Learning Outcome 6
Apply knowledge of management principles and systems in planning, monitoring, and evaluating dietetic services and practice for effectiveness, efficiency and cost-containment as part of quality improvement.
Artifacts:
Artifact 1 – NUTR6003 – Supervised Practice II – Cherokee County Food Service Rotation Evaluation
Reflection:
During the Coordinated Program, the first rotation I completed was a 180 – 200 hour food service rotation with the Cherokee County School Nutrition program. Since I had not done a rotation before and had little experience working in the food service industry, aside from a brief stint as a server, I was not sure what to expect.
North of Atlanta, Cherokee is a large suburban county. The Cherokee Nutrition program provides nutritious breakfast, lunch and snacks to students and staff in the county. Their goal is to improve students’ nutrition status, health and academic performance through the food they provide. My time at Cherokee allowed me to apply the management principles I had learned in my classes at Georgia State University (GSU) and participate first-hand in planning, monitoring and evaluating dietetic services. All of which helped the county to be more effective and efficient at keeping costs down and provide the best nutrition possible for the children.
The 2012 – 2013 school year, when I completed my rotation, marked the first year a series of new federal regulations promulgated by the United States Department of Agriculture that mandated a new menu pattern and stricter nutritional standards were introduced. These regulations, surrounding school breakfast and lunch, made it difficult for the county to keep costs down while providing healthy meals for students. I worked alongside my preceptor, Linda Dittrich, to help her design nutritious menus for the Elementary, Middle and High School students. The regulations required offering more fruit, vegetables and whole grains to the children and meeting set calorie limits. Menu planning was made even more challenging through required daily minimums on fruits and vegetables, which were essential to meet in order to receive government reimbursement. I found the trickiest food group to incorporate successfully into the menu was the vegetable group. This was because the regulations necessitated several subgroups to be served weekly: dark green, red/orange, legumes, starchy and other. Since the children are required to take a fruit or vegetable with each meal, Cherokee made sure to offer a wide variety of selections in order to prevent plate waste.
To help the county avoid plate waste and gain some insight into children’s’ preferences, I worked with another intern to design a plate waste study for the summer feeding program. We decided to focus our study on fruit, as it is one of the required components children ages one to eighteen must take at each summer feeding meal. Specifically, we selected medium-sized cut oranges (6 slices) and whole medium-sized apples. Both of the fruit selections were served fresh and pre-bagged. We also wanted to collect data to see if gender had anything to do with the amount of fruit wasted. Neither of us had conducted a study like this before, so we were not sure what the best way to approach it was. We brainstormed different data collection methods and ultimately created a sheet with columns that listed the amount of fruit consumed: None, 1/6, 2/6, 3/6, 4/6, 5/6, or all. The sheet also included a box where we recorded the gender of each child. We conducted the study during the lunchtime feeding at the Canton YMCA, one of the summer feeding sites in Cherokee county; we collected data at this site over the course of two days.
On the first day, sliced oranges were served as the fruit option. The children were required to take a fruit (oranges), a vegetable or both as part of the reimbursable meal requirement. 65 lunches were served and 39 children selected oranges (60%). Of the 39 children that selected oranges, 11 males and 12 females consumed 1/3 or more of their oranges. Therefore, 59% of children that selected oranges ate more than 1/3rd of their fruit.
On the second day, whole apples were served to the children. On this day, 75 lunches were served and 55 children chose apples (73%). Of the 55 children that selected apples, 12 males and 9 females consumed 1/3 or more of their apples. Therefore, only 36% ate more than 1/3 of their apple. Overall, we found that even though more apples were selected as the fruit choice, more of the apples were wasted than the oranges. We were shocked and saddened to see that 49% of apples and 39% of oranges were discarded whole! Many times the fruit was not even taken out of the bag.
I was optimistic going into the study. It did not seem like it would be very difficult to record how many children took a particular fruit and observe how much each child ate of the fruit. However, I soon realized my assumption was incorrect and found myself digging through the trashcan to make sure we had accurate data. The amount of waste was surprising and reinforced the need for the county to offer children a wide selection of fruit and vegetable options. Allowing them to select something they will enjoy and not discard.
I believe this was a successful study. It permitted us to gauge the amount of waste that was occurring. If I had more time, it would have been interesting to see if more apples were wasted than oranges because the children preferred oranges, or because the oranges were pre-sliced.
