Chapter IV

RESULTS AND DISCUSSION

In order to achieve the goal and vision of the Nutrition and Dietetics Service of Hospital

A, standards are established to serve as guide or tool in the evaluation and monitoring of the

performance of the said service. This research focused on the assessment of food service operations

in a hospital in Leyte with the standards set by the Department of Health. Interviews were

conducted to key informants. The researchers agreed not to divulge the identity of key informants

and the subject institution for security and confidentiality purposes.

ADMINISTRATION AND MANAGEMENT

MENU PLANNING

The DOH Hospital Nutrition and Dietetics Service Management Manual (2010) notes that

menu planning is the basic and essential activity in the Nutrition and Dietetics Service. It is

therefore important that the policies and procedures, as well as guidelines, should be carefully

considered. Properly planned menus ensure that patients receive nourishing and safe meals, and

variety of foods within the budget of the institution. The Nutrition and Dietetics Service use a 15

to 30-day cycle menu for patients and personnel. Several factors are considered in menu planning

including: available budget, supplies, manpower, and equipment.

In the Menu Planning standards prepared by Hospital A, their Administrative Dietitian

shall consider budgetary allowances, personnel equipment and seasonal food items availability in

menu planning. The Section Head will review the 28-day cycle menu and shall recommend its

approval to the Chief Administrative Officer (CAO). The 28-day cycle menu shall meet the

nutritional requirement of the different diet orders. The NDS staff shared:
“Kada bulan kami kami nag aandam ngan nagplaplano hin menu.”

“We prepare the menu plan every month.”

A cycle menu is used for the guidance of all production areas. As much as possible, planned

menus should include vegetable and fruits that are in season and are immediately available in the

locality and should be within the skill and capabilities of the dietary personnel, especially the cook.

They should also be within the capacity, condition, and scope of the available kitchen equipment.

Moreover, the planned menus should be flexible. A cycle menu should meet the nutritional

requirements of the person to be served. Aside from its nutritional value, the food must also be

palatable and satisfying for the patients. Also, differences in ethnic, religious, and cultural

background are to be considered. For Hospital A, they prepare special meals for Muslim patients

when pork is their menu for the day.

PURCHASING

Policies and practices in purchasing and receiving foodstuff deliveries vary among

institutions. Based on the standards set by DOH, the Administrative Dietitian should be responsible

for ordering the needed foodstuffs based on the daily menu and patient census, with the approval

of the Chief Nutritionist-Dietitian and the Chief of Hospital.

The person in charge of purchasing should strive to obtain the right product at the right

time, in the right quantity, and at the right cost. Foodstuffs should be purchased either by open

market of competitive bidding. Competitive bidding is established as the principal mode of

procurement but the existence of certain procurement conditions warrants the use of alternative

mode of procurement such as Negotiated Procurement, Shopping, Limited Source Bidding, Repeat

Order, and Direct Contracting. For those procurement projects undertaken through competitive
bidding, procurement tenders/invitations must be publicized in the prescribed media and locations.

Submission of eligibility documents forms a crucial role in the public bidding (DOH Customized

Procurement Manual Volume 2, 2010).

The purchasing policies set by Hospital A state that food procurement shall conform to RA

9184. All supplies shall be procured by Bids and Awards Committee. Food procurement shall be

done by use of petty cash fund, in case of failure in competitive bidding. The NDS will prepare

the Project Procurement Management Plan (PPMP) every third quarter of the current year. The

Section Head will review and sign the prepared PPMP. The reviewed PPMP will be submitted for

recommending approval of CAO and follow-up procurement status will be done by Administrative

Assistant or Dietary Clerk. The NDS will prepare Purchase Requests based on approved PPMP.

However, Hospital A cannot religiously follow their PPMP daily. There are times when there is

an unexpected increase in the number of patients admitted in the hospital. There are instances in

which Hospital A implements Code Blue protocol, meaning the hospital has to prepare additional

food for the employees on duty. Due to these inevitable circumstances, Hospital A practices

shopping procurement to address food demand.

RECEIVING

Receiving is a management responsibility which involves ensuring that the items ordered

are satisfactorily received in terms of quantity and quality. Extra care should be expected in the

checking orders and weighing food being received.

The receiving officer should be a staff Nutritionist-Dietitian or well-trained competent

Nutrition and Dietetics Service personnel. The agency inspector should be present (Internal

Control Service).

