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International audience; The problem addressed in this paper was motivated by a real optimization problem of supply chain of the hospital center of Troyes (HCT). The HCT is currently seeking to review and improve its logistics processes. The implementation of techniques and methods of operational research must provide solutions to improve the efficiency of logistics activities. In this work, the studied problem focuses on the catering component of the hospital logistics. A novel mathematical model for the production scheduling of multi-products and multi-stages food processes in hospital catering is proposed. This mathematical model has been implemented in commercial solver CPLEX and it has been tested on real instances of HCT and from the literature. The implementation results of the mathematical model proposed have proved its efficiency for the scheduling of the food production process.

International audience; This paper aims to study a real case of an optimization problem derived from a hospital supply chain. The present work focuses on developing operational decision support models and algorithms for production process scheduling in hospital catering. The addressed production system is considered as a flexible job shop system. The objective is to minimize the total flow time. A novel mathematical model and two metaheuristics for the production scheduling of multi-product and multi-stage food processes are developed. These methods have proven their effectiveness for the scheduling of operations of the food production processes and allowed significant improvements in the performance of the studied production system.

International audience; Hospital is a complex supply chain made up of multiple structures, stakeholders, operations, as well as information and material flows. Due to the Covid-19 pandemic, hospital overcomes several major challenges these last few months, which leads to consider its supply chain digitalization as a priority to improve healthcare and hospital services quality. Interesting in the specific service of hospital food, this article asks: How does digitalization support hygiene requirements in the hospital food supply chain? It describes the modelling and design of a hospital catering application, which aims to build a digital catering area in support to hygiene requirements.

According to the literature the prevalence of the risk of malnutrition o hospitalized people exceeds 25% of patients, this evidence is also related to low meal satisfaction. To reduce hospital malnutrition it is also important to improve the consumption of meals by implementing organoleptic and nutritional quality (O&NQ). The Local Health Agency of Trieste (ASUITS) has conducted surveys to find out how to evaluate and improve the procurement qualifications of hospital catering systems (HCS) and how to implement O&NQ. The production processes of meals served in two clinics using Cook Chill (CC) and Cook/Fresh - Hot Hold (CFHH) production process, respectively, were evaluated from 2017 - 2019. The Nutrient Analysis Critical Control Point process was applied for the evaluation of two catering systems. In addition, the antiradicalic power (ARP) of 120 samples of meals by the University of Trieste was analysed. In 2019 an investigation was conducted to compare the satisfaction and ARP content of meals served to patients in two hospital wards (N = 60). The meals to patients of two wards respectively with CC Cold Plating Retherm (PR) and CC Hot PR were served. Meals produced by the CC production process highlight the average loss of 50% of ARP compared to the CFHH. Meals produced by the CC Cold PR method limit the loss of ARP by 15-40% less compared to the CC Hot PR method. The satisfaction of patients who have consumed meals produced by the CC Cold PR method is double compared to that of patients who have consumed meals produced by the CC Hot PR method. The surveys have produced significant evidence to evaluate hospital meal production processes and to improve O&NQ. The results were used to develop recommendations for the drafting of tender specifications capable of also protecting nutritional variables. The evaluation of the O&NQ of HCS represents a central determinant of food safety and nutrition security and must be taken into consideration in the procurements procedure. Key messages Hospital catering contracts must evaluate and guarantee organoleptic and nutritional quality. Integrated evaluation of organoleptic and nutritional quality is an integral part of hospital meals.

