4.0 OBJECTIVES
I After going through this unit, you should be able to:
4.1 INTRODUCTION
In the earlier units of this block you have learnt about various utility services of a
hospital inter connected with these, dietary services is another important area which
aims at improving the palient care.
In this unit you will learn about the planning and organisati;n of dietary services of a
hospital. To begin with, you will learn about the role and functions of dietary services
departmei~tin a Bospital. Thereafter you will learn about various planning
considerations which one need to take into account while developing's dietary
services department. Towards, the end you will learn about some of management
issues including policies, processes and control mechanisms.
Hospitals these days receive patients of varying nature, with different cultural
background, with varied food habits and with different di>eases. The cliniciai~sand
dieticians have not only to meet the requirements of patients as per their nature of
diseases, their ilutritional status and to tackle any problems related to underlying
pathological conditions. In fact the doctors and tlie dieticians have to coordinate their
activities in the best interest of patient care. Dietary service is one of the m ~ s t
important hospital supportive services contributing to the recovery of health, through
scientifically prepared diets, educating the patients attending the hospitals for
treatment regarding use and utility of diffirent foods and balanced diets.
Dieticians or the Food Service Managers have to be fully involved during the Planning
, Process of dietary services of a hospital. Proper Planning and laying down clear cut '
policies and procedures will enable in Bmooth functioning of the service and lead to
the patient satisfaction and thus better patient care. Zn day to day management of the
service planning of menu is critical bcc;ruse il affects thc work schedule, purchasing
plans, equipment uset production and distrihuri~m.The main objective of the
dep:lrtment should be to provide a halanced diet to the patielit as per physician's
instructions, properly prepared, clistributed in an aesllletic lnanner and considering his
underlying disease condition wherever applicable.
Ilospital dietary service is a service which caters to the needs of outpatients regarding
diet and food counselling and provision of diet to in-patients as per tlieir requirement
considering the nature and type of disease.
ReCieipt and ~tordgeArea: The area should have easy outside access for receiving of
supplies, loading, unloading platform with platform scales are needed. Door space
should be enough to permit handling o i crates. There should be enough space for
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storage of food items and includes shelves, racks, barrels, drums etc., which are
needed to store various items. Walk-in-refrigerators are ~leededfor supplies to be
kept in reserve for certain food items. 15-20% of total space is needed for these
activities. The storage area should be rodent free.
Day Store: In this store supplies for one day's requirement issued from main store
are temporarily stocked. We need few bins and 1-2 refrigerators in this area.
Preparation Area: Preliminary preparation of food involves peeling, washing,
soaking, cutting, chopping, slicing, mincing, kneading and sorting before being sent
for cooking, The area should be located between the storage and the cooking area. It
should have all facilities of washing with sinks, drain boards work top tables, peelers,
slicers, grinders, mincers etc.
Cooking Area: This areB should be located between preparation area and the point of
distribution for direct flow and to avoid any criss cross traffic. It should be fitted with
. cooking ranges, bulk cookers, fat frying equipment, chapati puffers, baking ovens.
Service Area: This sl~ouldhe adjacent to Lhe cooking area, where the cooked food is
put in the different pot and call be carried in food service trolleys which have
normally a double jacket in keep the food warin till it is served. For such patients who
are on different therapeulic diets and to be prepared for each patient, the food can be
. arranged in specially designed ways which are also loaded in the Food Lrollqs.
Dish Washing and PotIPun Washing: Adequate facilities need to be provided with
proper equipment and 11oL and cold water. The automatic dish washing machines are
also available now-a-days. Area for potlpan waslli~lgshould be separate hut aqjacent
lo each other preferably.
Other Facilities: The area should be properly ventilated and have good ligbting
arrangement. Adequate number of exhaust fans sl~ouldbe fixed to let out ally steam
and fumes. In addition we should have L.P.G. cylinder Bank, steam supply and
electrical points for utilisitlg different equipments. Flooring with tileslkota stones lor
easy washing and cleaning is needed. A seminar rooin in a large teaching hospitals is
needed for training student nurses and dieticians and other shff members.
Adequate space is needed for the offices of Catering Manager, Dieticians and other
staff members working in the department. Provision should be made for staff change
rooms, lockers for each worker, attached toilets and resl room for staff working there.
'A room is also needed for clerks maintaining different records.
Luyout of a Patient Kitchen
Day Store
I
Supervisor
n o 0 Preparation urea
Staff Rooms
Support und Utility Services-I Equipment: Detailed list of equipments is cnclosed as Annexurc I I . 'I'he choicc depends
upon h e budgetary provision, facilities to he provided rind the policies of thc hospital.
4.5 STAFFING
It may not be possible to generalise the requirement of staff according to tlie sizc of
the hospital. It will vary from liospital to hospital due to the differences in the type of
foocls served, physical facilities, equipment, type of service. Following type of
organisational structure is recommended for largc hospitals of' 500 beds ar~dabove.
