FOOD SERVICE MANAGEMENT AND ADMINISTRATION

Volume 2 GUIDELINES
FOR

FOOD SERVICE UNITS IN HOSPITALS AND HEALTH INSTITUTIONS

Compiled by Working Group HMC Sub-committee for Nutrition Services - 1993 Revised by Directorate Nutrition Department of Health - 2001 -

Copyright 2001 Department of Health, South Africa All rights reserved This publication is intended to support nutrition activities and may be copied and distributed as required. Distribution for remuneration is not permitted. Permission from the copyright holder is required for any changes to the format or content of this publication

Guidelines and National Diet Manual for Food Service Units

CONTENTS
1 2 2.1 2.2 2.2.1 2.2.2 2.2.3 2.2.4 2.2.5 2.2.6 2.2.7 2.2.8 2.3 2.3.1 STATUTORY POLICY OPERATIONAL POLICY STA NDA RDS OF SERVICE FINA NCIA L PLA NNING Budget Budget Period Guidelines for the Planning of a Food Serv ice Budget Calculating the Food Serv ice Budget Calculating the Food Cost Sub-div ision of Food Serv ice Budget Cleaning Material Stationary PA TIENT NUTRITION The Normal Diet 4 4 4 4 4 5 5 6 7 7 8 8 8 8

2.3.1.1 2.3.1.2 2.3.1.3 2.3.1.4 2.3.1.5

2.3.2

Meal and Menu Plannin g Factors Influencing Meal and Menu Planning The Meal Plan The Uniform Menu The Cycle Menu

9 9 10 10 12 12 12

Therapeutic Diets

12

2.3.2.1 The Meal Plan 2.3.2.2 Menu Planning

2.3.3

2.3.3.1 Separate Facilities available for Kosher or Moslem Kitchen 2.3.3.2 No Separate Facilities available for Kosher or Moslem Kitchen
2.3.4 2.3.5 Ethnic Groups Other Meals for Patients

Religious Groups

13 13
13 13

12

2.3.5.1 2.3.5.2 2.3.5.3 2.3.5.4

2.3.6

Out-Patients Lodgers Maternity Outpatient Unit (MOU) Travelling Patients

13 13 13 14
14

2.3.6.1 Plate Waste Studies 2.3.6.2 Opin ion Survey

2.4 2.4.1 2.4.2 2.4.3 2.5 2.6 2.7 STA FF MEA LS Food Serv ice Personnel Creches at Health Institutions Prov ision of Tea for Staff SPECIA L FUNCTIONS OFFICIAL VISITORS CHRISTMA S LUNCH

Meal Testing

15 15
15 15 15 16 16 16

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PREFACE
Providing food within a hospital or health institution is an inclusive service that has to be rendered to patients and staff for 365 days a year. The purpose of this manual is to provide guidelines for hospitals and health institutions to facilitate optimum and cost-effective food service manage ment and administration.

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STATUTOR Y POLICY

The following acts apply to food service management and administration:

Machinery and Occupationa l Safety Act, 1983 (Act 6 of 1983) Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act 54 of 1972). Public finance manage ment Act, no.1 of 1999 Labour relations Act, Skill development bill Regulations governing Hygiene requirements for food premises and the transport of food. Government Gazette 30 July 1999.

OPERATIONAL POLICY

Operational policy is defined in the following manuals, handbooks and guidelines:

Ration scales Recipe Manual South African Food Based Dietary Guide lines Hygiene and safety handbook Equipment handbook

2.1

STANDARDS OF SERVICE

The standard of service e.g. type of menu, the serving times of meals, the serving methods, shifts of food service personnel, budget allocation, etc. must be determined by the Food Service Manager or Supervisor in collaboration with the Hospital Management. The National Department of Health sets minimum standards for food service units to imple ment. To standardize the food service and ensure a service of high quality in all institutions, Food Service Managers and Hospital Management must adhere to the Nationa l minimum sets of standards e.g. meal plan, cycle menu, serving t imes of meals, serving methods etc. Food Service Managers in collaboration with the Hospital Manage ment can determine extras they would like to add to the minimum standards if they wish to provide an extraordinary service to their clients that are still within the limitations of their budget.

