Nourish Fall Newsletter: Connecting the Seams of Patient Care With Food

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In the 2017 Fall Issue: 

Connecting the seams of patient care through food by Jason Bilsky, Yukon Hospital, and Nourish 

The Long and Winding Road: Telling a New Story of Hospital Food
By Stephanie Cook, Regina Qu’Appelle Health Region

HGMH's Therapeutic Garden Has Become a Model Space for Natural Healing
By Louise Quenneville, Hôpital Glengarry Memorial Hospital (HGMH)

Patients in Charge of Their Own Meals Through Room Service!
By Josée Lavoie, CHU Sainte-Justine

Letting Patients Guide Our Actions: Food for Thought!
By Carlota Basualdo, Laura Tkach and Danielle Barriault, Alberta Health Authority

Resources on Food and Patient Experience

Connecting the seams of patient care through food.

By Jason Bilsky, CEO and President, Yukon Hospital and the Nourish team

Jason Bilsky is the CEO and President of Yukon Hospital. The Yukon Hospital Corporation is participating in the Nourish Innovator program with innovator Leslie Carson, Manager of Nutrition and Food Services, and supporting participant Laura Salmon, Director, First Nations Health Programs.

When someone gets sick and goes to the hospital, they do not ­­see the healthcare system as parts but take a continuous personal journey through it. It doesn’t matter which hospital they enter or what treatment or services; patients tend to take in one overall experience towards recovery. However, when there are gaps, they notice. From the moment the patient steps into the hospital doors, factors like wayfinding and information flow, to cleanliness and especially the food that appears on a plate all contribute to a holistic patient experience.

While the food that is served at a healthcare institution exists as a line item in a budget, it can also be an opportunity to connect to a broader continuum of patient care. Comforting and healing food is one of the most fundamental touchpoints in a healthcare experience that connects the patient to a feeling of safety and comfort in a foreign space that feels far away from their home. There are many competing priorities in the complex healthcare system, but food is central to a person’s well-being.  It breaks down boundaries between the hospital walls, the home and the greater community.

Patient experience is one of the strategic pillars around which hospitals are defined, and the quality of patient experience is determined by the patient. This means that patients need to be listened to as whole people, where their care is not just limited to clinical needs and medical treatment. Taking a holistic perspective to patient-centred care also means looking at the person outside hospital walls and understanding their social context, home situation and food traditions or practices.

Patient-centred care is about putting power and autonomy back into the hands of patients by helping them to access what they need to feel safe and well cared for — including food.
Connor, a staff member showing off traditional food served at Yukon Hospital.

Connor, a staff member showing off traditional food served at Yukon Hospital.

The Yukon Hospital chooses to serve fresh and nourishing traditional food in order to meet the needs of Indigenous peoples who visit our hospitals. To be sick is a deeply vulnerable state. Patient-centred care is about putting power and autonomy back into the hands of patients by helping them to access what they need to feel safe and well cared for — including food. A truly safe healthcare environment must include cultural safety. Offering choices around culturally appropriate foods at the times when patients need it most allows hospitals to embrace the healing power of food as part of the recovery process.

Providing culturally relevant foods is doing business in a respectful, ethical and culturally appropriate manner. It also demonstrates values that intersect with heeding the calls to action of the Truth and Reconciliation Commission, an obligation that healthcare institutions should strive towards. It represents an example of reflecting on policies and practices and not perpetuating historical injustices.

Innovating around food in healthcare is not without its challenges. To deliver the traditional food program, the Yukon Hospital had to set up the ability to source wild meat while complying with food regulations. This requires a commitment to seeing patients as people and the dedication to turn constraints into opportunities.

We must remember that addressing food as a priority is not a sprint, it is a marathon.

We must remember that addressing food as a priority is not a sprint, it is a marathon. Food and the way it is sourced, prepare and served -- as well as communication about its role in healing -- can be integral to a holistic model of care. However, including and upholding these unique practices requires ongoing advocacy and passion.  It requires breaking down the walls to build alignment and capacity around what is important to us. While sprints may be necessary in acute healthcare, we must not lose sight of the important endeavors that only reveal their benefits in the long-run.

