Food Services and Nutrition Management
Year One Semester Two
Study Guide
2013-2014
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No part of this publication may be reproduced, stored in a retrieval system or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording or otherwise without
expressed permission of the publisher.
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Ottawa, Ontario
K1N 9J6
www.cha.ca
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2
Food Services and Nutrition Management Year One Semester
Two
2013-2014
Table of Contents
Unit 5: Quantity Food Production ............................................................................................... 6
Unit 6: Financial Management...................................................................................................40
Unit 7: Sanitation, Safety and Security ......................................................................................71
Unit 8: Quality Food Management ...........................................................................................122
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Introduction
Introduction
The Food Service and Nutrition Management (FSNM) program is fully accredited by the
Canadian Society of Nutrition Management (CSNM). The two-year program is designed for
individuals currently working in food services in health care or other institutional settings who
wish to pursue a career in food service management.
A food service nutrition manager is involved with the day-to-day operation of the food and
nutrition/dietary department and is an active member of the management team. He/she provides
the much needed link between administrative and food service personnel. The role of this
manager is to incorporate education and experience in coordinating and supervising operations
of the food service department and to provide quality, economical meal service. The emphasis
on cost control, quality assurance, accreditation, menu planning, patient counseling and safe
food handling makes for a stimulating and challenging program.
The first year of study focuses on food management, while the second year explores nutrition
and diet therapy and focuses on the clinical aspects of the food service and nutrition manager’s
role.
Learning Objectives
Upon completion of the Food Services and Nutrition Management Program, students will be
able to:
1. Understand the basic physiological processes of digestion,
2. Identify the food sources of the key nutrients and their functions in the body,
3. Understand the relationship between nutrition and maintenance of good health,
4. Understand the principles involved in menu planning,
5. Understand the rationale for therapeutic nutrition modifications, and
6. Follow established procedures for writing modified diets for various disorders of the
human body.
Program Components
The Food Services and Nutrition Management Year One Semester One program includes:

Four structured study units, with written assignments to be completed between
September and December

30 Supervisory Hours per months

10 days Field Placement
Study Units
Each study unit includes learning objectives, required readings, suggested supplementary
readings and an assignment.
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Introduction
The study units in the program are:
5.
6.
7.
8.
Quantity Food Production
Financial Management
Sanitation, Safety and Security
Quality Food Management
Unit Assignments
Unit assignments are available individually on the Gateway. Students must upload all completed
assignments directly to the Gateway for grading.
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 5
Food Services and Nutrition Management
Year One Semester Two
Unit 5: Quantity Food Production
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Unit 5
Quantity Food Production
Objectives
Upon completion of this unit, the learner will:










Identify the basic objectives of cooking in food production;
Describe methods of cooking and heat transfer including conduction, convection and
radiation;
Follow procedures standardize recipes and analyze results, including food quality, cost,
sensory evaluation, yield and portion sizes;
Prepare quality standards for standardized recipes;
Convert a recipe from imperial to metric;
Implement a sensory evaluation of a food product;
Explain the importance of portion control;
Describe two different methods to determine production requirements;
Compare and contrast different food service production systems;
Discuss quality control methods in the food production, distribution and service to clients.
Introduction to Quality Food Production
The objective of food production is the preparation of menu items in the needed quantity and
desired quality at appropriate cost. Today’s food service operations are expected to be easy to
manage, flexible, cost-effective to operate, and be responsive to modern technology.
The food service manager must be familiar with the food preparation methods for various types
of food products. To be a successful cook requires knowledge of the science of food preparation
as well as the art of cooking. Knowledge of the food products and the most appropriate method
of preparation along with a good food sense, leads to food items which are tasty, well prepared
and presented with foods that complement the dish. In this unit the basic cooking methods will
be covered but for more detailed information a good basic food preparation text will be useful.
As a food service manager, you must be aware of cooking methods for different food products.
Pages 461-484 in your textbook provides a comprehensive synopsis of the principles of basic
cooking. Your food service facility is your laboratory for this aspect of the course.
It is quantity that makes food preparation in a food service facility differ from family food
preparation. There are several different types of food preparation and service systems from
which a health care facility can choose. These systems range from ones where the majority of
food items are prepared from “scratch” (conventional system) to those where items are entirely
prepared by a central kitchen or commissary (located outside the facility). Health care facilities
often use a combination of two or more food production systems.
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Unit 5
Throughout the 1990’s, control was the principle concern in food service operations. Shared
food services and group purchasing became increasingly popular as a means of “pooling”
resources and controlling costs. Labour and production is organized and controlled through the
use of work and production schedules which aim to streamline work effort and save time. Food
quality and quantity are also controlled. This is done by testing, evaluating and costing recipes
and menu items. During this process food preferences and nutritional adequacy are considered.
The challenge in today’s food service environment is balancing control and client satisfaction.
Principles of Cooking
Food is cooked for many reasons. Cooking destroys harmful microorganisms, alters texture,
taste and aroma, and it can make the item easier to eat and digest. Cooking involves the
transfer of heat or energy from an energy source to the food item.
When heat is transferred to any material, its molecules absorb the energy and begin to vibrate.
The moving molecules are in contact with neighbouring molecules and the energy is transferred
to these neighbouring molecules. The more energy that is transferred the faster the molecules
will vibrate. Picture a pot of water put on an element, as the heat is transferred from the element
to the pot and then into the water, you can see small bubbles of water leaving the bottom of the
pot and rising to the surface. As the heat transfer is increased the water starts to bubble more
until it comes to a rolling boil. This is the result of the water molecules vibrating quickly and
causing the movement within the water. In most cases of heat transfer the energy moves from
the outside of the product to the interior. The exception to this is with microwave cooking.
The main methods of heat transfer include conduction, convection, radiation and microwave
energy. Microwave energy is a type of radiation, but the amount of heat transfer is dependent
on the type of molecules present in the substance to be heated.
Conduction is the transfer of heat through direct contact. Often food is in a cooking container
such as a pot or fry pan and the heat from the energy source first conducts the heat to the
cooking container and transfers this heat by conduction to the food within. In some cases the
food is placed directly over the energy source and the heat is transferred directly to the food
item. An example of direct conduction of the energy to the food item would be cooking hotdogs
over an open fire. Those same hot dogs heated in a sauce pan suspended over the fire would
require the heat to be transferred to the pot, that energy transferred to the water and finally the
energy from the water being transferred to the hot dogs. Conduction is a slow method of heat
transfer and in the case of a cooking pot also depends on the ability of the material the pot is
made of to conduct heat. Copper and aluminum are two very good conductors of heat, while
stainless steel conducts and retains heat poorly. Many stainless steel pots are constructed with
an aluminum bottom core or with an aluminum or copper bottom.
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Unit 5
Convection is when energy is transferred by the movement of a liquid or a gas. Natural
convection occurs through the tendency of warm liquids and gases to rise. The cooler
molecules sink and they in turn are heated. The movement of the molecules throughout the
liquid causes currents which allows for the transfer of heat to the whole product.
Mechanical convection is when air or liquid is moved to circulate the heat around the product.
Examples of convection are the fans in convection ovens which move the air to circulate around
the food in the oven, and when liquids are stirred while being heated.
Radiation is the transfer of energy to a product either through heat waves or light waves.
Microwave ovens convert the electrical energy to radiation energy which is absorbed into the
food and excites the molecules within the food product. This produces the heat which is
transferred throughout the food and cooks it. Substances react differently to microwave energy,
depending on their composition; microwaves are absorbed, transferred or reflected. Foods with
a high moisture, sugar and fat content absorb microwaves and will readily heat up.
Infrared cooking involves the transfer of heat from waves of energy directly to the food item. The
intervening medium (air) does not assist in the transfer of energy. The glowing coils of a toaster
and the glowing coals of a fire are examples of how radiant heat is used to cook foods.
Effects of Heat
The effects of the heat depends on the composition of the food product being heated. Foods are
made up of proteins, fat, carbohydrate and water as well as small amounts of minerals and
vitamins. The reactions of heat on a food depends on its composition.
Proteins are long helix shaped chains of amino acids. As a protein is heated it loses its moisture
and becomes firm. This is known as coagulation. Consider the changes in an egg as it is
poached. At first it is a jelly like consistency and as it is heated it loses it's clear colour and
becomes firm.
The longer it is cooked the firmer the egg white becomes. This also explains the differences in
firmness of a steak cooked rare to one that is well done.
Fats may be solid in the uncooked food item or in liquid form such as in a cooking oil. When
heated the solid fats melt and liquefy. This provides juiciness to the food item when heated or
cooked. Consider the juiciness of a hamburger made from extra lean ground beef to one made
of regular ground beef. The hamburger made from the regular ground beef will be moister than
the one made from extra lean beef. Fats may usually be heated to high temperatures without
burning. Each fat will have its own smoke point- that is the temperature at which it will begin to
smoke and burn.
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Unit 5
Carbohydrates in foods are in the forms of sugars or starches. Heat has differing effects on
sugars and starches. Sugars are simple carbohydrates which when heated to high temperatures
caramelize or become brown and their flavour changes. Starches are complex carbohydrates
which when heated absorb water, swell and become softer. This process is known as
gelatinization. This is what gives starches the ability to thicken liquids and is also the
characteristic which provides structure to baked goods.
Water is a forgotten constituent of most foods; however all foods contain some water. Fruit and
vegetables contain high percentage of water, while flours and nuts contain significantly less
water. When water is heated to the boiling temperature, the liquid changes to a gas and is
evaporated as steam.
Cooking Methods
Cooking methods may be classified as either dry heat or moist heat or combination cooking.
As the names imply, dry heat is a method in which the heat is transferred to the food without a
liquid medium (although fat may be used) and moist cooking uses either liquid or steam in the
transfer of the heat to the food product. Examples of dry heat cooking are grilling, broiling,
roasting, baking, sautéing, pan frying, deep frying. Moist heat cooking includes poaching,
simmering, boiling and steaming. Combination cooking includes braising and stewing. The
choice of cooking method depends on the food item to be prepared and the desired outcome.
For example a tender cut of meat may be preferable roasted and served medium rare, while a
tougher cut of meat may be better prepared with a combination method such as braising.
Your textbook has a brief review of the basic cooking techniques for specific foods. The
following list of food production techniques should be reviewed and understood. While a food
service manager does not have to be a chef, you should be able to guide your staff in the
correct use of basic cooking methods.
Topics relating to food preparation which FSNM students should review.
 Principles cooking- including the effects of heat on proteins, starches, sugars, fats and
liquids.
 Dry heat cooking methods including broiling, grilling roasting, baking, sautéing, pan-frying
and deep-frying.
 Moist heat cooking methods including poaching, simmering boiling, and steaming.
 Combination cooking methods such as braising and stewing.
 Preparation of stocks and sauces.
 Soup preparation including cream, stock and chilled soups.
 Cooking of eggs and dairy products.
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Unit 5
 Principles of meat cookery including beef, veal , lamb , pork and poultry
 Preparation of fish and shellfish.
 Vegetable preparation including salads and salad dressings as well as cooked vegetables.
 Preparation of grains and pastas
 Preparation of fruit.
 Principles of baking, including quick breads, yeast breads, pastry, pies and cookies, cakes
and frostings .
 Preparation of custards, frozen desserts and dessert sauces.
For those with limited knowledge of basic cooking, you may wish to research basic cooking
techniques in cookbooks from libraries.
Food Production
A food production sheet is an important part of the kitchen production system. It shows the
number of particular food items that must be prepared for a meal and should include information
on the number of items remaining after the meal.
One production schedule may be all that is needed for kitchen staff in a small food service
department. Larger operations may have several production schedules, each designed for a
particular working group (e.g. salads, desserts, main kitchen, etc.)The food items listed on the
production sheet are taken directly from the planned menu. The number needed is based on the
projected or forecasted number of portions required.
In a long term care facility, it is fairly easy to forecast the number of servings of each entree and
dessert to prepare for a meal, as past usage records and records of residents' likes/dislikes can
be used for reference. In hospitals, menus are marked in advance by patients and the chosen
menu items are tallied by a clerk or other food service staff. This figure is then padded or added
to allow for changes in number at the time of service by a figure that comes from historical data.
The production for a cafeteria is usually based on past historical data. The closer the forecasted
number of food items required is to the actual number served, the more control in food costs.
Forecasting is covered in your textbook on pages 452-453.
At the end of meal service, a tally of the amount of remaining food should be recorded. As well,
additional information regarding weather conditions, unexpected guests, day of the week, etc
should be noted. This information is kept to be used in forecasting the amount to prepare during
the next menu cycle. Figure 1 is a sample production schedule. Exhibit 20.2 on page 456 of
your text, Foodservice Manual for Health Care Institutions also gives an example of a daily
production sheet.
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Unit 5
Figure 1
SAMPLE: PRODUCTION SCHEDULE
Date: Monday, October 1, 1990
MEALS
ANTIC
P NO.
MENU ITEM
RECIPE
FILE
NO.
Breakfast
35
2 grapefruit
-
15
mins
scrambled
eggs
B-05
20
mins
PREP
TIME
crisp bacon
whole wheat
toast
15
mins
butter
-
EQUIPME
NT
NEEDED
PORTION
SIZE
TOTAL
YIELD
AMOUNT
LEFTOVER
small knife
2
grapefruit
each
18
grapefrui
ts
L. grill
approx
125 g
tray,
broiler
GARNISH
COMMENTS
2 grapefruit
1 curled
orange
slice
2 cherry
40
servings
5 servings
parsley
sprig
Approx 10
refused
grapefruit.
Identified &
provided
alternative(s)
2 strips
70 strips
-
-
toaster
2 slices
6 loaves
-
jam
coffee
tea
Lunch
45
clam
chowder
L-25
60
mins
18 litre pot
approx
200 mL
50
servings
approx 4-5
chopped
parsley
grilled
cheese
L-46
70
mins
grill
1-2 slice
sandwich
45
servings
-
pickled
olive
1 onion
cole slaw
L-150
30
mins
salad
shredder
125 g
50
servings
4-5
-
D-75
30
mins
total
time
broiler
2 chops
100
chops
4 chops
fresh mint
leaves
glazed
carrots
D-285 10
kg
45
mins
15 litre pot
180 mL
9 kg/50
portions
nil
mashed
potato
D-210 8
kg
45
mins
15 litre pot
140 mL
7 kg/50
portions
nil
mint jelly
3-340
mL jars
-
-
approx 20
mL
-
-
tossed salad
D-308
-
L. bowl
200 g
50
portions
-
carrot cake
D-414
20
mins
7 L pan
cut cake
6x9
54
portions
4 portions
4 cole slaw
refused too
difficult to
chew and
digest.
Identified
fresh fruit
Dinner
48
chilled apple
juice
broiled lamb
chops
3 refused disliked
lamb.
Identified
cream
cheese
icing
6 salads
refused
7 refused
dessert
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Unit 5
Quantity Control
Standardized Recipes
Quantity control in food production is concerned with minimizing food waste and maximizing
yield and maintaining food quality. When the menu is planned, there should be standardized
recipes for each menu item. The standardized recipe means that it has been tested and
adopted for use in a particular facility. It will ensure that every time a menu item is prepared, it
will taste the same and will have the same yield.
It is not easy to develop recipes. Initially it is done by preparing a recipe in a small family-size
quantity. The sources of recipes may be from peers, co-workers, other institutions, magazines,
newspapers and cookbooks. In selecting a recipe look for recipes which will meet a niche of
your market. For example do you need a recipe for a vegetarian entree or a dish which will be
appropriate for a certain ethnic group?
Recipes should be evaluated for the cost and availability of the ingredients as well as for the
ease of preparation, equipment required and service. The recipes are first prepared in the
amount of the original recipe following the exact procedures and exact quantities of ingredients.
Critique the product and the method and make changes to the original size recipe. It is often
better to make just one change at a time. Once you have a satisfactory product, this will be your
comparison product for the final large scale recipe.
The next step is to triple the recipe and evaluate the product with your control/ comparison
product. Determine any changes which must be made and modify the written recipe. Determine
the yield of this recipe.
The next stage is to increase the recipe to yield a standard of 25, 50, 75 or 100 portions. The
size of the recipe will be determined by the size of the facility and the anticipated requirement
for the product. Prepare the recipe for the larger quantity and adjust for the handling loss of a
large quantity recipe. This loss is due to the extra batter, sauce, gravy or pudding which remains
in the larger sized equipment. Losses may be due to the evaporation of water and from the
shrinkage of food ingredients.
Common adjustments to recipes developed from family size recipes include:
 reduction in the amount of liquid.
 lengthening of some cooking times for individual steps in the recipe (e.g. sautéing)
 adjustment of herbs and seasonings. The direct multiplication of herbs and seasonings may
result in excess.
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Unit 5
Your textbook, Food Service Manual for Healthcare Institutions, p. 458 discusses four ways to
adjust a recipe. A sample recipe evaluation sheet is also provided in Exhibit 20.3 (pp. 459).
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 5
Below is a table illustrating the adjustment of a recipe from a yield of 12 to 75 using the factor
method.
Adjusting a recipe from a yield of 20 to 75: Baked Beans
Step 1
Step 2
Step 3
Step 4
Original recipe
Yield = 20
Converted volume
Multiplied
by factor
Rounded
weights
Ontario white beans, soaked
3 cups
500g
1.875 Kg
2 kg
Onion, small dice
¾ cup
125g
468.75 g
450 g
Bacon lardons
125g
125g
468.75 g
450 g
Anaheim chile, small dice
2 Tbsp
30g
112.5 g
100 g
Molasses
1/4 cup
100mL
375 mL
375 mL
Maple sugar
1/3 cup
100g
375 g
375 g
Ketchup
1 cup
250mL
937.5 mL
1L
Cider vinegar
1 Tbsp
15mL
56.25 mL
60 mL
Worcestershire sauce
2 Tbsp
30mL
112.5 mL
125 mL
Instant coffee powder
2 tsp
2g
7.5 g
7.5 g
Salt and pepper
TT
TT
TT
TT
Ingredients
Measures to weights
Factor: 75/20 = 3.75
The final approval of the prototype product is the final sensory evaluation. It is tasted by a
sensory or taste panel composed of the cook, staff, clients/residents, etc. If the product is
found to be acceptable to all, it can then be produced for larger quantities.
Several panel tests may occur while the recipe is being resized before it has been found to be
"perfect". Figure 2 outlines things to consider when taste-testing food products and includes a
sample questionnaire.
Standard recipes can be reproduced each time they are made with no difference in quality and
quantity. Because of this prediction of quality and quantity, they require less supervision in the
kitchen. Figure 3 is an example of a Standardized Recipe. Recipes should all be written in a
format that:
 lists ingredients in the order in which they will be combined,
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Unit 5
 lists quantities of ingredients in both weight and volume measures,
 describes the form of the ingredients, e.g. chopped onions,
 has simple procedures that are stated clearly,
 states pan type and size, cooking time and temperature, size and amount of serving.
When recipes are written in Imperial format, there may be the need to convert them to Metric.
The reference in the required readings gives the steps to converting a recipe to metric as well
as the acceptable measures to use in the metric system. Your textbook covers the writing of
standardized recipes on pages 455-457.
Portion Control
In combination with the standardized recipe is portion control. Portion control means using
measured serving sizes to ensure that each person is given a specified quantity of a food item.
Portion control regulates the number of servings each batch of food will yield from a
standardized recipe. Portion control helps prevent running short of an item halfway through
service because the amounts first distributed were too large. Accuracy depends on the use of
appropriate ladles, scoops and scales for measurement.
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Unit 5
Figure 2
SENSORY EVALUATION OF FOOD (TASTE PANELS)
“A sensory evaluation is made by the senses of taste, smell, touch, and hearing when food is
eaten. The complex sensation that results from the interaction of our senses is used to measure
food quality in programs for quality control and new product development. This evaluation may
be carried out by one person or by several hundred.”1
For taste testing of food products, the following guidelines should be followed:
 Set up a special testing area that has minimum number of distractions. It should be quiet,
free from foreign odours and smoke.
 For most tests, taste panellists should be separated from each other to prevent distraction
and communication among them.
 As little information as possible about the test should be given to test panellists as this
information may influence results.
 Each taste-panellist should receive the same size sample under the same serving conditions.
The samples should be typical of the product.
 The number of samples to be tested should be restricted to four or less.
 When requesting preference of one product over another, it may be better to present one
sample at a time if the two products differ greatly in appearance.
 Colour differences can be masked by coloured or dimmed lights.
 Food samples should always be served at the temperature at which they are normally eaten.
 Assign a code to each sample that will not give the panellist a bias towards one product.
Taste panelists should be given water and/or crackers with which to rinse the taste of each
sample from their mouth.
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Unit 5
Figure 2 (continued)
PREFERENCE QUESTIONNAIRE #1
Name:
Date:
Product:
Taste these samples and check how much you like or dislike each one.
Sample #
Sample #
like very much
like very much
like very much
like slightly
like slightly
like slightly
dislike slightly
