Management of dietary services at National Institute of Cancer Research and Hospital (NICRH), Bangladesh

Patient meals are an integral part of hospital treatment and crucial to aid recovery. A cross-sectional study was conducted to determine the Management of Dietary Services at National Institute of Cancer Research and Hospital. The purpose of this study was to make provision for safe, clean, hygienic and nutritious diet for the indoor patient as per their caloric requirement. This study compiled from 1 January to 31 December 2017 and the sample size was 113(dietary personnel 9 and patients 104) and it was purposive sampling technique. Data were collected through semi-structured questionnaire and observational check-list. Data analysis was done using SPSS software version 20. Satisfaction level was categories in to Satisfied and Dissatisfied. Among the service receiver of this hospital 15.4% were found satisfied with the dietary services. Cleanliness status of kitchen was average. It was highly suggested that the higher number of trained manpower needs to be appointed in future as required. Moreover, a standardize cooking system should be adopted by the authority for improving the quality of cooking food in order to obtain increased patient’s satisfaction.


Introduction
Food service (US English) or Catering Industry (British English) defines those business, industries and companies responsible for any meal prepared outside the home. The dietary service is one of the important supporting services of the hospital unlike any other supporting services. The objective of the diet services is to make provision for clean, hygienic and nutritious diet for the indoor patient as per their caloric requirement. The dietary service is one of the important supporting service of the hospital unlike any others supporting service. The objective of the diet service is to make provision for clean hygienic and nutritious diet for the indoor patient as per their caloric requirement. The dietary service can be providing either by in house provision or by out sourcing (Das, 2010). Dietary guidelines are sets of advisory statements providing principles and criteria of good dietary practices to promote national wellbeing. They are intended for use by individuals (Dietary Guidelines for Bangladesh, 2014). The following advisory statements indicate what type of foods have to be consumed, the extent to which they have to be consumed, including the use of spices, condiments and water. It also suggests the use of healthy preparation and cooking methods for the retention of nutrients and to promote better health (Waid et al., 2019). Patient satisfaction has become a key criterion by which the quality of health care services is evaluated. When looking at overall hospital patient satisfaction, foodservice satisfaction may sometimes go unnoticed, as nursing and physician quality and the quality of technical medical care are more commonly identified in the research. However, the need to assess the food services in a hospital is not only important for patients 'welfare and Asian J. Med. Biol. Res. 2020, 6 (3) 549 nutrition but also for financial reasons (Abdelhafez et al., 2012). The present study is conducted to determine the management of dietary services at National Institute of Cancer Research and Hospital. Access to safe and healthy variety of food is a fundamental human right. Proper food service and nutritional care in hospitals have a beneficial effect on the recovery of patient and quality of life. (Green et al., 2016). The number of undernourished hospital patients is unacceptable and leads to extended hospital stays, prolonged rehabilitation and unnecessary costs to health care. An essential in successful catering management is customer satisfaction; however, in a hospital setting, this is a complex phenomenon and influence by many factors. The public generally view hospitals as institution and intuitional catering has a reputation for being poor. The negative image of hospital food is wide spread and is therefore not necessarily related to the food itself (Cardello et al., 1996). Since the health industry is more becoming competitive and patients are becoming more discriminating about quality, the health care has redefined patients, recognizing them as customers (Kondrup, 2004). The competitive environment has forced dietitians to provide higher-quality food service with limited resources. As Parasuraman et al. (1985) asserted, quality is an elusive and indistinct construct" and is not an easy one to define. The provision of food service system which optimizes patient food and nutrient intake in the most cost effective manner is therefore seen as essential. The patient satisfaction shows no relationship to the cost of providing and the type of food service method adopted, using criteria of extent of choice, whether meals are appetizing and how they are served (Audit Commission, 2001). The importance of hospital food service and use of food as treatment are not new and can be traced back to the earliest medical works (Cardello et al., 1996). Concern with the role food may play in the recovery of patients was also highlighted by Florence Nightingale who wrote in her 'Notes' in 1859, that 'The most important office of the nurse, after she has taken care of the patients' air, is to take care to observe the effects of his food' (Nightingle, 1859;Hu et al., 2000). Promoting optimal nutrition status can lead to faster recovery times and reduced hospital costs. European research on food and nutritional care in hospital has recognized that it is necessary to define responsibilities, promote staff qualification, enable patients' participation in nutritional decisions and integrate the health care team into nutritional care (Dekker et al., 2015). It is mandatory to get patients' feedback to assess the satisfaction level on the service provided. We decided to collect feedback from the patients with a commitment to take note of all comments received and plan to look into those areas of service to improve based on their feedback. Their feedback will reflect our quality of service. The present study is conducted to determine the management of dietary services at National Institute of Cancer Research and Hospital.