In this issue, other Nourish innovators create opportunities with food to connect the seams in patient experience and improve conditions both downstream and upstream. Stephanie Cook in Saskatchewan wants to challenge the narrative around bad hospital food by telling a new story about the value of serving better, more respectful and comforting food to patients. In Ontario, Louise Quenneville shares the healing power of hospital gardens with patients to support emotional, psychological and physical well-being. Josée Lavoie innovates with a new hospital room service model in Quebec to offer greater choice around when patients eat. Lastly, Laura Tkach, Carlota Basualdo, and Danielle Barriault describe how Alberta Health Services are finding strategic ways to engage directly with patients to co-develop nutritious and tasty menus and diets.

The ultimate goal of healthcare institutions is to keep the patient out of the hospital and healthy at home. By being intentional around modelling healthier eating and offering more culturally relevant food choices, we can support patients to have faster recovery times and less returns to the hospital, but we also help create a healthier population overall.

Resources on Food and Patient Experience

Looking for further information and tools to help you explore how food can impact patient experience?  All of these resources can be found in the Resources section of along with other reports, tools, and information compiled by the Nourish team and innovators.

Becoming Food Aware in Hospital: Best practices for a multi-level approach to improve the culture of nutrition in hospitals
Year: 2015
Source: Research Institute for Aging (Canadian Malnutrition Task Force)
An outline of evidence based recommendations to encourage a positive nutrition culture in hospitals including education, training, organization and departmental changes.

Nutrition Counselling in Clinical Practice How Clinicians Can Do Better
Source: Journal of the American Medical Association
Year: 2017
This article notes that nutrition and health behavior change should become a core competency for all physicians and other health professionals working with patients at risk for nutrition-related chronic disease. Despite overwhelming evidence that relatively small dietary changes can significantly improve health, clinicians seldom discuss nutrition with their patients.

Creating a Great Patient Experience: Improving Care with Food and Nutrition Services
Source: Journal of the Academy of Nutrition and Dietetics
Year: 2017
This article reviews the roles of the clinical RDN and food service staff in optimizing patient satisfaction. Patient dining, retail foodservice operations, and the integration of registered dietitian nutritionists (RDNs) within the interdisciplinary care team are all important components of the overall patient experience.

Patients First: Improving patients’ food and drink experience through a better understanding of their priorities
The Patient’s Associations
Year: 2016
This report covers a large-scale, independent survey of patients’ preferences and experiences of hospital meals in the UK. By establishing patients’ preferences and priorities and linking this to their satisfaction with what is currently offered, it will be possible to give guidance to providers of food and meal service to develop and improve their offer.

Best practices for Nutrition, Food Services and Dining in Long-Term Care Homes.
Source: Ontario Long Term Care Action Group, Dietitians of Canada
Year: 2013
A working paper exploring how to implement quality nutrition, hydration and pleasurable dining in order to enhance the quality of life, and care, for residents in long-term care.

Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost.
Source: Journal of the Academy of Nutrition and Dietetics
Year: 2017
A comprehensive evaluation of a room service model at an Australian acute care facility showed results of increased energy and protein intake, decreased food waste to 12% and meal costs by 15%, and increased patient satisfaction.

Plow to Plate: The Community Hospital as Change Agent
Source: New Milford Hospital, Connecticut
Year: 2012
Plow to Plate is a program that advocates healthy food as a direct path to disease prevention while promoting the local agricultural economy. Plow to Plate delivers a fully integrated, healthful food service program to patients, staff and the community, using fresh produce from local farms. The initiative saw a dramatic increase in patient satisfaction.

Hospital Food - An opinion piece
Source: Flavour Journal
Year: 2017
This opinion piece takes a critical look at the current state of hospital food, with a focus on the UK’s National Health Service, and explores how findings from studies of high-end gastrophysics research could help to improve it. For example, ‘Eye appeal really is half the meal’, even in hospital. A number of concrete recommendations and low-cost solutions are proposed.