dislike slightly
dislike slightly
dislike very
much
Sample #
dislike very
much
dislike very
much
Comments:
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PREFERENCE QUESTIONNAIRE #2
Name:
Date:
Product:
Taste the two sample in the following order:
#317
#294
Which of these two samples do you prefer?
Comments:
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Unit 5
Figure 3
HEARTY BEEF SOUP
50 Servings (200 mL each)
INGREDIENTS
MASS
Ground Beef
2.3 kg
Celery, chopped
660 g A.P.
VOLUME
1L
555 g E.P
Onion, thinly sliced
450 g A.P.
METHOD
Brown meat with celery,
onion and garlic until onion
is transparent. Drain off
excess fat
850 mL
400 g E.P
Garlic, cloves
Cabbage, grated
4
300 g A.P.
750 mL
250 g.E.P
Turnip, chopped
450 g. A.P.
625 mL
Add all remaining
ingredients and simmer for
30 min. stirring
occasionally.
300 g. E.P
Carrots, chopped
450 g. A.P.
625 mL
300 g. E.P
Beef Bouillon or stock
5L
Canned tomatoes
4 cans
(798 mL each)
Salt
25 mL
Pepper
5 mL
Bay Leaves
4
Basil
10 mL
Worcestershire sauce
25 mL
Macaroni
500 g A.P.
1L
© 2013 Canadian Healthcare Association. All rights reserved.
Add simmer 15 min
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Unit 5
Food Quality
The sensory evaluation of food was previously discussed in this unit. “Food Quality is evaluated
by sensory, chemical and physical methods. Sensory methods are used to determine if foods
differ in qualities as taste, odour, juiciness, tenderness or texture and to define the extent and
direction of the differences”2 the physical and chemical testing of foods are used by food
manufacturing plants where they have sophisticated quality control and product development
laboratories. These methods are used to identify differences in the colour, texture and flavour of
foods.
The sensory analysis of foods has three main purposes:
 detecting differences among two or more food items
 describing the characteristics of the food item
 determining the acceptability of a product and a preference for one product over several
samples.
Quality Standards
In describing the characteristics of a food there are many characteristics to consider such as the
appearance of the food item. This would include the colour of the item and other optical
characteristics such as clarity, frothiness, sparkle, as well as the physical form. As it is well
known that we eat with our eyes first, the appearance of a food product is vital to the perception
of quality.
The aroma and flavour are other characteristics to evaluate. Does the product taste and smell
as you would expect it to. The odour and taste of garlic would be a desirable characteristic in a
spicy spaghetti sauce, while in a hollandaise sauce this would be undesirable. Other categories
of characteristics include the taste of the product, the consistency and the mouth feel of the
product. Quality judgements refer to the acceptability of the product. Terms such as delicious,
excellent, objectionable, poor can all refer to the quality judgement.
Once the desired attributes of the product have been developed a description of the product
should be prepared. The following is a description of a quality standard of a Blueberry Muffin.
“A blueberry muffin should be scored on overall acceptability including appearance, texture,
tenderness and flavor. The crust should be crisp, shiny, pebbly, and golden brown with a wellrounded top free from knots. It should be large in volume compared to weight. The interior
crumb should be moist, light and tender with a coarse, even grain and no tunnelling. The whole
blueberries should be moist but not discolour the muffin. The muffin flavour should be delicate,
not bready or too sweet and the blueberries should have a natural taste.”
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Unit 5
“Quality standards are measurable statements of the aesthetic characteristics of food items, and
they serve as the basis for sensory analysis of the prepared product. Quality aspects include
appearance, color, flavour, texture, consistency, and temperature”3
Evaluating quality standards can be done using a score card. A sample score card is provided
below.
Score Card for Cake4
Date: ____________________________
Sample No
Factor
Qualities
Standard
Comments
1
1. External
appearance
2. Internal
appearance
Shape, symmetrical,
slightly rounded top,
free from cracks or
peaks
10
Volume, light in weight
in proportion to size
10
Crust, smooth uniform
golden brown
10
Texture tender, slightly
moist, velvety feel to
tongue and finger
10
Grain, fine, round,
evenly distributed cells
with thin cell walls, free
from tunnels
2
3
10
Color, crumb even and
rich looking
10
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3. Flavor
Delicate, well-blended
flavour of ingredients.
Free from unpleasant
odors or taste
10
Directions for use of score card for plain cake:
Standard
10
No detectable fault, highest possible
score
Excellent
8-9
Of unusual excellence but not perfect
Good
6-7
Average good quality
Fair
4-5
Below average, slightly objectionable
Poor
2-3
Objectionable, but edible
Bad
0-1
Highly objectionable, inedible
Evaluator signature:_______________________________
Now that you have the description of the quality characteristics, and a standardized recipe you
are then able to evaluate each production of the product based on these characteristics. In a
food manufacturing plant a quality assessment panel would evaluate the product produced on
each manufacturing batch based on these criteria. In a similar manner healthcare facilities will
have a taste panel prior to each meal to evaluate what is being served to the customer, resident
or patient and determine the acceptability of the products and the conformity to a standard.
Types of Food Production Services
A food service system is a collection of interrelated parts (production, distribution, service, etc.)
designed to work as a unit in order to accomplish one or more objectives (e.g. reduced labour,
improved work flow, higher quality of food served, etc.).
There are three primary food production systems currently used in health care facilities. These
are:
1. Cook Serve (or Conventional) System
2. Ready Prepared System - there are two types cook/chill and cook/freeze
3. Assembly - Serve (or Convenience) System
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Unit 5
See Figure 4 for a general comparison of three food production systems.
Your textbook reviews a fourth system, the commissary. See page 448 in your textbook for an
overview of the food production systems.
Cook - Serve System - or Conventional System
In this type of food service system, the menu items are procured and produced within the facility
where they are to be served. The preparation is finished as close to serving time as possible.
Food is then held in steam tables or other types of hot holding equipment and placed onto
plates while hot. Plated food may then be served to the consumer in various types of carts that
contain heat maintenance systems.
This system has many advantages. It is very adaptable to regional, ethnic and individual
preferences of the customers.
There is greater flexibility in making menu changes to take advantage of seasonal foods and
market promotions. There can be high quality of product, depending on the ingredients used
and the care taken in the production of food items. The main disadvantage to the conventional
system is the stressful work day caused by meal period demands. As well, this system is labour
intensive, requiring two shifts of employees to cover three meals.
Ready - Prepared System
There are two widely used ready prepared systems:
 cook/chill and
 cook/freeze
Menu items are prepared several days before serving in both the cook/chill and cook/freeze
systems. Products are cooked, packaged and chilled in the cook/chill method. The cook/freeze
process includes cooking, packaging and fast freezing the menu items. The food may be
"plated" before chilling/ freezing or this procedure can take place just prior to serving time. The
prepared items can be reheated if required. See Figure 5 for an outline of the two systems.
Basic principles and essential control checks for the preparation of food using cook/chill and
cook/freeze production systems are outlined in Figure 6.
In several areas of Canada, foodservice operations have combined their kitchens or production
areas in a central location. This commissary or food production centre is a central location
where food is produced, using the cook/serve, cook/chill and/or cook/freeze systems. Menu
items are requisitioned by the various food facilities and the food production centre does the
production on a large scale.
The main advantage to the Commissary system is the cost saving due to large volume
purchasing and reduced duplication of labour and equipment. There may be better quality
control when only one kitchen is preparing the food and it can be better supervised. Food safety
is enhanced as recipes are carefully monitored for compliance to the principles of HACCP. The
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 5
more sophisticated equipment allows for better control of temperatures thru the danger zone
because the equipment is designed for rapid heating and subsequent chilling. This means that
the time foods are in the danger zone is minimized. Food undergoes random microbiological
testing. The disadvantage to the commissary system is that packaging size may not be suitable
for all facilities, especially smaller sites.
When comparing kitchens using the ready-prepared and conventional systems, the readyprepared kitchen is often:
 less cluttered, -there is less food production and less need for large equipment
 safer - less equipment usage and fewer safety issues
 quieter - less machinery running, e.g. kettles, mixers
There are several advantages to the ready-prepared systems, both cook-chill and cook-freeze.
They reduce the peaks and valleys that exist in the conventional system. There is a reduction in
labour cost because the workload can be distributed over and 8-hour day and 5-day week.
There can be better nutritional quality of the food as it is not being held for serving as in the
conventional system. There can be better use and balance of the equipment when food
production is occurring throughout the day. There is better nutritional information concerning the
products as the ingredients are carefully controlled and the recipes are not subject to individual
cook's preferences. In summary, a well managed ready- prepared system has a sophisticated
system of internal controls.
The disadvantages to the ready-prepared system include the need for large cold storage and/or
freezer units. Recipes may have to be modified because freezing can affect the appearance and
texture of a food.
Assembly - Serve System
This system has no food production in the facility. It is sometimes referred to as the
"kitchenless" kitchen. All foods are received from a commercial source in a ready-to-serve form.
The principal advantage to this system is the savings in labour. There is no need for skilled
workers in food production. There is less waste and greater portion control as well as a savings
in equipment and space requirements. The disadvantages are limited menu choices and the
higher cost of purchasing these items. When the assembly serve system was first being
introduced to institutional food services, the menu choices were very limited. Now with greater
interest in this type of food service operation, competition is heating up between the suppliers
and the types of products being offered have greatly expanded and the cost of the items has
decreased.
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Figure 4
GENERAL COMPARISON OF THREE FOOD PRODUCTION SYSTEMS
CONVENTIONAL
(Cook/Serve)
READY-PREPARED
CONVENIENCE
(Assembly/Serve)
COOK/CHILL
COOK/FREEZE
Purchase raw basic
foods & limited
convenience items
Purchase raw basic
foods
Purchase raw basic
foods
Food purchased preprepared
↓
↓
↓
↓
Receive goods
Receive goods
Receive goods
↓
↓
↓
↓
Receive goods
Store goods
Store goods
Store goods
↓
↓
↓
↓
Store goods in freezer
or refrigerator
Prepreparation:
washing, cutting, etc.
Prepreparation:
washing, cutting, etc.
Prepreparation:
washing, cutting, etc
none
Preparation and
cooking; small
batches & short order.
Preparation and
cooking; large
batches
Preparation and
cooking; large
batches
none
↓
↓
↓
Portion & chill & store
or bulk chill & store
Portion & freeze &
store or bulk freeze &
store
↓
↓
↓
Short time holding in
refrigerator or steam
table or serve at once
Store in refrigerator
Store in freezer
none
↓
↓
↓
↓
Hold until serving
Hold until serving
Hold until serving
↓
↓
↓
↓
Portioning
Temper foods
Temper (thaw) foods
Temper (thaw) foods
© 2013 Canadian Healthcare Association. All rights reserved.
↓
↓
none
↓
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Unit 5
↓
↓
↓
↓
↓
Reheat as necessary
Reheat as necessary
Reheat as necessary
↓
↓
↓
↓
↓
↓
↓
↓
Service
Service
Service
Service
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Unit 5
Figure 5
THE COOK/FREEZE/CHILL SYSTEM
Raw Food Storage
↓
Preparation
↓
Cooking
↓
Rapid Chilling
←
Portioning (Packaging)
→
Blast Freezing
↓
↓
Refrigerated Storage
Frozen Storage
↓
↓
Transport and Delivery of
Chilled Food
Transport and Delivery of
Frozen Food
↓
↓
Reheating
(Rethermalization)
Reheating
(Rethernalization)
↓
→
Service
© 2013 Canadian Healthcare Association. All rights reserved.
←
↓
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Figure 6
PREPARATION OF PRE COOKED FOOD BY
ANY COOK/CHILL/FREEZE OPERATION
A. Basic Principles
1. Cook the food sufficiently to ensure the destruction of any pathogenic micro
organisms present.
2. Begin the chilling process as soon as possible after cooking and portioning is
complete (within 30 minutes after cooking). The food should be chilled to an
internal temperature of +3°C (37°F) within a period of one and half hours.
3. The food should be stored at a temperature between 0°C (32°F) and +3°C
(37°F).
4. Ensure that any rise in temperature of the food during distribution is kept to a
minimum.
5. For both safety and palatability the rethermalizing of the food should follow
immediately after the removal of the food from chill conditions and should raise
the temperature to at least 158°F/70°C.
6. The food should be consumed as soon as possible after reheating (within 2
hours). Discard unconsumed reheated food.
7. If the temperature of the chilled food rises above 10° C (50° F) the food should
be discarded.
8. Cross contamination especially between raw and cooked food must be avoided
at all stages.
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Figure 6 (continued)
B. Essential Control Checks
Check and record the following for every batch and menu item processed:
 the quality and the temperature (where appropriate) of the raw materials;
 the temperature at which perishable raw and precooked materials are stored prior to
preparation for cooking;
 the centre temperatures of meat and poultry during cooking;
 the period which elapses during the cooling process of large pieces of meat and poultry;
 the time of the chilling or freezing process for portioned foods and the centre temperature of
the food at the completion of the chilling process;
 the temperature of the chilling/freezing medium;
 the temperature of the food during storage and the air temperature of chill freezer store as
recorded on the automatic recording instrument;
 the rotation of stocks within the store;
 the temperature of the food at the completion of its distribution from the refrigerated store;
 the centre temperatures achieved during the reheating process for each type of food which is
subjected to a treatment prior to consumption.
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Unit 5
Meal Service Systems
After food has been produced, the next operation in food service operations is to deliver the
food to the client. In health care facilities, this can be done in three main ways - by tray, in
cafeteria service or by table service. Tray delivery is used for patient care in hospitals where
patients are unable to dine in a central location and the patients may be located on different
floors. Individual trays are assembled according to the patient's needs and there is good control
over providing the special diet for that patient.
Tray Delivery
There are two main types of tray assembly systems used in health care facilities:
 centralized
 decentralized
Centralized service systems are prevalent in most food service departments today because
they permit better control in the areas of food quality, production, and labour.
In a centralized tray service system, menu items are plated and the trays assembled in a central
location. The trays are then transported to the service location (e.g. patient's/resident's room,
cafeteria, etc). Dishwashing also occurs in the central location.
In a decentralized service system, the food will come from a central production area. However,
the method used for assembly and delivery differs from the centralized system and includes the
following steps:
1. Menu items are transported by food trucks (with heated and unheated
compartments) to serving pantries on each floor.
2. The trays are assembled. Items such as toast and coffee may be prepared in the
serving pantry and added to the trays.
3. The trays are delivered by hand or small trucks to the patients/residents.
4. Trays are returned to the pantries to be dismantled, cleaned and stored. Dishes
and flatware are washed or sent to the central dishwashing area and clean items
are returned to and stored in the pantries.
The preparation of trays can be done with hot food just prior to meal service or with cold food
and then the trays are reheated just prior to service. There are various advantages and
disadvantages to various tray delivery systems. In order to keep meals hot from service to
delivery to the patient, some type of insulated tray or cart is required. If the cart is to be heated,
then provision to keep juice, milk, ice cream, etc cold must be available. Often carts have
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FSNM Yr 1 Se 2
Unit 5
separate compartments for cold items or the items are stored in a refrigerated unit and placed
on the tray when it is being delivered to the patient.
Burlodge is an international company supplying specialized healthcare and hospital food
systems particularly suited to cook-chill and cook-serve applications. Please visit the Burlodge
website: http://www.burlodge.com . Click on the Canada. Also included in the readings are
three articles from the research and development section of this website. While clearly
promoting the company’s equipment, the articles do illustrate some of the challenges in meal
production and service in healthcare today.
Resident Meal Service
Cafeteria or table service is common in facilities where residents are able to come to a central
location to eat. This is common in long term care facilities, rehabilitation centres and some
nursing homes.
The food is delivered by servers and the resident is able to select their food choice either at the
cafeteria line or at the table. Portion control and individualized meals may be more difficult to
provide in this setting. This also is a more labour intensive way to serve meals. However, the
dining room atmosphere is more conducive to actually dining.
Staff and Visitor Meal Service
Most healthcare facilities will provide meal service for staff and visitors. This service may include
a cafeteria, vending machines, coffee shop, coffee carts in strategic places in the institution. As
many staff have a limited period of time for a meal break the food service operation needs to be
efficient and offer foods at a reasonable cost. This type of meal service is an important
opportunity for the facility to generate revenue. Effective marketing of the foodservice will
contribute to the effectiveness of the operation. More information is included relating to
marketing in the unit on Financial Management.
There are two basic types of cafeteria design, a straight line system in which customers start at
one end of the line and pass by the portioned food selections, the hot food section in which the
food service staff serve the product, beverages and finish at a cash register. This type of
cafeteria design is common in school feeding programs as well as in some commercial
cafeterias. The patron takes the tray to a table in the dining area of the facility. Some short order
cooking may be done on the service line such as eggs, toast for breakfast service and hot dogs,
grilled sandwiches, french fries for lunch and dinner meals.
In a scatter or shopping center design of the cafeteria servery, there are various stations where
the customer can select their food items from the station of their choice. The stations need to be
clearly identified with the food featured at that area. A center island in the middle of the servery
can be used to highlight featured foods which offer a high profitability for the facility. A common
marketing strategy is to place impulse items at the first station and also at the cashier station.
© 2013 Canadian Healthcare Association. All rights reserved.
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For both types of cafeteria design, the menu will dictate the space and equipment required. It is
a common practice in healthcare facilities, to use the patient menu as the framework for the
cafeteria menu and add other selections to provide more variety in order to attract the customer.
As the cafeteria pricing is based on determining a selling cost which will result in a profit, some
higher cost items may be included on the menu.
The objective of a staff meal service is to provide a fast, efficient operation which meets the
needs of the customers and provides a source of revenue for the facility.
Two of the additional readings (Sue Grossbauer and Michael Babines) discuss Room Service
as an up and coming trend in healthcare settings. While "room service" has various definitions
and procedures from one foodservice operation to the next, the core concepts are based on
hotel room service. A typical set of room service procedures allows clients to request meals
when they wish to eat, choosing from a restaurant-style menu that remains constant from day to
day. Foodservice employees produce the meal "on-demand" and deliver a tray to that client. A
typical turnaround time from order to tray delivery is usually under 30 minutes. The Children’s
Hospital of Eastern Ontario adopted a Room Service delivery system in 2006.
Conclusion
In quantity food production, one looks at a variety of ways of producing quality food. There is the
conventional cook to serve method of food preparation which is used in small facilities.
However, combinations of methods are used in most health care facilities these days. Food may
be prepared in advance, in cook/chill or cook/freeze systems, to utilize labour during slow
periods. It may be purchased from food production centres or produced on site.
Delivery to the patient in health care facilities is very different from the restaurant and cafeteria
service. There are methods of serving cold food on trays and reheating the trays just prior to
delivery to the patient as well as methods of sending hot food to the patient. It is important to
realize that there are advantages and disadvantages to each type of system.
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Unit 5
Metric Conversion
The proper measurement of ingredients with the right tools is critical to the success of any
recipe. Measures are classified as either dry measures or fluid. Fluid measures are measures of
volume, while dry measures are measures of weight. A 1/2 cup is a volumetric measurement; 4
oz. is a weight measurement. They are different.
Ounces vs. Fluid Ounces
Are ounces or fluid ounces ever the same? Yes, but it is just a coincidence. Butter, for instance,
just happens to weigh and measure the same. But few foods do, not even water.
Examples: 1 cup, by definition, holds 8 fluid ounces. But 1 cup of water actually weights 8.3
ounces. Whereas 1 cup of cracked pepper weights 4 oz. and a cup of table salt weighs 10.3 oz.
while 1 cup of honey weighs 12 ounces!
These weights to volume relationships are called Equivalents. For instance, 1 cup of honey
equals (is equivalent to) 12 oz.
The following website is an excellent review for measuring tips and techniques.
http://www.recipetips.com/kitchen-tips/t--1111/measuring-techniques.asp
Although cooking is not an exact science, differences in measurement can make your dishes
turn out less than perfect. Comparisons may confuse. Use either metric or imperial measures.
Do not mix the two.
Practice converting some of your recipes using the following conversion tool.
http://www.gourmetsleuth.com/cooking-conversions/cooking-conversions-calculator.aspx
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 5
Metric Conversion Guide
Temperatures
Fahrenheit
Celsius
Gas Mark
32°
0°
Weight
212°
100°
Imperial
Metric
250°
120°
1/2
1 ounce
30 grams
275°
140°
1
2 ounces
55 grams
300°
150°
2
3 ounces
85 grams
325°
160°
3
4 ounces
115 grams
350°
180°
4
8 ounces
225 grams
375°
190°
5
16 ounces
455 grams
400°
200°
6
1 pound
455 grams
425°
220°
7
2 pounds
450°
230°
8
475°
240°
9
500°
260°
Measurements
Volume
Inches
Centimeters
Units
Metric
1
2.5
1/4 teaspoon
1 mL
2
5.0
1/2 teaspoon
2 mL
3
7.5
1 teaspoon
5 mL
4
10.0
1 tablespoon
15 mL
5
12.5
1/4 cup
50 mL
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6
15.0
1/3 cup
75 mL
7
17.5
1/2 cup
125 mL
8
20.5
2/3 cup
150 mL
9
23.0
3/4 cup
175 mL
10
25.5
1 cup
250 mL
11
28.0
1 pint
500 mL
12
30.5
1 quart
1 liter
13
33.0
1 1/2 quarts
1.5 liters
14
35.5
2 quarts
2 liters
15
38.0
2 1/2 quarts
2.5 liters
3 quarts
3 liters
4 quarts
4 liters
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Unit 5
Endnotes
1
Larmon, E. (1977). Laboratory methods for sensory evaluation of food. Agriculture Canada,
p.6. (no longer in print).
2
Spears, M.C. (1995). Foodservice organizations A managerial and systems approach (3rd
ed.), Englewood Cliffs, New Jersey: Merril, p.378
3
Payne-Palacia, J. and Theis, M. (2010). Foodservice management principles and practices,
(12th ed.) Upper saddle river, New Jersey: Prentice Hall, pp. 214.
4
Ibid, pp. 215
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 5
Required Readings
Textbook(s)

