The Tray Matters

In 1998, Jackson County Memorial Hospital in Altus, Okla., received an overall meal service score of just 38% in its Press Ganey survey. By 2003, that number had soared to 93%. Key to the positive reviews—although not the only reason—was improvements made to patients’ tray, says Danielle Jensen, R.D., director of food and nutrition.

“People eat with their eyes first,” says Jensen. “You don’t want to overwhelm them with portions; you don’t want to overcrowd the plate. Patients can lose their appetite quickly if there is too much food and they grew up having to clean their plate.”

Paying attention to details was just one of the lessons learned from consulting firm Don Miller and Associates, hired to facilitate change in the hospital’s foodservice program.

Presentation is very well planned at Jackson County. Not only are the plate cover, plate bottom, mugs and bowls color coordinated, but the tray and tray liner also match. And because color is a critical element, explains Jensen, staff members avoid having one-color meals. If the meal contains corn and peaches, for example, cranberry salad is added to brighten the plate. Edible garnishes like fresh chopped parsley or ground paprika sprinkled on menu items are also used. Also, staff make sure the plates look clean and neat and not thrown together.

Seeing the tray from the patient’s point of view is key, notes Jensen.

“In addition, we make sure we serve what we say we’re going to serve,” Jensen says. “If we are serving oven-browned potatoes, then the potatoes are browned. Grilled chicken has grill marks.”

Item placement also makes a difference. Since most people are right-handed, the mug is placed on the lower right side of the tray with the handle at 4:30 (imagine a clockface.) Silverware—not disposables unless requested by patients—goes toward the bottom right for easy reach. “You want everything there for the patients so they don’t have to hunt for things,” says Jensen. The condiments are placed in a small container so they’re not scattered all over the tray.

“It looks so much nicer,” notes Jensen.

To train employees to do things consistently, photographs of trays showing proper food and servingware placement are used. “A picture shows details that you may not normally catch when you are in a hurry to serve the customer great hot food,” says Jensen.

Garnishes and presentation: At Memorial Sloan-Kettering Cancer Center in New York City, which has always enjoyed high customer satisfaction ratings—it ranked in the 99th percentile for overall food quality in the second quarter of 2012—making meal trays look appealing is another way of encouraging patients to eat better.

“Patients already have existing barriers and poor appetites and are not excited about food to begin with,” says Veronica McLymont, R.D., director of food and nutrition services. “Imagine if the tray does not look appealing. An attractive tray, one that’s put together well, will encourage them to eat, or try to eat, even before they taste the food.”

MSKCC uses a larger than typical tray, that McLymont says “is a crisp, beautiful black.” A customized liner with a muted design of fruit and leaves adorns every tray, with coordinating napkins. Meals are served on white china with actual flatware; the only plastic is for patients in isolation.

Eye appeal is furthered with a food and nutrition department-branded logo that appears on the menu, napkins and all printed materials. The logo’s design is a soup ladle with a heart inside and the tag line, “Care in Food.”

Employees, known as expeditors, are responsible for placement on the tray. They use drawings to guide them where items go, depending upon what patients order.
“Garnishing is very important to us,” says McLymont. Chefs use microgreens, thyme, basil, strawberries and lemon wedges to coordinate with meals.

McLymont is particularly proud of the presentation of puréed food for patients with swallowing issues, such as those with head or neck cancers. “They usually have a runny diet that’s very unappealing and doesn’t taste good,” she says.

Now, whatever a patient orders can be puréed. For breakfast there is French toast custard that’s shaped and tastes like French toast. For dinner, chicken paté with mashed sweet potato and carrots may be on the menu

“When it’s served, it’s decorated with sauce and a swirl—just like a restaurant,” McLymont says.

Letting the food shine: At the University of Missouri Hospital in Columbia, food reigns supreme. While presentation is important, for Rocky Galloway, a former restaurant owner now turned chef and supervisor of patient foodservices, “it’s more about the food, not the utensils and servingware. We’re bringing restaurant sensibility to hospital cooking.”

Under Galloway’s direction, foodservice is focused on fresh ingredients and housemade menu items, and the tray is a vehicle to showcase these offerings. Visual appeal comes from the food itself. The colors from freshly steamed vegetables make the tray look better, says Galloway. “I like the foods to be vibrant in color. It helps people have more appetite,” he says.

To ensure food is served hot—Galloway’s menu includes fresh salmon, oven fried chicken, Jamaican spiced kebabs with chicken and vegetables and shrimp scampi—an induction-based warming system on the tray carts keeps food at its proper temperature as trays make their way from the kitchen to the patients’ rooms. “We use a monitor to track every tray in the system, so we can control how long it’s been sitting, how long it takes to get to the patient,” explains Galloway. “No hot things are served cold and no cold things get hot.”

Since he started, the hospital has experienced its highest jump in customer satisfaction, moving from 72% to 92% in one year, says Galloway. “Once we started focusing on the food, everything really started to blossom.”