Winnipeg Free Press - PRINT EDITION
Taking the lid off hospital food
The WRHA's central kitchen makes meals more economically than hospital kitchens do. Surveys show patients find them tastier, too. SO WHY DO HSC AND ST. B STILL COOK THEIR OWN FOOD?
Kathleen Richardson still wears a white smock with the initials USSC sewn onto the front as she conducts a tour of an internationally recognized facility that prepares many of Winnipeg's hospital and care-home meals.
The smock is like a badge of honour to Richardson, who survived the tumultuous early days of the great provincial government experiment to centralize hospital food services in the city.
In the late 1990s the now-defunct USSC (or Urban Shared Services Corp.) became a political football. The Conservatives under Gary Filmon had championed a central food service to save money. Centralization occurred quickly and there were huge growing pains, with some patients terming the food inedible.
The NDP, concerned about union job losses in hospital kitchens, seized upon the early problems. "Frozen food has been a disaster," then-opposition leader Gary Doer pronounced a month before his party swept to power in September 1999.
The NDP vowed to halt the expansion of centralized food service in personal care homes. The city's two largest hospitals, St. Boniface and Health Sciences Centre, had been slated to receive food from the central kitchen by 2000. They never did.
Today, those hospitals are paying significantly more for their meals than the community hospitals that are on board. According to figures obtained by the Winnipeg Regional Health Authority, Health Sciences Centre spends 18 per cent more on food ($3.56 per patient per day more for meals and snacks) while St. B spends nearly 30 per cent more ($5.84 per patient per day more).
Given the number of patients each of the two major hospitals feeds, it is costing Health Sciences Centre an extra $2,136 per day and St. Boniface an additional $2,482 per day to nourish their patients compared to what it would cost if they were supplied by the central kitchen. Over a full year, the combined additional costs for both hospitals is a whopping $1.7 million.
The kitchens at both large hospitals are old. St. Boniface's kitchen was built in 1955 while HSC's dates back to the mid-1960s. Yet, officials say there are no plans in the works to replace them or contract meals out to the central kitchen.
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The facility that assembles and distributes more than 8,000 meals each day for Winnipeg hospitals and nursing homes is nestled in a nondescript building in the St. Boniface Industrial Park. It's believed to be the largest facility of its kind in the country.
Once operated by a private company under contract with USSC, the plant houses the nutrition and food services arm of the Winnipeg Regional Health Authority. It is now simply called the Regional Distribution Facility or RDF.
Unlike in the late 1990s, when the province closed several hospital kitchens in favour of a central facility, hospital food is no longer commanding huge headlines in Winnipeg newspapers. And, as the saying goes, no news is good news.
Richardson, the WRHA's chief nutrition and food services officer, recently took a Free Press reporter, photographer and videographer on an extensive tour of the facility. It began with the room that spews out "tray tickets," which dictate the contents of each patient's hospital meal tray.
As new patients or residents are admitted to client hospitals and care homes, their dietary needs and preferences are recorded and entered into a computerized system.
There are a multitude of factors that are considered. Is the patient or resident on solid food or must the food be minced or even pureed? Is the client lactose intolerant or on a low-sodium or gluten-free diet? Do they prefer tea over coffee with their meals? Would they like carrots instead of broccoli?
All these dietary imperatives and preferences are recorded by an aide at the hospital. The information arrives just prior to the printing of tray tickets outlining precisely what each patient will have for their next meal.
"We have 97 different diets and you can have any combination thereof," says Richardson. Included among the choices are various ethnic and religious food preferences, including bannock, caribou, arctic char and selections of kosher, East Indian and vegetarian dishes.
"We have to have for any possible combination enough foods and enough variety, in the right textures, for that complicated diet that fits Canada's Food Guide," she says.
Much of the food that is eventually served to patients arrives frozen at the central kitchen, some of it having been specially prepared for the Winnipeg facility. This includes some of the entrees that are served, vegetables and prepackaged foods for special diets, such as pureed whole wheat bread.
A succession of storage rooms at varying temperatures allows the food gradually -- and safely -- to thaw just in time for use. Richardson grabs an 8.5 by 11-inch pouch of frozen chicken noodle soup from a large stack to show visitors. "It's a really nice product. It's all gluten free, little baby noodles in there," she says.
Salads, salad plates and sandwiches are prepared on site. Up to 2,000 sandwiches -- 18 different kinds -- are made daily. A Selkirk Avenue bakery, Donut House, supplies the fresh bread, scones, bagels and muffins.
Local suppliers are used when possible, Richardson said. Naleway Foods, for instance, makes the perogies and cabbage rolls that are served. Smith's Quality Meats makes all the roast beef (sliced at the RDF for sandwiches and entrees), pork and corned beef used. A little over half of the food the central kitchen serves originates in Manitoba. All is sourced from local distributors.
Because folks in hospitals and personal care homes are usually weak and have little appetite, small, nutritionally dense portions are favoured. For example, the RDF serves a high-protein oatmeal that is made with milk, and it fortifies fruit juice with a powder that adds seven grams of protein and 100 calories to a half-cup serving. There are also no fillers in the meat it serves, Richardson says.
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One of the busiest areas in the RDF is the room where the meals are assembled on trays. Here, staff at eight work stations on each of two circular assembly lines stock trays in a 10C room at a rate of about eight per minute.
Each worker is surrounded by stacks of food, with responsibility for adding an entree, a beverage or a dessert. Accuracy is essential, especially for patients with special diets or food allergies. A checker examines all the trays before they're loaded onto trucks. In the case of special dietary concerns, trays are double-checked and signed off by a supervisor.
