This qualitative research aimed to study hospital food safety development and network, food safety development process, success factors supportive to hospital food safety as well as constraints. The study was done at 4 food safety model hospitals of Department of Health Service Support, Ministry of Pubic Health; Chiang Rai Prachanukrao, Khon Kaen, Ratchaburi and Songkla hospitals. Key informants were hospital administrators, nutritionist, multidiscipline health team, support groups from within and outside hospitals. Data collection used interview, observation, focus group discussion and evidence-based document review, for systematically explaining and synthesizing phenomena.
The study results found all of the four hospitals were tertiary care service level while having 480-1000 beds with food service delivery 500-1000 persons per day. The Nutrition Department of each hospital produced and managed food services for general, special, case-specific and tube-liquid meal patients. The food was also serviced for hospital staff, patients’ relative general visitors by the hospital food outlet welfare unit.
For development on hospital food safety policy, this was originated from the hospital accreditation policy while later in 2004 the Thai Government announced to be one of the national development agendas. The Ministry of Public Health by Department of Health Service Support has launched the food safety pilot project at 4 hospitals, and therefore initiated many model development activities while integrating the food safety with other health care activities.
For the key aim of development of hospital food safety, it found that the hospitals wanted their food service being clean and safe for their customers and staff. Also, they wished to build customers’ capacity in selection of buying a safe food, to advocate the hospital food service out let to produce hygiene food, and to encourage hospital staff being a good health behavior model and to extend the food safety to other institutions and communities.
For the development of hospital food safety process, this found all hospitals has established the food safety committee and taskforce while being the key human resources who developed food safety model and activity both within and outside hospital. The activities were firstly finding safe raw materials by incorporating with provincial and district agricultural and poultry offices. They also explored source and product network as well as coordinator for producing and transporting raw materials to the hospitals. Development of hospital food safety standard applied the food sanitation standard of Ministry of Public Health 30 items with additional assigned criterion made by the committee and taskforce. Surveillance was made on raw material contamination, cooked food and utensils, and catering food to the wards. Follow-up and evaluation was made by sampling food for investigation for health hazard and harmful. Development and extending food safety network, the hospitals have expanded to other settings, i.e., food safety farmer group, coordinating and technical support network, hospital weekend food market network, food safety hospital network, school network, prison network, monastery and hospital food outlet network. The development of these network applied participatory process with brainstorming in problem search, co-implementation, organizing knowledge building event for the network. Also, the hospitals have learnt with the network, done followed-up and evaluation as well as made network visits.
For the supportive factors which leading to the success, these were development and policy translation activities; 1) food safety policy of Ministry of Public Health and province, hospital health service quality policy, the hospitals translated these policy directly and indirectly to committee and taskforce for policy implementation, 2) support of the hospital administrators while all prioritized and provided various resource to the committee and taskforce, 4) clear assignment and support of team work oriented, each hospital clearly appointed the committee and taskforce, which consisted of health team representing from each hospital department with a clear division of job responsibility, 4) resource allocation, the hospital administrators have provided financial support for office and building space set-up for proactive activities to both within and outside hospitals, 5) modification of system and method in support of hospital food safety, which were modifying purchasing procedure, opened system by encouraging the farmer group together with responsible hospital staff setting the price of product, food menu adjustment in line with the raw material availability as well as local vegetable and seasonal fruits, 6) building motivation force, the hospital administrators admired and appraised the hospital food safety team at the hospital meeting, general public and reward, beside the hospitals presented the “Food Safety” and “Clean Food Good Taste” banners to the networks that could pass the hospital food safety assessment criteria, 7) team strength, it found that the core team played a critical role contributing to the project success, the team was at high leadership, continuous and proactive, intentional, devoted, organization beloved, consultation and exchanged ideas even now no new policy and financial support from the central government.
For supportive factors which arisen from outside hospital; these were local policy, provincial food safety and consumer protection policy and collaboration of other agencies. The limiting factors to the hospital food safety were 1) raw materials produced by local farmers did not meet the hospital demand and listed even the hospital tried to adjust the menu suited to the raw product availability, the remote network lacked of management competency and hardship of transporting raw materials to the hospitals, 2) discontinuous of central policy and financial support, 3) lack of suitable performance indicator used for assessment of the project as well as lack of knowledge on systematic evaluation, 4) implementation by sectoral government agencies could not done in a full integration manner, and 5) the administrators failed to pay attention to the hospital food safety program.
The overall outcome arisen from the hospital food safety program which found mass advocacy to the development of food safety movement within and outside hospital. These were; origination of many safe food producers supplying to the hospital and increased farmer income, the hospital food service were safe and satisfied by the customers and hospital staff, the hospital adjusted its menu fitted to local seasonal raw product and availability, the food handlers changed their process for hygienic and safe food, advocacy to the emergence on development of food safety in community hospital, school, prison and monastery, and collaboration encouragement between the hospital and local institutions for the development of safe food for consumers.