Mestrado em Gestão das Organizações : Ramo de Gestão de Empresas (parceria com a APNOR) na Escola Superior de Tecnologia e Gestão do Instituto Politécnico de Viana do Castelo A alimentação nos hospitais é de extrema importância para a recuperação do doente. No entanto, os custos na área da saúde foram aumentando e os gestores hospitalares são obrigados a recorrer a ferramentas de gestão que levem à redução dos mesmos, recorrendo ao outsourcing. Em Portugal o fornecimento de refeições nesta tipologia de entidades é, com decisão da administração, da responsabilidade de entidades especializadas em Alimentação Coletiva, com a abertura de um concurso público. As entidades prestadoras de serviço no fornecimento de refeições deverão possuir uma gestão de custos para auxiliar no processo de tomada de decisão de acordo com especificações técnicas dos cadernos de encargos de fornecimento de refeições hospitalares. Este trabalho tem como principal objetivo estudar a relação entre o custo de refeições fornecidas a utentes hospitalares e a qualidade inerente, de forma a avaliar se o preço base apresentado e os preços contratuais são viáveis para a entidade prestadora de serviços de fornecimento de refeições. A amostra de estudo é constituída por nove cadernos de encargos de hospitais nacionais. No que concerne a metodologia foi realizado um estudo de caso, no qual se elaborou um plano semanal de ementas para almoço e jantar de acordo com as capitações exigidas. Posteriormente determinaram-se os diferentes custos de matérias-primas, mão-de-obra e gastos gerais de fabrico, apurando assim um custo padrão de refeição tendo por base valores de referência de experiências anteriores, conseguindo com diferentes simulações avaliar o custo/qualidade das refeições servidas. Os resultados obtidos ao longo da investigação permitiram concluir que, embora alguns dos custos não sejam possíveis de quantificar, para que a entidade subcontratada aumente os seus lucros e reduza custos, será possível fornecer refeições hospitalares perante um mundo competitivo, ou seja, respeitando somente o preço contratual e reduzindo à qualidade dos géneros alimentícios existirá um impacto financeiro geral positivo, no entanto associa-se assim uma possível insatisfação por parte dos utentes em relação às refeições servidas. La alimentación en los hospitales es de suma importancia para la recuperación del paciente. Sin embargo, los costes en el sector de la salud han ido aumentando y los gestores hospitalarios se ven obligados a recurrir a herramientas de gestión que permitan la reducción de los mismos, recurriendo al outsourcing. En Portugal, el suministro de comidas en este tipo de entidades lo realizan empresas especializadas en Alimentación Colectiva mediante concurso público, cuya elección corre a cargo de la administración del hospital. Los proveedores de servicio que suministran comidas deben presentar la gestión de los costes para ayudar en el proceso de toma de decisiones, según las especificaciones técnicas de los pliegos de condiciones del suministro de comidas hospitalarias. El principal objetivo de este trabajo es analizar la relación entre el coste de las comidas suministradas a los usuarios de los hospitales y la calidad inherente, para que, de esta forma, sea posible evaluar si el precio base presentado y los precios contractuales son viables para la entidad prestadora de servicio que suministra comidas. Este estudio está basado en una muestra constituida por nueve pliegos de condiciones de hospitales nacionales. Respecto a la metodología, se ha efectuado un estudio de caso, en el que se ha elaborado un menú semanal para la comida y la cena basado en las capitulaciones establecidas. Posteriormente, se han determinado los diferentes costes de las materias primas, mano de obra y los gastos generales de elaboración, estableciendo de esta forma, un coste estándar de comida basado en los valores de referencia de experiencias anteriores, evaluando con diferentes simulaciones el coste/calidad de las comidas servidas. Los resultados obtenidos a lo largo de la investigación han permitido llegar a la conclusión de que, aunque sea imposible cuantificar algunos de los costes, para que la entidad subcontratada aumente los beneficios y reduzca los costes, no será posible sin suministrar comidas hospitalarias ante un mundo competitivo, o sea, respetando solamente el precio contractual y reduciendo la calidad de los productos alimenticios existirá un impacto financiero general positivo, sin embargo, provocará una posible insatisfacción por parte de los usuarios relativamente a las comidas servidas. High quality hospital food is of extreme importance to a patient’s recovery. Still, the cost of health care has risen so much that hospital boards have been compelled to resort to outsourcing many of their management tools, including catering for patients. In Portugal, hospitals procure this service by public tender from companies specialized in large-scale group catering. Catering companies are expected to have a cost management system to assist them with the decision-making process when meeting the technical specifications for hospital food. The main purpose of this paper is to study the relationship between the cost of meals supplied to patients and the quality of the food, in order to determine whether the base price presented and the price the services are contracted for are financially viable for caterers. For this study, we examined the catering specifications from nine Portuguese hospitals. The method applied was a case study consisting of weekly lunch and dinner menus provided at the stipulated cost. We later calculated the actual cost of the raw materials, of the labour and the general preparation expenses. This enabled us to determine a standard cost per meal based on reference values for previous experiences. Several simulations were used to determine the cost/quality ratio of the food served. The results obtained during the study enabled us to conclude that there are some costs that cannot be quantified, by which a caterer might increase his profits and cut down on costs. However, such is the competition that only by reducing the quality of the food whilst still respecting the contracted price, can a caterer ensure that he makes a profit, although this would be accompanied by the patients’ discontent with their meals.

