination

• premise, fixtures, fittings, equipment, transport vehicles can be cleaned, water, ventilation, storage etc.

food safety program for vulnerable populations

• must have documented and audited program

• must be available on premise for staff

• audited within 6 months of opening!

audits

• staff

• cleanliness

• CCPs

• support processes documented? - training, cleaning, pests, temps,

• what is procurement

• process for ordering

• product info form PIF

• process for receiving

• inventory control

• procurement - purchasing

• ordering - identify product, characteristics (shelf life, delivery, size etc.), assess reqr, contracts

• PIF - gives details: supplier, description, ingredients, country of origin, nutritional, allergen, shelf life

• receiving - demo, correct product, storage

• inventory control - FIFO, records in system, when stock reduced refill

FSP support programs in the tool

hour rule

0-2 hrs use immediately to fridge <5C

2-4 hrs use immediately

>4hrs throw away

military

• dietitian role

• production distribution

• nut reqr

• unique considerations

• nut, FSM, therapeutic, education,

• self-service, private contractors

• reqr

  1. PALs

  2. gender

  3. age

• field kitchens, ration packs, allergies, culture, logistics, ration packs

correctional facilites

• dietitian role

• production distribution

• nut reqr

• unique considerations

• menu planning, therapeutic, nut ed, FS

• centralised or counter service (lower security)

• meet basic needs, diet guidelines, mental health

• cost effective, security levels, alc, Vegemite, coffee, bones, allergens, no luxury items

child care

• dietitian role

• production distribution

• nut reqr

• unique considerations

• puree, solid

• unique - growth level, iron, cultural, breast milk, high risk allergies, involve children in food prep

aged care

• dietitian role

• production distribution

• nut reqr

• unique considerations

• nut reqr QHNSMM

• unique - texture, malnt, dining room , aged care quality standards

food service cycle main vs mid aged care

dysphagia

causes

incidence

nut impact

IDSSI and purpose

swallowing difficulty

stroke, cancer, ABI, Muscular sclerosis

hosp - ICU 7.9%

older pts/rehab - 50%

community 65+ 15-30% (lots of silent aspiration)

aged care 50%

1. reduced food intake

2. dehydration malnt

3. QoL

4. text-mod diets

standard initiative

IDDSI chart

test methods

spoon, fork, syringe flow

allergen labelling

• ingredients

• summary statement

• warning statement - uncommon ingredient, warn of allergen chance

• advisory statement

• exemptions - glucose syrup gluten

food allergen mment in FS

identify - CCPs

assess

manage - CQI

audit

support programs - trainmen etc.

tips for sustainable health care

• local produce, products

• seperate organic, recyclable landfill

• equipment low energy

• minimise water usage, utilise grey water

• menu planning - e.g. reduce meat