2.2

FINA NCIAL PLANNING

The goal of the Department of Health is to provide the best possible food service to hospitals and other hea lth inst itutions, within limited financia l resources.

2.2.1 Budget At the beginning of each financial year a certain a mount of the total hospital budget is allocated for provisions. It is the responsibility of the Food Service Manager or Supervisor to budget and control the spending of this amount to render the required service and to meet the expectations of the management.

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Financial planning and accountability for the food service unit are major responsibilities. Cost effectiveness is essential for a successful operation. A budget is a forecast of future needs. Food service budgets include operating data as well, the number of meals to be served, and labour time require ments. Budgets are based on factual data from past records. A budget is a valuable manage ment tool used as a guide for allocation of resources and for comparison with actual operations, the basis for financial control.

BUDGET CYCLE
BUSINESS PLAN

FEEDBACK

IDENTIFY/SET OBJECTIVES

ADJUST BUDGET ACCORDINGLY

PRE PARE BUDGET

COMPARE EXPECTED WITH ACTUAL EXPENDITURE

The department uses the following types of budgets:

o Zero- based budget , which requires managers to justify in detail each request for funds and to re-evaluate all activities each year. There is no carry-over from previous years, each year- budget begins with a Zero ba lance. o Incremental budgeting starts from the present baseline of the progra mme or sub-programme, questioning whether it should be increased, reduced or left unchanged in order to attain the programmes objectives subjected to the overall resource constraints of the departmental base line.

2.2.2 Budget Period The government has set out a 3-year spending plan, namely the Medium Term Expenditure Framework (MTEF). The MTEF details 3-year rolling expenditure and revenue plans for national and provincial departments.

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2.2.3 Guidelines for the Planning of a Food Service Budget The following schematic diagra m details all records and documents needed for the planning of the food service budget:

Ration scale Cycle menu Standardised recipes Perishables and Non- Master orders Meal statistics Perishables contracts (Patients and Personnel) Ordering records Delivery control (quality and quantity) Cold rooms, deep freezer and store room records Stock control reports BUDGET

2.2.4 Calculating the Food Service Budget The budget calculation starts with the calculation of the total number of feeding days per annum. A feeding day is the total number of meal times per day including 3 mea ls. The total number of meal times includes resident personnel and patients three meals as well as one meal for day personnel per day, if meals are offered to personnel.

Example:
(i) Resident personnel and Patients

The average sum of all resident personnel and patients for breakfast, lunch and supper over a year divided by three equals to the total number of feeding days.

M EAL TIME Breakfast Lunch S upper TOTAL

NUMBER OF P ERSO NNEL/PATIENTS 20 20 20 60

60 x 365 ---------- = 7 300 feeding days

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(ii)

Day personnel (one meal per day)

The number of feeding days for day personnel are calculated as follows: take the number of midday meals eaten during the year multiplied by 5 and divided by 12 equals to total number of feeding days. The main meal is usua lly 5/12 of the total days meal, breakfast equals to 3/12 and supper equals to 4/12.

Example:
Single meal per day = 10

10 meals x 365 days x 5 -----------------------------12

= 1 521 feeding days

Total number of feeding days = total number of funds spends (R15 000) for previous financia l year divided by total number of feeding days (1 521 + 7 300 = 8 821)

i.e:
(iii)

R 15 000 ------------- = R 1.69 8 821

Calculate the number of feeding days for all normal and therapeutic diets.

2.2.5 Calculating the Food Cost Obtain the recent updated price list for stock on hand at the finance section Plan the number of feeding days for the new financial year. Take into account the increase or decrease in personnel and patients. Determine the food cost per person per day according to the ration scales and the contract price per food item. Multiply it with the planned statistics and obtain the amount for 1 financial year. For example to determine the meat price: calculate the average cost of the cuts that will be used on the menu as well as the number of times the cuts will be used. This is the procedure to be followed for all items (Fruit and vegetables, milk products, oils

and margarine, baked products, eggs and groceries).