Ethical consideration
This study was conducted with the intention of protecting the human rights of all subjects. All the information collected for the study was utilized only for the purpose of thesis and was not disclosed to anyone outside the research team. At the beginning, approval was obtained from the ethical committee of NIPSOM, under the Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Before collection of data, written permission was taken from the director of National Institute of Cancer Research and Hospital (NIRCH), Dhaka. Also written permission was taken from the respondents. A complete assurance was given that all information keeps confidentially.

Study Design
A cross sectional study was carried out.  Critically ill patients and those who were not on normal diet  Unwilling to participate in this study e. Tool of the study: A semi-structured questionnaire was prepared keeping in view the objectives and variables of the study. Separate questionnaires were used for service receivers and service providers. The questionnaire was first developed in English version and then translated into Bengali. Data from the respondents were collected through face-to-face interview.

Results and Discussion
This cross-sectional study was carried out among 9 dietary personnel and 104 dietary service receivers to assess the state of management of dietary services at National Institute of Cancer Research and Hospital (NICRH). The findings of the study on the basis of the analysis had been presented as per the followings sections: The demographic characteristics of the service provider & service receiver are shown in Table 1.  Table 1 showed that the 33.3% respondents were from below 50 years' age group and 66.7% (n=6) respondents were 50 years and above age group. Among the respondents 77.8% were male and remaining 22.2% respondents were female. One fourth dietary personnel were illiterate, 4(44.4%) dietary personnel had educational level below SSC and 3(33.3%) dietary personnel had educational level SSC and above. From the respondents 33.3% had monthly family income from 10001-25000 taka and 44.4% (n=4) respondents had monthly family income above 25000 taka. Majority of the dietary personnel (66.7%) had duration of service of ≥27 years. Majority of the service receiver (51.9%) were from 31-50 years' age group. One third of the respondents (32.7%) were from above 50 years' age group and rests (15.4%) were from up to 30 years' age group. Most of the service receivers (55.8%) were female and rest (44.2%) were male. Among the service receivers, 42 (40.4%) service receivers had no formal education, 30 (28.8%) service receivers had educational level up to primary, 14(13.5%) had educational level below SSC and 18(17.3%) had educational level SSC and above. Majority of them (59.6%) had monthly family income upto10000 taka and 28.8% (n=30) had monthly family income from 10001-25000 taka. Among them, 34.6% (n=36) service receivers were staying in the hospital for up to 10 days and 30.8% (n=32) service receivers were staying in the hospital from 10 -20 days.  Table 2 showed the location of the kitchen was in ground floor. There was adequate space for passage of loaded lorry. It was not well ventilated and lighting was inadequate. Chimney was present but not properly functioning. There were no facilities for safe drinking water, toilet, changing room and cold room for perishable item. Enough space was not present in the kitchen. Water supply was present but not adequate.  Table 3 showed that nails of dietary personnel were not trimmed. Dietary personnel did not use gloves, apron, and cap. They did not wash hand before food handling. Cleanliness status of the utensil, floor and premises were average. Wastes were disposed twice a day. The condition of supplied food was unhygienic.  Table 4 showed that majority of the dietary personnel (66.6%) faced problem due to lack of manpower, 3 (33.3%) dietary personnel faced problem due to inadequate ventilation, 2 (22.2%) dietary personnel faced problem due to lack of modern equipment for cooking. Others problems that were faced by them were lack of training (11.1%), lack of modern equipment for cleaning (11.1%), lack of trolley (11.1%) and lack of facility for health checkup (11.1%). Majority of the dietary personnel (66.6%) stated that increasing the number of trained personnel would be the solution of problems. Others stated that adequate ventilation (44.4%), supply of adequate trolley (22.2%) and modernization of kitchen unit (11.1%) would be the solution of problems.  Table 5 showed that most of the service receivers (91.3%) did not receive various kinds of food from hospital and 9 (8.7%) received various kinds of food from hospital. Most of the service receivers (69.2%) received whole meal and 32 (30.8%) did not receive whole meal from the hospital.  Table 6 showed that among the service receivers, 44 (42.3%) faced problem due to low quality food. Others faced problems due to lack of safe drinking water (14.4%), food not given timely (11.5%), same food given daily (8.7%), low quality of rice (8.7%), low amount of food (7.7%) and under cooked food (3.8%).    Table 7 showed that among the service receivers, 31 (29.8%) suggested that quality of food should be improved. Others suggested that authority should take action (15.4%), amount of food should be increased (7.7%), food should be given timely (6.7%), pure drinking water should be supplied (5.8%), and variety of food should be given (3.8%).

Conclusions and Recommendations
Good food service was not only necessary for physiological and therapeutic needs of the patients but also one of the important public relation measures. Proper diet for proper patient reduces patient's sufferings. Though resources were limited, proper management can ensure quality dietary services and thereby ensure better health care  All the personnel of dietary services should be trained.  Hygiene and sanitation of cookhouses should be improved.  Kitchen staff should wear specific PPE for cleanliness of food.  Cooking process should be improved in such a way so that micronutrient can be preserved as for as possible.  Increase the number of personnel in the dietary department.