Puckett, R.P. (2013). Food service manual for health care institutions (4th ed.). San
Francisco, CA: Jossey-Bass.
Chapter 20, Food Production, pp.447-485
Appendix 20.1, A Culinary Glossary, pp.486-488
Chapter 21, Distribution and Service, pp. 489-506
Readings from Course Reader

Grosbauer, S. (2005). Tips for successful room service implementation. Dietary
Managers Association.

Babines, M. (2007). Interactive hospital menus reach prime time. Press Release,
Nashville, TN. February 13, 2007.

McMaster, C. (2011). Cost control: It’s everybody’s business. Food Service and
Nutrition: Canadian Society of Nutrition Management News, 10-12
Internet readings
 Burlodge Canada website: http://www.burlodge.com (Click on Canada)
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 5
Unit 5 Assignments
To complete the Unit 5 assignment, please access your account on the Gateway at
www.cha.ca. The assignment is available in Word Format on the Gateway for you to
download. Once completed, please upload your assignment into the designated location.
© 2013 Canadian Healthcare Association. All rights reserved.
39
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Unit 6
Food Services and Nutrition Management
Year One Semester Two
Unit 6: Financial Management
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 6
Financial Management
Objectives
Upon completion of this unit, the learner will:










Discuss financial reports used in food service;
Apply accounting procedures used in food service;
Collect and analyse data to implement cost control measures;
Discuss federal and provincial taxes and implications on cost control measures;
Interpret performance indicators in cost control systems;
Interpret financial statistics used in food service;
Describe procedures for developing and revising budgets;
Describe the use of computers in word processing and spreadsheet/accounting;
Discuss the uses of workload measurement systems;
Explain the role of marketing in a nutrition and food services department.
Introduction
Financial planning and accountability for the foodservice organization are major responsibilities
for the manager. Cost-effectiveness is essential if operations are to be successful especially
with today’s economy and competitive market.1
Sound financial management includes knowing the direction and goals for the current period of
operation, measuring the progress to date in meeting those goals within the resources available,
and making any necessary adjustments to keep the operations on track. In addition it includes a
plan for future operations and activities.
Budgeting
Every food manager will be controlling budgets and also be controlled by them. It would be a
disservice to yourself and your organization if you were not knowledgeable in the fundamentals
of budgeting.
A budget is a plan, often in chart form, of how one expects to perform financially during a
specified period of time. It is the organization’s business plan expressed in financial terms. As
such, it should be based on the mission, goals and objectives of the organization. A budget
includes an estimate for all items of expense and revenue and usually covers a one year period.
The budget must relate to measurable activities such as meals served, patient visits etc.
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 6
In both our business and personal lives the effective use of a budget assists in achieving our
goals. If your goal was to purchase a new car, some of the considerations might include:
How much you wish to spend?
Do you need to borrow the money?
Should you lease or buy the car?
What will be the cost of operating the car?
By considering and making decisions relating to these variables you will know if your goal is
achievable or if it needs to be modified.
In foodservices it is important to have a clear understanding of the goals of the department and
to use the budget to meet those goals. Budgets are used at every level of management. There
are several kinds:
 operating budgets include the expenses and incomes which occur on a regular basis (e.g.
food, wages, supplies, training costs etc.). The operating budget may have costs such as
heating and maintenance allocated to your department budget or it may be included in the
overall organizational budget.
 equipment (or capital) budgets are prepared to help in deciding the priority of equipment
purchases (or major renovations to a facility). Departments submitting capital budget
requests are asked to justify such requests to the committee which approves such a budget.
All departments may be competing for a share of a limited amount of funds.
 cash budgets show the inflow and outgo of cash and the amount of cash on hand.
Budgets require time to prepare. They should be considered a guide on how to manage the
department's finances for the coming year. To prepare a budget, one must forecast activity,
and the expenses and revenues there will be in the coming year. To forecast is to determine
costs using available data.
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 6
A manager or food service supervisor needs to determine:
1. the current level of expenditure,
2. the additional costs needed due to inflation to maintain the same level of service or
additional savings required and the implications on the level of service, and
3. calculate the costs of new programs and services.
In addition the following information is required:
1. estimated client statistics (patients, cash customers) for the coming year, including
active patient bed count and estimated admissions ( including established and new
programs),
2. estimated inflation factor for supplies and overhead,
3. estimated salary increases ( if applicable) for the year,
4. staffing increases or decreases deemed necessary, and
5. other major policy changes
6. environmental conditions which will affect cash sales
By gathering this type of data the manager or supervisor will be prepared to forecast revenue
and expenditures.
Most foodservice departments in health care institutions will have two or more sections of the
department. These may include cafeteria operations, patient or resident foodservices, catering
and clinical services. These different sections of the department may have separate budget
accounts or cost centers which when combined complete the overall departmental budget. All
expenses and revenues specific for a certain area are allocated to that cost centre. Some costs
which are shared such as dishwashing, production and administration may be prorated and
charged back to specific cost centers. For example patient dishwashing may account for 60% of
the work required in the dishroom. All of the dishroom costs including labour and supplies would
be prorated so that the patient service account would be charged with 60% of these costs. This
internal prorating of costs may be determined by measuring workload or by estimating the
allocations. They may then be adjusted when further data or information supports such a
change. This method of allocating revenue and expenses allows the manager or supervisors
responsible for each area to track their financial performance and to make decisions based on
the true cost to provide a service.
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 6
Revenue
Most food service departments in hospitals and long term care facilities are allotted an amount
of money per patient or resident day. For example, this may be $7.50 per day per
patient/resident. Then, the food service director must know the number of patients/residents that
are served per day. Multiplying these two numbers gives a forecast of the revenues from
serving the facility's main clientele.
Most facilities have a record of occupancy for the past year which can be used in forecasting the
number of clientele.
Other sources of revenue to the food service department are also included in the budget. These
may include: cafeteria sales, catering, Meals-on-Wheels, marketed services such as a weight
loss program for staff. It is necessary to consider factors which will influence the revenue from
these sources and to reflect these changes in the budget. A new or amalgamated tax such as
the HST may alter patron's spending patterns and this will be reflected in your revenue for the
period.
Expenses
The category entitled expenses can be divided as to labour and operating costs. To determine
labour costs, it is necessary to estimate the number of employees needed and the number of
paid hours (hours they work in the year) plus the benefits they receive, e.g. vacation, sick
leave, statutory holidays. As the traditional foodservice operation is staffed for seven days a
week, the labour budget includes replacement costs for employees on vacation, sick leave,
statutory holidays and relief for days off. Operating costs are those expenses other than
labour. This includes food costs, purchases of equipment, cleaning and stationary supplies, staff
training, etc.
Often the expenses are referred to as fixed and variable costs. Fixed costs do not change
regardless of volume. Salaries in a health care facility may be a fixed cost because the basic
staff does not change regardless of volume of meals served. Variable costs change with the
volume; food costs are a variable cost because the more meals served, the higher the expense.
In many organizations the budgeted costs are allocated throughout the year either on a monthly
or accounting period basis. By using past documentation, the budget can be fine-tuned to
include seasonal variations in certain budget areas; e.g. sick leave replacement costs may be
greater in the first quarter of the calendar year, annual leave replacement costs may be greater
in the summer or in December. Activity levels throughout the organization may vary throughout
the year. Some acute care institutions may close beds during a summer slow down or during
the school break. Such variable activity levels will have an impact on the variable costs and
these variations in patterns of spending may be included in the budget. The budget should be
viewed as a general guideline for operating throughout the year. In some circumstances
forecasts may have to be changed. For example, a change in legislation may have an effect on
the operating cost of the foodservices.
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Budgets may be fixed or flexible. The fixed budget is based on a definite level of sales or
activity, whereas a flexible budget provides cost information for differing levels of sales activity.
Fixed budgets are common in a facility that provides one specified volume of meals (e.g. long
term care facility with 100 residents eating every meal in-house). Flexible or variable budgets
are used when estimating volume of sales and costs, as in cafeteria operations.
In determining a flexible budget, a high and low volume of sales is determined based on past
figures and experience (e.g. On statutory holidays, 50 meals are served in the cafeteria while on
regular days, there may be 200 people eating meals). Expenses and profits are calculated for
each
extreme to determine a projected range of costs that could occur. This can help the food service
manager explain why variations in their monthly expenses can occur.
You may come across a system called zero based budgeting. This was designed to overcome
problems encountered in operational budgeting (e.g. the perpetuation of past errors and
unnecessary costs). Usually, zero based budgeting means that all current and new activities are
identified, analysed and evaluated before funds are allocated. The result is that food service
must justify the need for each item and type of financial resource requested (food, equipment,
personnel, etc). Zero based budgeting does have some drawbacks. Requests must be
thoroughly reviewed and this is time consuming. An assumption is made that former budgeting
methods are incorrect. This is not the case. Former budgets provide an accurate synopsis of
previous challenges, and while the type of budgeting may no longer be appropriate for the
department, the overview of challenges can be built upon to provide a better means of
controlling expenditure.
In many food service facilities, it is important to know how to budget for catering and restauranttype activities as well as for patient services, as this is one area where sales volume can directly
affect the revenues available to the department.
Accounting Methods
Two methods of accounting are used for preparing financial statements. They are: cash basis
accounting and accrual basis accounting.
Cash basis accounting records events when cash is received or paid out. When the
department receives payments, they are recorded as revenues in that month. This occurs
whether the payment is for services rendered some months in the past or for services to be
provided in the future. Expenses are recorded in the same manner that is in the month the
payments are made, even though the foods and services purchased were delivered in the past
or will be delivered in the future. For example, cash basis accounting could be used to record
the payment of an insurance premium in the month it is actually paid for. This occurs even
though the benefits of the insurance coverage would occur over twelve months. Cash basis
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accounting has the advantage of being very simple. Most people use this method for their
personal finances.
Accrual basis accounting is a method of recording events as they occur, not when cash is
received or dispersed. Revenue is recorded when it is earned, not when cash is received. For
example, if the dietary department is sent a deposit towards a catering function which they will
provide in the next month, the payment is not recorded as a revenue until the catering is actually
provided. The same procedure is used for recording expenses. An expense is entered when
supplies or services are received, and not necessarily when cash payments are made. For
example, a contract food service fee may be paid for at the beginning of the year but it is
recorded monthly as the service covers a one year period.
Accrual accounting includes costs due to depreciation. Depreciation is “an accounting
technique that spreads the expense of capital equipment or buildings over their life spans,
because value decreases gradually with time."2 Depreciation recognizes that fixed assets, such
as capital equipment are useful to the facility for several years. This period of time is known as
the fixed asset's useful life. In most cases, a fixed asset (such as a new steam table) requires a
large cash outlay at the time of purchase. If a steam table is estimated to have a useful life of
five years, a proportionate amount of its purchase cost would be included in each year's
operating budget.
e.g.
purchase cost of the steam table = budgeted cost per year
5 years
Financial Statements
One of the basic accounting statements you will receive is the statement of income (profit and
loss statement or income statement) shows whether the operation has made or lost money over
a specific period. The revenues are listed in one section and the expenses in another. The
difference between the total revenues and expenses is the profit or the loss. See Figure 1 for
an example of an Income Statement.
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Revenues
Revenues can be considered the income that the department earns from doing business. It
includes patient meals and non-patients meals. The food service department will be allotted a
certain amount of money per patient/resident per day in the facility. This will be the revenue
from patient meals. Non-patient meals refer to cafeteria sales, catering, meals-on-wheels,
vending machine operations as well as marketed services such as a weight-loss program.
Meal census is the term for the total number of meals served to the patients/residents and
paying clientele (staff, cafeteria customer, visitors, etc.) in one day. A meal day is the amount of
food provided for a person during one day. Typically a meal day consists of three meals and a
refreshment. Usually the number of patient/resident meal days corresponds to the number of
days of care provided. In many cases, health care patient days equal the number of patient
meal days minus ambulatory care meals.
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Figure 1
ANY HEALTH CARE FACILITY
Statement of Income
Food Service Department
Current
Month
Actual to
Date
Approved
Budget to
Date
Variance
REVENUES
Patient/Resident meals
Non-patient/Resident meals
a)
Cafeteria
b)
Catering
c)
Vending
d)
Meals on Wheels
TOTAL
EXPENSES
Labour
a)
Paid Hours
b)
Benefits - vacation
-
sick leave
-
statutory holidays
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Operating Costs
a)
b)
Food
-
general (cans, flour,
read)
-
meat, fish, poultry
-
dairy produce
-
fresh produce
Equipment
-
small equipment
-
equipment maintenance
c)
Replacement (dishes,
cutlery)
d)
Overhead
e)
Staff Training/Travel
f)
Miscellaneous
TOTAL
BALANCE
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Cafeteria selling prices are calculated carefully in order to attract customers and operate
profitably. Prices charged should recover expenses (food, labour, supplies and other operating
costs). Careful consideration should be given to the amount which customers will be prepared to
pay or what the market will bear. A cafeteria menu which has many expensive items may not be
perceived as having value and will have the potential to encourage customers to bring meals
from home or purchase them elsewhere. On the other hand if the selling price does not cover
the costs then the institution is subsidizing the cost of the cafeteria meals. In some situations
this may be acceptable to the institution. Such an example could be the provision of a night
meal service for shift workers. The food service manager or the department head need to keep
track of the extra expenses in providing such a service and relay this information to the senior
management.
In any revenue generating service it is important to keep accurate and complete financial
records. In cafeterias and restaurants, computerized cash registers can provide valuable
information for the food service operators. The print out of information will tell the operator the
number of each food item sold on a particular day, the average charge per customer, sales
relating to particular time periods during the day, the number of customers, number of employee
sales, total sales, tax collected by category such as provincial sales tax (PST), the Goods and
Service tax (GST) and the Harmonized Sales Tax (a combination of the PST and the GST). The
types of tax, the rates of tax and the Legislation surrounding taxes will differ in each province for
the sale of food and liquor.
Vending machines provide food and beverage on a twenty-four hour basis. Vending machine
services may be self-operated, in which case the institution purchases or leases the machines,
provides the products to stock the machines, cleans and maintains them. All the profits from
running the vending service return to the institution. Several companies provide vending service
to health care institutions as an independent supplier. Depending on the volume of sales and
the specific contract with the vendor, the institution may receive a percentage of the profits as a
commission from the supplier. Suppliers may also offer volume rebates to institutions when the
reach a certain volume of sales.
Meals-on-wheels is a service provided to persons in the community who are not able to cook
their own food for any number of reasons. The meal is provided by the food service department
of an institution and the transportation and delivery is provided by volunteers. Prices for the
meals are carefully determined in order to cover food, labour and supply costs, yet remain
affordable for the clientele.
Expenses
Cost control means managing money, materials and labour in such a way as to obtain
maximum quality of product and efficiency of effort within a specified budget.
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Labour Costs
Labour costs account for one-half to two-thirds of the food service operating expenses. Direct
labour costs are those related to wages and salaries. Benefits such as sick leave, pension
benefits, etc. which are measurable are classified as indirect labour costs. Indirect labour costs
also include items which are more difficult to measure such as labour turnover, training, etc.
There are other factors that reflect labour costs to a foodservice operation that must be
considered. These include:
1) productivity - the quality and quantity of work an employee can perform;
2) the amount of labour saving equipment being used;
3) the hours of work;
4) the amount of non productive time - meetings, illness, breaks;
5) the menu pattern complexity;
6) the form in which food is purchased - convenience versus prepared-on-site;
7) type of food service - cafeteria, tray delivery, retherm, cook\chill etc.;
8) the number of meals served per day;
9) working conditions - temperature, lighting, physical plan of kitchen and its
location in relation to rest of the institution; and
10) efficiency of staff scheduling.
Some concerns that elevate labour costs are absenteeism, overtime, abuse of sick leave, high
rate of staff turnover, work duplication, poor performance and training. It will be evident that if
there is a high rate of absenteeism or sick leave, labour costs will be higher. An annual turnover
rate exceeding 10% also adds to labour costs. Training costs are another significant part of the
labour budget. Training needs to be carefully evaluated to ensure that value is received for the
training dollars spent.
Food Costs
Food costs account for the next highest percentage of the foodservice operation's expenses.
Food cost must be calculated for patients/residents meals and for other revenue generating
operations, such as catering.
Nutritional supplements and formula are included in the food costs. Careful monitoring the use
of supplements will help to bring this aspect of the food budget under control. The manager,
food supervisor or dietitian should check that prescribed supplements are being consumed by
the patient or resident.
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The food cost per meal day is the first important calculation done in the food service operation.
To arrive at a figure, the number of patient/resident meal days for the month is obtained
The conventional way of determining the non patient meal days is to divide the cafeteria
receipts by an amount which represents the average price for the three meals. A suggested
figure is arrived at by pricing a patient's menu according to cafeteria prices. The total price of
the menu for the three meals is divided into the total cafeteria cash receipts. This number of
cafeteria meal days is added to patient meal days to get a total meal day value. An example is
displayed in
Figure 2
A Sample Selection of Menu Items Priced at Cafeteria Selling Prices
Breakfast
Lunch
Dinner
Snack
Juice
0.45 Soup
0.50 Soup/Crackers
0.70
Muffin
0.60
Cereal
0.40 Entrée
1.50 Entrée
2.00
0.55
Egg
0.45 Side Salad
0.60 Vegetable
0.50
Coffee,
Cream and
Sugar
Toast & Butter
0.40 Dessert
0.55 Potato
0.40
Coffee, cream
and sugar
0.55 Bread/Butter
0.40 Dessert
0.75
0.55 Bread/Butter
0.40
Tea, milk and
sugar
Tea, milk
0.55
and sugar
TOTALS:
2.25
4.10
5.30
1.15
The total price of this menu for three meals and snack is $12.80.
This amount is then divided into total daily cash receipts as follows:
If cash receipts from cafeteria = $1,280.00
Then number of meal days = $1,280.00 = 100 Meal days
$12.80
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Menu costing is one important part of a food service manager's responsibilities. The raw food
cost is found by costing a standardized recipe for each menu item. Figure 3 shows an example
of a costed recipe. Storeroom purchase records or invoices provide the price of ingredients to
use in the calculations.
Figure 3 - Sample Recipe Cost Sheet
ITEM:
Dessert
TYPE OF
SERVING PAN:
66 X 42 CM
TOTAL YIELD:
50
Servings
DATE:
November
AMOUNT PER
PAN:
ENTIRE
PAN
NO. OF PORTIONS
50
PORTIONS
PER PAN:
59
SIZE OF
PORTIONS:
7x7x5
cm
RECIPE Peach
Cobbler
UNIT
Bakeshop
AMOUNT USED
weight
INGREDIENT
UNIT
PURCHASED
COST/UNIT
AS
PURCHASED
COST
PER
BASIC
UNIT
COST OF
AMOUNT
USED
6 x 2.84 mL
22.90
1
tin
3.83
7.68
metric
measur
e
Measure
or count
Canned
Peaches
2 tins
2 tins
Sugar
granulated
681 g
40 kg bag
28.40
1
kg
.71
.48
Salt
28 g
12 x 1 kg box
15.53
1
kg
1.29
.04
Flour, All
Purpose
908 g
40 kg bag
38.40
1
kg
.96
.87
Baking
Powder
112 g
3 kg tin
6.25
1
kg
2.08
.23
Shortening
454 g
20 kg tin
25.50
1
kg
1.27
.58
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Milk,
Homogenized
Unit 6
6L
Garnish 1
Maraschino
Cherry
50
1L
1.01
1L
1.01
6.06
2x4L
24.20
1L
3.02
2.01
Labour Hours to Prepare: 2 Cooking Temperature: 190°C
Cooking Time: 35 minutes
Total Cost: $ 17.93
Cost Per Portion: .36
It is important to practice portion control in a food service operation; otherwise food costs may
rise. Figure 4 shows an example of the effect on food costs for a meal if larger than the
standardized portions are served.
FIGURE 4
The Cost of over-serving Menu Items
Food Item
Recommended
Selling Price
Serving Size
Actual Serving
Size
Cost of Increased
Portion Size
Roast Chicken
90 g
$ 2.50
120 g
$ 0.83
Green Beans
125 mL
$0.60
200 mL
$ 0.36
Mashed Potato
125 mL
$ 0.60
200 mL
$ 0.36
Cost of over served portions per meal: $1.55
Each time a meal was served with these incorrect portions the cafeteria would lose $ 1.55 in the
sale of this meal.
Actual food production costs include a factor for labour, overhead and other operating expenses
in order to prepare a menu item. To establish a selling price for food item or meal in a cafeteria
or catering operation, one must establish a percentage of profit or markup that is desired. This
amount will vary depending on the type of product and the type of operation.
The textbook has a good discussion on establishing the menu selling price on pages 359-362.
If actual food costs are more (or less) than the budgeted amount, you need to know the reasons
for the discrepancies or variances. Some discrepancies create more concern than others. For
example: the amount spent on meat for one month was $400.00 more than the budgeted meat
allowance. This would be a great concern for a forty bed nursing home (whose total meat
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budget is quite small), but perhaps not as serious for a 750 bed hospital (where the amount
"overspent" was a very small percentage of the total meat budget). The percentage of variance
from the total budget is a good indicator of the seriousness of the problem. At certain times of
the year the food cost per meal day will be higher than at other times of the year. The cost of
meals for the Christmas and New Year period may be higher that for another month due to the
more festive menu planned for residents. Identifying cost variances which affect overall planning
and spending is vital to controlling food costs effectively.
To calculate the food cost per meal day for the month:
1. determine the cost of your food inventory on the first day of the month,
2. add to this the food purchases for the month,
3. subtract the cost of the food inventory as of the end of the month, and
4. divide this figure by the total number of meal days for the month. (See example below.)
Sample Calculation of Food Cost per Meal Day
Cost of Food Inventory, March 1st $10,000.00
Food purchased, March 1st 31st inclusive 5,000.00
15,000.00
Cost of Food Inventory, March 31st $8,000.00
Cost of food used during month
If number of meal days for month
Then food cost per meal day =
1,000
$7,000.00
=
1,000
7,000.00
= $7.00
This method of calculating food cost per meal day includes the cost of food pilferage, spoilage
and waste.
Other Costs
Keeping records on repair costs and maintenance are useful when determining whether or not a
certain piece of equipment should be replaced. Before requesting to purchase a piece of
equipment, determine first if it is essential and whether or not the cost will be offset by reduced
labour expenses. Information is also needed on the initial and ongoing operating costs, service
with regard to maintenance and repair, size required, etc.
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Supply costs include expenses for disposables such as paper and plastic plates, small
equipment such as pots, pans, utensils, replacement of broken dishes, cleaning supplies and
ware washing supplies etc.
Other costs that occur in food service are those for overhead - lighting, electricity - staff training
and travel, etc. See Figure 1.
Preventative equipment maintenance to ensure the safe and efficient operation of foodservice
equipment is discussed in the textbook (pp. 536-539), with a sample equipment record card on
page 537.
Nutritional supplements are expensive and controlling the use and cost of these products is
usually the responsibility of either the nursing or food service department. The article by Sandra
MacDonald outlines how one hospital monitors and evaluates their "practices and procedures to
ensure cost-efficient and effective use of nutritional products".
Financial Indicators and Analysis
Thus far in this unit indicators for food cost have been discussed including the food cost per
meal day. This data does give the food service manager some information for the comparison of
performance. Other indicators which can be used include ratio analysis, trend analysis and
break-even analysis.
A ratio is defined in the Merriam Webster's Collegiate Dictionary as "the relationship in quantity,
amount or size between two or more things: PROPORTION."3
Various types of comparisons can be made using ratio analysis. These would include the meals
per labour hour, meals per full time equivalents and labour minutes per meal, number of trays
assembled per minute. The type of operation will vary greatly in the actual ratio, for example in a
hospital with a non selective menu, the output of trays on the conveyor belt would be expected
to be much higher than in a facility with a selective menu. In a hotel operation, the number of
meals served per waiter will be much higher in a banquet situation, than in a restaurant food
service operation within the hotel.
In commercial food service operations other ratios such as the solvency ratio is used to
"examine an establishment's ability to meet its long- term financial obligations and its financial
leverage.
Solvency Ratio =
Total Assets
Total Liability
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Other solvency ratios examine the relationship between liabilities and equity (debt to equity
ratio) and between liabilities and assets (debt to asset ratio)."4
Cafeterias and commercial food service operations often use ratios to determine their
profitability. The profit margin is the ratio of net profit over sales. When there is a capital
investment another profitability ratio would be return on assets. This is the net profit divided by
the total assets.
Trend Analysis is the comparison of financial outcomes comparing indicators over several
periods of time. For example, if you started a ‘meals on wheels’ program four years ago; in the
first year you served 1000 meals, the next year you served 1600 meals and in the third year you
had 2500 meals. The trend analysis would show you that the activity of this program has
increased steadily. If everything else remained stable, the trend analysis would indicate that you
could expect a similar increase for the fourth year.
Break-even- analysis is a term to describe when an operation will cover its costs and begin to
make a profit. In a new restaurant, the break-even point would be greater than for an
established business, as there will be all the start-up costs to consider in the operation. To
determine the break-even point of the operation the costs between fixed costs and variable
costs need to be determined.
The formula for break-even point is as follows:
Fixed Cost
Break-even point =
Variable Cost
1Sales
Consider a restaurant which has fixed costs of $ 40, 000 per year, variable costs of $ 85,000
and sales of $ 150,000 per year. The break-even point for the restaurant operation can be
calculated as
40,000
Break-even point =
85,000
= 90,909
1150,000
This restaurant would not begin making a profit until it had reached a sales figure of $90,909
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Computer Applications
Computerized systems are becoming easier to use and lower in cost to implement and
maintain. Computers make it possible to perform certain tasks in a shorter period of time and
with better accuracy than when manual methods are used. In addition, a great deal of
information can be analysed and stored for later reference. These are just some of the reasons
why computerized systems are being introduced in more and more food service departments.
Management Information Systems
The means of communicating information and data within a department or organization to assist
management in making decisions is known as a management information system (MIS). The
first steps in developing a management information system is to identify the objectives of the
system and what data are required.
In considering the information needed from a management information system, the food service
manager needs to consider several factors:
 the accuracy of the information - for example the selling price of an item may be rounded off
to the nearest cent. Or the other hand a program calculating a drug dosage may need to be
very accurate to 3 or 4 digits after the decimal point
 when you require the information - For example the month end closing inventory costs
should be available in time to calculate raw food costs
 completeness of the information - all the data are available to allow the food service manager
to make a decision
 the organization of the data - data are concise and presented in a manner which allows the
manager to come to a meaningful decision.
 cost effectiveness - the data must be able to be retrieved in a cost effective manner. As the
name implies a MIS is a system that organizes individual pieces of information and presents
it in a manner which allows the information to be analysed
In your textbook, Food Service Management for Health Care Institutions, chapter 10 reviews
management information systems (MIS) and the various elements of a MIS. Starting on page
191 it looks specifically at computers in food service operations.
Food Services Computerization
Many people expect that conversion to an automated MIS system within the food service
department will solve many of the problems. Unfortunately this is not true; any system is only as
good as the information provided to it. The computer adage holds true that
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GARBAGE IN = GARBAGE OUT
Consider the areas within a food service department which are automated. Computer programs
are used to plan and implement budgets and production sheets, forecast price changes with
varying patient numbers, etc. One of the results is that routine clerical work for supervisors may
be substantially reduced.
Computer tallying of patient menu choices allows for more accurate food ordering and food
preparation, resulting in significant savings to the food service operation.
Computerized printouts which list the amounts and costs of food ordered can be compared with
predicted figures found in your budget. Adjustments to the menu can be made to correspond to
computerized reports on market changes. If, for example, you have pork on the menu twice a
week and prices for pork go up, you are easily able to replace the item on the menu with a less
expensive meat.
If your menu is computerized it is easier to take advantage of cost saving opportunities. For
example, a surplus of strawberries on the market can be used by changing the regular dessert
for a particular meal.
Nutrient analysis allows dietitians and diet technicians to quickly determine a patient or person's
actual intake and will be able to use that information in assessing their nutritional status
The first steps in considering a conversion to an automated system or upgrading an existing
system include:
1. Assessing needs - what information is required now and what information will be
required in the future? The food service manager needs to have a clear understanding of
the objectives of computerization or upgrading.
Determining requirements - consider what you wish the computerized system to accomplish.
Who will be using the computers and where should they be located to maximize efficiency.
2. Reviewing potential software suppliers. - this market research will prove to be invaluable.
There are many companies which provide food service specific software. Visit food
service operations which are using differing software to determine their satisfaction with
the product, problems they encountered and the degree of assistance and training
provided by the software company. Other considerations include the cost of the product
including annual fees, compatibility with existing computer applications and how user
friendly the programs are.
3. Determine hardware requirements - Once you have determined your software
requirements you are then ready to establish the hardware requirements. Software
companies will be able to inform you of the hardware requirements for their systems.
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4. Purchasing the software & hardware- In most cases this will be considered a capital cost
and may require a public tender. It is essential that the specifications are very precise
and reflect your needs.
5. Implementation of the system. - the key to a successful implementation is a
comprehensive implementation plan. This will include the sequence of task required, the
time for completion and the person responsible for each task.
6. You may decide that inventory control is the first stage, followed by production control,
menu planning and analysis, food cost accounting, sales control and finally labor
productivity. During the implementation stage audit checks of the system's accuracy
need to be done as a quality control measure. Another critical task is the effective
training of all personnel using the system.
7. Monitoring and maintaining the system. Any system requires regular back up of the data.
Backup should be stored in a location away from the actual system in case of fire or
water damage. Procedures need to be developed for addressing system failures. A
review of the performance of the system should be done at regular intervals.
In most instances computerization in food service allows for more accurate, timely information
for the manager to use. However, they are not the cure for every management problem. Food
service managers need to have a good understanding of the benefits and limits to the
computerized systems used in their departments in order to make informed decisions about
upgrades or new products on the market. After reading chapter 10, take the time to investigate
the computerized programs used in your food department. Look at what data is collected; how is
it collected (automatically or is it manually inputted?); how is the data used and who is
responsible for data collection, updating and quality control.
Workload Measurement
The development of a workload system for hospitals was an initiative of the Canadian Hospital
Association and Health and Welfare Canada. The initial focus of workload measurement was in
the area of laboratory services and diagnostic services. The program expanded to include other
areas of hospital services. For Nutrition and Food Services the first work load measurement
system was for the clinical nutrition services and in 1993 the patient service workload
measurement service was developed.
A work load measurement system (WMS) is defined as a tool for measuring the volume of
activity provided by a specific service in terms of a standardized unit of productive personnel
time. It is important to note that a WMS will not account for every minute of the day for an
individual - time to speak to a co-worker about a social event, the pleasantries of the work
environment and down time are all factors which will not be accounted for . This is considered a
normal part of the culture of the workplace.
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The WMS developed for Nutrition and Food Services was developed by a working group in
which dietitians and food service managers were represented. The WMS now in place across
Canada is under the umbrella of the Canadian Institute for Health Information (CIHI).
A standardized workload measurement system has two major uses:
 a powerful management tool to provide specific measurable information which allows the
manager to plan, budget, staff and review the performance for a specific occupation group.
 as a tool to allow comparison of the productivity of peer groups.
The workload measurement system is designed to track the work of the unit producing
employees. Management and secretarial support are not included in this system. For example
in clinical nutrition services the clinical dietitians and diet technicians are included but the clinical
nutrition manager is not included in the WMS.
Clinical Nutrition Services
For the clinical nutrition service the two categories in which work is classified are Direct Patient
Care and Non-Patient Activities.
Direct Patient Care is further broken into:
 Assessment- Determining the need for nutritional intervention.
 Nutritional Care- The planning, implementing and monitoring of the care provided.
 Education / Counselling- The actual patient education and counselling.
 Clinical Documentation- This category includes all records which are patient specific, (eg.
patient care records, patient related correspondence and the cardex.)
Non Patient Care Activities are:
 Departmental Support - this includes activities such as participation in quality assurance,
quality management, meetings, taste panels, preparing statistics, committee work within the
department, special projects, data input and the time to travel within the institution.
 Teaching / Education - This differs from the patient education and counselling in that it is the
teaching of staff, other health care members, health students and dietetic interns.
 Hospital / Community Services - Includes activities that are a service to the profession,
hospital wide committees, public education and public relations.
 Research - In this category research refers to the work done on a formal research project. It
does not include reading about a new development or searching out new activities.
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Each diet tech and clinical dietitian would record their daily workload under these categories.
Workload measurement may be designed to provide information about the amount of time
caring for specific categories of patient, eg cardiology, pediatrics, intensive care, geriatrics. The
number
of patients they had during the month is also recorded. Patients are categorized as a new
referral or active carryover.
For inpatients a new referral is the first time a patient has been seen on this admission by
clinical nutrition services.
An active carry over is a patient who is receiving ongoing nutrition care in the form of
intervention by nutrition services staff. Active carryovers also apply to patients seen by nutrition
services in the previous month and who are still in hospital and receiving active clinical care (eg.
monitoring of intake , adjustment of meal pattern.)
For outpatients a new referral is the first time within a twelve month period that a client is seen
as an outpatient by a member of clinical nutrition services. An active carryover is a client who
has been seen by a member of the clinical nutrition services within the past twelve months and
is now being seen either for a new problem or in follow up.
As an example, a patient who is seen in a clinic for dietary counselling for hypertension in March
and then is seen in the diabetes education program in September would be classified as a new
referral for the March visit but as an active carry-over for the September visit, even though the
staff in the diabetes education clinic have never met this patient before.
By combining the WMS information for each team of clinical nutrition services and the number
of patients (both new referrals and active carry-over) the management of the department can
determine how much time on average is required for specific types of patients. They are also
able to determine the productivity of individual practitioners and make comparisons within the
peer group.
Patient Food Services
The patient food services WMS is designed to track all the activities associated with the
provision and preparation of meals provided by the institution to the patients. It includes general
and therapeutic diets, nourishments, tube feedings, infant formula and infant feeding, outpatient
meals, and the provision of supplies to clinics. The patient food services WMS tracks the
activities from the purchasing, preparation, serving, distribution and pick up of meals and/or
trays. It does not include functions related to the revenue generation or non-patient activities of
the department, nor does it include the work of management and personnel categorized as
operational support.
The work load for patient food services is categorized under six main activities:
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 Procurement- those functions which are related to maintaining the inventory control for
patient food services.
 Production- the preparation of foods either by cook-serve, cook-freeze, cook-chill,
commissary or a combination of these methods.
 Distribution- this includes the functions related to the assembly, delivery and collection of
meals/ trays. This can be to the bedside or to satellite dining rooms by food services
department staff.
 Sanitation- this includes the activities to maintain the cleanliness and sanitation of the patient
services area including equipment, dishes, cutlery, trays , serving pans, carts, and the
removal of waste.
 Menu Control - The activities relating to the distribution and return of patient menus and the
gathering of data from the menu for the food tally or forecasting of anticipated menu item
production.
 Departmental Support - The activities of the non management and non operational support
staff to support the general functions of the department. This can include the attendance at
meetings and participation in hospital functions and the time spent teaching other individuals.
A patient food service area of the department will not have their own staff dedicated to do the
production, preparation and ware washing for patient food services. The staff for these functions
will most likely be doing these activities for the cafeteria and catering sides of the department.
Steps to implement a WMS:
1. By keeping track of the revenues generated in the department from food service and the
revenues from the non-patient food service a simple calculation can determine the ratio
of the patient food services to the total department for the allocation of the productive
time for each of these functions.
For example if during a specific month you had the following statistics;
Patient Food Services
Inpatient trays
3000
Outpatient meals
525
Emergency department trays
975
Total trays
4500
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To convert the tray count to meal days divide the total number of trays by 3. In this example you
have 4500 / 3 = 1500 meal days for patient food services.
For the same period you had the following non patient revenues
Non patient revenues
Cafeteria sales
$ 3500
Vending sales
$ 1000
Catering
$ 1500
Meals on wheels
$ 1000
Total revenue
$ 7000
To convert the non patient revenues to meal days, divide the monthly revenue by the calculated
cost of the meal day. For example if your meal day recovery cost is $ 7.00, the total number of
non patient meal days are 7000 / 7 = 1000
The total meal days for the department are 1500 patient meal days + 1000 non patient meal
days = 2500
The ratio of patient meal days to the total is 1500 / 2500 = .6
Therefore for all the shared services 60 % of the labour time is allocated to the patient food
services.
1. Identify all the activities associated with patient food services.
2. Develop standard times for each activity. This can be determined by conducting time
studies for a month
3. Develop workload recording forms including the number of patient meals by source of
request (eg. inpatients, outpatients, special clinics)
4. Develop a Department Workload report.
The area of WMS for patient food services is a complex reporting system. Students are not
expected to know all the details of the WMS but should be familiar with the basic principles. By
using the reporting measures developed by the Canadian Institute of Health Information, the
cost per patient tray for various activities can be calculated and provides the food service
manager with valuable concrete information.
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Unit 6
Marketing and Merchandising
Marketing is looking at the needs of the buyer rather than the needs of the seller. “To produce
targeted results, not only must marketing become a way of doing business in the health care
operation, it must become a function of management.”5
As a consumer, you have been the target of marketing techniques every day. When you turn on
the television or the radio, you are bombarded with messages to encourage you to purchase a
particular product or service. In a food services department the various suppliers and vendors
have a marketing strategy to obtain your business. As a customer, what are the most important
aspects of the service and product provided to you?
Marketing in nutrition and food services has taken on a new meaning in the current economic
climate in which we are operating. In health care, food services are an important part of the
facilities' revenue generation. The revenue which is generated from the food service department
becomes part of the overall revenue of the facility.
Your text book has defined the terms of marketing in Chapter 3. It is important for food service
and nutrition managers to be able to use these marketing techniques.
The marketing cycle starts with the identification of current and potential customers. In nutrition
and food services there are many customers of our products and services. Consider who your
customers are - the patient, the patient's family and friends, the staff of the hospital who
patronize your food service operation, internal customers such as the nurse on the floor who
wants to help a patient with a meal, other departments who use the catering services.
This is indeed a broad mix of customers and they may have differing needs and desires from
your department.
The marketing mix consists of four aspects:
 product - this is the what you have to offer to meet a customer's wants and needs. What is
unique about what you offer and how does this have perceived value for your customers.
 place - a common phrase about business is that location is everything. If a product or service
is easily accessible to the customer when they wish to have it, the business has more
chance of success. Cafeterias are designed to allow staff to purchase their meals in a
minimum of time and return to work within the scheduled time allotted for the break or meal.
 price- the amount of money charged for a particular service or product. The customer wants
to feel they have received good value for their money. That perception of value depends on
their particular situation. Have you ever complained about the price of a meal in a family style
restaurant, yet feel that you have received value for a much more expensive meal at a fancy
restaurant.
 promotion- this is how you let your customer know of the product and service you have to
offer.
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The front line staff who deal with your customers are key personnel in the marketing of your
department. A cheerful dietary aide who likes the food and tries to make sure the patient
receives what they wish, will leave the patient with a positive feeling about the service. On the
other hand an unpleasant server will give the patient the feeling that the service is second rate.
Once you have completed your marketing plan and are in the process of implementation the
merchandising aspect of your plan will take on added importance. Your text book has good
information on sales promotion beginning on page 41.
Branding
As a marketing strategy, branding refers to the use of nationally or locally labelled products for
sale in an existing foodservice operation.6
An example of branding is the use of a well known speciality coffee such as "Second Cup" as
part of the cafeteria hot beverages. The institution and the company owning the brand enter into
a contractual agreement that the brand is the only one sold at that site.
Another example of national branding is the presence of Tim Horton kiosks within facilities to
provide coffee and baked goods for point of purchase sale. Some other examples are the use of
a national brand of pizza, the presence of a McDonald's in place of a coffee shop. The 2005
spring MenuSource newsletter published by Campbell’s Foods, and in the reading section of
this unit, features the experiences of Mount Sinai Hospital as they ventured into a marketing
partnership with Campbell’s.
Does your facility use branded products on patient menus, the cafeteria or any commercial
activity?
Other than the use of national brands, some facilities create their own house brands. They may
feature home baked style cakes, cookies and muffins and may even have the product prepared
within site of the customer. The aroma of the product being baked along with a creative name
and highly visible promotional materials will create a demand for the product.
Your text covers the marketing of food services, however; there are other opportunities for
marketing within a nutrition and food service department. Some examples include marketing of
nutrition counselling for weight loss programs, the marketing of management experience as a
consultant service to other facilities, and sales of nutrition education materials. A well balanced
marketing of the products and services of the department will ensure that the expected
revenues are produced and contribute to the overall success of the institution.
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Conclusion
Financial Management consists of obtaining, controlling and spending funds within a costing
system. The budget is the primary document used to plan, analyse and control costs. The food
service department's budgetary needs are in competition with proposals submitted by other
departments so requests must be justified and well documented. Because of the increased
importance of financial criteria in health care, supervisors are finding that effective decision
making in their jobs depends on an accurate interpretation of financial information. It is not
usually difficult to lower costs by jeopardizing ("cutting down") on food quality or by reducing
portion size; however client satisfaction may be affected. The challenge in controlling food costs
is to have a perceived high value on the products and services offered. The efficient use of all
resources including labour, food and supplies will result in high quality food service within
reasonable costs. The abilities of a trained and capable supervisor are necessary to maintain
food quality and service within the financial limitations imposed by the budget.
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Endnotes
1
Payne-Palacio, J. and Theis, M. (2009). Introduction to foodservice. New Jersey: PrenticeHall, p.590.
2
Hudson, N.R. (2006). Management practice in dietetics. California, Thomson Wadsworth, p.
442.
3
Merriam-Webster Online Dictionary copyright © 2011 by Merriam-Webster, Incorporated
4
Spears, M.C. (1995). Foodservice organizations A managerial and systems approach (3rd
ed.). Englewood Cliffs, NJ: Merril, p.716
5
Puckett, R.P. (2004) Food service manual for health care institutions. San Francisco, CA:
Jossey-Bass, p 51.
6
Payne-Palacio, J. and Theis, M. (2010). Foodservice management. New Jersey, p. 504.
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Required Readings
Textbook(s)