Protein undernutrition is a major health concern for older adults, especially for those who are ill. There is growing consensus for a protein intake target of 1.2 - 1.5 gram per kg bodyweight per day (g/kg/d) for these older adults. However, this target is not reached by the majority of older adults. Therefore, more effective and novel strategies to increase protein intake are warranted, including the use of protein-enriched foods and drinks. This thesis evaluated the impact of the developed protein-enriched foods and drinks on protein intake and physical performance among older adults. The studies in this thesis were done as part of the Cater with Care® project; a collaboration between the university, care organizations, and partners from the food industry. The industrial partners developed the products, focusing each on different product categories: Carezzo Nutrition developed bread, pastry, and fresh juices and soups; The Kraft Heinz Company focused on long shelf-life and convenience foods; and the Veal Promotion Foundation produced veal meat. To fit the products to the needs of the target group, interviews with undernourished older adults (at home or hospitalized) and with dietitians were conducted (chapter 2). These interviews showed that undernutrition awareness is low among older adults. To treat undernutrition by changing their eating habits, older adults need to be aware of their health problem, they need to be willing to change, and they need to be able to understand and implement the dietitian’s advices. This process takes time while undernutrition should be treated immediately. For immediate treatment, enriched products could be used, without first creating awareness. According to the interviewees, enriched products should fit within older adults’ eating habits, and have small portion sizes. To gain insights in food choices of hospitalized older adults (65 years and older) an observational study was conducted. In this study, energy and protein intakes of 80 hospitalized older patients at low and high risk of undernutrition were assessed (chapter 3). Patients who received an energy- and protein-rich menu, because of their risk of undernutrition, were better able to reach the protein and energy targets than patients with a low risk of undernutrition receiving a standard menu. Based on these results we proposed that all hospitalized older adults – both at low and high risk of undernutrition – should receive an energy- and protein-rich menu. Subsequently, a pilot study was done in a care home and a rehabilitation center with the aim to explore the potential of the developed protein-enriched products to increase protein intake (chapter 4). Participants did not compensate their consumption of regular protein-rich foods (e.g. dairy, cheese) upon the introduction of protein-enriched foods and drinks. The 22 institutionalized elderly (mean age 83 years) consumed 12 gram protein per day more than they did before the intervention. Consequently, more people met the protein target of 1.2 g/kg/d than before the intervention. We concluded that protein-enriched products enabled institutionalized elderly to reach protein intake targets. Furthermore, we gained valuable feedback to improve the assortment of protein-enriched products for the effectiveness study. In the final study, effects of the protein-enriched products on protein intake and physical performance were studied in a randomized controlled trial during hospitalization and subsequent recovery at home. During the hospital period in which 147 older patients participated, patients that received protein-enriched products increased their protein intake compared to the control group that already received a protein-rich hospital menu (chapter 5). As a result, 79% of the intervention group reached a protein intake of 1.2 g/kg/d, compared to 48% of the control group. Finally, effects of the protein-enriched products were tested at home, for a longer period (chapter 6). Half of the hospital phase participants (n = 75) continued the intervention at home for 12 weeks. The protein-enriched products were successfully implemented in the daily menu of the older adults: the intervention group had a higher average protein intake (1.5 ± 0.6 g/kg/d) than the control group (1.0 ± 0.4 g/kg/d) during the 12-week intervention period. Seventy-two percent of the intervention group reached a protein intake of 1.2 g/kg/d during the 12-week intervention, compared to 31% of the control group. Protein intake of the intervention group was mainly increased by the following protein-enriched products: bread, dairy drinks, dairy desserts, soups, and fruit juices. However, despite the successful improvement of protein intake, we found no added value on physical performance in the first 6 months after hospitalization. It was concluded that with the protein-enriched familiar foods and drinks, we have a feasible, acceptable, and appetizing long-term strategy to increase protein intake of older adults in various settings. We envisage a beneficial role of these protein-enriched products in combination with physical activity in older adults with lower protein intakes.