"We deliver lunch and supper and then we plate breakfast the night before and deliver breakfast on the day that it is being served starting at about 4:30 in the morning," Richardson said, noting that a number of the 215 workers in the facility were once employed in city hospital kitchens that were closed in the 1990s. In case of a blizzard, breakfast is occasionally trucked to the institutions the night before to reduce the risk of delivery problems. Each delivery site stocks two days worth of meals as a contingency measure. That food is continually rotated.
At each client hospital and long-term care home, trays are placed in rethermalization units that keep the food refrigerated until shortly before use. Dividers separate tray items that are served cold from those served warm. The food is heated just before the trays are served to patients.
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The central kitchen faced a blizzard of bad reviews when it was in its infancy. The Free Press reported 700-plus complaints in November of 1998 and 71 in March 1999. But since then food satisfaction rates have improved greatly.
Part of the problem in the early days, Richardson says, was that centralization occurred too quickly, before the bugs in the system were worked out. "It was several years (till about 2000-2001) until we weren't in crisis type mode," she says now.
The central kitchen also learned some lessons through trial and error. For instance, some foods, such as toast, don't lend themselves to being prepared in advance. The facility serves muffins, scones and bagels instead and leaves it to the individual institutions to prepare toast for those who request it.
Because the Winnipeg plant was one of the first large central hospital kitchens of its kind anywhere, it has received visits from curious hospital and government officials from across Canada and the United States and as far away as Europe and India. The Niagara health region is in the process of converting to a centralized service, and officials from Calgary, New Brunswick and Newfoundland have recently consulted with Richardson and her group. Other jurisdictions, such as Saskatoon, have centralized meal provision in a hospital instead of constructing a separate facility.
Today, the Winnipeg Regional Health Authority's central kitchen claims a client satisfaction rate of 86.3 per cent based on its last annual satisfaction study. Richardson said that's high for the food service industry. It's also a higher rating than for the two big hospitals the NDP government blocked from receiving meals from the RDF. According to the WRHA, the satisfaction rate for Health Sciences Centre food is 78 per cent; for St. Boniface, it's 73 per cent. (As part of her mandate, Richardson manages the kitchen at HSC, but the RDF does not provide it with meals.)
As part of its quality assurance program, the central kitchen provides comment forms for patients, residents and institution staff to fill out if they have issues with its food. "They're not all negative," Richardson says of the responses. "But every single one of those comes across my desk so I still have a pulse of what's going on."
In late 1998, a senior in one of the hospitals served by the central kitchen complained: "You could play football with the scrambled eggs. They're just big hard lumps."
Asked, if her kitchen's scrambled eggs get such reviews today, Richardson says: "No, I don't get any comments on scrambled eggs, which usually means they're OK."
Then she added: "In fairness, a lot of the products have come a long way."
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For years, Richardson brought up the idea with successive NDP health ministers of expanding the RDF's reach to include Health Sciences Centre and St. Boniface General Hospital -- without success. "We've just never been given the go-ahead," she says. She has not raised the issue with the current health minister, Theresa Oswald, who has held the portfolio since 2006.
Providing meals to the province's two biggest hospitals would require the RDF to boost its output by 38 per cent. The central kitchen could not accommodate the two giants overnight. It would require considerable planning and investment.
Richardson said she would consider building a second, smaller production facility to accommodate St. B and HSC if she ever got the green light. An advantage of a second facility would be the flexibility that would come in the case of an unforeseen disaster at either plant.
However, Oswald and hospital officials appear content with the status quo despite the significantly higher kitchen costs at Health Sciences Centre and St. Boniface hospital.
Senior administrators with the two hospitals declined, through an intermediary, to be interviewed about the state of their aging kitchens and their patient-food plans.
WRHA spokeswoman Heidi Graham acknowledged in an e-mail that the hospitals' kitchens "will be in need of upgrading sometime in the future." She said only "very preliminary work" has been done to identify "potential options to upgrade the kitchens," but no recent comprehensive study has been undertaken.
In an interview, Oswald acknowledged that food costs were higher at the two hospitals. However, she noted that there would be significant upfront costs in expanding the RDF to accommodate the big institutions.
"We're not going to dismiss it as an idea out of hand," the minister said. "(But) it's not... something that we're contemplating in the immediate future."
Oswald admitted that she has not considered expanding the role of the Regional Distribution Facility as part of her department's efforts to trim costs. In fact, she pointed out that all new personal care homes these days are being constructed with their own kitchens.
"We're glad that the centralized food system is publicly owned and managed, and that's not apt to change anytime soon," the minister said. "But I will be forthright in telling you that I still need to see some work being done to convince me that the RDF is the only way to go."
The WRHA's central kitchen
-- Operates 18 hours per day seven days a week.
-- Prepares and delivers more than 8,000 meals each day.
-- Provides meals to Seven Oaks, Concordia, Victoria and Grace hospitals, Deer Lodge Centre, Misericordia Health Centre, Riverview Health Centre, Calvary Place, Concordia Place, Meals on Wheels and Winnipeg Regional Health Authority crisis centres.
-- Employs 215 full-time, part-time and casual staff at a 50,000-square-foot facility in the St. Boniface Industrial Park.
Daily meal-cost comparisons*
Central kitchen: $19.54 per day (includes delivery costs)
Health Sciences Centre: $23.10 per day
St. Boniface General Hospital: $25.58 per day
*Includes three meals, snacks, supplies and salaries.
Source: Winnipeg Regional Health Authority.
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Republished from the Winnipeg Free Press print edition May 4, 2013 ??65535
Updated on Saturday, May 4, 2013 at 9:42 AM CDT: Cutline fixed
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