Medical Si~perintendcnt'
I
Chief ~ i c t a :of'
~ Services
(Chief Momi~gcrIChief1)icticiun)
MallagerlDietician ManngerIDietician
(Patient Care Service) (Commercial Catering)
I I
ring
Beds
50 100 200 300 400 500 750 .
br. Dietician 1 1 1 2 2 3 4
Head Cook 1 2 2 3 4
Cook 1 2 3 3 4 4 5
Asstt. Cook 2 4 6 7 8 8 1 0
Read Bearer 1 2 2 3 4
Total 8 16 25 32 35 43 60
C
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n
I
Besides these workers, a store keeper, a11orclalylporter and secretarial assistance is needed. I
4.6 MANAGERIAL ISSUES
The department should be concerned with supply of proper diets at fixed timings
maintaining good hygiene. The quality of preparation and cookillg of different meals
should be strictly monitored. The feed back from the patieotslstaff to whom the food
is served acts as a control mechanism lor improving the service. It is important to
involve the staff members of the llospital like nurses, doctors, other para-medical
workers in decision making like purchasing, inspection of materials; opinion and
advice regarding the diets served, fixing of cost of diets for staff etc. Regular feed
back from the staff working in wards regarding the cliezs served to the patients is
equally important. The officer incharge should ensure:
4) Theelnployees should be given 2-3 sets of rtnnforms and ensure they wear it.
5) On the Job training of new e~rlployeeswho join the department should he done.
2) Dieticians should form part of the team to identify the sources of purchase either
spot purchase or on rate contract basis. Thcy should delermille the frequency of
purchasing different items.
3) The procedures for purchase should be laid down. It will be economical and
convellient to have most of the food items on rate contract basis tixed for a year.
4) Powers of emergency purchases whenever required should be delegated to the
officer in-charge of the service.
5) The food items received should be inspected by a team comprising of 3-4
members which sl~ouldinclude DieticianIOfiicer in-charge as well. Aflet receipt
of goods the stocks should be entered in the stock registers and maintain proper
consimption records under the supervision of the colltrolling ofticer.
6 ) The storage bins, racks, cupboards, rel'rigerators, coolers elc, should be properly
maintained and kept clean.
Support md Utllny &rvkw-I 7) Proper sanitation and cleanliness including
. . rodent control measures should be
observed.
8) A supervisory staff should be available in the patient kitchen during all the
working hours.
9) Work schedule should be planned properly avoiding split shifts as far as possible.
10) Dieticians should visit the wards everyday and have liaison with the staff nurses
and the patients. ,
11) Requisition of different diets from the wards should be signed by the sister
in-chzirge giving the bed number, ward number and the type of diet required by
the patient.
12) Nurses sbould also check and supervise the distribution of meals in the wards.
13) Supplementary requisitions for those patients who are admitted late in the day,
should also be entertained by the dietary department.
14) Service timings should be fixed with due regard to the traftic on floor, lifts aiid
local food habits of the people in general.
15) Menus should be planned in advance and also displayed everyday on a notice
board in the main kitchen. The rneals should supply physiological needs aiid
should be appealing and attractive to the patients.
16) Records pertaining to the diets served sliould be maintained ai daily basis and
compiled on weekly and monthly basis. Cost analysis of diets should be worked
out every weeklmonth.
17) Charges for meals for staff members and visitors should be fixed by a committee
involving management and staff members whiCh should be reviewed periodically.
*
patient kitchen and commercial catering and also available in two shifts as the ,
department has to work for at least in two shifts to cover the breakfast and dinner. , D ,
Petty thefts and pilferagesare common in the food service department. These mostly
involve food dishonestly consumed in the premises, stealing patient food, eating
leftover foods and pilfering food items from the stores. The offenders are usually the
employees of food service department, llousekeeping and maintenance personnel.
4
Proper inspection and receipt of materials, maintaining stocks, issue of materials f
under authorisation czY dieticians enables uproper control and check pilferage of i
materials. Moreover, the stores should always be locked and have very limited
accessibility to the stores.
&
Cost control measures include cost analysis of materials consumed, working out unit
costs and developing standards by adopting standard costing techniques. With this;ue
I
can develop norIns and also detect any deviations and take corrective steps. This will
also enable budgetary control and fixing charges for commercial catering purposes.
.Daily checking of foods prepared and served, feed back from patients and staff act as
a strict control mechanism and also helps in taking corrective measures. Officer in-
charge/Dieticians/Supervisorsshould go around the wards, talk to the patients and
discuss the food problems with them.
iii) Contacting nurses and patient in the wards by the DieticiausIJr. Dieticians1
Catering Supervisors to get feed back from the patient and ward staff.
i Physical check for usual impact, temperature of food, taste alid variety of
food
o Method of serving
0 Method of trailsportation
1) a) In-patient catering
b) Diet Counselling
c) Commercial
a) 49
b) 12
1. *
Support and UUUty Sewlces-I
4 FURTHER READINGS
Geervani, P., Situutionul Analysis of the Economics of Hospital Dietary Services with
Special reference to Andhra Prudesh, Proceedings of the XXII Annual
Convention, Indian Dietitics Association, Hyderabad, 1990.
Gibony, Mc Jr., Hospital Dietary Department: A guide to Planning and Service, Jan.
1961.
merapeuGc Nant~Gorra
The normal diet may be modified to:
1) provide change in consistency;
2) increase or decrease the energy value;