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Food scientist and Accredited Practising Dietitian Lillian Forrest worked in a clinical hospital setting for several years before moving into the foodservice area. She’s now Nutrition Project Manager for HealthShare NSW, the business unit within NSW Health which provides foodservice operations to more than 150 hospitals across the state.

Lillian’s role is a diverse one, encompassing the planning, development and management of nutritional services for HealthShare NSW, which need to meet the NSW Health Agency for Clinical Innovation dietary specifications and nutrition standards in order to optimise nutritional outcomes for patients.

“I’ve got a team of five foodservice dietitians who work with me, each of whom is responsible for a different local health district within NSW Health,” Lillian tells us. “My role is to oversee menu development to make sure we are in fact meeting the required nutritional standards and that there is appropriate choice and variety for patients based on the diet code. We also have quite a lot of input into the procurement and supply chain side of things – making sure we can provide the right food to the right patients.”

Lillian traces the current strategic approach back to 2011, when NSW Health published its Nutrition Care Policy. “The nutrition standards and dietary specifications were designed to make sure that no matter which NSW hospital a patient was in, they would be getting the same quality food meeting the same standards.”

Making this a reality is not without challenges, as Lillian explains: “A key challenge is the sheer diversity of patients in hospital at any one time. HealthShare NSW covers foodservice for paediatric hospitals and units through to acute tertiary hospitals and multipurpose centres like aged care facilities, so there is a really broad spectrum of patients across a range of age groups. On top of that, we also have increased multiculturalism within NSW, and consequently we need to be mindful that we are providing food that is appropriate to the patient demographics across any particular facility. For example, our menu in Armidale would necessarily be quite different from that in Canterbury, not only because it’s a different type of hospital but because the cultural background of the patients is different and that needs to be reflected in the type of food and cuisine styles we serve.”

Logistics and food safety are also important considerations. “HealthShare NSW has just undertaken a major review of the supply chain, working with various consultants to help us get to this stage. Part of that has been looking at the food items provided within hospitals and not only how we can refine or improve what we make available to patients, but also improving our stock management and minimise any waste generated by the kitchen. Instead of looking just at product and price, we’re now looking at product, price and service.” This has led to an improvement in order lead times, and a focus on ensuring products are received with appropriate use-by dates so they don’t need to be discarded prior to use.

“Regardless of what kind of hospital it is – aged care, paediatric, mental health unit – we always have to be mindful that we’re serving food to people who are in a vulnerable population,” Lillian emphasises. “Within the NSW Food Authority Guidelines and regulations that we have to adhere to – in addition to our own nutrition care policy – there are policies regarding which foods are definitely not allowed on hospital menus.” Some of these may seem surprising, such as alfalfa sprouts, strawberries and rockmelons. Lillian explains, “some foods are easier to sanitise than others – the medium in which sprouts are grown, for example, can be known to harbour particular bacteria. Patients who are acutely unwell are more at risk of contracting a food-borne illness and that’s exactly what we’re trying to avoid – we don’t want to make them any sicker and we also want to avoid any hospital-acquired malnutrition.”

It’s also important that there is adequate variety of food over each week’s menu – “you’ve got to have variety with respect to texture, colour, taste and appearance,” Lillian points out. “You always eat with your eyes first, so if you’re served a chicken meal with hollandaise sauce, potato and cauliflower, that will be a bland-looking meal because it’s essentially the one colour. Food presentation is very important and a key part of our menu development.”

Another area of attention is staff training. With HealthShareNSW currently focused on rolling out the My Food Choice program across the state’s hospitals (as detailed last issue), training is being undertaken to ensure the implementation goes ahead smoothly. “At the same time, we’re reminding staff about the nutritional guidelines we have to follow – there are audits which come from both my team and the food safety team to make sure staff are following the guidelines and policies we’ve set in place and that there’s ongoing training when required. For example, when staff members come back from leave we look at whether we need to touch base on any areas or expand their training a little more.”

The most rewarding part of the job for Lillian is receiving positive feedback from patients and staff. “When staff members communicate that patients have told them how much they’ve enjoyed their meal, or that we’ve provided good customer service as well as food that’s appropriate for them, that’s good feedback to have and it’s what makes the role enjoyable. More generally, it’s a privilege to be able to influence what goes on patient menus and to ensure we’re meeting the nutritional standards. We’ve done various reports which showcase the improvements made to hospital menus over the past five years – when you look back on that, it gives you a good sense of achievement.”