In addition to the plate waste study, I worked with the same intern to create a sensory evaluation to test potential new menu items for the 2013 – 2014 school year. We decided to conduct the evaluation using a preference test to see what sensory aspects of each food our population preferred. We had conducted a sensory evaluation in our food science class so we decided to use a similar scorecard because it worked well. The scorecard we created asked participants to try each of the three menu items (kale salad, roasted chickpeas and charro beans) and rate their level of likeability for each in the following categories: overall likeability, appearance, aroma, taste, color and texture. Since the school year had ended, we were unable to test the new food items on students. Instead, we selected a population of approximately 25 school nutrition employees, food service employees and custodians. We believed this group was an appropriate audience for the study because these individuals work in the school system and frequently consume the school’s food. If we had conducted the sensory evaluation on a group of children, we would have designed a more kid-friendly score card with less complex categories such as smell instead of aroma, and feel instead of texture. We would also use smiley faces to rank preference and ensure understanding.
There were a couple of unexpected hiccups in our study that required us to think fast and make adjustments. The cooks decided to make two versions of the kale salad, raw and steamed. They also accidentally served the roasted chickpeas warm and the recipe called for them to be served chilled. We embraced these mistakes and quickly revised our scorecard to ask participants to taste and rank both kale salad preparations. We also conducted a second evaluation the following day to test the chilled chickpea dish. Since we needed to update the scorecard to include the cold chickpea dish, we also included two additional new menu items, whole-wheat cornbread muffins and Mexican mashed potatoes. It was beneficial for us to return the second day to conduct the sensory evaluation because we were able to collect data on more menu items for the county.
In addition to asking participants to rank their level of preference, we also included questions for overall favorite and least favorite and to see if they felt the menu items would be something students would purchase in the cafeteria. We also asked them what grade levels they served as some menu items may be more appropriate for certain grade levels.
Our data showed that the Mexican mashed potatoes ranked highest in overall likeability at 8.3 (like very much) and the charro beans ranked the lowest at 5.5 which is slightly above neutral. All of the other menu items ranked between neutral and like moderately. The Mexican mashed potatoes were also overwhelming listed as the population’s favorite recipe. This was consistent with our overall likeability data.
Finally, we queried participants to see whether or not they believed students would purchase the new menu items in the cafeteria. 50% of the population recommended starting to serve the Mexican mashed potatoes in the cafeteria. All of the other menu items received less than a 50% vote. Through conducting this sensory test we were able to justify for Cherokee County what recipes they should move forward with and try for the coming school year.
Before starting the CP program, I did not realize the food service industry was a career path for Registered Dietitians. Linda and the rest of the team in Cherokee county taught me the importance of the RD’s role in school nutrition and showed me how a RD can positively impact the nutrition of children. The skills I learned during my rotation are invaluable and I appreciate the team’s dedication to my growth as a future RD.
Artifacts:
Artifact 1 – NUTR6003 – Supervised Practice II – Cherokee County Food Service Rotation Evaluation
Reflection:
During the Coordinated Program, the first rotation I completed was a 180 – 200 hour food service rotation with the Cherokee County School Nutrition program. Since I had not done a rotation before and had little experience working in the food service industry, aside from a brief stint as a server, I was not sure what to expect.
North of Atlanta, Cherokee is a large suburban county. The Cherokee Nutrition program provides nutritious breakfast, lunch and snacks to students and staff in the county. Their goal is to improve students’ nutrition status, health and academic performance through the food they provide. My time at Cherokee allowed me to apply the management principles I had learned in my classes at Georgia State University (GSU) and participate first-hand in planning, monitoring and evaluating dietetic services. All of which helped the county to be more effective and efficient at keeping costs down and provide the best nutrition possible for the children.
The 2012 – 2013 school year, when I completed my rotation, marked the first year a series of new federal regulations promulgated by the United States Department of Agriculture that mandated a new menu pattern and stricter nutritional standards were introduced. These regulations, surrounding school breakfast and lunch, made it difficult for the county to keep costs down while providing healthy meals for students. I worked alongside my preceptor, Linda Dittrich, to help her design nutritious menus for the Elementary, Middle and High School students. The regulations required offering more fruit, vegetables and whole grains to the children and meeting set calorie limits. Menu planning was made even more challenging through required daily minimums on fruits and vegetables, which were essential to meet in order to receive government reimbursement. I found the trickiest food group to incorporate successfully into the menu was the vegetable group. This was because the regulations necessitated several subgroups to be served weekly: dark green, red/orange, legumes, starchy and other. Since the children are required to take a fruit or vegetable with each meal, Cherokee made sure to offer a wide variety of selections in order to prevent plate waste.