Puckett, R.P. (2013). Food service manual for health care institutions (4th ed.). San
Francisco, CA: Jossey-Bass.
Introduction to Budget, p. 80, (Department Budget)
Chapter 10, Management Information Systems, pp. 190-205
Chapter 11, Control Function and Financial Management, pp. 207-235
Chapter 3, Marketing and Revenue-Generating Services, pp. 37-50.
Readings from Course Reader

Truber, H. (Winter 2008). Financial management in health care food services. Food
Service & Nutrition, Canadian Society of Nutrition Management News.

MenuSource – Your quarterly resource for creating mealtime possibilities. Campbell’s
Healthcare, Spring 2005.
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Unit 6 Assignments
To complete the Unit 6 assignment, please access your account on the Gateway at
www.cha.ca. The assignment is available in Word format on the Gateway for you to
download. Once completed, please upload your assignment into the designated location.
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Unit 7
Food Services and Nutrition Management
Year One Semester Two
Unit 7: Sanitation, Safety and Security
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Sanitation, Safety and Security
Objectives
Upon completion of this unit, the learner will:










Implement procedures for maintaining and monitoring standards for safety, sanitation
and security;
Describe how bacterial growth occurs in food and be able to take the necessary steps to
minimize bacterial growth;
Recognize the major causes of food contamination and take preventative action;
Implement a HACCP approach to food preparation;
Identify the major features of WHMIS and know what information needs to be included
on material safety data sheets, workplace labels and recognize the WHMIS hazard
symbols;
Implement WHMIS training for food service employees;
Describe preventative maintenance requirements and be able to apply knowledge of
government and institution regulations to develop cleaning and maintenance programs;
Describe procedures for handling emergency situations;
Discuss the basics of facility planning and design and the role of the food service
manager;
Discuss the concepts of waste management, energy and water conservation.
The Food Service Environment
Safe food handling and accident prevention requires commitment and a proactive approach on
the part of employers and employees. The food service supervisor plays a major role in the
process of preventing food contamination and occupational accidents. In this unit you will cover
the principles of safe food handling including HACCP, safety and WHMIS as well as the security
of the food service operation.
“Food managers, especially those responsible for providing food to highly susceptible or at-risk
populations, have a critical role in the prevention of foodborne illness. In effect, food managers
and the employees they oversee are public health providers. It is their job to protect customers
from food that could become unsafe though mishandling. Food service managers need to instil
a sense of urgency about the potential for food borne illness and provide the training and
education needed to ensure food handlers know proper procedures and controls. Food service
managers themselves must be well educated on the related topics of food microbiology, food
law, risk analysis, HACCP and standard operating procedures. These are a few of the
knowledge and skill requirements needed on the part of the manager to design, implement and
manage an integrated food safety program effectively.”1
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Sanitation
Sanitation Regulations
In Canada, several different departments and different levels of government share
responsibilities for maintaining public health. Local municipalities have the responsibility for
environmental health. Each provincial government has Acts and Regulations governing the
conditions and safety under which food is purchased, held, prepared and served to the public.
At the federal level, Health Canada, Agriculture and Agri-Food Canada and The Canadian Food
Inspection Agency all have responsibilities towards the safety of the food that is produced and
sold to the public. At the municipal level, the local department of health plays an inspection role.
Food-Borne Illness
Food-borne illness may result from poisoning by bacteria toxins, poisoning by chemicals or by
harmful microorganisms in food.
Microorganisms - living cells that exist everywhere and are invisible to the naked eye - can be
both beneficial to man or disease-producing. There are different types of microorganisms bacteria, viruses, parasites, molds and yeasts. Foods, such as beer, cheese, sauerkraut,
vinegar and yogurt, would not exist without certain ones. Microorganisms which are diseaseproducing are called pathogens. Of particular concern to food service operators, are bacteria,
as they multiply rapidly in the right conditions of warmth and moisture and are not killed by
refrigeration or freezing. Bacteria particularly like high protein foods, such as meat, eggs, milk,
fish, shellfish and poultry.
Some food-borne illnesses of which to be aware are:
 staphylococcus aureus - involving ham, cooked meat, poultry, meat and potato salads, fish
and cream desserts.
 trichinosis - involving pork
 salmonellosis - involving meat, poultry, milk, eggs, shellfish, pudding and gravies
 hepatitis A - involving shellfish, raw oysters, clams, milk, meat and water
 E-coli ("Hamburger Disease") involving meat and raw milk and contaminated drinking water
 botulism - involving improperly processed low acid foods, fish, mushrooms, smoked meats
 staphylococcal intoxication - involving foods high in protein, cream-filled baked goods,
ham, potato salad
 listeria monocytegenes - bacteria which are present in the environment, found in
processed and packaged foods, cheese, sausages and salami, raw milk
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 shigellosis - associated with milk and dairy foods. Raw vegetables, poultry and salads such
as potato, tuna, shrimp, macaroni and chicken.
 Norwalk virus family- associated with salad ingredients and shellfish. Contaminated food
handlers may spread this to salads, eggs, clams and bakery items.
The most frequently cited factors involving foodborne illness are:
Temperature Abuse
 failure to properly cool food,
 failure to thoroughly heat or cook food,
 foods allowed to remain at bacteria-incubation temperatures,
 failure to reheat cooked foods to temperatures that will kill bacteria Cross-contamination
 raw, contaminated ingredients incorporated into foods that receive no cooking,
 cross-contamination through careless employees or improperly cleaned equipment,
 infected employees who practise poor hygiene.
Depending on the type of food-borne illness, those people affected will have symptoms of fever,
abdominal pain, diarrhoea, nausea, vomiting, dehydration, sore throat, headache, muscular
stiffness.
Safe Food Handling
Safe food handling from the producer through to the consumer is important to prevent foodborne illness. All food is a potential source of contamination. A food contaminant is any
substance present in a food that might cause illness or harm to people. For example, a piece of
glass found in food could injure the mouth and is a food contaminant.
It is important to purchase food only from government-approved sources and to examine each
food item carefully for signs of spoilage, adulteration or filth when received and to return those
products that fail to meet standards. Frozen foods must have been maintained at -18°C (0°F) or
lower through delivery, those requiring refrigeration must have been kept at 4°C (40°F) or lower.
A metal stem probe thermometer should be used to take the internal temperature of all meat
which has been received. Storage facilities must be clean, well-ventilated and at the correct
temperatures for the products being stored.
Storage Temperatures:
 Refrigerators at 4ºC (40ºF) or lower;
 freezers at -18ºC (0ºF) or lower; and
 dry stores between 10ºC and 21ºC (50ºF and 70ºF).
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All foods must be kept in closed containers to prevent contamination.
Special care must be taken in not transferring contamination from raw foods to ready-to-eat
foods. Cross-contamination is the transfer of harmful microorganisms from one food to
another, sometimes via equipment, utensils or human hands. Raw food should be stored below
cooked food in a refrigerator. All cooked foods must be covered. Equipment and utensils must
be cleaned and sanitized after each use. Food handlers must also be trained to wash their
hands after handling raw food, after sneezing, coughing, nose-blowing, using the toilet and
handling money. The food handler should not use his bare hands to handle food; clean and
sanitized tongs, spoons or utensils should be used for each product. If gloves are worn, they too
must be kept clean.
Temperature control is the most significant factor in the control of foodborne illness. Food
temperatures between 4°C and 60°C have been identified as the danger zone, because within
this temperature range and under the right conditions bacteria can double every 10 to 20
minutes. Frozen foods must be thawed under correct conditions and temperature. There has to
be strict control on temperatures for cooking, cooling, holding, reheating and serving foods.
Many food service operations in Canada are becoming involved in supplying any excess food to
programs, such as "Food Banks" and "Soup Kitchens". Special attention must be given to food
being given away. Figure 1 is an example of the instructions given by food programs regarding
the care which must be taken in providing prepared food for reuse in a soup kitchen operation.
Both the donor and the recipient must take care to handle food safely.
Personnel
Correct hygiene for food handlers is vitally important in prevention of food-borne illness. Food
handlers must be correctly trained and monitored for good health and personal hygiene; they
must wear clean clothes and cover their hair; they must properly wash their hands prior to
handling objects and surfaces which could contaminate food. Food handlers can be the carriers
for disease organisms which are present on hands, face, hair, in their mouths and intestinal
tracts.
Cleaning and Sanitizing
Effective cleaning and sanitizing will remove visible soil and reduce invisible microorganisms to
safe levels. Care must be taken that toxins from cleaning agents are not allowed to remain on
food contact surfaces as these toxins could be a cause of foodborne illness.
Machine and manual cleaning and sanitizing of utensils, dishes, pots, pans must meet the
requirement of the National Sanitation Code. Items to be washed by hand must be sorted,
scraped, and pre-rinsed. Regulations for manual washing specify:
 3 sinks
 first sink has hot water 44°C (110°F) with detergent
 second sink has hot water 44°C (110°F) for rinsing
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 third sink has sanitizing solution at 24°C - 44°C (75°F-110°F) for 1 to 2 minutes
Air drying is recommended as the drying cloth may be contaminated and may reintroduce
bacteria to sanitized items.
Machine washing should have wash water not lower than 60°C (140°F) and rinse temperature
should be 80 - 90°C (176 - 194°F). There are specific times for each cycle depending on the
type of machine. A thermometer must indicate the temperatures of the wash water and rinse
water.
Appendix H of the Food Safety Code of Practice outlines the types, symptoms and prevention of
major food-borne illnesses. The problems associated with high risk products and of cross
contamination are addressed. The Food Safety Code lists the procedures for handling,
preparing and storing various types of food in pages 58-91. Correct hand washing procedures
are outlined on page 126. Detailed procedures for manual and machine washing are provided
on pages 106-110.
Cleaning Procedures
A cleaning procedure is step by step instructions on how to clean a particular area or piece of
equipment. Cleaning procedures should be stored or posted in an area that all staff involved in
cleaning has access to them. The benefits of cleaning procedures are many: 1) provides a step
by step guidance document; 2) ensures consistency in cleaning from day-to-day and from
person-to-person; 3) provides the facilities expectations on how to clean an area/piece of
equipment, so everyone is aware of these expectations; 4) assists in ensuring the safety of the
individual completing the cleaning task.
Cleaning procedures should include the following:
1. Title or Heading of what is being cleaned
2. Tools needed (i.e. equipment, chemicals, personal protective equipment (PPE’s))
3. Step by step cleaning instructions.
Writing cleaning procedures can sometimes seem like an overwhelming task. To help improve
your abilities in writing cleaning procedures it is helpful to observe and ask questions of the staff
that are performing the cleaning task to see how they are currently doing the cleaning task.
1) Have the employee completing the cleaning task explain to you what they are going to
do (make simple notes of what they have said).
2) Observe the actual cleaning process making notes of what they are doing (include tools,
chemicals, PPE’s used in your notes). Ask the employee questions about the process
and get them to verbally explain the process during your observation. Having the
employee explain to you will assist you in better understanding what they are doing and
why they are doing it.
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3) Compare what employee has actually done to what they said they were going to do. It’s
okay to find some differences between what they said they were going to do and what
they actually did (i.e. they may have said that they put the wet floor signs up and then
sweep, but during the observation they swept and then put up the wet floor signs). Many
people find it difficult to verbally explain tasks step by step and in detail and often give
better detail by actually explaining the task as they are doing them.
4) Draft your cleaning procedure and ask for staff involved in the cleaning to read it and
provide feedback. You may also want to clean the piece of equipment yourself, based
on your cleaning procedure, to see if your instructions make sense.
5) Amend the cleaning procedure based on feedback accordingly.
You may also want to contact your chemical company or equipment supplier to see if they can
provide further information on how to clean a particular piece of equipment.
Kitchen Floor Cleaning Procedure
Equipment needed:

Cloth (clean)

Scrapper

Broom

Dustpan

Wet floor sign

Mop (clean)

Bucket with wringer

Hot water

Floor cleaning chemical (As per MSDS sheet you must wear goggles and
rubber gloves while dispensing this chemical).
Cleaning Instructions:
1. Move any moveable equipment and mats out of the way
2. Post wet floor signs
3. Sweep and dispose of any debris
4. Scrape any stuck on debris and dispose of this
5. Fill bucket with hot water and floor cleaning chemical at proper dilution (use the
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chemical dispensing unit in the housekeeping closet).
6. Submerse mop into bucket (containing hot water and floor cleaning chemical)
7. Wring out mop to desired dampness
8. Begin mopping at the furthest point from the door
o
Outline an area/section
o
Mop in a “figure 8” motion
9. Change water as needed
10. Repeat steps 2 to 9 as necessary
11. Once completed, empty contents of bucket into floor sink in housekeeping closet.
Rinse bucket. Remove dirty mop head and place in laundry bag.
Environment
Foodservices facilities must conform to local building ordinances, public health regulations, fire
and safety regulations. Ventilation, lighting, plumbing, washrooms and food waste and garbage
disposal all have regulations or guidelines that must be met. It is essential that the facilities be
cleaned on a regular basis. Rodents and insects are a source of contamination. Regular and
systematic inspections should be carried out to detect their presence. Inspect and monitor
supplies of cereals, flour, rolled oats, pasta and store these products in sealed containers.
Rodenticides must never be used while food preparation is taking place and it is best to have a
licensed pest control operator using approved chemicals and methods to come and eradicate
an infestation.
Food waste and garbage must be handled, stored and removed in a way which prevents
contamination or nuisances such as odours, insects or rodents. Wet and dry garbage should be
sorted and disposed of separately. Garbage receptacles must be cleaned and sanitized after
being emptied at least once a day.
The Food Safety Code of Practice lists procedures for maintaining the cleanliness and safety of
foodservices facilities (e.g. floors, walls, ceilings, washrooms, etc.) Appropriate ventilation,
lighting and garbage disposal are also included. Some tips for housekeeping and general
maintenance are outlined in pages 111-112. Appendix A defines and describes how to
implement the HACCP System.
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Figure 1
FOOD SAFETY
FOOD RISK LEVELS - The degree of care necessary for safe handling of the foods you wish to
accept will vary with the degree of risk posed by the food.
A LIST OF HIGH RISK AND LOW RISK FOOD AND THE DEGREE OF CARE REQUIRED IS
ON THE FOLLOWING PAGE.
PROTECTIVE MEASURES FOR HIGH RISK FOOD
Once hot food is collected, the considerations of TIME, TEMPERATURE and PROTECTION
from contamination must be continued by the agency accepting the donation. When dealing with
hazardous food, its exposure to danger zone temperatures should be avoided or the time
minimized. To be sure the food remains safe to eat the following points should be met.
1. Containers used to pick up food must be of food grade material and provided with lids.
All food containers must be washed and sanitized between each use.
2. Coolers equipped with ice packs must be provided at all times.
3. Food must be transported directly from point of pick up to point of delivery.
4. The internal temperature of the food should be recorded and the time noted when the
food arrives at your agency. This information should be compared with the time and
temperature records sent with the food. If the food has been in the danger zone for more
than 4 hours it should be discarded
Example
Food on buffet
time - 2:30 p.m.
Internal temperature
50º C
Refrigerated
time - 4:30 p.m.
Internal temperature
30º C
Food is picked up
time - 5:50 p.m.
Internal temperature
10º C
Food arrives at site
time - 7:00 p.m.
Internal temperature
8º C
DISCARD FOOD BECAUSE ELAPSED TIME IS 4.5 HOURS AT DANGER ZONE INTERNAL
TEMPERATURES.
5. Upon arrival at your agency, hot food should be:
a) Transferred to refrigerated storage until time of preparation and service, or;
b) Reheated to a temperature of at least 74º C if it is to be served immediately.
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6. Upon arrival at your agency, cold food should be transferred to refrigerated storage until
time of service.
7. Food should be stored in a manner to prevent cross contamination (cooked and readyto-eat foods should be stored above raw meat, poultry and fish in the cooler.)
8. Donated prepared food (leftovers) should not be stored long term. This type of food
should be served as soon as possible after its time of arrival.
For example:
1) Food arriving in morning is served at lunch.
2) Food arriving in the afternoon is served at dinner.
3) Food arriving in the evening is served at lunch the next day.
Options 1 & 2 are preferred since the time lapse between acceptance and service is the least.
2. IN DOUBT ABOUT THE SAFETY OF THE FOOD, THROW IT OUT!!!
FOOD RISK LEVELS- The degree of care necessary for safe handling of the foods you wish to
donate will vary with the degree of risk posed by the food. Listed are examples of foods which
fall into HIGH or LOW risk levels and the degree of care required at each level.
HIGH RISK
FOODS
 meat and meat dishes
 poultry and poultry dishes
 fish and seafood dishes
 gravy and stew
 cream or egg based sauces
High risk foods require careful
monitoring of TIME and
TEMPERATURE as well as
PROTECTION from contamination
to ensure food poisoning bacteria
does not have an opportunity to
grow.
 salads - egg, tuna, meat , pasta
 sandwiches - egg, tuna , meat
and chicken
LOW RISK
FOODS
 muffins and tea biscuits
 bread and rolls
 fruit pies
Low risk foods also require
protection from contamination but
they do not require special care
with respect to time and
temperature
 cakes without a dairy or eggbased icing or filling
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PROTECTIVE MEASURES FOR HIGH RISK FOOD
Food considered acceptable for donation should meet the following criteria.
1. Minimum time has elapsed between preparation of the food and recovery of leftovers.
Suggested time is 2 hours.
2. Food has been held at acceptable hot or cold holding temperatures between preparation
and recovery of left overs. Acceptable temperature for hot food is 60º C (140º F) or
above and for cold food 5º C (41º F) or below. Food that has been allowed to enter the
danger zone between 5º C and 60º C should NOT be considered for donation.
3. Food has been exposed to a minimum of handling or risk of contamination between
preparation and recovery of leftovers. (use tongs and spoons to minimize hand contact)
4. Food has not passed its "best before" or "expiry date".
5. Food packaging is not damaged. (e.g., dented cans, opened boxes)
Consider the following points when preparing food for donation.
1. Hot food should be quickly cooled prior to leaving the premises. Food should be stored
under refrigeration in containers not exceeding 10 cm (4 in.) in depth.
2. Cold food should be maintained at 4º C or less while awaiting pickup.
3. The internal temperature of the food should be recorded when the food is put into cold
storage and when it is picked up. A copy of this record should be sent with the food.
4. If it is necessary to transfer the food from the donators container to the receivers this
should be done as quickly as possible with the use of spoons and tongs in order to
minimize hand contact. Food should not leave the premises in food grade containers or
if a cooler with ice packs are not provided for its transport.
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HACCP - The Hazard Analysis and Critical Control Point
System
The HACCP System is a process that identifies specific hazard and preventative measures for
their control to ensure the safety of food throughout the preparation cycle, rather than
depending on end product testing. It was developed to prevent foodborne illness in space foods
for NASA. Traditional approaches to sanitation focused on cleanliness, but HACCP
concentrates on cross-contamination and time-temperature controls. The System identifies the
Critical Control Points (CCP) of different stages in the foodservices operation at which food
might become contaminated because of cross-contamination or time-temperature abuse. A
CCP is unique to the HACCP system in that the user can focus on preventative measures on
identified problems, rather than relying on general sanitation measures. CPPs vary from food to
food and between operations and food service systems.
The HACCP system consists of seven principles which are as follows:
Principle 1
Identify the potential hazard(s) associated with food production at all stages, from growth,
processing, manufacture and distribution until the point of consumption. Assess the
likelihood of occurrence of the hazard(s) and identify the preventative measures for their
control.
Principle 2
Determine the points/operational steps that can be controlled to eliminate the hazard(s)
or minimize its likelihood of occurrence -(Critical Control Point). A "step" means any stage
in food production and/or manufacture including raw materials, their receipt, and/or
production, harvesting, transport, formulation, processing, storage, etc.
Principle 3
Establish target level(s) and tolerances which must be met to ensure the CCP is under
control.
Principle 4
Establish a monitoring system to ensure control of the CCP by scheduled testing or
observations.
Principle 5
Establish the corrective action to be taken when monitoring indicates that a particular
CCP is not under control,
Principle 6
Establish monitoring procedures to confirm that HACCP is working effectively.
Principle 7
Establish a documentation system for all procedures.
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A HACCP flowchart is recommended for each food product, identifying the Critical Control
Points and the controls, from purchasing to consumption. Figure 2 is a sample of identified
hazards for foods on a cold buffet. This is an example of Principle 1 of the HACCP principles.
Figure 3 is an example of a flow chart for the preparation of frozen chicken or turkey. Note that
the control points are monitored from the time the product is received until it is served.
To integrate the HACCP principles in all components of the facility's food safety systems a
HACCP coordination group is suggested. The function of the group is to plan, co-ordinate,
educate and review HACCP safety programs and other systems within the facility. Individuals
who are familiar with the various components of the food handling from purchasing to recipe
development and the preparation and serving of the food product are all good persons to have
on the committee. The support of administration is required to develop policies which are
consistent with and support the HACCP principles.
Figure 2
Canadian Restaurant & Foodservices Association
STEP: "COLD HOLDING" (ie. Salad Bar, Buffet Bar)
Hazard (if any)
Contamination
Failure to Control
Temperature
Standard
Control
1. Do not introduce a fresh
batch of product into a
partially used batch, as
above.
Monitor. Train
2. Use commercially filled and
unopened containers for
products such as milk,
condiments.
Monitor
3. Throw our unused puddings,
custards etc. which have
been held cold for service.
Monitor. Train
4. Avoid contamination from
customers at self- serve
areas.
Keep foods covered by a sneeze
guard. Provide clean tableware to
customers wanting refills. Use
separate clean and sanitized utensils
for each item. Use pre-packaged
items when possible. Assign staff to
monitor the area.
1. Product being held must be
maintained at a temperature
Measure the temperature every two
hours.
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of 60°C.
2. Discard product which is held
for more than 4 hours.
Monitor. Keep a time chart
3. Don't introduce a new batch
of cooked product into one
which has been held hot.
Monitor. Train.
Reprinted with the permission from the publisher of
Canadian Restaurant & Foodservices Association,
NSTP Instructor's Manual, 1993.
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Figure 3
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Safety
Employers are required by law to provide information, instruction and supervision to protect the
health and safety of all their workers. Safe working habits that promote an awareness of
potential hazards, are an important first step in fostering a culture of safety in the work
environment. Accidents occur because of unsafe acts or unsafe conditions. It is the
responsibility of the food service manager to ensure that employees follow safe work practices
and take appropriate protective measures to avoid exposure to a hazard. The nature of work in
a food services operation puts employees at risk for accidents. Consider all the potential
hazards in an institutional kitchen- from the water on a dishroom floor to the knives and sharp
implements in use to the heat from cooking equipment. Mangers and supervisors who do not
take due care to ensure a safe working environment can be charged under provincial legislation
and can be fined for breach of safety regulations.
Safety Programs
Developing a safety policy and implementing a safety program helps:
 make employees aware of hazards, know the protective measures to take and ensure
correct work habits are followed,
 the food service department meet legal requirements (e.g. Homes for the Aged and Rest
Homes Act, Public Hospitals Act, Nursing Homes Act),
 employees clearly understand their legal and individual roles and responsibilities to regularly
and routinely maintain health and safety standards,
A safety program includes training staff both on-the-job and in the classroom. A safety
committee has members who include both management and union representatives, supervisors
and workers. Frequently there are two co-chairs for the safety committee with management and
labour sharing the responsibilities.
Management has a responsibility:
 to set safety standards
 maintain job descriptions and specifications relating to safety
 see that all personnel are instructed in safety procedures
 maintain safety supplies and keep equipment in good working order
 establish safe working conditions
Employees have responsibilities as well. They include:
 observing the correct prescribed procedures for operating equipment and using protective
devices and clothing
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 reporting to supervisors any potential hazards and any needed repairs or maintenance
 prompt notification of accidents
Employees have the right to refuse work if they have reasonable cause to believe that they are
in immediate danger. They must notify their supervisor of their concern and identify the
hazardous situation and the reason for their refusal to work. Together the supervisor and the
employee (and if available another person informed about safety) try to resolve the problem and
if it is resolved to the satisfaction of the employee, the employee resumes the normal work as
assigned. If the problem is not resolved to the employee's satisfaction, the employee may
continue to refuse the work and a government safety and health officer must be notified. The
regulations concerning the right to refuse work will vary form province to province. The
supervisor needs to become familiar with the regulations in their province.
Patients/Clients have responsibilities as well. They include:
 observing the safety signs posted in the facility, eg. No Smoking, Wet Floor - Slippery
 identifying to staff any problems with their room, appliances, etc.
A safety committee is usually responsible for establishing safety inspection procedures,
developing safe work procedures, accident investigation, auditing the safety program and
preparing for emergencies. A system for self-inspection of the department for safety and
sanitation should be conducted regularly. Figure 4 is an example of a sanitation/safety checklist
used daily in a hospital.
Job Safety Analysis is one method to identify the hazards associated with a particular job. From
your analysis of past accidents, identify those jobs which appear to be high risk or select a new
job where the hazards have not been clearly identified. The job selected for safety analysis
should be broken down into all the steps in the order in which they occur. For each step in the
sequence consider the potential hazards. Consider the hazards associated with the work
environment (eg. noise, temperature, lighting, ventilation), the equipment (eg. knives, cooking
equipment, serving utensils), and the process (the manner in which the work is done). Once the
hazards have been identified the way to overcome the hazard must be determined. These may
be to remove the hazard, control the hazard, revise the work procedures or if these do not
eliminate the hazard, reduce the exposure to the hazard.
Figure 4
Figure 4 - SAMPLE
AREA:
INGREDIENT CONTROL CENTRE
EQUIPMENT REQUIRED:
50g and 100g weights
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DATE:
Check according to the code:
Completed by:
S = Satisfactory
ITEM
S
U = Unsatisfactory
U
REMARKS
AREA OUTSIDE INGREDIENT CONTROL
ROOM
1. Storage racks clean/in good repair
2. Shelves level
3. Lights, vents, walls, baseboards –
clean and in good repair
4. Floor clean; no litter
5. Door locked
INGREDIENT CONTROL ROOM
1. Racks clean, in good repair
2. Shelves level
3. Trays on shelves clean
4. Supplies stored securely on shelves
5. All food items not in original containers
covered
6. Food stored up off floor
7. Bins clean, in good repair
8. Scoop holders in ingredient bins
9. Work table clean to sight
10. Utensils and measures clean
11. Food handling minimal; proper utensils
used
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12. Hand wash sink clean; towels and soap
available
13. Soap dispenser works
14. Cardinal Electronic Scales (2)
-
clean to sight
-
weigh accurately
-
never turned off
Test with 50g and 100g
weights
15. Can opener clean to sight
16. Cleaning supplies available
17. Garbage emptied at least twice/day
18. Garbage can kept covered when not in
use
19. Garbage cans sanitized at end of shift
20. Empty boxes removed to garbage room
21. Heavy/bulky items transported by truck
22. Exit free from trucks
23. Step stool available
24. Cardboard box ripper available
25. Walls, ceiling, vents and baseboards
clean
26. Lights sufficient and in good repair
27. Floor clean, no litter
28. Door locked
29. Swap test results
STOREKEEPER’S DESK/AREA
1. Desk kept neat, clean
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Unit 7
Desk sturdy, in good repair
UPRIGHT MOBILE FREEZER
1. Shelves level
2. Clean interior and exterior
3. Thermometer present and working
4. Temperature kept at 0º F or lower
5. Temperature recorded daily each am and
pm
MEAT REFRIGERATOR
1. Handle in good repair; door easy to open
2. Thermometer present and working
3. Temperature kept between 35-40ºF
Temperature:
4. Temperature recorded daily AM and PM
5. Buzzer, lights, fan in good repair
6. Light on
7. Fan guards in place
8. Light covers and fan guards clean
9. Racks and shelves clean, in good repair
10. Food stored off the floor, covered
11. No other items stored on shelves with
eggs or egg product. Tempering frozen
eggs dated.
12. Floor clean and dry
13. Walls, ceiling and baseboards clean/in
good repair
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14. Outside floor drain clean and covered
GENERAL SUPPLY REFRIGERATOR
1. Handle in good repair; door easy to open
2. Thermometer present and working
3. Temperature kept at 40ºF or lower
Temperature:
4. Temperature recorded daily AM and PM
5. Buzzer, lights, fan in good repair
6. Light on
7. Fan guards in place
8. Light covers and fan guards clean
9. Racks and shelves clean, in good repair
10. Food stored off the floor, covered
11. All opened canned goods:
(a) stored in covered plastic
containers
(b) labeled and dated
(c) less than 3 days old except
ketchup and pumpkin
12. Bins clean, in good repair
13. Scoop holders in ingredient bins
14. Walls and ceilings clean/ in good repair
VEGETABLE PREP AREA
1. Double sink drains clear; plugs available
2. Sink and counter clean to sight
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3. Taps free from leaks
4. Proper water pressure available
5. Cleaning supplies under Hallde Food
Prep Mill Table
6. Vegetable brushes available, secure on
wall
7. Appropriate kind, number of knives
available
Swab blade:
8. Knives stored in rack secured on wall
9. Knife rack clean
10. Lighting sufficient (direct)
11. Garbage cans sufficient in number
12. Garbage cans covered when not in use
13. Garbage cans emptied 3-4 times/day
How full:
Time:
14. Garbage cans sanitized at end of shift
15. Walls, ceiling & baseboards clean/in
good repair
16. Floor clean and dry
17. Wet floor sign available
18. Doors to Salad and Bakeshop Areas
clean and locked
19. Swab tests results
HANDWASHING SINK
1. Clean to sight
2. Soap, paper towels available
3. Soap dispenser works
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SCALES (TOLEDO 100 kg, CARDINAL,
22kg)
1. Clean to sight
2. In good repair
3. Weigh accurately
Use 50g and 100g weights
4. Cardinal scale never turned off
VEGETABLE PREP TABLES
1. Countertop clean to sight
2. Pots stored upside down, secure on shelf
3. Sufficient lighting (direct)
4. Shelves clean and level
5. Floor drains clear/covered/clean
PERSONAL HYGIENE
1. Hand washing
Observe at:
a: good technique
0700 Storekeeper supervisor
b: no nail polish
0800 ICC Aide
c: Sign displayed
0900 Vegetable prep Aide
2. Clean Uniforms and aprons
5. Hairnets cover all hair
6. Jewellery
a: Only plain wedding band without stones
worn
b: Earrings – small studs; no stones;
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c: No facial piercing
d: Chain – plain with no pendant
7. No gum chewing
8. Safe shoes (enclosed heel and toe)
GENERAL
1. Schedules and procedures available in
areas
2. Intercom system in good repair
3. Mail boxes secured on walls and doors
4. Door kept locked at all times
5. Only 1CC employees
6. Broom and dustpan available
FIRE EXTINGUISHER AND BLANKET
1. Extinguisher dated
Last dated:
2. Blanket available
WHMIS
1. All decanted products have labels
2. MSDS available in the area
PEST CONTROL
1. Absence of rodents, roaches, flies
2. Pest sprays available
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Figure 5
SPECIFIC SAFETY RULES
SAFE KNIFE AND BLADE HANDLING
Much of the work performed in food services is done with knives and blades or electrical
equipment. Cuts and dismemberment are frequent accidents in this area. Safe handling of
knives is of prime importance to prevent accidents and human suffering. The following rules
must be adhered to at all times:
 All users must be trained to use and sharpen knives before they are authorized and
assigned to use knives.
 Each knife has been designed for specific cutting operations and should be used for the
job to which it is suited.
 Knives shall be used only for cutting, never for other purposes (opening cans with a knife,
for example, is very dangerous to the user, harmful to the knife and it leaves a dangerous
ragged edged can).
 All knives shall meet a high standard of quality, sharpness, and safe storage.
 Sharp blades shall be maintained at all times (dull knives and blades are more apt to slip,
cannot be precisely controlled, and are more dangerous).
 Only knives in good condition shall be used. They must never be worn or have loose or
broken blades.
 Knives shall not be carried on the body unless sheathed and all knife sheaths shall be
maintained in a safe and sanitary condition.
 A cutting board shall be used and the board shall be anchored on the work surface in
such a manner as to prevent slipping. No cutting shall be done on stainless steel
surfaces.
 Only one person at a time shall be allowed to perform cutting duties on one board or in
one area. No other persons' hands or fingers are allowed near the cutting operation
Safe Knife and Blade Handling
To ensure safe cutting:
 Have clean, dry hands.
 Pick up the knife firmly by the handle, never by the blade (the handle should be clean and
dry, not greasy).
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 Maintain a secure, comfortable grip to ensure control of the knife.
 Curl your fingers under, to steady the food you are cutting, for controlled, even-sized, safe
cutting.
 Cut away from yourself and others. Never cut if another person is close enough to be cut.
 Be attentive and alert to the job. Do not speak to others while cutting. Never direct your eyes
away from the blade and your hands.
 Never engage in or tolerate horseplay with knives.
 Never try to catch a falling knife, step aside, let it fall and warn co-workers.
 Never allow a knife to protrude over the edge of your work surface.
 Never submerge a knife under peelings or among debris. Keep your work area tidy.
 Wash the knife, sharpen, rewash, and place in knife rack after each use.
 Never submerge a knife or blade in water, for yourself or others to wash.
 Carry one knife at a time with the tip pointed down, sharpened side of the blade to the rear,
the arm close and parallel to the body.
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WHMIS –The Workplace Hazardous Materials Information
System
The Workplace Hazardous Materials Information System (WHMIS) is a communication
system developed by the joint action of the provincial and federal governments, industry and
labour. WHMIS was designed to ensure that all employers obtain the information they need to
know about the hazardous materials they work with. The system came into effect in 1988 and
applies to any workplace in Canada.
The purpose of WHMIS is to:
 protect employees by providing information about the hazardous materials in the workplace,
 set standards for the information required to be revealed concerning hazardous materials,
while at the same time,
 protecting manufacturers legitimate trade secrets.
WHMIS is a communication system which has three main methods of communicating
information; including the use of labels on products, material safety data sheets and employee
training and education systems.
Federal and provincial legislation stipulates that the employer is responsible for ensuring that:
 employees comply with the legislation
 hazardous substances are labelled properly
 an inventory listing is maintained of all hazardous materials in the workplace
 material safety data sheets (MSDS) are developed/obtained and kept up-to-date
 the material safety data sheets (MSDS) are available to employees
 all workers are trained on how to handle these products safely.
WHMIS uses a pictogram to clearly identify types of hazards which products pose. Figure 6
contains the classes of WHMIS hazards and the pictogram.
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Figure 6
WHMIS HAZARD SYMBOLS
Class of Hazard
Hazard Symbol
Class A
Compressed Gas
Class B
Flammable or Combustible Material
Class C
Oxidizing Materials
Class D
Poisonous and Infectious Materials
1. Materials causing immediate and severe toxic
effects
2. Materials causing other toxic effects
3. Biohazardous infectious materials
Class E
Corrosive materials
Class F
Dangerously Reactive
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There are several types of labels which are used with WHMIS. The supplier labels are provided
by the manufacturer, supplier or distributor of the product and should be included with all
WHMIS controlled products. Supplier labels must contain the following information; identify the
chemical product, identify the supplier or manufacturer, reference the MSDS, display the
WHMIS hazard symbols and provide information concerning risks, precautionary measures and
first aid information. Figure 7 is an example of a material safety data sheet and Figure 8 is a
supplier label.
Workplace labels are required when a controlled product is transferred to a different container
or the supplier label is unable to be read clearly. Workplace labels must contain the product
identifier, information concerning the safe handling of the product and a reference to the MSDS.
A third type of label is the hazardous waste labels which must be used when chemicals
controlled under the WHMIS legislation is sent for disposal or recycling.
It is important to ensure that all components of the WHMIS program are maintained up-to-date
when hazardous materials are added or deleted from use within a department. This includes
filing new MSDS's in master and departmental manuals and ensuring all appropriate labels are
affixed to container. As well, employees need updating on handling new products. There is a
requirement that employers be able to show that there has been ongoing education programs
concerning WHMIS. The manger of food services and the supervisor need to keep records of
which employees have received WHMIS training and the content of the training.
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Figure 7
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Figure 7 continued
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Figure 8
SUPPLIER LABEL
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Safety of Kitchen Equipment
All electrical equipment must have CSA (Canadian Standards Association) certification to be
sold in Canada. This informs the purchaser that a product or system has been evaluated under
a formal system, which includes examination, testing and inspection, and that the product or
system complies with applicable standards. In other words, requirements for safety and/or
performance have been met.
Remember the following potential safety hazards when using electrical equipment:
 loose plugs indicate the attachment plugs need repair because they can wobble or pull out of
the receptacle too easily
 odours may come from burned or overheated wires
 sizzles or buzzes from the electrical system
 arcs/sparks anywhere in the electrical system
 damaged wire insulation
 electrical shocks may be a warning of potential for electrocution
 overheated switch plates, cords and plugs - they should never be too hot to touch
 permanently installed extension cords as these should only be temporary installations
Since fellow employees have to work after you in the same area, inspect your work area before
leaving it. See that equipment or appliances are turned off and that equipment is stored
properly.
Preventative maintenance programs include “regular and systematic inspection, cleaning,
lubrication, and replacement of worn parts, materials, and systems in order to prevent costly
breakdowns and prolong equipment life”2
It is worthwhile to establish equipment preventative maintenance programs at work.
Preventative maintenance programs relate to the regular cleaning of equipment using standard
procedures and a regular, planned maintenance of the equipment by qualified personnel. Some
facilities will have their maintenance staff specialize in the repair and care of specific types of
equipment. The plumber on staff may be assigned to the dishroom area in the facility and refer
any problems which he is unable to correct to the appropriate trades person. Some facilities set
up service agreements with outside trades which include periodic and regular inspections of the
equipment, the replacement of worn parts and the required repairs. The food service
department needs to maintain records of all the equipment in the department. The information
on record should include the date of equipment purchase, supplier equipment manuals and
warranty information. The dates of the installation of the equipment and the company who
installed the equipment as well as information concerning the authorized service companies
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should be kept in a systematic manner. The dates and type of service required is also
imperative.
The Goals of a preventative maintenance program include:

