Menu Planning & Assessment

Keys to Menu Planning & Assessment

Know your Client preferences & demographics Have Menu Objectives to measure the menu against Familiarise yourself with the relevant tools & policies Understand your budget/food service system/equipment and storage facilities Engage staff, involve in process Recognise the staff skills and staffing levels Is your Menu Design relevant & appropriate Understand Menu combinations - texture / taste / nutrition / presentation / variety

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STEP 1: RESEARCH YOUR CLIENT GROUP

Demographic data Satisfaction Survey results Nutrition status Diagnoses
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Meeting Expectations
Private Hospital -Pts expect a better food service than in a restaurant Aspects of Client Satisfaction
Food quality, appearance Food temperature Flavour Attitude of staff delivering food & menu
Attentive, courteous

Timeliness & reliability of service Menu Flexibility or Customisation

Variation of portions Choice of foods Ability to self select
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MALNUTRITION IN AUSTRALIAN HOSPITALS

Lazarus et al 2005 Nutr & Diet
100 80

Hospital Comparisons
% PTS MALNOURISHED

Found 37% patients were severely or mild to moderately malnourished using Subjective Global Assessment
Middleton et al 2001 Intern Med J

61% 60 42.3% 40 20 37% 18.8% 35%

16.7%

Found 35% pts were severely or mild to moderately malnourished using SGA
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RN

,N SH

, , S LD SW W Y GE NTS D OR CES R A, Q INCE QL , NS SLE V WE AT E, SVPH ST GE PRIN X AND ST IV PR ALE NSW NSW
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Common Barriers
Lack of clearly defined responsibilities in planning/management of nutritional care
Nutrition screening 40% of responses (POWH)

FOOD IS MEDICINE HENCE LET YOUR MEDICINE BE YOUR FOOD

Lack of sufficient education among all staff groups Lack of influence of the pts Lack of cooperation amongst staff groups Lack of involvement of hospital management
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Hippocrates 400BC
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Barriers to adequate nutrient intake

Poor choice and availability
Poor menu planning, lack of variety Poor cooking methods, nutrient losses

International Programs
Better Hospital Food Programme:
Initiative 1 - Protected Mealtimes Periods on a hospital ward when all non-urgent nonclinical activity stops. During these times, patients are able to eat without being interrupted and staff can offer assistance.
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Poor access
High acuity Packaging and presentation Staffing Variety
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Benefits of Good Nutrition

Reduced infection risk, pressure areas, falls, mortality rates Improves immune function, stamina, quality of life, potential drug and nutrient interaction, independence

STEP 2:
SELECT RELEVANT MENU OBJECTIVES
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Menu Planning Objectives

Meet customers needs, go beyond expectations Meet the budget limitations Meet nutritional goals, see relevant standards Provide predictability with purchasing, production and distribution Provides criteria/standard to meet May alter with each menu review project
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Examples of Menu Planning Objectives

Improve on client satisfaction scores Increase nutrient density of texture modified meals Reduce food service costs Meet 50% of the RDI for Long Day Care Centres Improve nutrient density of MOW soups and main meals. Aim for standard of >20g protein/main meal, >5g protein/dessert Satisfy food preferences of the residents
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STEP 3: WHAT TOOLS, STANDARDS AND POLICIES EXIST ?

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Menu Planning Standards

Nutritional Standards for Hospital Menu Development, DRAFT V7, November 2006 Department of Human Services (Victoria) Nutrition Standards, November 2005 Food Service Guidelines for healthcare. NSW Institute of Hospital Catering Ltd, 1997 Hospital Menu Assessment Tool, NSW Health, 1999 Nutrient Reference Values, NHMRC, 2005
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Menu Planning Standards

Dietary Guidelines for Australian Adults, NHMRC, 2003 Dietary Guidelines for Children and Adolescents, NHMRC, 2003 Nutrition Policy for Children in Hospital, The Childrens Hospital Westmead Wentworth AHS Food and Nutrition Policy, Wentworth Area Health Service, 1998
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NSW Health Hospital Menu Assessment Tool

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Menu Planning Standards

Hospital Menu Assessment Tool, NSW Health 1999 Assesses nutritional quality of hospital menus (full diet menu) and menus for hospital cafeterias, food courts and bistros.
Advantages: Self assessment tool for food service managers/dietitians managers/dietitians Highlight areas for improvement in nutrition quality of the menu Setting a quantitative benchmark, comparisons over time
Fat

Dunn and Williams AJND (1995)