Receiving is done to ensure items ordered are satisfactorily received in terms of quantity

and quality and prevent or minimize wastage. Food and Non-food items shall be received and

handled in accordance with good sanitary practice. In Hospital A’s standard of procedures, the

Food Production Supervisor will receive all items in agreement with the original order. The Market

Orders slip must always be on hand to check all delivered against specifications and quantity called

for. The Food Production Supervisor together with the Representative of the Inspection Committee

will check for quantity, quality, weight, labels, etc. of all foods ordered. They shall not accept and

shall return to the supplier any item that is not what was ordered, dented, rusted, damaged cans,

thawed frozen food, damaged produce, poor quality produce (i.e. meat) and items with incorrect

weight. The Food Production Supervisor will sort the received items; direct to food production,

dry storage, and cold storage. He/She will supervise the piling of received items into the proper

storage area. However, this is not always the case in Hospital A. They sometimes allow

unauthorized personnel (i.e their cook) to receive the goods. An informant stated:

“Mayda la kami staff nga parag receive hit gindedeliver nga raw materials ngan

pansahog. Pero kun danay busy hya pagbulig pagdispatch hit mga pagkaon para

ngadto ha wards, it amon cook it nareceive. Ginsisigurado namon it kalidad,

ginrereject it diri napasar ngan iginbabalik ha supplier.”

“We have a staff for receiving deliveries which include raw materials and

ingredients. However, when he’s busy helping in dispatching cooked food for the

wards, one of our cooks receive the deliveries. We make sure the quality of the
products delivered. We reject those that don’t pass the quality control and return

them to the supplier.”

Hospital A NDS staff always check if the deliveries are complete and not yet spoiled nor

expired because these will affect the quality of the food and worse, these will aggravate the

condition of the patients. Sometimes, the hospital encounters problems in the delivery of raw

materials. The staff shared:

“Sometimes replenishment of supply gets delayed and sometimes the supply changes all of

a sudden like for example we wanted fish to be delivered but instead we got a different

meat.”

In addition, the NDS staff stated that whenever they encounter problem/s with the delivery

of ingredients and raw materials, they have no choice but to adjust the menu planned for the day.

STORING AND INVENTORY

In the DOH Manual, storing is the responsibility supplementary to receiving. The proper

storage of food immediately after it has been received and checked, is an important factor in the

prevention and control of loss or waste. Adequate space for storage should be provided in a

location accessible to receiving and preparation area. A store side or trained reliable NDS

personnel should be in charge of the storeroom, under the supervision of a Nutritionist-Dietitian.

Proper storing is essential to retain the quality of food product. In the Hospital A’s

customized standards, the stock clerk, with the supervision of the dietitian, will store the goods

received and all products will be dated upon receipt or when they are prepared.
Dietary supplies may be issued from the Nutrition and Dietary Service storeroom or from

the Property Section storeroom. The process of issuing foodstuffs from the Nutrition and Dietetics

Service storeroom should be guided by the following steps:

 Food should be issued only upon presentation of a properly prepared and signed requisition

slip.

 The requisition slip must contain a list of all items and quantities requested and must

include the signature of the requesting personnel. Prepared and duly signed requisition slips

should be presented to the storekeeper.

 The storekeeper should dispense the food items requested and then record them on the

stock card.

 The storeroom keeper shall be responsible for all the food items issued out.

Hospital A is thoroughly specific in the steps, procedures and manner of storing raw meat,

frozen meat, poultry, eggs and dairy items, fresh fruits, fresh vegetables, canned items, coffee, tea

and cocoa, and juices and dry milk in their customized manual. The hospital has a walk-in freezer

for storing meat products. They also have different refrigerators which are properly labeled for

storing other raw materials.

Aside from the specifications on the procedures in storing raw materials and ingredients,

Hospital A is also particular on the storage are maintenance. Storage area specifications are as

follows:

 Storage area will be easily accessible for receiving new items.

 The walls, ceiling, and floor will be maintained in good repair and regularly cleaned. The

area should be well lit and ventilated. The temperature will be in the range of 50º to 70ºf.

 Shelving will be sturdy and provided with a surface which is smooth and easily cleaned.
 Shelving shall be mounted at least 6 inches from the floor and 18 inches from the ceiling.

 All foods will be stored away from the walls and off the floor.

 Cross-stack bags of sugar, flour, and other commodities to permit air circulation.

