Introduction to Patient Choice Standard

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Having the ability to choose their food impacts on how much patients eat and their experience in hospital.

Ensuring patients have different options and a variety of tastes, textures, colours and food presentations prevents them from getting tired of the menu or developing menu fatigue.1

The Patient Choice Standard guides how often different food groups should be offered and the choices that should be part of the menu. This ensures patients are offered a range of foods consistent with the core food group recommendations.2 It also makes sure that healthcare facilities across the state offer consistent food services to patients and promotes equity.

The Patient Choice Standard ensures that patients are able to:

  • choose a diet that will provide them with the recommended number of serves from each of the core food groups, as outlined in the Australian Dietary Guidelines
  • eat foods and drinks at their preferred mealtime, e.g. tea for breakfast and supper
  • select from a menu that aligns with the guiding principles of the Nutrition Standards.

Respecting patient preferences and choice

NSW Health prioritises patient preferences and choice in food provided in facilities.

Including consumers in the menu design process can identify cultural preferences to be incorporated in menus at a facility and ensure that preferences and choices are available for that patient cohort.

Systems should be in place to minimise instances where patients do not have a choice and support them to meet their nutritional needs. Instances where support may be required include when the patient:

  • is unable to select foods for any reason, e.g. absence at time of ordering, fatigue, cognition, language, unable or unwilling to engage
  • does not consume food because they cannot reach it or open the packaging
  • is not provided with suitable options to choose from
  • where there are no food options on the menu that meet a patient’s taste preference
  • is on a default or non-select diet (as defined in the glossary).

The Patient Choice Standards include four components:

    Overall menu design actions

    Actions to plan, design and review a menu that prioritises patient needs and preferences. Considerations include length of stay and menu review.

      Actions for each menu item, e.g. bread or soup, when developing a menu. Following the menu item actions will allow for variety within meals and across the menu cycle.

      Minimum number of options

      Minimum number of options: outlines the minimum options of a food item to be on a menu. They can be used for two purposes:

      1. To design a menu that provides variety and choice.
      2. To be able to easily assess and benchmark a menu for variety and choice.

      To allow flexibility in the service delivery models, menu planning and implementation, the number of main meal options and menu patterns are not specified.

      Facilities are encouraged to extend the meal service by offering additional items and options. It is intended that facilities have flexibility in service models, menu planning and implementation to meet the needs of their patients.

      Standard serve size

      Set for specific menu items. The following were considered in developing the standard serve sizes:

      • Minimum serve size acceptable to patients
      • Food industry norms which influence the packaging size of portion-controlled products
      • Serve sizes set in other jurisdictions.

      Setting

      There are variations in the adult Nutrition Standards by setting, specified by:

      • Acute care facility
      • Mental health facility
      • Short stay.

      Assessing your menu

      A menu should comply with the actions outlined in the overall menu design actions.

      The menu should also be assessed against the actions for each menu item included in the columns:

      • minimum number of options
      • minimum standard serve size
      • menu item actions.

      Patients in mental health facilities

      A consideration when designing menus for patients in inpatient mental health facilities is variation in the length of stay. Patients may be admitted for a shorter length of stay to manage an acute presentation, or they may have a long length of stay which ranges from months to years in duration.

      As a result, the menu in mental health facilities may need to be designed with a larger number of choices to prevent menu fatigue for these patients.

      References

      1. do Rosario V, Walton K. Hospital Food Service. 2019. DOI: 10.1007/978-3-319-75388-1_74-1.
      2. Australian Government National Health and National Medical Research Council. Australian Department of Health and Ageing. The Five Food Groups. Canberra: Australian Government; 2015 [cited 11 Mar 2022].
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