2.2.6 Sub-division of Food Service Budget The food service budget need to be classified/ sub divided into the following categories: o o o o o o o Meat, fish, poultry, mutton and pork Oil, butter, margarine Eggs Milk and diary products Bread and baked products Fruit and vegetables Groceries

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The above categories must be given percentages from the main budget. A specific percentage must be worked out from the consumption reports and allocated to a category. The a mount must be divided by 12 as to obtain the monthly a mount to be spent on a specific category:

Example: Budget: R 100 000

ITEM M eat, fish, poultry Oil, butter, margarine E ggs M ilk and dairy products Bread and baked products F ruit and v egetables G roceries TOTAL PERC ENTAGE 30% 2% 3% 7% 13% 10% 35% 100% AMOUNT R30 000 R2 000 R3 000 R7 000 R13 000 R10 000 R35 000 R100 000

2.2.7 Cleaning Material A monthly summary should be kept for how much of each chemica l/agent was used and the cost per item. The average of 12 summaries may be used to determine the budget for cleaning materia l. Stationary

2.2.8

A monthly summary should be kept for how much of each chemica l/agent was used and the cost per item. The average of 12 summaries may be used to determine the budget for cleaning materia l. All external purchases must be included before the total a mount is budgeted for.

2.3

PATIENT NUTR ITION

Patients receive nutrition care as an integral part of patient care when they are admitted to hospital. Nutrition care is administered within specific guidelines. Nutrition must be adapted to the condit ion of the patient. If the illness does not require a modification of the diet, a normal diet is provided. The consistency of the diet must be changed to soft, light or liquid according to the patients needs. Certain disorders require therapeutic modification of the diet as part of the treatment, for instance renal diets for patients with renal failure. Patient nutrition must satisfy conditions required by the religious conviction of the patient, for instance diets for Jews, Mosle ms and Hindus. The planning of diets must a lso take the ethnic eating habits of patients into account. Meals must at all times be served attractively and hygienically and must be microbiologica lly safe. The food budget must be taken into account when providing food.
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2.3.1 The Normal Diet A norma l diet is based on the recommended dietary allowances (RDA) for healthy persons and includes a variety of foods. All menus must be nutritionally analyzed by a Dietitian to determine whether the specific energy, proteins, carbohydrates and fat are provided for each group, according to the recommended daily allowances (RDA). The South African Food Based Dietary Guide lines are used for food choices. A normal diet should provide sufficient dietary requirements for healthy persons who require no additional dietary modifications.
Recommende d Daily A llowances (RDA). Energy Carbohydrates Protein Fat

6300 - 8400k j 204 - 272g 56 - 99g 41 - 55g

2.3.1.1

Meal and Menu Planning

The menu is the spindle of the activities of a Food service. Menu planning is a responsible and enormous task. It should be done considering several factors. Factors Influencing Meal and Menu Planning

2.3.1.2 (i)

Type of client The age, nutritional require ments and eating patterns of clients according to culture, race or religion is a very important factor to consider when planning a menu Budget Choose dishes, which are economical, if the budget is limited. The portion sizes will also be influenced by the budget. Refer to the ration scale for portion sizes. Personnel The availability of personnel and the knowledge and skills of the food service workers will determine the type of dishes, which can be planned on the menu. If the availability of staff is limited the dishes should be simple and not time consuming. As the efficiency of the staff improves the complicity of the dishes can also increase. The workload should be spread evenly during the day, but during peak preparation hours e.g. before lunch, most of the staff should be on duty.

(ii)

(iii)

(iv)

Equipment The available equipment in the food service unit will determine the type of dishes and the cooking and preparation methods, which can be used. The condition of the equipment will determine the ir availability to perform. Kitchen lay-out The distance between the preparation, cooking and the serving area will determine whether food will deteriorate while waiting or the pilferage and traffic rate in the food service unit will be high. The efficiency of the layout can influence the type of dishes and the productivity of the personnel.

