The challenges of improving hospital food

The saying “you are what you eat” has taken on more meaning in Canadian society, with growing interest in the quality, origins and farming practices of the food we eat.

For some hospitals, this phrase is “you are what you serve” with food service being increasingly scrutinized, and there are many Ontario hospitals with efforts underway to improve the quality of hospital food.

However, these efforts face formidable challenges because of the nutritional and regulatory constraints of serving food to sick patients as well as the costs of food services at cash strapped organizations.

Hospital food has traditionally had a bad reputation, and for good reason. Ontario’s hospitals feed patients three meals and two snacks a day on an estimated budget of less than $8 per day per patient, excluding labour costs. It is no wonder that many associate hospital food with bland sandwiches, canned fruit and Jell-O as hospitals aim to feed patients in a way that is nutritionally balanced, broadly appealing, cost effective and easy to assemble.

In an era of tight hospital budgets, food services are often cut or looked to for efficiencies. Ontario’s hospitals operate largely with global budgets, meaning that they receive a fixed amount of dollars per year from the Ministry of Health and Long-Term Care to run the entire operations of the organization – which includes staff salaries, equipment, medicines and supplies such as food.

Michael Young, Executive Vice President at Sunnybrook Health Sciences Centre, notes that “hospital executives find it difficult to make investments in food services with so many competing demands for investments in direct patient care.” With many demands on scarce dollars, Heather Fletcher, manager of food services at St. Michael’s Hospital agrees, saying “food isn’t always a priority.”

Despite the challenges of resource allocation, some Ontario hospitals are starting to pay more attention to food, and see the quality of the food provided as part of overall patient care.

Food and Ontario’s focus on Quality & Patient Satisfaction

In Ontario, the introduction of the Excellent Care for All Legislation in 2010 put an increased emphasis on the measurement and improvement of quality in hospitals.  Quality of care is measured through a number of indicators, such as patients’ clinical outcomes and complication rates, as well as measures of the patient satisfaction. All hospitals in Ontario measure patient satisfaction using the same survey tool – which asks patients about various aspects of their hospital experience.

Research suggests that hospital food is an important part of the patient experience, and contributes to patient satisfaction, or dissatisfaction with their care.

Anne Marie Males, VP of Patient Experience at Scarborough General Hospital, says: “Food service is not considered a key department of most hospitals. It’s a service that it has to be there. A lot of people don’t give it much thought, but when you talk to patients, its amazing how important food is to them.” Males, who is leading the introduction of more fresh and home-cooked foods at the Scarborough General Hospital through a grant from the Ontario Greenbelt Foundation noted that a motivating factor in implementing this program was “being in the hospital at 6 pm and seeing families coming in with dinners from home… as the food being served to patients was so foreign and did not provide comfort.”


Providing comfort through food can be a challenge as many hospitalized patients are required to adhere to a strict diet. Heather Fletcher, director of food services at St. Michael’s Hospital notes that “nutrient targets are set for various diet types with goals for sodium, fats, carbohydrates, protein and total caloric intake” for various groups of patients. This can be quite complex.

For example, St. Michael’s Hospital serves 97 different diet types, and has 47 different diets to respond to allergy restrictions. The hospital serves more than 540,000 meals per year to patients.

Mary Keith, a registered dietician and nutrition education coordinator at St. Michael’s Hospital, notes that all food served to patients must go through ongoing nutrient testing and taste panels with hospital dieticians to ensure that meals are meeting nutritional targets and are appropriate to overall therapeutic needs of patients in the hospital.

The complexity of preparing and serving food to patients with specialized diets on a tight budget has lead many Ontario hospitals in the past few decades to move away from cooking food at on-site hospital kitchens, to outsourcing much of their food preparation and production. Companies such as Compass Group and Aramark specialize in food preparation for hospitals at large, off-site industrial kitchens.

Many hospitals have adopted an approach, known as “rethermalization” where hospital kitchens focus on the assembly and reheating of pre-prepared, frozen foods using special ovens. The “kitchenless” hospital has been described as an innovation that can save hospitals about 20% of food services costs.