To help the county avoid plate waste and gain some insight into children’s’ preferences, I worked with another intern to design a plate waste study for the summer feeding program. We decided to focus our study on fruit, as it is one of the required components children ages one to eighteen must take at each summer feeding meal. Specifically, we selected medium-sized cut oranges (6 slices) and whole medium-sized apples. Both of the fruit selections were served fresh and pre-bagged. We also wanted to collect data to see if gender had anything to do with the amount of fruit wasted. Neither of us had conducted a study like this before, so we were not sure what the best way to approach it was. We brainstormed different data collection methods and ultimately created a sheet with columns that listed the amount of fruit consumed: None, 1/6, 2/6, 3/6, 4/6, 5/6, or all. The sheet also included a box where we recorded the gender of each child. We conducted the study during the lunchtime feeding at the Canton YMCA, one of the summer feeding sites in Cherokee county; we collected data at this site over the course of two days.
On the first day, sliced oranges were served as the fruit option. The children were required to take a fruit (oranges), a vegetable or both as part of the reimbursable meal requirement. 65 lunches were served and 39 children selected oranges (60%). Of the 39 children that selected oranges, 11 males and 12 females consumed 1/3 or more of their oranges. Therefore, 59% of children that selected oranges ate more than 1/3rd of their fruit.
On the second day, whole apples were served to the children. On this day, 75 lunches were served and 55 children chose apples (73%). Of the 55 children that selected apples, 12 males and 9 females consumed 1/3 or more of their apples. Therefore, only 36% ate more than 1/3 of their apple. Overall, we found that even though more apples were selected as the fruit choice, more of the apples were wasted than the oranges. We were shocked and saddened to see that 49% of apples and 39% of oranges were discarded whole! Many times the fruit was not even taken out of the bag.
I was optimistic going into the study. It did not seem like it would be very difficult to record how many children took a particular fruit and observe how much each child ate of the fruit. However, I soon realized my assumption was incorrect and found myself digging through the trashcan to make sure we had accurate data. The amount of waste was surprising and reinforced the need for the county to offer children a wide selection of fruit and vegetable options. Allowing them to select something they will enjoy and not discard.
I believe this was a successful study. It permitted us to gauge the amount of waste that was occurring. If I had more time, it would have been interesting to see if more apples were wasted than oranges because the children preferred oranges, or because the oranges were pre-sliced.
In addition to the plate waste study, I worked with the same intern to create a sensory evaluation to test potential new menu items for the 2013 – 2014 school year. We decided to conduct the evaluation using a preference test to see what sensory aspects of each food our population preferred. We had conducted a sensory evaluation in our food science class so we decided to use a similar scorecard because it worked well. The scorecard we created asked participants to try each of the three menu items (kale salad, roasted chickpeas and charro beans) and rate their level of likeability for each in the following categories: overall likeability, appearance, aroma, taste, color and texture. Since the school year had ended, we were unable to test the new food items on students. Instead, we selected a population of approximately 25 school nutrition employees, food service employees and custodians. We believed this group was an appropriate audience for the study because these individuals work in the school system and frequently consume the school’s food. If we had conducted the sensory evaluation on a group of children, we would have designed a more kid-friendly score card with less complex categories such as smell instead of aroma, and feel instead of texture. We would also use smiley faces to rank preference and ensure understanding.
There were a couple of unexpected hiccups in our study that required us to think fast and make adjustments. The cooks decided to make two versions of the kale salad, raw and steamed. They also accidentally served the roasted chickpeas warm and the recipe called for them to be served chilled. We embraced these mistakes and quickly revised our scorecard to ask participants to taste and rank both kale salad preparations. We also conducted a second evaluation the following day to test the chilled chickpea dish. Since we needed to update the scorecard to include the cold chickpea dish, we also included two additional new menu items, whole-wheat cornbread muffins and Mexican mashed potatoes. It was beneficial for us to return the second day to conduct the sensory evaluation because we were able to collect data on more menu items for the county.
In addition to asking participants to rank their level of preference, we also included questions for overall favorite and least favorite and to see if they felt the menu items would be something students would purchase in the cafeteria. We also asked them what grade levels they served as some menu items may be more appropriate for certain grade levels.
Our data showed that the Mexican mashed potatoes ranked highest in overall likeability at 8.3 (like very much) and the charro beans ranked the lowest at 5.5 which is slightly above neutral. All of the other menu items ranked between neutral and like moderately. The Mexican mashed potatoes were also overwhelming listed as the population’s favorite recipe. This was consistent with our overall likeability data.
Finally, we queried participants to see whether or not they believed students would purchase the new menu items in the cafeteria. 50% of the population recommended starting to serve the Mexican mashed potatoes in the cafeteria. All of the other menu items received less than a 50% vote. Through conducting this sensory test we were able to justify for Cherokee County what recipes they should move forward with and try for the coming school year.
Before starting the CP program, I did not realize the food service industry was a career path for Registered Dietitians. Linda and the rest of the team in Cherokee county taught me the importance of the RD’s role in school nutrition and showed me how a RD can positively impact the nutrition of children. The skills I learned during my rotation are invaluable and I appreciate the team’s dedication to my growth as a future RD.