Nutritional Factor Variety Menu Characteristics and Specific Criteria assessed
Menu Cycle and Frequency of revision Seasonal variation in menus Number of hot meal choices at three main meals Use of continental breakfasts and protein alternatives Nutrition education messages on menus Meal serving size options Availability of bread Availability of high fibre breads and breakfast cereals Availability of fresh fruits Use of legumes Type of fat spreads offered Percentage of high fat main menu items Low fat food choices indicated on menu Availability of low fat dairy products
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Cereals, vegetables and fruits

Compare with other hospitals Nutrition indicator used with others eg. Budget, pt satisfaction
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Dunn and Williams AJND (1995)

Nutritional Factor Alcohol Menu Characteristics and Specific Criteria assessed
Whether it is offered and what type

Food Service Guidelines for Healthcare (1997)

Minimum daily provision on tray
FOOD GROUP Min. no. of Min. serving size serves/day 1 1 1 1 2 4 1 120g can fruit/100ml juice 90g 60g 60g 1 slice bread 180g hot cereal 30g cold cereal 70g rice/pasta (cooked)
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Comments

Fruit - Fresh Fruit - other Starchy veg Dark green leafy Other Breads & cereals

One piece of fruit/day 1 rich vit c source/day Should include 1 rich bbcarotene source - Dark green/orange/yellow veges Wholemeal bread and wholegrain cereals should be offered

Salt

Percentage of highly salted main menu items Optional salt selection on the menu Optional addition of sauces and gravies Average number of serves of calcium at each meal Availability of dairy products Percentage of good haem iron main menu choices Availability of vitamin C sources at meals
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Calcium

Iron

Food Service Guidelines for Healthcare (1997)

FOOD GROUP Min. no. Min. serving size of serves/ day Meat, poultry, fish, eggs, legumes, nuts, seeds
2 75g meat,fish,poultry 1-2 eggs 11/2 cups cooked legumes 100g nuts/seeds/25g TVP 1 serve = 200ml milk/40g cheese/200g yoghurt

Comments

1 choice at each meal <15g fat, <15mmol na Meat, poultry, fish, eggs, legumes should be incorporated into salads and sandwiches 1 milk based dessert 2 milk drinks offered/day LF milk available at each meal Unsaturated margarine available at each meal

Milk, cheese, yoghurt

Fat spreads
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STEP 4: FIND OUT ABOUT THE FS SYSTEMS & BUDGET ?

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Production Systems
There are four main types of production systems Cook-serve or Cook-fresh CookCookCook-chill CookCook-freeze CookConvenience ALL have an impact on the menu What are the advantages and disadvantages of each when considering menu planning?
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EQUIPMENT

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PREPARATION AREAS

STORAGE AREAS

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Know the Equipment and Storage

Limitations of space and equipment Understand what equipment you have to work with and when it is utilised Adequate storage in fridge, freezer and dry store Balance complex dishes with pre packaged items to improve workflow

What are the Staff Skills ?

Jamie Oliver School dinners most used cooking implement was a razorblade School Canteens - buyers guide compatible with traffic light guide developed as an educational tool

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Sample of a menu template 7 day cycle

FOOD GROUP
SOUP 1 SOUP 2

SUN

MON

TUES

WED

THUR

FRI

SAT

STEP 5: BUILD THE MENU USING A TEMPLATE

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MEAT/ ALTERNATIVE MEAT/ ALTERNATIVE VEGETARIAN OPTION POTATO/RICE/ PASTA MAIN SALAD SANDWICH VEGETABLES DESSERT JUICE

Beef Lasagne Spiral Pasta

Chicken

Lamb

Beef

Chicken

Fish Pork

Steam Rice

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Rice Pudding

Evaluation of Menu

STEP 6: RECIPE TESTING AND MENU EVALUATION

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Prior to implementation: Meets nutrition standards Impact of special diet menus on workflow Foods in season and within budget Presentation Workflow compatible with staffing, equipment and storage Variety/repetition
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Menu Basics
Nutritional goals & standards menu assessment tool NRV & Dietary guidelines Proportions of food choices (fat, salt) Fundamentals Variety Combinations Colour Texture Consistency Taste Menu descriptions Popularity Know your customers February 2008 Carmel Lazarus

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Menu descriptions
Ensure appropriate terminology is used Describe the dish by referring to the main ingredient
Apple pie, Mixed Bean salad

Avoid names customers wont understand

Chicken Riviera, Tropical Sherbet

Refer to sauce used, cut of meat, cooking method, cuisine, temperature of dish
Chilled puree minted soup Grilled Chicken Breast & Gravy Thai beef Salad
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Menu Popularity
McClelland and Williams (2003)