Minimizing down time of the equipment

Maximizing the lifetime of the equipment

Minimizing energy costs

Ensuring operational safety

Maintaining consistent product quality

Maintaining/improving equipment dependability

Preventing equipment from failing

Prevention of small problems from becoming big problems (and thus save money)
An effective preventative maintenance program will:

Train staff on the use and maintenance of food service equipment,

Help employees recognize the importance of regular scheduling for cleaning equipment,

Ensure that cleaning standards for each piece of equipment are adhered to, and

Maintain equipment records (service contracts, repair history, spot checks, etc.).
Below is an example of a preventative maintenance schedule for floors:
Equipment to
Be Cleaned
Frequency
Task
Equipment
needed
Responsibility
Floors
As necessary
Wipe spills
Cloth, mop,
bucket, broom,
dustpan, wet
floor sign.
Dietary aide, cook
Daily
Damp mop
Cloth, mop,
bucket, broom,
dustpan, wet
floor sign,
Dietary aide
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scrapper
Weekly
Scrub
Floor scrubber
machine, wet
floor sign
Dietary aide or
housekeeping aide
Monthly
Polish
Floor polisher
Dietary aide or
housekeeping aide
Annually
Check
finish/reseal
Sealant
Maintenance
Other important items of concern regarding safety are:
Working areas (e.g. floors, stairs) must be kept safe for everyone using them. These surfaces
need to be kept clean, dry and clear of all obstacles to prevent accidents from occurring.
Storage areas must be monitored closely. Heavy or loose items may fall on employees. It is a
common safety violation to have boxes piled too high in store rooms. Improper lifting could lead
to personal injury. Cleaning supplies and chemicals must be stored away from food.
Personal protection is also essential for maintaining a safe food service environment. This
includes wearing appropriate footwear, protective clothing and using equipment properly.
Fire Safety
Food service operations have more fires than any other type of business operation. A food
service manager must be aware of the potential for fire and identify the correct procedures for
handling hazards which could cause a fire. There are four fire classifications. Portable fire
extinguishers are also classified to indicate their ability to handle specific classes and sizes of
fires. Labels on extinguishers indicate the class and relative size of fire that they can be
expected to handle. Class A extinguishers are used on fires involving ordinary combustibles,
such as wood, cloth, and paper. Class B extinguishers are used on fires involving liquids,
greases, and gases. Class C extinguishers are used on fires involving energized electrical
equipment. Class D extinguishers are used on fires involving metals such as magnesium,
titanium, zirconium, sodium, and potassium. Each fire extinguisher also has a numerical rating
that serves as a guide for the amount of fire the extinguisher can handle. The higher the
number, the more powerful the extinguisher.
A
Fire
Extinguisher
Class "A" Fire
Class "A" or "ABC" Extinguisher
Wood, paper, textiles, other ordinary
Uses water, water-based chemical, foam,
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B
C
D
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combustibles
or multi-purpose dry chemical. A strictly
Class A extinguisher contains only water.
Class "B" Fire
Class "ABC" or "BC" Extinguisher
Flammable liquids, oils, solvents, paint,
grease, etc.
Uses foam, dry chemical, or carbon
dioxide to put out the fire by smothering it
or cutting off the oxygen
Class "C" Fire
Class "ABC" or "BC" Extinguisher
Electrical: Live or energized electric wires
or equipment
Uses foam, dry chemical, or carbon
dioxide to put out fire by smothering it or
cutting off the oxygen
Class"D" Fire
Class "D" Uses dry chemical to put out fire
by smothering it or cutting off the oxygen
Flammable metals
Letter-shaped symbol markings are used to indicate extinguisher suitability according to class of
fire.
For example, an extinguisher that is rated 4A:20B:C indicates the following:
The A rating is a water equivalency rating.
Each A is equivalent to 11/4 gallons of water. 4A=5 gal. of water.
The B:C rating is equivalent to the amount of square footage that the
extinguisher can cover, handled by a professional. 20 B:C=20 sq. ft. of
coverage.
C indicates it is suitable for use on electrically energized equipment.
When analyzing these ratings, note that there is not a numerical rating for Class
C or Class D fires. Class C fires are essentially either a Class A or Class B fire
involving energized electrical equipment where the fire extinguishing media
must be non-conductive. The fire extinguisher for a Class C fire should be based
on the amount of the Class A or Class B component. For extinguisher use on a
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Class D fire, the relative effectiveness is detailed on the extinguisher nameplate for the specific
combustible metal fire for which it is recommended
Extinguishers suitable for more than one class of fire should be identified by multiple symbols
placed in a horizontal sequence
The acronym "P.A.S.S." describes the four-steps used in operating a fire extinguisher.




Pull - Pull the safety pin on the extinguisher.
Aim - Aim the hose of the extinguisher at the base of the fire.
Squeeze - Squeeze the handle to discharge the material.
Sweep - Sweep the hose across the base of the fire from side to side.
It is vital to know what type of extinguisher you are using. Using the wrong type of extinguisher
for the wrong type of fire can be life-threatening.
Common fire hazards in food service operations include the deep fat fryers and the cooking oil
or fat used. The flashpoint of oils is between 425º F and 500º F. If a fire is in contact with oil the
severity of the fire will be greatly increased. Grease and oil can accumulate on the walls,
surrounding equipment and particularly on the hoods over the cooking area of the kitchen.
Hoods must be cleaned regularly if they are not equipped with a automatic wash down feature.
In this instance good sanitation practices are part of the fire safety program.
Food service employees need to be able to recognize what causes fires and how to prevent
them from occurring. Training in fire safety includes identifying, understanding and eliminating
common fire hazards. The process also involves learning the procedures to follow in case of a
fire and practising in response to alarms and emergency situations.
Emergency Planning
Emergency Food Service is an organized emergency response designed to provide food for
those who cannot feed themselves, or those without food or food preparation facilities; and
recovery workers and volunteers.
Take some time to go through the publication from the Public Health Agency of Canada,
Emergency Food Service: Planning for Disaster. Ask to see and review the emergency food
service plan in your facility.
Guy Robertson (2004) in his article, Emergency Planning for Long Term Care / Seniors Nursing
Home Residential-Care-Facilities, says a good emergency plan starts with a summary of the
risks that prevail at your facility. Every region has its natural risks, from high winds and winter
storms in the Maritimes and Central Canada, to flooding on the Prairies, to earthquakes in
British Columbia. Heat waves and freak storms are increasingly common across North America.
Any of these risks can lead to property damage, power outages and supply problems for care
facilities.
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Technological risks include computer failures and data loss, toxic spills, electrical fires and
explosions. Technological problems often result from human error. Somebody pushes the
wrong button or forgets to push the right one, and the lights go out all over town. Somebody
else trips over a cable in the server room, disables an entire network and you lose access to
your electronic files, including those pertaining to essential resident care.
While human error is unintentional, some harmful actions are purposeful. These are security
risks: theft, sabotage, vandalism and fraud. What risks threaten your facility? Remember that
risks at nearby sites can threaten you directly. Nearby threats are called proximity risks, and
every property manager should be aware of them.
Once you've determined the risks to your facility, consider the best ways to mitigate them. There
are always means of dealing with a risk so that it's less likely to disrupt your operations. For
example, if you're concerned about power failures, investigate the feasibility of a backup
generator. Ask your staff and residents to report any facility problems promptly. You should be
able to mitigate most of your risks to the point where they no longer pose serious threats to your
facility.
But occasionally risks turn into emergencies. You need an emergency response plan to deal
with the real thing. You don't need a huge binder to tell you how to evacuate your building or
restore your power. Often a small brochure containing the standard procedures is more useful
than a binder that only a few of your staff members have studied carefully. You can print
separate brochures for staff and residents. You can include handy reminders and space for
notes and personal information, including room numbers, addresses, family contacts and the
locations of refuge areas and safe gathering sites. When they're attractively laid out and contain
concise, practical response measures, brochures are ideal tools for emergency orientation and
procedural training. They're also much less expensive than those binders.
After an emergency, many organizations rely on business resumption (or continuity) plans,
which contain solutions to problems that arise after the storm has died down or the fire has been
extinguished. Often a resumption plan begins with a damage assessment checklist, which
guides you through your facility and points out those areas where different kinds of damage can
occur.
A key component for any care facility's resumption plan is a strategic alliance program. After an
emergency, you might have difficulty in obtaining supplies that in normal circumstances you'd
take for granted. What if severe weather puts your usual delivery service out of action for a few
days? Fortunately, you've organized an alliance with a local taxi firm, which will pick up
medications, groceries and office equipment from suppliers and deliver them to you as soon as
possible.
Your residents might be frightened or disoriented by an emergency. To restore their good
morale, you should include normalization guidelines in your resumption plan. Getting residents
to talk about their experience during an emergency is one way to ease their anxiety. Another is
to hold a "closure party," during which staff and residents are served refreshments and given a
chance to celebrate the conclusion of events relating to the emergency.
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Your resumption plan can contain advice concerning alternative sites for residents, a list of postemergency service priorities, a summary of emergency team activities, and advice regarding the
auditing and testing of the plan. Since each care facility is unique, each should have an
emergency plan customized to meet its specific needs. A template plan will not necessarily give
you the most effective guidance. It's up to you to ensure that your facility has a plan that takes
into account those institutional characteristics that makes it different from a facility in a different
part of the country, city or neighbourhood.
Food service personnel must be prepared to act quickly and appropriately in emergency
situations.
Things to note in planning:
 have a contingency plan
 have food stocks on hand without need of refrigeration or have items readily available
 have foods that can be served without heat
 use disposable dishes & utensils
 consider waste disposal
 ensure that there is a safe water supply
In a unionized environment, a contingency plan is essential in case there is a strike. In an acute
care hospital, elective surgery will be cancelled and any patients who are well enough will be
discharged home. However in long term care facilities and in correctional services, the food
service will need to supply meals to the normal complement of residents as well as for the staff
who are still working in the facility. Strikers will most likely set up picket lines around the
institution and try and disrupt deliveries. Some suppliers who have a unionized work force may
refuse to cross the picket line for deliveries. The menu for a strike situation should be easily
prepared and served and meet Canada's Food Guide. In making a plan for a strike situation, the
following are some of the considerations; what will be on the menu, will it be purchased or
prepared in house, what suppliers will the facility purchase from, how will supplies be delivered,
who will be available to work in food services, how will you serve the meals to your residents,
what type of dishware will you use, who will do the cleaning of the kitchen and what types of
meals and snacks will you provide to volunteers and staff who are working extended hours.
When the strike is over and the employees return to work, the facility needs to have a plan on
how to facilitate the return to normal operations and to minimize tension between the employees
who were on strike and those who had worked during the disruption.
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Security
Security includes the protection of all cash, merchandise, equipment and supplies in a facility as
well as of the workers employed there. Theft is a major problem in food service operations.
There is theft of money from sales of food in cafeterias and vending machines as well as the
theft of food.
A good internal security program needs to be established where few people have access to the
cash from sales of food. Keeping storerooms and refrigerators locked when they are not in
constant use or if they are out of sight from most workers is a preventative measure most
foodservices facilities employ. Controlling the amount of inventory and the amount of leftovers
also helps in controlling theft. If all goods are accounted for, it is difficult to steal items without
them being noticed. Controlling access to locker rooms during the day will discourage
employees from stealing food and storing it until they leave for home.
Large facilities attempt to control access to the public of certain work areas. Name tags worn by
all employees identify people who should not be in the kitchen area and pinpoint those who are
not employees at that facility. Many facilities have implemented a security watch program where
employees note if there are strangers in an area and report to the security guards in the facility.
Environmental Management
The food service manager and the employees in a food service operation need to be active
participants in the management of energy and water use, as well as limiting the amount of solid
waste leaving the food service department. The efficient management of these components will
benefit both the environment and reduce costs in the foodservice operation.
Energy Conservation
The old saying "If you can't stand the heat, get out of the kitchen" reveals a great deal about the
amount of wasted energy used in food service operations. In past decades it was taken for
granted that kitchens were energy inefficient. Various factors gave impetus to the need for
energy conservation including the cost of energy, a possible shortage of oil and gas supplies in
the western world and a growing awareness of the environmental damage from the use of fossil
fuels.
Energy is used within the foodservice department for the heating and cooking of food, for
refrigerated and frozen storage of food, for maintaining food at correct serving temperatures.
Equipment which is not properly sized for the amount of food to be prepared will be energy
wasters- oversized ovens and cook tops will use a great deal of energy, as are excessively
large refrigerators and freezers. The maintenance of equipment will help to ensure that they are
operating efficiently. Worn gaskets around refrigerator and freezer doors allow cold air to
escape and warm air to enter. The compressors then have to work harder to cool the warm air.
Condensation also contributes to energy inefficiency. Spears in 1995 categorized energy use
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within food services as direct and indirect energy. The above examples of energy are
categorized as direct. Indirect energy is the energy used to maintain a comfortable working
environment as well as for sanitation and waste disposal.
Conserving energy is a major focus both in individual homes, and large businesses.
Foodservice organisations are actively seeking new ways to reduce energy costs.
Programmable ovens, re-use of hot and cool air, installation of more efficient equipment, and
sealing building envelops to reduce energy leakage are just a few ways to reduce energy
consumption in a large scale kitchen.
When electricity is used as an energy source, the cost of the electricity depends on the time of
day and whether it is a peak demand time for the electricity. The cost per kilowatt hour is much
greater at these peak times. Hospital Food Services (HFS) in Ottawa has made efficient use of
electric energy. HFS is a production center for healthcare facilities in Ontario. To take
advantage of the reduced energy costs during the late evening and night period, Hospital Food
Services: Ontario (HFS) scheduled the cooking of roasts during this period and the meat is then
sliced and either chilled or frozen for distribution. This is an example of the control of direct
energy costs. Another initiative to control energy costs involved using the heat extracted out of
the air for blast chilling and blast freezing to heat the hot water in the plant.
Water Conservation
Greater attention has been given to the concept of energy conservation in food services then to
water conservation; however, the cost of water is also a consideration in the operational costs.
Water is one of our natural resources and it is incumbent upon each of us to use it wisely.
In Ottawa, the municipality invoked an additional tax on water use to pay for the sewage
treatment the use of water incurred. This represented a great cost to institutions, which in turn,
led to changes in equipment design to low temperature ware washing machines which operate
between 120º F and 140º F. In these machines sanitizing is accomplished by chemicals not
heat. The recommended sanitizing chemical should be used in the proper concentration and it
must be dispensed automatically in the final rinse water. Other water saving practices in ware
washing are batching soiled dishes whereby the capacity of the dishwasher is matched to the
load. Recycling of grey water from the dishroom is also frequently done.
Solid Waste Management
Solid waste management has become a concern for all municipalities. The cost of land fill and
the pollution resulting from incineration are a great concern. Foodservice operations can play a
role in the environmental health of our planet. Consider the purchases of the raw materials for
the food service operation. We receive food in tins which are in cardboard boxes, meat products
may be in individual portion packs, which are also in larger cartons, fresh produce arrives by the
case, frozen vegetables are in plastic bags in a large carton. The typical food service operation
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has tins, bottles, plastic bags and cardboard boxes in its' garbage. The three R's of the
environmental movement have meaning within food services- that is to:
 Reduce
 Reuse , and
 Recycle
"Waste prevention, or “source reduction,” is the strategy behind reducing and reusing waste.
By designing, manufacturing, purchasing, or using materials in ways that reduce the amount or
the toxicity of trash created, less waste is generated and fewer natural resources are used.
Reusee is often part of the waste prevention strategy, stopping waste at the source due to
preventing or delaying a material’s entry in the waste collection and disposal system. "3
Institutional cafeterias which used disposable coffee cups, have offered their patrons a price
differential if they used their own coffee mugs. The savings in solid waste accumulation was
substantial and customers often received a larger cup of coffee - depending on the mug they
choose! This is an example of reduce and reuse. Another example of reuse is the selling of the
foil pans which frozen entrees are delivered. These pans are washed and sold for a nominal fee
to the institutional employees to use at home. The proceeds from such sales were used to
purchase a refrigerator for employee lunches. Plastic pails are also in great demand in the
spring as cottagers are opening up their summer homes.
Your text has a good discussion of the elements of a recycling program for food service
operations. The article by Matt Del Vecchio provides tips for the use of green cleaning products,
sustainable food, coupled with other proactive measures to reduce energy and water use.
Environmental concerns and attention to the problems of our fragile planet are a legacy to future
generations. Food service managers who take an active part in maintaining and improving the
environment will contribute to the health of the world and be fiscally responsible.
Facility Planning & Design
A well designed & equipped food service department allows for the efficient preparation &
service of high quality food products. The actual design of the kitchen and dining areas is based
on the nature of the food service operation, the menu, the clientele and the objectives of the
organization.
The design of a new or renovated food service department is complex; there are varying
equipment requirements and the flow of the raw materials to the final product requires the
efficient use of space and equipment. Once the decision has been made to construct a new or
renovated food service facility a planning team will be formed. The food service manager is one
member of the team, along with the administrator, the architect, and the food service consultant.
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Each of these members of the team will bring their own expertise to contribute to the project.
Before beginning more detailed aspects of planning the facility, consideration needs to be given
to what type of food service you require and the scope of the services to be offered. Some of
the characteristics of the operation to consider are:
 The customer - the demographics of your customer base is a prime consideration. Do you
have many different customers with differing needs? How many customers will you be
serving daily? Where are the customers located - on site or in satellite locations?
In the Ottawa area a Jewish campus is being planned to serve the needs of the Jewish
community on this campus with the Jewish family services, a day care centre, schools, a
long term care facility and a recreation centre. All of these facilities will be located in different
buildings. All of the customers follow a kosher diet but they have differing needs based on
their age and usual food habits. The long term care facility will be the prime provider of food
which is kosher to these sites. The food needs of the teens in high-school will differ from the
needs of the elderly in the long term care facility. The majority of the customers will be at the
noon meal, although this long term care facility requires three meals a day for 365 days.
 The menu requirements - Differing customers will have differing menu requirements. A prime
example of this is at the Olympic games. Coaches and officials have different requirements
than the athletes. Each country has different food customs. The menu must be planned to
meet all of these needs. This has a direct impact on the space and equipment required.
 Food purchasing - there needs to be a clear understanding of how the food will be purchased
and in what form. It is also important to consider how often food will be purchased.
If the majority of the food is to be purchased frozen there will be a requirement for large
freezer space. A food service operation in a large city with major food wholesalers will be
able to deliver goods on a weekly basis.
 Production methods - the methods used to prepare the food will also influence the design
needs. A conventional system will have differing needs that a cook freeze/cook chill system.
 The latter production methods will require higher capacity cooking equipment and increased
raw material & finished product storage.
 Delivery systems- How will the food be delivered to the customers. In a hospital setting tray
service is the norm; while in a long term care facility the residents eat in mid size dining
rooms. A fast food restaurant uses the customers to carry their food to the eating area. When
satellite operations exist either within a building or external to it, the delivery system needs to
be carefully planned. Food delivery carts are bulky and require space to receive the food
products, at the delivery site and at the cart wash area.
 Hour of operation - Institutional food services such as hospitals & long term care food
services usually provide meals three meals /day and refreshments for 365 days year. On the
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other hand a school cafeteria may provide a breakfast and lunch service on school days
only.
Along with these considerations, the food service manager needs to be familiar with the latest
trends in consumer food preferences and technological developments in the food service
industry. A food service facility designed and built for today must be serviceable & flexile to
meet the demands of the future.
Once the information noted above is gathered together the planning team can begin to work on
the bad functional plan. For a small renovation of a specific area within the department the food
service manager may be able to prepare the functional program. Larger renovations or new
facility design require a institutional planning consultant to prepare the document. Careful review
of the document in the draft stages is essential, as this is the information which will guide the
planning process.
"The functional program is a verbal description of how the facility will function and what
resources will be required. It should include all capital and operating aspects needed to properly
plan the building or department. This will include:
 functions or scope of services of each department or functional area
 procedures
 determinants of space such as workload or staffing
 staffing or manpower depending on the provincial and hospital requirements
 key relationships among and within departments space on a room, elemental and
departmental basis"4
The architect for a new building will then develop the schematics. These schematics will show
the initial overall shape of the building on the site, the blocks of space assigned to each
functional area and the circulation pattern for the overall building.
"From the schematics or block drawings the next preliminary plans or sketch plans are prepared
by the architect. They indicate layouts within the blocks, that is, they show how each department
will function, its circulation patterns, relationships of rooms and their preliminary configurations.
The building systems are similarly refined. As a part of this step, an outline description or
specification of what is included in the work and the types of building materials and systems to
be used is prepared. This includes such items as
 materials to be used to construct the building structure and exterior walls;
 materials for interior finishes for floors, walls and ceilings;
 site works;
 transportation systems such as elevators, dumbwaiters, car lifts, tube and conveyance
systems and so forth;
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 electrical work;
 plumbing work including medical gases;
 heating, ventilation and air conditioning and
 power plant requirements including electrical power."5
From this sketch plans the final working drawings are developed and known as architects
blueprints.
The architect blueprints contains all the details of the construction including the plumbing &
electrical requirements, the materials to be used, the fixtures and built in furniture are indicated.
Following the approval of the architect plans and approval to precede with the project the
contract documents are prepared. These are advertised and made available to interested
parties who bid on the project. The successful bid is not necessarily the lowest bid as the facility
needs to consider the reliability and past performance of the firm submitting the bid.
It’s always an exciting day when the work begins on a new or renovated food service operation.
However, planning needs to occur before this date on how the rest of the operation will function
during the construction phase. Some of the challenges will be the temporary loss of space,
noise and the accumulation of construction debris.
For new construction, the planning will involve the purchase of furniture and equipment, the
installation of the fixed equipment and the development of the policies and procedures for the
operation of the new food service operation. Prior to the occupation of the new facility, there will
be an inspection to ensure that all the construction details have been completed. Fixed
equipment needs to be tested to ensure that it is operational. Staff will need to be hired and an
orientation and training program developed. The cleaning, stocking and move into the new
facility is another step towards the completion of the project.
Once the food services have been operational for a time, a final evaluation of the project will be
completed for any outstanding items which are covered under the contractual arrangements
with the contractors and suppliers. A successful facility design will be a major factor in the
delivery of high quality food to the customers.
The selection of equipment and furnishings for a foodservice operation needs to be based on
the size of the operation, menu requirements and the type of food service operation. In addition
consideration must be given for the manner in which food is purchased and stored on site. The
type of energy source in the area is also a consideration. Your textbook has detailed information
concerning the selection of equipment and furnishings.
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Conclusion
The primary focus of institutional food service is to provide nutritious and safe food. To achieve
this sometimes lofty goal, a food service manager must take into account food safety and
sanitation, workers’ safety and security, the flow-of-food and facility design and waste
management. When any of these facets are out of sync, there is great risk to either the patient
or the worker, and this affects not only health, but the reputation of the institution as a whole..
Part of the food supervisor's job includes the day-to-day monitoring of sanitation and safety
procedures to help ensure that all those who are part of the health care facility are able to eat,
work, and live safely.
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Endnotes
1
Payne-Palacio, J. and Theis, M. (2009). Introduction to foodservice. New Jersey: Pearson PrenticeHall, p. 91.
2
Payne-Palacio, J. and Theis, M. (2009). Introduction to foodservice. New Jersey: Pearson PrenticeHall, p. 400.
3
http://epa.gov/osw/conserve/rrr/reduce.htm, accessed June 10, 2011.
4
Ziebarth, S. (1991).Feeling the squeeze, Facilities Development, Ottawa, ON: CHA Press, p 242
5
Ibid p. 244
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Required Reading
Textbook(s)