(v)

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(vi)

Storage space and delivery The institution/hospital stipulates the delivery days. In collaboration with the suppliers the delivery times of the different food items should be determined. The available storage space must be kept in consideration. This will a lso influence the variety and frequency of dishes on the menu. Product selection The food service manager or supervisor must do the perishable product selection. In collaboration with the procure ment officer, the variety of food items, from the contract document may be indicated for ordering by the procure ment depart ment.

(vii)

(viii) Image of institution The quality, appearance and acceptability of the food served will either build or harm the image of the hospital/institution. The Food service units should strive for: o Optima l client satisfaction within the limited resources o Institution image building o Being proud about the task/work performed 2.3.1.3 The Meal Plan

The meal plan is a list of the basic components of each meal. It is used as a starting point in the planning of the menu. It is the pattern on which the food items on the ration scale will be divided on a daily menu, and to streamline operational procedures in the food service unit. The prescribed food items are planned on a menu framework according to the frequency per day/week allowed. The meal plan is prescribed in order to ensure uniform meals in hospitals that meet the patients nutrit ional require ments and are within the food budget.

The Provinces provides guidelines on meal plans, but can be changed from time to time if circumstances warrant it.

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The meal plan listed below is a guide line to be followed for patients on the norma l diet:

M EAL TIME

EARLY MO RNING Breakfast

FOO D ITEM S Tea/Coffee w ith milk and sugar F ruit* /F ruit juice (150ml) Dry breakfast cereal/P orridge w ith milk and sugar P rotein dish (optional) Brow n bread M argarine Jam/P eanut butter/M eat extract Tea/Coffee w ith milk and sugar Tea/Coffee w ith milk and sugar S oup (optional) M ain dish S tarch 2 v egetables 1 v egetable and 1 salad Tea/Coffee w ith milk and sugar Desert (optional) Tea/Coffee w ith milk and sugar S oup (optional) M ain dish S tarch 1 v egetable or salad Brow n bread M argarine Jam/P eanut butter/M eat extract Tea/coffee w ith milk and sugar Tea/Coffee w ith milk and sugar

10 :00 Lunch

OR

14 :00 Supper

20 :00

* Fruit may be served at any other meal time ( 1 fruit per day)

2.3.1.4 (i) (ii) (iii) (iv) (v)

The Uniform Menu

Is the plan of the list of dishes with their preparation or cooking method stipulated, which will be served together for a specific mea l on a specific day. A menu is planned to meet the needs of a specific group of people e.g. patients in a hospital, the elderly in an old age home, children in a home or place of safety. The menu should be planned to ensure variety in: Taste: The individual dishes in a meal should not clash, but comple ment each other. Not more than one strongly flavoured dish per meal. Aroma: The aroma of food will stimulate hunger and should be pleasant and appetizing. Colour: The plate of food should look colourful and appetizing. Texture: The different food items on the plate should vary e.g. something crispy, something smooth, something fine and something coarse Shape: The food ite ms must not be for example be everything round (Meatballs, boiled

potatoes, peas, and mealies).

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(vi) Temperature: Variety in temperature in the same meal will always be appreciated. The day- temperature will determine the te mperature of the food served e.g. cold lunch on a hot day. In order to ensure uniformity in respect of menus, the following guide show how many times per week protein rich foods may be repeated. This fit in with the ration scales and includes breakfasts, lunches and suppers:

Protein Distribution Option 1:

TYPE OF FOOD E ggs (boiled, fried, scrambled, or poached) S ausage F ish P oultry M inced meat Roast (e.g. roast chicken) M eatless dish (e.g. cheese dish) S tew TOTAL NUMBER OF SERVINGS P ER WEEK 3 2 3 2-3 3-4 1 2-3 3 21 Meals

Protein Distribution Option 2:

TYPE OF FOOD S ausage F ish P oultry M inced meat Roast (e.g. roast chicken) M eatless dish (e.g. cheese dish) S tew TOTAL NUMBER OF SERVINGS P ER WEEK 1 3 3 2 1 1-2 2 14 Meals