This video details the complex processes involved in getting food from suppliers to patients’ bed sides at Sunnybrook Health Sciences Centre.

Innovations within Constraints: What Some Ontario Hospitals are doing to Improve Food

Heather Fletcher argues that “rethermalization technology doesn’t need to be a barrier to adding fresh items to hospital food menus” and that there are opportunities to add more fresh and locally-grown foods within existing food preparation, assembly and reheating processes by for example adding locally-grown blueberries to fruit crisps which can be prepared off-site, frozen and re-heated at the hospital.

One challenge of accessing fresh foods is the supply chain by which hospitals and hospital food providers purchase foods. Fletcher notes that efforts to add fresh, local foods to the hospital menu meant that the hospital had to engage in conversations and partnerships with suppliers, including farmers and help them learn how to participate in hospital food procurement processes, with which they were previously unfamiliar. All hospitals foods must comply with certain safety and quality standards.  Fletcher noted that “Changes to the very structured supply chain meant that we had to develop relationships with farmers and communicate our criteria clearly ,so we were comfortable that we could provide the food to patients with no risks.”

Operating in a very different context, the Sioux Lookout Meno Ya Win Health Centre located in Northwestern Ontario and serving the needs of primarily First Nations communities was required to have specific legislative authority in order to serve traditional foods, such as game meats and fish, which are non-inspected foods. Dave Murray, CEO of the Health Centre notes that serving traditional foods “that are familiar to the palates of patients from remote, First Nations communities provides a great deal of comfort.” Murray describes the traditional foods program, which operates out of a separate kitchen as an organizational priority, linked to the “ethos and culture of the organization, which is to provide a culturally appropriate experience to our patients.”

The Scarborough Hospital is also aiming to improve the cultural appropriateness of food services, through their pilot project. Anne Marie Males noted that given the diverse patient population of Scarborough, there was a need to “discover universally appealing comfort food” for all cultures, with homemade soup stock being a major project.

One question is why hospitals would not raise their spending on food if it improves patients’ experience and satisfaction. For example, if a 300 bed hospital doubled the amount it spends on food (excluding labour) from $8 per day to $16 per day, this would add around $11,000 per week to food budgets or a little more than $500,000 a year. Given that Ontario’s hospitals make investments in new technologies, such as Magnetic Resonance Imaging (MRI) machines that can cost hundreds of thousands of dollars, perhaps investing in food, and the promise of improved patient satisfaction, is a worthwhile consideration for hospital executives.

There are major fiscal and operational challenges to improving patient satisfaction and comfort  through better quality food. However, some hospitals in Ontario are developing approaches to improving the quality of food – it will be interesting to see whether they spread across the province.

The comments section is closed.

  • Angela says:

    I forgot to say, where is all that money going, that we pay? To doctors’ lawyers only? :(

  • Angela says:

    It would be nice to interior decorate and provide decent food at hospitals. Everyone wants to get out of the hospitals faster than they are able because of how uncomfortable it is to be in them. Ah, well!

  • Hilary Henley says:

    Here in Chatham Kent in 2016, the CEOs of both the LHIN and the CK Health Alliance received dismissal bonuses of over $ 1 million combined. They are set for life for doing their jobs poorly. How bizarre. This nonsensical model has been a part of health care for far too long and needs to stop; I’m sure Chatham Kent isn’t the only place in the province where this has occurred. Health care is not GM. This is money wasted, pure and simple. And hospitals must stop using all that single use plastic on patient trays, not to mention jello! Revolting. Whatever happened to common sense?

  • LOVEDAY says:

    Hospital management needs to be innovative say, through gardening, poultry, dairy etc for a fresh supply assurance.

  • Jacob Faith says:

    Most hospitals don’t appear that they have scarce dollars when you look at their annual reports. Even non profit institutions bring in over 80,000,000 in net income.

  • May Wong says:

    Hospital sent too much high position directors to foreign countries for conference when they are really tagging on with personal trips – a very costly conference that may be hospitals should cut and hire more nurses and psws and improve quality of food for patiemts.