Puckett, R.P. (2013). Food service manual for health care institutions (4th ed.). San
Francisco, CA: Jossey-Bass.
Chapter 12, Environmental Issues and Sustainability, pp. 239-260
Chapter 13, Microbial, Chemical, and Physical Hazards: Temperature Control, pp.
261-284
Chapter 14, HACCP, Health Inspections, Environmental Sanitation, Food Code, and
Pest Control, pp. 285-310
Chapter 15, Safety, Security, and Emergency Preparedness, pp. 311-341
Chapter 22, Facility Design, Equipment Selection, and Maintenance, pp. 507-540.

Food Safety Code of Practice – For Canada’s Foodservice Industry, Canadian
Restaurant and Foodservices Association, 2013 – the entire book.

Food Service Workers Safety Guide, Canadian Centre for Occupational Health and
Safety,
6 th ed. 2011 – the entire book.
Readings from Course Reader
 Del Vecchio, M. (2008). The green cleaning movement In The Food service industry: The
clean prairies. The Canadian Sanitation Supply Association.
 Warren, L.J. (Summer 2000). Aspects of security in correctional food services. Insider
Magazine. American Correctional Food Service Association.

McKendry, R., & Mackey, L. (Spring 2012). Infection! Protecting our food from us. Food
Service and Nutrition: Canadian Society of Nutrition Management News, 6-8

Mooney, N. (Winter 2011). Theft and security: Address future issues proactively before
they become problems. Food Service and Nutrition: Canadian Society of Nutrition
Management News, pp. 14
Internet readings

Emergency Food Service: Planning for Disasters, Centre for Emergency Preparedness
and Response, Public Health Agency of Canada, 2007.
http://publications.gc.ca/collections/collection_2007/phac-aspc/HP5-25-2007E.pdf
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
Robertson, Guy (2004). Emergency Planning for Long Term Care / Seniors Nursing Home
Residential-Care-Facilities. Originally published in July/August 2004 issue of LTC, Long
Term Care Assoc. of Ontario magazine and retrieved from: http://www.onwellness.info/0services-disaster

Canadian Centre for Occupational Health & Safety (2000). Health and Safety
Committees:http://www.ccohs.ca/oshanswers/hsprograms/hscommittees/
© 2013 Canadian Healthcare Association. All rights reserved.
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Unit 7 Assignments
To complete the Unit 7 assignment, please access your account on the Gateway at
www.cha.ca. The assignment is available in Word format on the Gateway for you to
download. Once completed, please upload your assignment into the designated location.
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Unit 8
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Unit 8
Food Services and Nutrition Management
Year One Semester Two
Unit 8: Quality Food Management
© 2013 Canadian Healthcare Association. All rights reserved.
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Quality Food Management
Objectives
Upon completion of this unit, the learner will:


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

Describe the steps in strategic planning and be able to use the direction of the strategic
plan in managing the food service department to support the direction of the institution;
Define and describe the purpose and characteristics of a policy and procedures;
Write policies and procedures which are clear and be able to implement a policy and
procedure in the work place;
Apply principles of quality management and risk management to the operation of a food
service department;
Discuss the purpose and process of accreditation;
Describe methods of collecting valid information about clients and evaluate their
satisfaction with the food and food service;
Identify appropriate standards for food service activities and apply these standards.
Introduction to Quality Management
"Health care reform has forced administrators to transform their view of quality as an intangible
to a view that recognizes it as an identifiable, measurable, and improvable entity. Although
responsibility for quality was once delegated to a single department, managers now recognize
quality improvement as the responsibility of each individual in the organization. Quality
improvement is seen as a long-term, proactive (rather then retrospective) strategy to improve
patient care and satisfaction, increase utilization, strengthen productivity, and enhance costeffectiveness throughout the organization."1
To be truly effective an organization needs to know what its purpose is and keep that purpose in
the forefront as it adapts to the changing environment in which it conducts its business. This
statement of purpose is known as the mission statement. The mission statement is concise
and contains the values of the organization. The mission of the organization will assist in
keeping the organization focused and moving towards its goals.
The business world is changing rapidly. With constant changes comes both opportunities and
threats to an organization. In order to position the organization to maximize its opportunities and
to minimize its threats, a strategic plan is required. A strategic plan is an organized approach
for the long term management and positioning of a facility. It involves the Board of Directors and
senior management in evaluating the internal environment and the external environment and
analysing the institutions ability to respond to these threats. The strategic plan needs to include
the stakeholders in the plan. This will include patients, families and residents as well as the staff
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of the facility, including medical staff in a healthcare facility. In the business world the
stakeholders include the investors, customers, suppliers and staff. Once the overall direction
has been determined the implementation of polices and procedures to support the strategic plan
needs to begin.
Different types of performance standards exist in health care facilities to monitor food service
activities. Each has been developed to ensure that everyone knows what is expected of them
and to check that what should be done to maximize quality of care is actually being carried out.
Standards provide valuable guidelines for the assessment, treatment and continuity of care that
patients/residents receive in a facility. There are standards for organizational functions, for
customer service, patient care functions, health and safety, etc.
What is quality? "Each organization-and each of its departments- has defined 'what quality looks
like' for its products and services. The definition provides a baseline for meeting or exceeding
customer expectations for quality."2 A variety of audit tools or forms are used to help a
department and facility measure quality and determine how well they are complying with the
standards. Emphasis is usually placed on measuring the outcome of patient/resident care.
Policies and procedures are based on the objectives and goals of a facility by stating what
should be done (policy) and how it can be accomplished (procedure).
The Quality Assurance process develops standards for achieving quality and ensures that
appropriate policies and procedures are in place and followed. For example a quality assurance
program could determine a policy and procedure is required for cleaning the meat slicer (e.g.
who is responsible for the cleaning, the method of documentation with regard to cleaning
schedules, recording when the task was performed, etc.).
Risk management focuses on identifying and investigating how accidents (e.g. slipping on a
wet floor) or high risk situations (e.g. not informing a physician of an inappropriate diet
prescription) can be minimized or avoided. Risk management programs establish
documentation procedures for identifying and controlling risk factors.
Accreditation is a voluntary process that any health care facility may undergo to show that their
organization meets certain predetermined nationwide standards. Accreditation is a form of
public accountability where surveyors evaluate the standards and procedures of a particular
institution or residence and determine which level of accreditation they are entitled to.
Policies and procedures, quality assurance, risk management and accreditation all interrelate.
For example, policies and procedures may exist for equipment repair. A quality assurance
program checks that the policies and procedures are adequate and that they are being followed.
A risk management program considers factors involved in equipment maintenance and ensures
that the policies and procedures include steps to minimize potential risks (e.g. documenting
when a mixer was checked, cleaned, fixed, etc.). Surveyors evaluate the system for equipment
maintenance and determine whether your process meets the nationally established standards
and criteria for accreditation.
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Organizational Design
An organization structure is similar to the skeleton of the human body. It provides the framework
for the efficient flow of the necessary activities of the facility. Formal organization is usually
represented by a chart that is a graphic display of the formal relationships in the facility. Figure
1 shows an example of the organizational chart of a long term care facility.
The solid lines show the delineation of authority and reporting in the organization. Dotted lines
denote relationship and communication. The complexity of the chart will vary with the size of the
facility. The acute care hospital usually is the most complex of all health care facilities in
organizational structure.
The Department of Dietetics or Food Service in a facility is an integral part of a health care
facility. Generally the department is responsible for the administration of the food services
system, the supply of food to clients, the provision of clinical services in terms of food and
nutrition and the training and education of employees as related to food. The food services
system can encompass the development of menus, recipes, purchase and receipt of food and
equipment, and financial control of all aspects of food production.
The supply of food to clients entails production and service of safe, sanitary, nutritious and
palatable food to people who include residents, patients, staff and clients such as Meals-onWheels, clinics, etc.
Clinical services include prescribing the appropriate foods to a person, interpreting and
implementing diet orders.
Resources within the food service department include people, time, finances, equipment and
facilities. It is the department director who must exploit these resources as efficiently as
possible. To meet daily nutritional requirements within these constraints is the responsibility of
the department. Effective and efficient planning, control, and constant evaluation are critical.
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Unit 8
Policies and Procedures
The purpose of a policy and procedure manual is to give employees and managers the
information they need to do their work. A policy is usually a very general statement about an
activity. The policy manual contains rules and details "what to do" and guidelines for decisions.
It is usually presented in a formal authoritarian tone. A procedure is a series of steps explaining
how the policy can be implemented. The procedure manual is operational and tells "how to do"
something. It is directive in tone and gives a logical series of steps to follow. Figure 2 is an
example of a policy and procedure established for the cleaning of a meat slicer. Policy and
procedure manuals can appear as separate manuals or combined. The combined manual is
usually preferred as not all policies have procedures (for example, a policy on ‘no smoking’) and
not all procedures stem from written policies as many procedures relate to the organization’s
objective of giving care or treatment.
Well-organized manuals provide an easy access to information.
There are several benefits of a policy and procedure manual:
1. It clarifies responsibilities and work done within the department (eg. it is the Early Cook
who turns on the ovens).
2. It may result in improvements in procedures. When you begin to write out all the steps
required in a specific operation, you may discover areas of overlapping responsibilities
or work methods which require unnecessary steps.
3. Improvements to interdepartmental relationships. It will help improve communication
between departments when the various jobs are delineated (e.g. Housekeeping is
responsible for cleaning floor spills).
4. It is a filing system for required information. All the information is in one location and can
be easily found.
5. Easy to review and update (a regular review is necessary). A straightforward format can
be easily revised.
6. It can be used to orient and train new employees.
7. It can be used for objective performance rating.
8. It can be used to measure standards of performance (e.g. is the employee fulfilling all
the items under personnel heading, dress code etc.).
The following list serves as a basic guide to assist in the preparation of policies and procedures.
Individual health care facilities would adjust this information to suite its own needs.
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Suggested Headings for Policies and Procedures
1. Introduction, Philosophy, Objectives
2. Management Tools

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Communication
Meetings
o Departmental
o Interdepartmental
Budget controls
Operating Budget
Capital Budget
Monthly and Yearly records
Daily meal census
Purchases
o Food
o Other supplies
o Equipment, etc.
Salaries and wages
Cost analyses
Recoveries
Other expenses
Physical inventory
Reports
3. Purchasing

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Specifications
Food
Equipment
Other supplies
Procedures
Ordering
Forms
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6. Clinical/Nutritional Services
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Procedures & schedules
Requisitioning
Frequency
Areas of storage
Minimum/maximum standards of
inventory
Menus
Menu plan system
o Typing of menus
o Distributing & tallying menus
Normal or regular diets
Therapeutic diets
Nourishments assessments
Patient and family instructions
Charting
Ward rounds
Ambulatory care
o Out-patients
o Clinics, outreach programs
o Day care centres, etc.
Research
Instant formula
7. Meal service