Meat, especially minced meat, can be extended with TVP (textured vegetable protein) or dried legumes in the a mounts as shown on the ratio scale. Roasts can be replaced or alternated with stews Polony or processed cold meats can be served in summer in place of stews, where acceptable or applicable taking into consideration the cultural and eating patterns of the community serviced. The Cycle Menu

2.3.1.5

It is recommended that:
Institutions to choose from 8,12 and 16 day cycle menus, to accommodate longterm patients and for variety. Cycle menus for winter and summer; are drawn up according to, the meal plan by the person in charge of each food service unit. The cost and availability of food items and the facilities available (staff/equipment) are taken into account in planning the menus.

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2.3.2 Therapeutic Diets Under certain circumstances it becomes necessary to change the consistency and the kind of food supplied to the patient as part of the treatment of his disorder. All therapeutic diets are planned to meet the patient's food require ments as far as possible. The most common therapeutic diets are clear-liquid, full-liquid, light, soft, high-protein, sodium-reduced, low energy (reducing) and diabetic diets please refer to the National diet manual. In the absence of a dietician the food service manager of supervisor must consult the regional office. The Meal Plan

2.3.2.1

The meal plan for therapeutic diets corresponds as far as possible with the meal plan for the norma l diet. The meal plan must, however, be adapted according to the requirements of the specific diet; for example diabetic diets require in between snacks. Menu Planning

2.3.2.2

The menu for therapeutic diets corresponds as far as possible with the menu for the normal diet. However, changes are introduced in accordance with the specific instructions for each therapeutic diet; for example salt free diet whereby salt must not be used during food preparation.

2.3.3 Religious Groups It is the policy of the Health department; to let persons of a particular religious group who must be supplied with mea ls determine whether separate facilities for the preparation of Kosher, Mosle m or Hindu diets should be provided or whether individual arrangements should be made.

Jurisdiction of the religious leaders:

The religious leaders may come and inspect the food service unit. The religious leaders must submit a yearly programme to the hospital superintendent for inspections. The hospital superintendent will give it to the food service unit. An inspection task team must be formulated representing (3 me mbers from each party:

A standardized format for inspections must be agreed upon. A report must be produced after each inspection. The report must be submitted to the hospital superintendent for action. 2.3.3.1 Separate Facilities available for Kosher or Moslem Kitchen If a separate kitchen is available, meals are prepared according to the prescriptions for each group. The same mea l plan as for a norma l diet is followed. Therapeutic diets are adapted according to specific prescript ions.

hospital and religious group)

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2.3.3.2

No Separate Facilities available for Kosher or Moslem Kitchen

If separate kitchens for the different religious groups are not available, simple changes are introduced into the normal or therapeutic diet, which fit in with the prescriptions of specific religious groups. For instance:
RELIGION DIET ALLO WED Chicken, F ish, Red meat, eggs, soya, legumes, cheese S trict kosher: Do not serve milk and meat dishes together. F ish, halaal chicken or soya, halaal red meat and legumes Chicken, fish, cheese, eggs or soya, legumes and mutton P ork NOT ALLO WED

KO SHER

MO SLEM HINDU

N on-halaal red meat and pork Red meat, pork

2.3.4 Ethnic Groups If different ethnic groups are served in the hospital, carbohydrate dishes in particular can be adapted to the eating habits of each specific group, e.g. rice or pasta can be replaced with samp, mealie rice or mealie porridge and bigger starch portions may be given.

2.3.5 Other Meals for Patients 2.3.5.1 Out-Patients

No meals are provided for outpatients except in the following cases:

A meal can be provided in cases where clinical tests require it. If an out-patient have to wait a long time or overnight, an economical meal is provided consisting of the following:
Breakfast Lunch Supper
P orridge w ith milk and sugar Lunch of the day S upper of the day

2.3.5.2

Lodgers

Breastfeeding mothers who lodge-in get the sa me mea ls as ment ioned above. Maternity Outpatient Unit (MOU)

2.3.5.3

In this unit there are often no facilities available for the preparation of meals. However, as patients do not eat large meals while in labour, an economical meal is provided for them. Porridge with milk and sugar, soup, bread with spread, tea or coffee with milk and sugar are provided for these patients as and when necessary.

