Hospital FSDs fighting a battle against corrugated cardboard

Published in FSD Update

By 
Dana Moran, Managing Editor

cardboard pieces

With food allergies, picky patients and staffing shortages to contend with, it may be hard to imagine that one of the biggest pain points facing healthcare foodservice directors today is the corrugated cardboard box. But this simple delivery method is causing massive problems throughout their facilities, hospital operators tell FoodService Director.

“The fact of the matter is, cardboard is filthy,” says Eric Eisenberg, corporate executive chef for nutrition, catering, retail and conference services at Seattle’s Swedish Health Services. Corrugated products can sop up and retain liquids, dirt and insects—and worse—from hospital loading docks and anything they come in contact with during transit. It’s a fact that hospital certification boards like DNV GL and The Joint Commission are well aware of; and so they began requiring healthcare facilities to ban corrugated products from all patient units, including foodservice areas.

The problem for operators: Almost every product that enters their facility, from peanut butter to produce, arrives packaged in corrugated cardboard. Items that are double-boxed with an interior layer of smooth cardboard, such cereal boxes, are safe—but that’s the exception rather than the rule.

Christopher McCracken, director of nutrition services for UC San Diego Health system, has directed his staff to de-box individual items into large plastic containers—though that solution isn’t without hiccups. “If there’s ever a recall, I don’t know what’s affected because of the serial number,” he says. “Like individual [jars of] peanut butter—they don’t have that information on them.”

There’s also a freshness issue. Eisenberg says he has directed staff to rotate old items to the top when refilling the plastic boxes, but says he has no way of knowing if it’s actually happening. “That’s especially the case in places where the whole case isn’t necessarily distributed to a nutrition room,” he says. “In many hospitals, they have a floor stock person who goes around and replenishes supplies. If you’re topping off, how long has the stuff been in the bottom?”

De-boxing also requires two resources operators might be short on: manpower and space. McCracken says the state of California required his new facility to include a de-boxing room in its blueprints, though older hospitals are being grandfathered in. Eisenberg says he had a bit of a “d’oh” moment recently when he realized Swedish hadn’t planned for de-boxing space at a facility that’s already in the middle of construction.

Despite the headaches caused by corrugated cardboard, neither Eisenberg nor McCracken think the bans are a massive overreaction on the part of the certification boards. Eisenberg in particular cited a mock Department of Health survey at a Swedish facility several years ago where an inspector swept a storage room with a black light. “There, on a couple of cases, were little drips and drops and urine-soaked paw prints from rats and stuff—and you’re horrified,” he says. While that issue since has been corrected, “We’re a long way from having a perfect solution—but I think [de-boxing] is going to become a part of peoples’ regular process,” Eisenberg says. “I think, in healthcare, the idea of cardboard will go away.”

More From FoodService Director

Menu Development
ramen bowl spoon chopsticks

Asian noodle soups are a popular lunch option at YouTube’s San Bruno, Calif., campus, says Trent Page, the GM at Bon Appetit Management who runs the company’s three corporate dining venues. But Page noticed an increasing preference for customizable dishes and vegan preparations among the 1,000 customers he feeds daily. Inspired by a recent visit to Japan, he introduced tsukemen to the menu—a dish that features most of the traditional ramen ingredients (noodles, eggs and vegetable garnishes) served separately so diners can mix and match. “Separating the components makes it more customizable...

Ideas and Innovation
chicken dinner

For the last three years, we’ve hosted an event called Winner, Winner, Chicken Dinner. We sponsor the local chapter of Future Farmers of America to raise the chickens, and we have to arrange all the transporting from farms to the distributor, which keeps the birds in a freezer until we’re ready. We build hype by having students vote on the proprietary spice blend they would like on the chicken. It helps the nutrition team get involved in the educational process and showcase local food purchasing.

Ideas and Innovation
employees generation multicultural

We are no longer short staffed, ever. On a given day, missing two team members from a team of 50 would leave us 96% staffed. The actual choice of wording places a positive emphasis on those that did come to serve our guests and patients. We no longer use the phrase “short staffed”; this is a game-changer when we are challenging ourselves as culture facilitators or leaders.

Ideas and Innovation
food symbols allergens

To make safe food as accessible as possible for our guests with allergies, we are creating an allergen-friendly kitchen this summer. Students and community members will be able to use our mobile app to place orders for allergen-friendly food and pick them up at the central kitchen. The kitchen will also produce grab-and-go options that will be distributed across campus.

FSD Resources