The aim of the study was to reduce food waste in a hospital, a hospital cafeteria, and a residential home by applying a participatory approach in which the employees were integrated into the process of developing and implementing measures. Initially, a process analysis was undertaken to identify the processes and structures existing in each institution. This included a 2-week measurement of the quantities of food produced and wasted. After implementing the measures, a second measurement was conducted and the results of the two measurements were compared. The average waste rate in the residential home was significantly reduced from 21.4% to 13.4% and from 19.8% to 12.8% in the cafeteria. In the hospital, the average waste rate remained constant (25.6% and 26.3% during the reference and control measurements). However, quantities of average daily food provided and wasted per person in the hospital declined. Minimizing overproduction, i.e., aligning the quantity of meals produced to that required, is essential to reducing serving losses. Compliance of meal quality and quantity with customer expectations, needs, and preferences, i.e., the individualization of food supply, reduces plate waste. Moreover, establishing an efficient communication structure involving all actors along the food supply chain contributes to decreasing food waste.

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals' quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers.

Ziekenhuis Gelderse Vallei voerde in november 2012 het nieuwe maaltijd-serviceconcept At Your Request in. In april 2013 werd in een tussenmeting de hoeveelheid voedselverspilling gemeten. Eén van de uitkomsten is dat er veel minder voeding van patiënten terugkomt. Ook blijken zij daadwerkelijk meer te zijn gaan eten.

De rol van voedsel in ziekenhuizen is de laatste jaren toegenomen. Niet alleen in relatie tot de lichamelijke en geestelijke gesteldheid van de patiënt, maar ook met betrekking tot duurzaamheid. In dat kader heeft het ministerie van EL&I een opdracht uitgezet enerzijds om te kijken hoeveel derving er is bij bepaalde ziekenhuisconcepten en anderzijds om een structuur aan te reiken, waarmee ziekenhuizen inzicht kunnen krijgen in de hoeveelheid voedselverspilling in de eigen situatie en de processen waar die plaatsvindt.

In Nederland wordt jaarlijks voor ruim 4,4 miljard euro aan voedsel verspild. Een gigantische 'waste'. De zorg doet daar dapper aan mee door iets meer dan twee miljard voor haar rekening te nemen. Er valt dus veel te winnen. Jelle Ferwerda, hoofd voeding van de Sint Maartenskliniek in Nijmegen, behoort tot de koplopers bij het tegengaan van verspilling. "Besteed het geld dat je ermee uitspaart aan een betere kwaliteit van je maaltijden."

In Nederland wordt jaarlijks voor ruim 4,4 miljard euro aan voedsel verspild. Een gigantische 'waste'. De zorg doet daar dapper aan mee door iets meer dan twee miljard voor haar rekening te nemen. Er valt dus veel te winnen. Jelle Ferwerda, hoofd voeding van de Sint Maartenskliniek in Nijmegen, behoort tot de koplopers bij het tegengaan van verspilling. "Besteed het geld dat je ermee uitspaart aan een betere kwaliteit van je maaltijden."

De rol van voedsel in ziekenhuizen is de laatste jaren toegenomen. Niet alleen in relatie tot de lichamelijke en geestelijke gesteldheid van de patiënt, maar ook met betrekking tot duurzaamheid. In dat kader heeft het ministerie van EL&I een opdracht uitgezet enerzijds om te kijken hoeveel derving er is bij bepaalde ziekenhuisconcepten en anderzijds om een structuur aan te reiken, waarmee ziekenhuizen inzicht kunnen krijgen in de hoeveelheid voedselverspilling in de eigen situatie en de processen waar die plaatsvindt.

Dit onderzoek heeft betrekking op de nieuwe wijze van uitserveren van maaltijden binnen het Máxima Medisch Centrum (MMC). Dit nieuwe concept sluit aan bij een gezond en duurzaam voedselpatroon. Verondersteld is dat de maaltijdservice resulteert in positieve effecten op het gebied van 'people', 'planet' en 'profit'. Daarnaast is er de gedachte dat het concept resulteert in een verbeterde service aan de patiënt, terwijl er geld bespaard wordt, de CO2-productie gereduceerd wordt en voedselverspilling tegengegaan wordt. De beleving van een maaltijd is niet enkel afhankelijk van de kwaliteit van het voedsel. De ambiance waarin gegeten wordt speelt een minstens zo grote rol. Binnen MMC wordt zelfs gezegd dat ambiance voor 70% de beleving van voedsel bepaalt. Binnen het uitserveerconcept neemt het creëren van een fijne ambiance daarom een belangrijke rol in.