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2.3.5.4

Travelling Patients

Provisions for travelling (state) patients are supplied according to the number of meals they will require during their journey. Children must be taken into account e.g. milk powder must be provided. Therapeutic diets e.g. liquid diets and diets for cancer patients, must be catered for.

Examples of food and menu items for long and short distances:
FOO D Protein dishes E ggs Dry beans Cheese Chicken Red meat EXAMPLE OF M ENU ITEM S

Boiled Dry beans fricadel Three bean salad G rated/diced/portions S avory tartlets Cold chicken portions S lices of cold meat M eat loaf M eat balls Cold processed meat Vienna sausages P olony S cones/muffins/corn fritters Bread/bread rolls *P otato salad *P asta salad *Rice salad

Starchy dishes

* may be combined w ith protein rich dishes

Vegetables Carrot sticks/salad w ith v ariation Cucumber, sliced Tomato, sliced or whole Fr uits/Fr uit juice F resh fruits e.g. apple pear, banana, peach, orange/ 500ml fruit juice

Meal plan for long and short journeys*:

P rotein S tarchy Vegetables F ruit Tea Coffee S ugar M ilk pow der 60 - 90g 60 - 120g 60 - 80g 150g 2,5g (1-tea bag) 2,5 (1 sachet) 10g (1 sachet) 5g

Or

or or

P ow der juice S oup

Or

15g 30g

* Meals must be ordered in advance, at least 24 hours before departure.

2.3.6 Meal Testing It is essential that me mbers of the hospital manage ment and the food service manager or supervisor regularly evaluate meals that are provided for patients. In order to ensure
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quality; food must be evaluated at least four times a year and without prior notice to a testing panel consisting of at least five staff me mbers. 2.3.6.1 Plate Waste Studies

It is essential that plate waste studies should be done at least 3-4 times a year to determine which dishes are popular and which ones are not. The plate waste study helps the food service manager or supervisor to adjust the menu according to the client needs. Opinion Survey

2.3.6.2

An opinion survey should be done 2-3 times a year before a new menu is planned in order to take into account the cultural eating patterns and the likes and dislikes of the clients.

2.4

STAFF MEALS
The provincial policy applies.

2.4.1 Food Service Personnel 2.4.2 Creches at Health Institutions Meals are provided for the Children of state officials who are cared for in crches, and are included in the tariff set out. The following mea l plan is provided for children in crches:
M EAL TIME FOO D ITEM S Dry breakfast cereal/P orridge w ith milk and sugar Brow n bread M argarine Jam/P eanut butter/M eat extract/C heese/F ish paste Rooibos tea w ith milk and sugar Rooibos tea w ith milk and sugar Brow n bread M argarine Jam/P eanut butter M ain dish S tarch 2 v egetables or 1 v egetable and 1 salad F ruit Desert (optional) Rooibos tea w ith milk and sugar (Winter) F ruit Juice (S ummer) S oup (optional) E gg/V ienna/P olony Brow n bread Margarine Jam/P eanut butter/M eat extract 200ml M ilk

BREAKFAST

10 :00

LUNCH

15 :00 SUPP ER

2.4.3 Provision of Tea for Staff

The status quo at the Province concerned may continue.

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2.5

SPECIAL FUNCTIONS

Funding of special functions, e.g. farewell functions, birthdays and special teas are not permitted. Meal coupons may not be used to pay for sandwiches. The food budget does not provide for sandwiches.

2.6

OFFICIAL VISITORS

Expenditure for meals and/or refreshments in connection with official visitors must be covered by the entertainment allowance of the medical superintendent, if any; alternatively, it can be funded by the hospital board.

2.7

CHRISTMAS LUNCH

The hospital board can fund extra expenditure with respect to a special menu on Christ mas Day.

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