Food Preferences in Hospital

Highest Scoring Food & Food Classes
Fresh Fruit (peaches, cherries, sberries, bananas, grapes, nectarines) sberries, Poultry Red Meat Orange Juice Ice Cream Baked Potato Prawns Offal (kidneys, brains, tripe) Spinach Devon Parsnips Soyabeans
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Juice, ice cream and fruit salad were popular Devon, creamed spinach and offal were least popular Popularity of soups have declined 1993-2001 1993(20-29% unpopular) (20Popularity of meat choices has fallen 199319932001 (20%-43%) (20%Improvement in acceptability of green vegetable choices Decrease in popularity of desserts
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Lowest Scoring Food & Food Classes

Kennewell & Kokkinakos 2001

Menu Controls
Standardised recipes Portion control Ingredient Specifications Production schedules revised Staff training on new menu and workflow Revision of work schedules Developing new purchasing plans Budget
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Menu Evaluation post implementation

Patient Satisfaction Surveys Taste Test Feedback from FS & Nutrition support staff Microbiological testing Plate waste surveys
Digital photography Visual Scales

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Thickened Fluid Wastage Survey

Provide 6 x tetrapaks per pt per day ($8.40) Wastage is measured over 7 days 25% consumed Interviewed pts Reasons for non consumption
31% of pts dislike the flavour 15% need assistance 15% couldnt open the packaging
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Activity 1
You are working as a new graduate Dietitian in a rehabilitation hospital. The menu has not been changed for a number of years and patients do not receive a menu. The Dietitian visits pts daily to take their food preferences The demographics of the pts have changed. The pts are Discharged early from hospital, stay a minimum of 3-4 3weeks, are elderly, and at risk of poor nutrition Where do you start? What information given is useful? What could the Dietitian change?
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A private hospital has asked you to review the menu as they have had very negative feedback from recent patient satisfaction surveys The patients are short stay; 2-3 days and the average age is 4024055 yrs The menu is currently selective and there are menu staff who deliver and collect the menu. The menu has not been reviewed for more than 10 years, when the hospital was refurbished from an aged rehabilitation facility facility to a short stay, acute care facility. It is the same menu with alot of offal and wet dishes.
Where do you start? What are your menu objectives? What are the issues you need to consider when redesigning the menu? menu? How would you evaluate the success of the new menu?
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Activity 2

Activity 3
You have been asked to review the menu for a mental health unit for residents with age range of 4-94 yrs old. 4The current menu is non-selective. The kitchen nonstaff are unskilled and the menu consists mainly of pies/pasties and quiches. Nursing staff have reported weight gain among some residents How would you assess the menu? What changes would you make to the menu? Who would you involve in the changes? What are the main issues you need to consider when making these menu changes?
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References
Institute of Hospital Catering NSW Branch. Food Service Guidelines for healthcare. IHC, Sydney 1997 Kennewell S, Kokkinakos M, Food Preferences of Inpatients in an Australian teaching Hospital what has happened in the last 12 years? AJND 2001;58:1, 15-22 15Stewart L, Hunwick H, Nutrition in Foodservice. Hospitality Press, Melbourne 1988 Hospital Menu Assessment Tool: manual version. NSW Department of Health Lazarus C and Hamlyn J. Prevalence and documentation of malnutrition in hospitals: a case study in a large private hospital setting. Nutr Diet 2005; 62:41-7 62:41Middleton MH, Nazarenko G, Nivison-Smith I, Smerdely P. Prevalence of Malnutrition and Nivison12 month incidence of mortality in 2 teaching hospitals. Intern. Med J 2001;31: 455-61 455Spears MC, Gregoire MB. Food service organizations: a managerial and systems approach (4th ed). Prentice Hall: Upper Saddle River NJ. 2000 Better Hospital Food Website - www.betterhospitalfood.com McClelland A., Williams P., Trend to better nutrition on Australian hospital menus 1986Australian 19862001 and the impact of cook-chill food service systems. J Hum Nutr Dietet, 2003; 16, 245cookDietet, 245256 Williams P, Nutrition and patients whose responsibility? Nutr Diet, 2002 59:4, 229-230 229National Health and Medical Research Council, Dietary Guidelines for Australian Adults, AGPS, 2003 Dunn G, Williams P, The trend to better menus in New South Wales:1986-1993. Aust J Wales:1986Nutr Diet 1995;52:36-42 1995;52:36NSW Department of Health. Hospital menu assessment tool: manual version. State Health Publication no. (HP) 990199. Sydney: NSW Department of Health; 1999. 1999. Allison SP. Hospital Food as Treatment. Clin Nutr 2003;22: 113-114 113Carmel Lazarus February 2008