Planning, Designing, Staffing & Quality control

1. Presenter: Dr Rudresh S A
Faculty Moderator: Dr Sanjay Arya

2. Hospital food service is essential to provide inpatients
with nutritious meals which shall help them to recover
from their illness.
Meals should be carefully planned and served as per
patient’s requirement.
The objective of a dietary service is to make provision
for clean, hygienic and nutritious diet for the patients
as per their nutritional requirement

3.  Selection, procurement and storage of food ingredients
 Inventory control of the food items.
 Menu planning of different kinds of food.
 Development of recipes as per the nutritional requirement of patients
 Preparation and cooking and presentation of food.
 Distribution of food and serving of food.
 Planned preventive maintenance programs for the equipment.
 Training and development of the staff.

4. Planning considerations:
 Number of hospital beds.
 Type of hospital and specialties available in the hospital.
 Number of meals served per day.
 Policy of serving food to in-house staff, residents, students, etc.
 Policy of serving food to visitors and patients.
 Type of dietary services.

5.  Type of food served, i.e. vegetarian/non vegetarian or
continental/intercontinental
 Hospital’s orientation and consideration for wellness tourism/medical
tourism.
 Design of the hospital, horizontal or vertical lay out.
 Turnover of patients.
 Percentage of specialized diet and modified diet.
 Availability of pediatrics department for formula room.

6.  Location
 Space Requirement-
50sq.ft per bed for a 50 bedded hospital and 15sq.ft per bed for a 500 bedded hospital
(7500 sq.ft). However due to space constraints 15-20 sq.ft per bed can be considered for
beds more than 100.
 Work Flow:
Source: Mc Gibony & S K Joshi, Quality Management in Hospitals, 2nd edition 2014

7. Receipt and
Storage Area
Normal &
Special diet
kitchens which
have
preparation
processing and
cooking areas
Pantry
Dispatch Area
Layout of Dietary
services

9.  Receipt and Storage Area- accessible to roads, outside door should be 5 feet wide,
the storage area should be divided into a dry storage and cold storage
 Food Preparation Area- Preparation area for vegetarian & non vegetarian food
 Special Diet Area- minor equipment will be added to the list of special diet area,
 Formula Room
 Serving Area- receives food in bulk from main kitchen and trays are prepared and
issued to the ward
 Dining Hall
 Washing Area
 Garbage Disposal
Layout Continued..

10.  Ventilation-provided with exhausts, for exhaustion of smoke and greasy material
 Air Curtains-control of flies and other nuisances.
 Lighting- Wash area: 500-1000lux, General Work areas: 200-500lux, Storage areas:
200-500lux
 Facility for Workers- Lockers, shower, toilets
 Engineering Services- Electricity, telephones, fire safety

11.  Today's kitchens care not only labour intensive but the equipment also play very
important role in the dietary services. The equipment save time and energy; so these
are responsible to a great extent for efficiency in the department. With the advent of
new technology, the modern kitchen is highly dependent upon the sophisticated
equipment.
Inspection and Maintenance:
It refers to routine cleaning, examination, lubrication and minor adjustment of
equipment. Maintenance can be of three types:
Preventive Maintenance
Corrective Maintenance
Breakdown Maintenance

12. Microwave Oven
Gas Oven
Food processors
 Mixer and grinders
Refrigerators and deep freezers
 Meat cutter and meat mincer
Dough Kneader
Roti maker or chapatti maker
Cookers
 Cooking vessels
Idli maker
Juicer
Dish washer
Cooking range
Water cooler
Soda maker
 Coffee maker
Food trolleys
Shallow fryer
 Deep fryer
Baking ovens.
Toaster
 Potato peeler
Boiler

13.  The requirement of the staff depends upon the size of the hospital, workload and level
of automation in the kitchen.
 To give an indication of the number of full time employees needed in a food service
unit, the total estimated work hours required to cover all activities in the organization
should be divided by the number of working hours in the day
 for >700 bedded hospital there shall be a requirement of 5 dieticians,50 kitchen
employees,2 supervisors and 10 helping staff is essential.(Todd Wheeler )
 DGHS 1989 recommends -
Dietitian: Patient ratio of 1:80 for a hospital with > 750 beds. Adequacy of personnel
in terms of number of staff in the kitchen is based on the size and workload.

15. Food hygiene legislation in India is developed by Food Safety and Standards Authority of
India. (FSSAI)
It’s an organization setup by Ministry of Health and Family Welfare which dedicates to
ensure Food Safety and Hygiene Requirements in India.
CRITERIA FOR EVALUATING QUALITY OF HOSPITAL KITCHEN:
1. Percentage of time food was not delivered within given time frame
2. Percentage of food wastage (raw material and cooked food)
3. Diet Distribution error per 1000 patients per days
4. Patient satisfaction
5. No. of complaints received from patients, attenders or staff.
6. Percentage of food poisoning due to food served from hospital kitchen
7. Wastage ,theft and pilferage
8. Pests and rodents menace observed during Inspection.

16.  There should be a documented quality manual which includes policy, scope of
services and SOP for every aspect of the dietary department. The document should
contain details of quality control system and it should be reviewed every year.
 There should be a system for planning of menu which will help to meet the demands
of the patient as per requirements and doctors recommendation. Menu planning
should be done in advance and displayed in the kitchen with help of dieticians
 Regular visits by the dieticians to all the wards, ICU, Special wards etc. is must for
assessment and reassessment of nutritional status and provide required dietary
advice and counselling. OP counselling should be done at the OP dietary counselling
clinics

17.  System for regular monitoring of allergic patients
 SOP for delivering food on emergency basis.
 Standard hygienic procedures to ensure food preparation, cooking, storage and
cooling.
 Food must be random tested by duty administrators
 Dietary supervisors should be available round the clock to monitor and supervise all
the kitchen work.
 Service timing should be fixed and ensured that food is served at right time.
 Compartmentation between raw materials and prepared
 There should be a system of monitoring and accounting of all the goods received and
stock ledger has to be maintained on daily basis.
 System for rotation of raw materials and measures to be taken for theft and pilferage.

18.  Discuss on the importance of having hospital dietary services.
 Discuss the medico administrative importance of hospital dietary service. How will you
organize a dietary department in a 750 bedded hospital?
 Dietary services in a medical college hospital
 Therapeutic diet service
 Menu planning in a corporate hospital
 Quality in dietary services of hospitals
 Dietary stores management

19.  Gupta S, Kant S, Chandrashekhar R, Satpathy S. Modern Trends in Planning &
Designing of Hospitals (Principles & Practice). New Delhi: Jaypee Brothers Pvt. Ltd.;
2007
 Joshi DC Hospital Administration. Jaypee Brothers Medical Publisher (P) Ltd; 2009
 Joshi S.K Quality management in hospitals. Jaypee Brothers Medical P; 2014
 MacEachern M. Hospital organisation and management. Physicians' Record
Company; 1969
 NHS, Southern Health Guidelines for Special Diets in Hospitals and Residential
getresource.axd (southernhealth.nhs.uk)
 OSHA, Occupational Safety and Health Administration [Internet]. Osha.gov. 2019
Available from: https://www.osha.gov/