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4. Receiving, Storing and Issuing
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Therapeutic diets
Nourishments and tube feedings
Tray make-up & delivery
Clerical records
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© 2013 Canadian Healthcare Association. All rights reserved.
Patients
o Diet prescriptions
o Meals and nourishments
o Tray assembly
o Delayed trays
Out patients
Non-patients (cafeterias)
o Facilities
o Hours of operation
o Food procurement
Standards of service
Charges
Guest trays
Catering
Ancillary Services
Vending
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5. Food Preparation, Production &
Distribution
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Menu
Recipe Standardization
Basics of food preparation
Portion control
Use of leftovers
Ingredient control room
Bakeshop
Main kitchen
Meat preparation
Salad and sandwiches
Catering functions
8. Personnel
o
o
o
o
o
o
o
o
o
o
o
Hospital Employment Practices
o Procurement
o Hiring
o Conditions of work
o Sick time
o Medical examinations
o Payroll
o Hours of work
o Payday
o Vacation
o Terminations
Union agreement
Staffing complements
Job descriptions
Work schedules
Time schedules
Personal hygiene
Employee discipline
Employee evaluation
Orientation
In-service training
Unit 8
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Coffee shop
Community / Outreach programs
Meals on Wheels
Home Care
Detoxification center
Wheels to Meals
13. Emergency/Disaster Plan
o
o
o
o
o
Bomb threat
Emergency feeding
Food poisoning
Internal/ external disaster
Strike
14. Relationships with other departments
o
o
o
15. Relations outside the facility
16. Quality Assurance Review
o
o
o
o
o
Objectives
Personnel evaluation
Financial
Operational
17. Legislation
o
Food and Drug Act
9. Physical Facilities & Maintenance
o
Preventive
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o
Unit 8
Corrective
10. Sanitation, Safety and Security
o
o
o
o
o
o
o
o
o
o
Sanitation controls
Cleaning schedules
Equipment cleaning
Ware-washing
Garbage control
Pest control
Bacteriological tests
Safety regulations
Fire regulations
Security
11. Energy conservation
12. Education Services
o
o
o
o
o
o
Orientation (departmental)
In-service
Dietetic interns
Student nurses
Medical residents, interns and students
Community
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In preparing a policy and procedure manual, the first consideration is to decide who will use the
manual, for example a manual for a clinical dietician will vary greatly from a manual for dietary
aides. However, if the decision is to have a departmental wide manual, then the need for
information for varying categories of staff has to be addressed. The next step is to prepare a
preliminary list of the policies and procedures to be included in the manual. Following this
organize the policies and procedures under broad categories. A food service manual may have
a section on administration of the department, human resources, clinical nutrition, sanitation and
safety, quality management, production and distribution.
Policies and procedures must be written such that they are clear and direct. The use of simple,
straightforward language, clear directive statements, and ‘active voice’ covey information
without room for misinterpretation. For example: “Wash your hands immediately after you use
the toilet” is clearer and more direct than “After using the restroom, the employee is to wash
their hands.”
Once the policies and procedures have been drafted, they should be reviewed for clarity and
ease of reading. Two suggestions to test for readability are: to read the policies and procedures
aloud and to have someone who is not familiar with the material review the writing. This allows
the writer to test if the material flows smoothly and in order.
In most instances the policy and procedure manual will need to be approved. This may be the
Director of the Department for policies and procedures which are department specific. In cases
where the policies and procedures overlap departments or affect external customers, senior
management will have final management.
Whenever there is a change in a policy or procedure which will affect the operations, there
needs to be a revision to the specific policy or procedure. In addition, the entire policy and
procedure manual needs to have a systematic review process. In most instances an annual
review is recommended.
The final step in the process of developing policies and procedures is to communicate the
information to the staff affected. Corporate wide polices may be communicated through the
institutional new letter, while departmental policies may be posted on bulletin boards and
discussed at staff meetings.
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Figure 2
Policy – Cleaning of Meat Slicer
It is necessary that all equipment used in a hospital’s kitchen be kept in a clean and sanitary
condition, especially those that are hard to clean, to prevent build-up of germs, mould and other
problems.
Procedure
1. Move slicer close to a sink.
2. Fill sink with strong, soapy water (use gloves if necessary)
3. Collect necessary tools for dismantling the slicer, plus clean and sterile tea towels, rags
and brushes
4. Unlock necessary screw nuts so that the parts will come apart
5. Place parts in soapy water except for slicer blade
6. Carefully handle slicer blade and place in basket and put through washer. Other small
parts, which touch the food, should also be machine-washed.
7. With brush and rag clean out all parts of the machine – use toothpick to get at small
corners
8. Wash well with soapy water
9. Rinse carefully and dry with clean towel
10. Wash any parts not put through machine an rinse in special anti-bacterial rinse
preparation.
11. Dry these parts.
12. Have supervisor check the machine.
13. After items which went through the machine are back and dry, re-assemble machine
14. Replace slicer in proper location and cover with clean cloth. Be sure the location has
been cleaned first.
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Quality and Quality Assurance
Quality
The notion of quality is subjective. Each person may have a different idea of what high or low
quality means, and it changes depending on the subject matter. Quality can be defined as a
certain set of attributes in which the beholder uses to judge a product or service. It can be
described as the degree of adherence to a standard. Standards are quantitative statements of
the expected level of performance against which actual performance can be measured.
For example, a particular procedure may be judged to be of high quality by health professionals
if:
 the appropriate therapeutic diet to use was confirmed (e.g. by the physician and the dietitian
or food service manager),
 the procedure for implementing the therapeutic diet has been evaluated as the best course of
action for the diagnosis,
 the procedure was correctly performed without complications (e.g. appropriate counselling,
correct name, proper preparation and service), and
 the patient/resident's condition improved (e.g. as indicated by patient response, medical
tests, etc.).
For the patient/resident there may be a different set of characteristics that constitute quality for
the same procedure. These might include:
 no delays in receiving the therapeutic diet
 good communication with food service staff
 choice of a wide range of menu items
Two people may have diverse views on the quality of a particular health service or procedure. In
health care, the first challenge is to reach agreement upon the characteristics of quality in
whatever we are examining.
For example, quality in health care can be seen as involving three elements: customers
receiving what they want, professionals providing the service the customer needs, and the
provision of service with the resources available to meet these needs.
While quality may exist in a product or service (e.g. the nutritional content and appearance of
food) there are some characteristics of quality which are equally as important but, perhaps, not
so apparent. Examples include the quantity of a food item served (Is there enough?), timeliness
(Are the meals served on time?) and costs (It may be worth $5.00 but not $20.00!).
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Quality Assurance
In order to determine if quality has been obtained (or not), it must be measured. This is not an
easy process. Therefore, most facilities measure a wide range of factors which affect and/or
contribute to quality care.
Quality Assurance in foodservice can be defined as the process of systematic documentation
for the purposes of evaluation and monitoring. This process allows us to assess what, where,
how and why we are doing things, and hopefully in doing so, maintain or improve our
performance.
Quality Assurance in the health care field is a means of working toward and achieving a degree
of excellence in the services delivered. Most departments have some quality control
mechanisms in place. For example, your department probably routinely records the temperature
of food items served. However, without some type of quality assurance program to monitor and
evaluate activities (measure them), it is difficult to determine if a control process is actually
carried out (e.g. Is the thermometer accurate? Are the personnel responsible for measuring
following correct procedures?). Figure 4 outlines the standards to be maintained for a simple
food safety/time temperature audit. It lists the objectives and the procedures for the audit.
The term audit refers to an assessment of observed data pertaining to a given topic or problem
in relation to a set of predetermined standards and the degree to which the actual performance
confirms to these established standards. Before beginning an audit, the size of the sample
needs to be determined. It may be feasible to conduct a food satisfaction audit with all the
residents on one ward of a long term care facility, however; if you were doing a tray accuracy
audit in a large institution, it would be more feasible to sample ten percent of the patients in a
particular section. The standard to be achieved needs to be established and the criteria you will
measure established. There can be a concurrent audit which means the method of review or
investigation of the quality of the care and service provided is being done at the same time as
the service or care is being done.
An example of this is the food safety/temperature audit in Figure 4 (continued) or the checking
of the appearance and accuracy of meal service, as shown in Figure 5. Both audit forms are
examples provided in the manual "Nutrition and Food Services Standards for Adult Care
Facilities" by the B.C. Ministry of Health. Once the sampling is done, the results need to be
calculated and the following questions answered. Did we meet our minimum standards? If there
were deficiencies, were the appropriate corrective measures taken to prevent a reoccurrence. If
all the standards were met, are there opportunities for improvements.
A retrospective audit is a method of review or investigation of the quality of the care and
service provided as it is reflected in completed records, for example, these are shown in
monthly statistics that are compiled. A review of the daily temperature checks is done monthly
and this report is considered a retrospective audit as it will indicate the degree of adherence to a
standard during the month. Figure 6 is an example of a Food Taste Audit form and Figure 7 is
a form for evaluating finished food products for quality assurance. Both these forms are used by
the Food Service Department at St. Joseph's Hospital & Health Centre in Peterborough.
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Unit 8
Quality assurance is an ongoing, developmental process specific to your facility. This is an
important point to keep in mind when deciding what elements your program should contain.
A quality assurance manual states your objectives, lists activities to achieve the goals,
designs standards to determine if the goals can be reached and documents your findings
including planned actions for improvement (e.g. education of personnel responsible for
measuring the temperature of the dishwashing machine, warnings with regard to improper
procedure, etc.). A quality assurance manual is very useful when preparing for accreditation.
Figure 4
Food Safety/Time Temperature Audit
Procedure and Scoring
Objective
Procedure
To ensure that perishable food or any of its perishable ingredients meets the
time temperature standards for food safety.
1. Audit 10 perishable food products or perishable ingredients.
Include each process (i.e. cooking, (re)heating, hot and cold holding,
chilling, thawing). It may take several days to complete one audit of 10
products.
2. Complete the audit form. Record date, product, location of product and
process.
o
o
o
Chilling process: any hot food which is being chilled.
Cold holding: any cold food in the refrigerator, preparation or service
area, not in chilling, hot holding or cook/reheat process.
Hot holding: any food held in hot food table or on range top.
3. Using a calibrated and sanitized thermometer, measure the temperature
of the food at its geometric centre and record this on the audit form
(exception: for thawing, temperature is taken at the surface of the food).
4. If the temperature standard is met: the audit is complete.
5. If the temperature standard is NOT MET the time section must be
completed. NOTE: Cooking and (re)heating do not have a time standard
so are complete at this point.
 Record the product # and time of audit.
 Estimate and record the accumulated time (*refer to audit form for
directions)
 If accumulated tiem exceeds facility time standard, the
© 2013 Canadian Healthcare Association. All rights reserved.
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FSNM Yr 1 Se 2
Unit 8
time/temperature standard is not met. Audit is complete for that
product. Identify the problem and record action/comments.
 Calculate time limit: (Time Standard - Accumulated Time) + Clock
Time (of Audit) = Time Limit. E.g. (4hrs - 2hrs) + 1200 noon =
2p.m.
 Reaudit at or prior to time limit.
 Record time/temperature standard met/not met.
 Record action/comments for any product not meeting standard.
Scoring
Assign 10 points for each standard MET.
Figure 4 (continued)
Food Safety/Time Temperature Audit - Example
TEMPERATURE
STANDARD
TEMPERATURE
DATE
PRODUCT
June
8
1990
1. Soup
LOCATION
2. Meat
Loaf
10
PROCESS
TEMP
MET
Hot
Holding
145°

Cooking
175°
NOT MET
IF STANDARDS
NOT MET:

3. Egg
Sandwi
ch
Cold Food
Counter
Cold
Holding
58°

4. Vanilla
Puddin
g
Regrig.#2
Chilling
115°

5. Mac.&
Cheese
Cooking
180°

6. Pur.Me
at
Hot
Holding
148°

7. Bk.
Cold
40°

© 2013 Canadian Healthcare Association. All rights reserved.
Proceed to TIME
section for all
processes except
cooking and
(re)heating.
TEMPERATURE
STANDARDS
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FSNM Yr 1 Se 2
Unit 8
Custar
d
16
Holding
Cooking &
8. Steak
Pie
Hot
Holding
160°

(re)heating
≥165°F(74°
C)
9. Ma.
Potatoe
s
Hot
Holding
152°

Hot Holding
≥140°F(60°
C)
Cold Holding
≤40°F(4°C)
10. Cream
y Rice
Chilling
40°
Chilling
≤40°F(4°C)

Thawing
≤40°F(4°C)
TIME &
TEMP
TIME
STANDARD
ACTION
PRODUCT #
TIME
OF
AUDI
T
ACCU
M.
TIME
REACHES
TIME
LIMIT AT
REAUDIT
TIME/
TEMP
1.Egg Sandwich
1155
3 hrs
1255
1300/56
°
2. Pudding
ACCUMULATED TIME: Total time since
cooked product reached 165ºF (74ºC)
Or
MET
NOT
MET

14456/6
8°

AUDIT
SCORE
90%
SCORING:
Sandwiches
discarded
At 1345 transferred
to shallow pans
FACILITY TIME
STANDARD
Assign 10 points for
© 2013 Canadian Healthcare Association. All rights reserved.
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FSNM Yr 1 Se 2
Total time that a product or its perishable
ingredients could have been between 40ºF
(4ºC) and 140ºF (60ºC)
Unit 8
each Standard Met
Acceptable Score:
100%
140º-70ºF (60º21ºC)
__2__ Hours
70º-40ºF (21º-4ºC)
__2__ Hours
Comments:
sandwiches.
1. Eggs should be cooked a day ahead and chilled before assembling
2. Pudding should be refrigerated in shallow pans
© 2013 Canadian Healthcare Association. All rights reserved.
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Figure 5
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Figure 5 (continued)
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Figure 6
FOOD SERVICES DEPARTMENT
FOOD ACCEPTABILITY AUDIT
MEAL
Menu Item
Time
Temp
Taste
Appearance
Texture
Corrective Action Taken
Special Diet Items
Rating Scale: 1- Very Good 2 – Excellent 3 – Acceptable
4 – In- appropriate
Date:
5 – Action Needed
Signature:
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Quality Management
Excellent organizations are distinguished by their concern for people - both employees and
customers. The emphasis on quality in a facility has always been oriented towards measurable
criteria and standards. The commitment of all employees to do their very best in performing their
jobs and to work together for the success of their organization is the basis for quality
improvement in a facility.
The top management in a facility need to provide the environment for the "team" approach
towards work. Employees should work together to share in providing the very best service
possible to the customer. Improvement is not a one-time effort but an ongoing step-by-step
process that builds on itself.
Continuous Quality Improvement (CQI) is defined as the “process of identifying areas in a
department that can be strengthened and working to make those areas better.”3 Total Quality
Management (TQM) is “the application of quality management processes throughout the
organization. This includes working on problems and strengthening areas that cross
departmental lines.”4 “Thus, CQI must be complemented with the concept of total quality
management (TQM), which is designed to look at problems and improvements that could be
made across departmental boundaries. In essence, TQM is a strategic concept that is
supported by QC, QA and CQI.”5
The term was originally coined in 1985 by the Naval Air Systems Command in the USA to
describe the Japanese-style management approach to quality management.
There are three basic concepts of quality improvement which apply to all work environments
including hospitals. These are:
 a focus on the customer or client
 measurement of quality
 processes for continuous improvement
The Customer
The customer is the focus of quality improvement programs. If you ask the question " Who is the
customer?" in healthcare the obvious answer would be the patient. However, the question
deserves more consideration.. A dietary aid in a long term care facility is the customer of the
cook. She needs to obtain the food from the cook in order to serve her customers - the
residents. In correctional facilities it may be difficult to consider the inmates as a customer;
however, the reality is that they are the reason the facility exists. It has been reported that more
prison unrest has been caused by dissatisfaction with the food than for any other reason. The
food service manager in a facility with inmates working in the kitchen would be wise to ensure
that his clients are satisfied.
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A definition of quality which focuses on the customer is "meeting or exceeding your
customer's expectations each time."
In healthcare, the concept of competing for customers has not been traditional thinking. In the
process of health care reform across the country, the decision makers considered such
information as the number of patients a health care institution served compared to a similarly
sized facility in the same geographic area. One major teaching hospital in a large urban area
noticed that the number of patients visiting the emergency services was declining. They
discovered that some patients were dissatisfied with the approach of staff to their care and
choose to go to another hospital. One method the hospital used to address the problem was to
have all staff receive training in customer service.
Measuring Quality
When the concept of quality management or quality improvement was established by Demming
in Japan, a key component was the use of quantifiable data to measure the quality of the
product. Some aspects of quality are more difficult to quantify.
The first step in measuring quality is to assess what the customer wants or needs. Then, define
quality in measureable terms, from the view point of your assessment. For example, if you
prepared a first class meal of Beef Wellington and served it to children at a day care center, you
may be serving a quality meal from the chef’s viewpoint, but not the customer’s. The chef may
identify and measure quality by the tenderness and temperature of the final product, while the
children would measure quality on the overall taste, appearance and perhaps tenderness (easy
to chew). The Food Manager may measure quality by plate waste.
Processes for Quality Improvement
Casting blame on employees concerning problems with quality is an out-dated concept. Quality
Improvement theory suggests that problems are based on the processes involved in work.
Consider all the steps involved in the delivery of a patient meal from the time of admission to the
bedside. Once a patient has been assigned a bed in the hospital, they have to get to the room
and occupy the correct bed. The doctor does a history and physical and then writes his order for
the diet along with numerous other orders for tests, treatments and medications. A clerk
transcribes the diet order to a diet list, and the list is sent to the food service department. In the
food service department a menu is prepared to correspond to the diet order and then
assembled on the tray. The cart with the trays is delivered to the patient’s floor and an aide
delivers the tray. In such a complex process, there are numerous opportunities for error.
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Methods to improve processes include:
 process standardization- this is the principle used in food manufacturing plants to ensure
consistency of product
 process improvement- making sure the process is as fail proof as possible
 process simplification - making sure that the process eliminates unnecessary steps
In the example of a patient receiving the correct tray one solution to simplify the process is the
implementation of a computerized diet office operation which is linked to the hospital patient
admission, transfer and discharge data base. At the time of the diet order being entered into the
data base on the ward, the information is automatically sent through the computer network to
food service and the appropriate menu is generated just prior to tray assembly.
When the concept of quality management is highlighted in a facility, all the employees of the
food service department would work together to provide the best possible service and food to
the patients and staff. As well, the food service employees would work together with the
employees of other departments, for e.g., nursing and housekeeping, to continually improve on
the service that is being provided.
The food service supervisor provides the link between employees and upper management. A
successful supervisor can help motivate employees to meet quality standards and continually
try to improve on these standards.
Your textbook has good information on the tools of quality improvement, e.g. benchmarking.
These will help the food service manager to present the data collected in a way that will assist in
the analysis and comprehension of the data.
Risk Management
Every food service activity has some measurement of risk associated with it. Risk management
is a broad concept that covers a broad spectrum of issues related to liability for what an
organization does or does not do. Risk management principles can be applied to a wide variety
of situations, from product liability for goods that do not perform as promised to injuries that
occur to the public as a result of an organization’s negligence".6
In essence, risk management means reducing the occurrence of undesirable events. In
contrast, quality assurance involves increasing the occurrence of desirable events (e.g.
eliminating, reducing or preventing risks). But the two are linked as quality assurance's
promotion of quality obviously contributes to risk management and vice versa. Risk
management is basically directed toward all persons, events and surroundings in health care
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settings while quality assurance is primarily directed toward patient care. Risk management
deals with specific incidents while quality assurance deals with overall care.
The following chart helps illustrate the close relationship between quality assurance and risk
management.
Quality Assurance
Risk Management
Objective
monitoring and improving patient care
to meet present standards of optimal
quality
reducing loss by ensuring that
acceptable quality care is provided
Scope
oriented primarily to patient care
relates to all organizational resources
Approach
review of groups of patients
review of incidents involving
individual patients
There is an onus on foodservice to document problems and any action taken to correct them.
This includes the time it took to respond to a situation (a timely response is expected), the
corrective action implemented (leak was repaired) and the follow up mechanisms to ensure the
problem does not recur (e.g. bimonthly checks for leaks in the dishwasher). The procedure is
important because legally a facility is responsible for determining that their actions (and/or the
actions of individuals within the organization) were average and reasonable under the
circumstances. For this reason it becomes essential to identify and focus on high risk areas first.
For example, any illness related to food contamination or poor sanitary conditions (e.g.
forgetting to put the soap in the dishwashing machine), requires immediate attention to
determine the cause and implement appropriate corrective measures (e.g. procedures to
designate who is responsible for ensuring the dishwashing soap has been added).
The purpose of recording "what happened" is to refresh your memory with regard to facts
related to past events. For example, you may feel that a physician has ordered a therapeutic
diet which is inappropriate for a particular individual. It is important that you make your feelings
known to the physician even if he/she decides not to change the original diet order. Records of
the date and content of your discussions with the physician on the matter could be considered
as admissible evidence should you be asked to testify in court.
Victor Rose talks about risk management in a long term care facility and the establishment of a
committee to look after this concern.
This brief article highlights how a facility can avoid being sued. He notes that because issues of
risk are multifaceted, they require an equally complex and systemic approach. Effective risk
management is a way of conducting day-to-day operations, encompassing preplanning to
prevent risk-laden situations and implementing procedures to follow when things go wrong. At
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the heart of a successful approach is an acknowledgment that organizations, like people, are
more often judged by how they handled a mistake, not whether one was made.
Accreditation
Most quality assurance standards are specific internal extensions of the general external
standards for quality as outlined by Accreditation Canada (formerly known as the Canadian
Council of Health Services Accreditation). In other words, Accreditation Canada defines national
health care delivery standards that are expected of all facilities (it is an external assessment of
quality); quality assurance programs within a facility are developed and changed based on the
pre determined, accepted standards for accreditation.
Participation in Accreditation Canada’s accreditation program is voluntary. A health facility
chooses to participate and is not legally required to do so. Health facilities believe that
accreditation provides an impartial review by knowledgeable professionals from the field. The
awarding of accredited status is an indication to those in the organization and the community
that the facility meets nationally established standards for quality.
Some health care organizations, especially small nursing and retirement homes, do not
participate in the accreditation program because they find it costly and time consuming.
However, with increased emphasis on public accountability, compliance with national standards
is a good way to enhance the credibility and image of any facility.
Accreditation Canada’s program is used by all types of organizations, from large complex health
systems, to small residences providing long term care, to community health organizations. Here
are a few of the health care and service areas for which standards have been developed:
 Acute Care
 Long Term Care
 Mental Health
 Rehabilitation
 Cancer Care
 Hospice Palliative and End-of-Life Care
Accreditation Canada continually reviews and updates its accreditation program. Its new
program called ‘The Qmentum accreditation program’, was launched, along with the name
change in May 2008. The goal behind the change was to build on the strengths of the former
accreditation program (called AIM) while simplifying the process. The quality focus of the new
Qmentum program) is to promote an integrated quality management (IQM) system that includes
risk and utilization management and quality improvement. The program also focuses on patient
safety. The new program offers renewed self-assessment and on-site survey components. The
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on-site survey is more customized to reduce workload for both organizations and surveyors.
The surveyors, healthcare professionals active in the field, will use an approach that will enable
them to ‘trace’ a client and/or process throughout the organization. The on-site survey also
offers an opportunity for surveyors to provide useful suggestions to improve current practices.
The accreditation process is a three-year cycle. An organization that successfully completes the
process is accredited for three years. Although preparing for accreditation requires critical self
review and hard work, it provides an educational experience for all involved in the process.
For more up-to-date information on the accreditation program see Accreditation Canada’s
website: http://www.accreditation.ca/en/ .
In Ontario, the operation of retirement residences is not regulated by provincial legislation.
However, residences may be accredited by the Ontario Retirement Communities Association
(ORCA). In the absence of province-wide standards, ORCA member residences have
voluntarily submitted to ORCA’s system of accreditation. By participating in ORCA’s
accreditation, a retirement residence demonstrates a commitment to quality and accountability
to its residents, staff and the public. There are 79 ORCA standards that have been identified as
essential to the safe operation of the retirement residence and the safety of the residents that
reside there. For more information, visit: http://www.orcaretirement.com/retirement-living/actsand-regulations/
Conclusion
The increased demand for accountability has created a necessity for health care facilities to
document their procedures and actions. Policies and procedures are developed for most food
service activities such as production, service, inventory, staffing needs etc. Quality Assurance
programs are implemented to ensure that appropriate standards are in place and that they are
followed. Quality Assurance activities are generally an ongoing part of food service operations.
These procedures are formalized (through written reports, documented results, etc.) to meet the
requirements of a quality assurance program. Risk management programs are a good example
of an area where the focus on quality assurance has become detailed and specific.
Accreditation is a voluntary process of public accountability, whereby a facility is required to
meet external, nationally accepted standards for quality. Policies and procedures, quality
assurance programs, including risk management and accreditation are all methods of
monitoring performance of food service departments and health care facilities.
Exploring the relationship between policy and procedure manuals and quality assurance will
assist both those responsible for developing or updating their policy and procedure manuals and
those developing, implementing or assessing their quality assurance programs. In order to meet
the shared goal of providing quality health care, managers must understand how quality
assurance programs and policies and procedures interrelate.
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Endnotes
1
Puckett, R.P. (2004). Food service manual for health care institutions. San Francisco, CA:
Jossey-Bass, p 69.
2
Puckett, R.P. (2004). Food service manual for health care institutions. San Francisco, CA:
Jossey-Bass, p 75.
3
Hudson, N.R. (2006). Management practice in dietetics. California: Thomson Wadsworth, p.
334.
4
Ibid. p334.
5
Ibid. p.334.
6
Hudson, N.R. (2006). Management practice in dietetics. California: Thomson Wadsworth, p.
334.
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Required Readings
Textbook(s)

Puckett, R.P. (2013). Food service manual for health care institutions (4th ed.). San
Francisco, CA: Jossey-Bass.
Chapter 4, Quality Management, pp. 51-69
Chapter 5, Planning and Decision Making, pp. 71-93
Chapter 8, Human Resource Management: Laws for Employment and the Employment
Process, pp. 145-168
Chapter 9, Human Resource Management: Other Needed Skills, pp. 169-187
Readings from Course Reader

Grossbauer, S. (Spring 2011). The dreaded audit: How a much misunderstood process
can become your favourite management tool. Food Service and Nutrition: Canadian
Society of Nutrition Management News, 14-15

Rose, V.L. (2006). Managing and mitigating Risk: An administrator’s view. Nursing
Homes/Long Term Care Management, 57-59
Internet readings

Chapter 4 on Quality Management refers specifically to the American JCAHO.
Accreditation Canada is equivalent to the American JCAHO. Accreditation Canada is a
private, not-for-profit organization dedicated to improving the quality of patient care for all
types of health care organizations. The principles and even the evolution of quality
care is very similar in Canada as the US – so, we have specifically left this Chapter
as a key reading – however, JCAHO standards do not apply to Canada. In the unit
assignment you have an opportunity to visit Accreditation Canada’s website and
explore their standards.

Accreditation Canada website (http://www.accreditation.ca/en/ )
Compilation of articles found this unit:
 Rose, V.L. (2007). Managing and mitigating risk: An administrator’s view. Nursing Homes:
Long Term Care Management, Medquest Communications, pp. 57-59. Retrieved from
www.nursinghomesmagazine.com June 2007.
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Unit 8 Assignments
To complete the Unit 8 assignment, please access your account on the Gateway at
www.cha.ca. The assignment is available in Word format on the Gateway for you to
download. Once completed, please upload your assignment into the designated location.
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