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menus and room service: how hospitals can transform patient experience (and save money)

small budgets, expensive suppliers, and a lack of management buy-in have given hospital food the well-deserved reputation of being tasteless, and well, gross. but a coalition of health leaders is spicing it up.

by meghan mcgee
published feb 11, 2022
last updated feb 17, 2022
read time 5 minute read
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read time 5 minute read
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how menus and room service is transforming the patient experience and saving money
montreal-based nourish aims to improve patient experience, while reducing food waste. getty
every day, a typical large hospital throws out more than one tonne of food, according to a 2014 report. in some canadian hospitals, more than 50 per cent of the food served to patients ends up as food waste.
one reason driving the deluge is the average daily food budget, which is less than $8 a patient — dollars that are stretched across three meals, two snacks, and beverages per patient, per day, to meet the ministry of health and long term care guidelines. these tight budgets often drive health-care institutions towards cheap and highly-processed foods, resulting in tasteless, reheated meals that are left uneaten on the tray.
another reason for the waste stems from the fact that many hospitals and long-term care homes no longer prepare their own food, instead, buying from large suppliers and distributors. and while preparing food off-site allows for efficient, one-stop shopping, it also requires a two-day lead time — 48 hours during which a patient could be moved, discharged, or scheduled for a procedure that restricts eating, resulting in a wasted meal.
a national coalition of healthcare and community leaders, including food secure canada and health care without harm, hopes to change that. organizations like montreal-based nourish aim to transform the reheated, industrial food served to patients into climate-friendly, plant-rich and culturally diverse meals.

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‘how can the hospital tray be a platform to dream big?’

nourish was founded in 2016 with funding from the mcconnell foundation — canada’s second-oldest charitable foundation — as part of its 10-year, $14-million sustainable food systems initiative. nourish, also a charity, supports hospitals and healthcare institutions in transforming the patient experience and reducing food waste. it set out to answer a simple question: “how can the hospital tray be a platform to dream big and transform our food and health systems?”
the coalition started with a cohort of 26 decision-makers across the country — that they call innovators — who were selected for their vision of how to elevate the role of food in patient care. with $100,000 in funding, they developed five project teams, each tackling a different dimension of food in healthcare, from creating more culturally-sensitive and sustainable menus to influencing policies.
since then, nourish has grown to a network of leaders, organizations, and communities and launched a second cohort in 2021, with a third set to launch next year.

food waste dropped from 45% to just 5%

when josée lavoie, manager of food services at montreal hospital chu sainte-justine and nourish innovator, gave patients the freedom to choose what they wanted, delivered to their room when they wanted, food waste dropped from 45 per cent in 2012 to just five per cent in 2019.
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the hospital also shaved almost two dollars off of the cost per meal by cutting ties with pricey external vendors and producing all meals in-house. before implementing these changes, a default of 180 patients per day were being served food, with several meals left untouched by those who weren’t hungry, too sleepy, had moved rooms or were discharged. now, the hospital produces less food, feeding about 130 patients a day who opt-in for a meal — it even earned an additional $150,000 by selling meals to visiting family members.
“the intervention for each hospital or healthcare centre will vary, but what we learned from sainte-justine is very promising,” says rachel cheng, communications manager for nourish. “already, other collaborators in the nourish network have taken this model and applied it in their region.”
tight budgets often drive health-care institutions towards cheap and highly-processed foods, resulting in tasteless meals. getty
tight budgets often drive health-care institutions towards cheap and highly-processed foods, resulting in tasteless meals. getty

on the menu

another example of successful food-cost savings comes from oakville trafalgar memorial hospital in ontario, which has been offering room service to its patients since 2011. every day between 7 a.m. and 6 p.m., about 130 patients order from set menus that offer anything from vegetarian to halal to texture-modified options. and the food is delivered to their room in less than 45 minutes.
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during the decade-old initiative, the hospital went from preparing simple foods like oatmeal and cream of wheat, to cooking almost everything in-house, including hearty, nutrient-dense soups and casseroles. the menu also includes local food — 30 per cent currently, and working towards 50 per cent – where local items are marked with a little green tractor.
room service began as a pilot project in the old hospital, while the current one was under construction. for four years, the team worked on developing menus, processes, and delivery models before moving into the new building in 2015. marianne katusin, manager of support services at the hospital and a nourish innovator, managed to get a full production kitchen and the required staff to support onsite cooking.
with the labour and infrastructure already budgeted for, the hospital cut costs by sourcing ingredients and making food onsite. swapping out pre-cooked grilled chicken for locally-grown raw chicken thighs saved it $14,000 per year.
it has also seen a drop in food waste. “not only are the patients ordering the items, they’re consuming them,” says katusin.

why aren’t more hospitals doing it?

but despite all that seems to be good about overhauling the way food is produced, it’s a huge undertaking — one that many institutions don’t have the capacity, or interest, to take on. still, last year, seven health care institutions were selected for the new anchor cohort with nourish, focused on health care institutions as a cornerstone of well-being in the communities they serve.
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“it’s the culture of senior management,” says martin gooch says of the approach many organizations take towards managing food waste. gooch is the chief executive officer of value chain management international, a company that helps businesses find ways to improve profitability, including identifying food waste. “they approach food as an amenity, the same as car parking [lots]. how do you provide this service at the lowest possible on-paper cost?”
and then there just simply infrastructure issues — many hospitals just don’t have the the capacity to support in-house production and local supply chains, let alone room service. there also needs to be system-level change — understanding existing procurement processes, sourcing local manufacturers, finding the labour and the infrastructure, all while mitigating food safety and consistency risks.
in the end, while the transition to a room service food model may seem daunting, the benefits seem to far outweigh the challenges of getting a program like nourish underway — not only in terms of saving money, but more importantly, improving the patient experience and their health outcomes.
meghan mcgee is a toronto nutrition scientist and a fellow in the certificate in health information at the university of toronto.
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