SINGAPORE: Every day, some 4,000 meals are churned out from a central kitchen in Tan Tock Seng Hospital (TTSH) for its patients, prepared by a team of more than 100 staff.
Located in the basement, this kitchen rustles up a variety of Chinese, Malay/Indian and Western cuisines. But it does not end there – the staff have to offer 40 different types of diet, including low-fat, low-purine and gluten-free.
The kitchen, about the size of three basketball courts, was bustling with activity when CNA Insider was there one morning. Machinery hummed in the background, and robots parked in one area bleeped, waiting to be activated to deliver the food.
The cooks were chopping vegetables, sautéing chicken and barking instructions to one another while plating the dishes, all as the smell of freshly baked banana bread wafted from the pastry corner.
Senior production chef Tay Kok Beng is in charge of this crew and oversees the patients’ meals and those for the staff, including doctors.
Often, he is the subject of the most brickbats, not only from patients complaining that the food is bland and unappetising, but also from colleagues in other departments – from dietitians to nurses – who have a big say in the menu.
“We have to work with dietitians and speech therapists because there’s a restricted diet we need to follow,” he explained, admitting that it is a challenge to balance taste and nutrition.
Here is what you would want to know about hospital food.
1. IT TAKES UP TO TWO YEARS TO CREATE A MENU
Mr Tay works in consultation with his colleagues to plan the menu, and it typically takes up to two years to come up with one.
Not only must they cater for many patients, with a multitude of different conditions and dietary requirements, they are also limited by the number of choices they can provide – it is impossible to personalise every meal.
But to offer enough variety, dishes on the menu are not repeated within a 14-day period. So only patients staying longer would eat the same dish again.
Mr Tay’s colleagues also have different concerns, as the menu must meet the nutritional needs of every group of patients – vegetarians, those requiring a higher caloric intake, and kidney patients to name a few – explained speech therapist Karen Chien.
So, for instance, a protein dish like chicken must be able to cater for medical conditions ranging from high cholesterol to diabetes. “There’s no one meal that can accommodate all our patients because (they) are so varied,” said Ms Chien.
2. THE FOOD IS DIVIDED INTO TEXTURES
Typically, hospital food is categorised into four textures: Regular (for the majority of patients), easy chew, soft-moist and blended.
For example, the blended diet caters for those with a swallowing problem or whose throat or tongue muscles are weak. Dietetic technician Jocelyn Huang described it as having the consistency of “very smooth puree, like baby food”.
For the easy-chew diet, the test is that one must be able to crush the food with a fork easily, and the item cannot be more than 1.5 cm2 in size.
3. THE TEXTURE MUST BE JUST RIGHT
The speech therapists and dietitians pay attention to the food textures, particularly the blended diet, because of the risk of choking.
The blended food must be lump-free. It cannot be too watery nor too sticky, as the food could get into a patient’s airway and end up in the lungs, which can cause a chest infection.
“That can be life-threatening for our patients, so what we’re trying to achieve is that the patients are safe with the food that we serve,” said Ms Huang.
Ensuring that the consistency and textures of the food comply with international standards, and that it is appropriate and safe to consume, is one of the roles of her colleague Ms Chien.
4. THE FOOD IS AUDITED DAILY AND MONTHLY
The meals are also audited daily, to ensure the suitability of not only the textures but also the taste.
“Sometimes (the kitchen) might add too much salt. That isn’t suitable for patients on therapeutic diets,” said Ms Huang. “So I’d ask them to … rectify the issue before they start serving the patients.”
In checking all three meals, she makes sure that the food presentation is appealing too.
There is also a monthly audit of the textures, taste and presentation, among other things, done by a team comprising Ms Huang, Ms Chien, principal dietitian Wong Siew Li, senior nurse manager Hasfizah Mohd Hanef and sous chef Goh Kim Hock.
“We have … to make sure that everything is consistent,” said Ms Wong.
There’s space for calibration between the speech therapist and diet technician. And also as a team we (have to) agree whether the taste is getting stronger and stronger or blander and blander throughout the year.
5. THE CHEF’S NOT ALWAYS THE BOSS
Mr Tay used to work in a hotel, where he called the shots in the kitchen. Not so now. And his chefs are often restricted in the ways they may enhance the flavour of the food.
For example, the use of spices such as pepper must be approved by the food team first. “Sometimes, you never know, (an herb) might not work with the medicines, so we work very closely with the dietitians,” he said.
“As a chef, I have to be more creative. I need to always brainstorm with (my) staff – not only salt and pepper can (bring out) the flavour.”
Hospital chefs like him often find themselves at loggerheads with the audit team. “The speech therapists ‘fight’ with the chef quite a bit because we need our food to be very specific,” admitted Ms Chien.
“Sometimes we see some texture inside (the food) that isn’t what we require … But sometimes the chefs are also faced with challenges that are beyond their control.”
Ultimately, it boils down to the patients’ needs. “Safety is the most important thing,” said Mr Tay. “And we want the patients to feel that they’re eating healthily.”
6. PATIENTS CAN HAVE A SAY
If there are patients who dislike the food, Mr Tay or one of his assistants would go to the ward to get their feedback.
“I can’t say, ‘No, not my problem.’ With the feedback we get, at least we’d know exactly what the patients want,” he said.
To address any complaints going forward about bland food, TTSH will be using a salt meter to test the salt content of meals objectively, highlighted Ms Wong. But she acknowledged:
When they’re unwell, usually their taste buds are a bit affected. And even if we agree that (a meal) tastes flavourful … we might still get feedback from them that it’s bland.
An initiative the kitchen has already taken, especially for malnourished patients who find the food bland and struggle to finish meals, was to replace the vegetables with a high-calorie dessert, like Bubur Pulut Hitam.
“It’s tasty, it meets the safety requirements and, at the same time, it helps to boost our patients’ nourishment,” Ms Chien said of the glutinous rice dessert.
7. MACHINES ARE EASING THE LOAD
The kitchen has a number of elderly staff – the oldest is a 75-year-old cook – who assist in duties such as preparing the ingredients.
In the past, some of them had to wash the rice – up to 270 kilogrammes a day – and vegetables by hand, which was bad for their backs, tiring and wasted a lot of water.
Mr Tay found a rice cooker from Japan that would wash the rice and could be programmed to even cook chicken rice. He also bought a vegetable washer, which his staff admit cleans better than them.
“In those days, you had to wash vegetables like clothes because some of the vegetables had worms and snails. So these are quite powerful (machines with) the pressure to get rid of (even) stones,” said Mr Tay. “All are happy.”
8. ROBOTS DO THE DELIVERIES
Some of the kitchen’s newest recruits are a team of 15 robots, known as automatic guided vehicles, which deliver the food to the wards for the nurses to serve to the patients.
Each robot can lift about 15 trays of food. They have designated areas and paths to follow. They even have their own lifts. And if you are in its way, it would ask you, nicely, to move aside.
Apart from freeing up manpower in the kitchen, the robots take on other roles such as delivering linen, once they are done with their food rounds, which include bringing back the dirty dishes.