    • Mai says:

      I am a dietary aide at PHSA in Vancouver operating under Compass Group in the Patients Department. I like to think we do offer a variety of healthy choices for our patients. Our cold dishes includes a variety of fresh fruits and vegetables and we encourage our patients to order those however we can’t control if they rather have fries instead. I can almost say the same about our hot foods. I mean frozen pre cooked food is not all that bad if we can maintain the quality during reheating and presentation. We have steamers and ovens which allows us to select proper cooking time by individual food items however, 90% of the time food is not being heated properly by placing everything in the steamer cooked by the same temperature and time frame. I can’t tell you how many times I’ve seen the cook pick up a piece of chicken breast in attempt to transfer onto a plate and you see half the breast slowly shred apart and fall back into the warmer while the other half remains on the tong, or pick up a piece of beef patty from a warmer to plating and half the patty is a dark brown the other half is a much lighter brown almost appear as half cooked half raw, steamed salmon with heavy white residue due to improper steaming trays. Presentation plays a huge role and anyone who can’t understand and accept that concept should not be in the food industry period. People today eat with their eyes first and with an already weak immune system it’s more of a torture for them to swallow that poorly presented plate in front of them.

      I believe that Compass is a great corporation who is reasonable with their employees myself included. I can say the majority of our staffs are hard working and somewhat cares more about getting the job done (as easy and to their utmost convenience possible) but not an once of care if our patients eat the food our not. There are a good amount of people who actually care about all that but because our kitchen is unionized and I’m not saying that it’s a bad thing but it really limits managements ability to select the appropriate person for the job. I’ve been here for 2 years now and really feeling the heat lately when reminding colleagues of our purpose. Its definitely very discouraging when you spend time to ensure the egg salad or tuna salad covers 100% of the bread to ensure an even filling layer when presenting the quartered sandwiches and you have a group of colleagues telling you not to do that because if management sees that they will expect that of everyone. All the waste I witness daily can account for more labour. Everyone is highly focused on finding short cuts to make their job easier absolutely no creativity along the process. There’s definitely a lot of moral issues in our kitchen. It’s not their money they simply don’t care.

  • Keith Parker says:

    money is not the problem
    The quality of the Chef/Cooks is your problem not the amount of money spent

  • Jean says:

    While I agree that we need to spend more money on food, there are many inexpensive meal options. Let’s bring Jamie Oliver’s can-do attitude to solve this problem! Feels like we need some outsider champions to move this agenda forward. I am not sure if food quality and taste is top of the priority for most hospital management.

  • Dan Carbin says:

    Interesting article. Is there any way hospitals in an area like the GTA could work together to procure fresh food from farmers for a lower price and more efficiently? It seems like a tremendous waste to have all 155 hospitals tackling this problem on their own.

    As for Mark’s comments, the government does strictly regulate the amount of funding that is dedicated to food in the LTC sector and I have rarely heard that the policy has led to culinary excellence. The challenge with a regulated budgetary line for food is that hospitals would start seeing that budget as the maximum amount they could spend on food. When the food budget inevitably failed to keep up with inflation (with food costs growing at 5% per year) hospital meals would get even worse.

  • Irene Jansen says:

    Contracting out health care food services means higher costs, worse quality.

  • Mark MacLeod says:

    Don’t get me started on hospital cafeteria food!

    Food shouldn’t be part of budget – it should be separate – an amount based on patient census – that has to be spent on food and forwhich a separate line item in the allocation is made and then audited. Then it is the government that is directly responsible for the amount of money allocated (and thereby the quality). Let’s put the responsibility directly there.

    • C says:

      I don’t get your reasoning…the budget is directly tied to census at most hospitals, nursing homes, etc. The government should not concern themselves in the budget of a hospital, unless of course it is owned by the government (ie: military hospitals). Most hospitals are privately owned and run, therefore are usually exempt from any government assistance.


Karen Born


Karen is a PhD candidate at the University of Toronto and is currently on maternity leave from her role as a researcher/writer with

Joshua Tepper


Joshua Tepper is a family physician and the President and Chief Executive Officer of North York General Hospital. He is also a member of the Healthy Debate editorial board.

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