Dit onderzoek heeft betrekking op de nieuwe wijze van uitserveren van maaltijden binnen het Máxima Medisch Centrum (MMC). Dit nieuwe concept sluit aan bij een gezond en duurzaam voedselpatroon. Verondersteld is dat de maaltijdservice resulteert in positieve effecten op het gebied van 'people', 'planet' en 'profit'. Daarnaast is er de gedachte dat het concept resulteert in een verbeterde service aan de patiënt, terwijl er geld bespaard wordt, de CO2-productie gereduceerd wordt en voedselverspilling tegengegaan wordt. De beleving van een maaltijd is niet enkel afhankelijk van de kwaliteit van het voedsel. De ambiance waarin gegeten wordt speelt een minstens zo grote rol. Binnen MMC wordt zelfs gezegd dat ambiance voor 70% de beleving van voedsel bepaalt. Binnen het uitserveerconcept neemt het creëren van een fijne ambiance daarom een belangrijke rol in.

Atualmente, percebe-se que algumas unidades hospitalares, preocupadas com as constantes mudanças no mundo globalizado, onde a demanda está em constante evolução, aplicam em suas organizações os procedimentos da organização hoteleira, com o objetivo de atender o paciente com maior qualidade. Este estudo teve por objetivo avaliar o modelo de gestão da hospitalidade hospitalar implantado em um Hospital localizado em uma cidade da Serra Gaúcha, e descrever o nível de satisfação dos pacientes em relação aos serviços prestados nessa organização. O método de pesquisa aplicado, face ao problema e aos objetivos, foi de caráter descritivo, de corte qualitativo. No estudo, empregou-se a pesquisa bibliográfica, entrevista estruturada com os coordenadores e gestores de áreas, entrevistas semiestruturadas com os pacientes internados atendidos através de convênios e particulares, e observação direta realizada no Hospital. Os aspectos levantados evidenciaram que os pacientes entrevistados possuíam um conhecimento limitado sobre o conceito de qualidade de serviços. O resultado também sugere que os gestores reavaliem o conceito e as estratégias praticadas para prestar um serviço com qualidade, levando-se em conta a importância da hospitalidade no ambiente hospitalar.

Atualmente, percebe-se que alguns hospitais procuram transformar sua imagem, deixando de ser um espaço de doença e sim um ambiente de saúde. Existem similaridades de serviços entre hotel e hospital e a implantação dos conceitos de serviços de hotelaria hospitalar pode ser relevante. Com o objetivo de verificar se as condições de estrutura e atendimento dos setores relacionados à hotelaria hospitalar são determinantes na escolha de um hospital pelo paciente, foi realizado um estudo de caso no Hospital Divina Providência. Para tal, estas condições foram analisadas através de aplicação de questionários aos pacientes e acompanhantes, entrevista com gestores do hospital e observação direta nos setores relacionados à hotelaria hospitalar. Este trabalho constata que a influência do médico é determinante na escolha de um hospital, porém, a estrutura e o serviço de atendimento de hotelaria hospitalar também são relevantes neste processo. Currently, is possible understand that some hospitals to turn his image, leaving to be an area of disease but rather an environment of health. There are similarities between the hotel and hospital services and the implementation of the concepts of hospital catering services may be relevant. In order to ascertain whether the conditions of the estructure and service sectors related to the hospitality of the hospital are decisive in choosing a hospital by the patient, a study was conducted in the case of Divine Providence Hospital. To this end, these conditions were analyzed through application of questionnaires to patients and associates, interviews with managers of the hospital and direct observation in sectors related to hospitality hospital. This study finds that the influence of the physician is crucial in choosing a hospital, but the estructure and service organization of hospitality hospital are also relevant in this process.

Ziekenhuis Gelderse Vallei voerde in november 2012 het nieuwe maaltijd-serviceconcept At Your Request in. In april 2013 werd in een tussenmeting de hoeveelheid voedselverspilling gemeten. Eén van de uitkomsten is dat er veel minder voeding van patiënten terugkomt. Ook blijken zij daadwerkelijk meer te zijn gaan eten.