 Any opened products shall be placed in seamless plastic or glass containers with tight-

fitting lids or Ziploc bags.

More importantly, food storage area doors must be equipped with locks for security. Hospital

A storeroom is properly equipped with locks to avoid contamination and pilferage.

HYGIENE, SAFETY AND SANITATION

To safeguard the health of patients and personnel, the Nutrition and Dietetics Service

should maintain highest standards of sanitation and safety in all areas of food service. An

understanding of sanitation and safety standards among nutrition and dietetics personnel is a must.

This can be attained through a well-structured training program with the emphasis on sanitary and

safety practices. Routine inspection of all nutrition and dietetics areas and personnel shall likewise

emphasize the importance of sanitation and safety (DOH Hospital Nutrition and Dietetics Service

Management Manual, 2010).

Every hospital should follow infection control practices to reduce the risk of food-borne

illness utilizing safe food storage, handling and preparation methods compliant with government

and local health standards.

The policy on maintaining cleanliness and sanitation of all the kitchen tools and equipment

involves all NDS staff. They must follow a strict procedure, cleaning frequency and schedule on

the following kitchen area and equipment: blender, can opener, carts (tray carts, dish carts utility
carts), refrigerator, walk-in freezer, trashcans, grill-gas, hoods and filters, microwave oven, pots

and pans, stove top, cabinets/drawers, floor and walls and ceilings.

Moreover, Hospital A policy states that:

1. All nutrition and dietetics section staff shall allot 30 minutes to conduct cleaning and

sanitation pre-and post-production.

2. The NDS staff shall maintain the sanitation of the section through compliance with

written and comprehensive cleaning schedules developed for the facility.

3. A cleaning schedule shall be posted with tasks enumerated and assigned personnel for

each one.

The rationale behind this policy is to safeguard and ensures clean food service to patients

and stakeholders involved. As mentioned by Staff Dietitian B during the interview:

“Moreover, we make sure all our staff follow strict proper hygiene and are of proper health

to handle food or go to work. We do not allow sick employees to go to work to avoid food

contamination.”

Pest/Vermin Control

The hospital premises, especially the area where the food is prepared, should be kept clean

and dry, free from flies, insects, vermin, and rodents at all times. Food contaminated by pests and

rodents are a serious public health hazard. Flies and cockroaches may infect the food with the

germs that can cause outbreaks of intestinal diseases like diarrhea, dysentery, gastroenteritis and

cholera. To safeguard the health of patients and personnel, the Nutrition and Dietetics Service of

Hospital A follows the following policies on pest control:

1. Dietary Department will post “No Animals Allowed” signage.

2. Regular spraying with insecticides will be done at least once a month.

3. Insect sprays, fly baits and pesticides will be used as part of the rodent control

program.

4. Cleanliness of the whole area will always be maintained.

Moreover, all doors and windows shall be properly screened, and an organized program of

pest control shall be maintained.

However, since the food preparation area of Hospital A is poorly ventilated, the staff leave

the windows open (without screens) giving unwanted access to flies and other insects.

Accident Prevention

Per Hospital A Nutrition and Dietetics Policy on Workplace Safety, the following must be

strictly followed:

1. The Nutrition and Dietetics shall ensure that all employees use safe habits and

precautions to prevent falls.

2. All NDS staff shall follow safe practices when transporting food.

3. All NDS staff shall practice safe techniques to prevent accidents in cooking and baking.

4. All NDS staff shall follow safety precautions to prevent accidents in food preparation.

5. All NDS staff shall take appropriate measures to prevent accidents in serving food.

6. Safety precautions shall be followed when electric equipment is utilized.

7. Knives shall be handled in a safe manner.

8. Floors shall be maintained in a safe manner.

9. All work areas shall be provided with adequate lighting, ventilation, and humidity

control
As mentioned earlier under Pest/Vermin Control, one of the major concerns of the cooks

in Hospital A is the poor ventilation in the food preparation area, which already violates Number

9 under Policy on Workplace Safety.

In addition, floors should be cleaned and dried daily. However, due to water shortage, they

leave their faucets on all day, letting the sinks overflow with water to be utilized in washing the

trays, dishes and other cooking tools. Hence, their floor in the washing area is always wet which

might be prone to slippage.

Since the management’s emphasis is on the internal environment of the organization, the

Chief Dietitian performs these tasks well with clear understanding of and is responsive to the many

elements of the social, ethical, economic, technical, and political environment which affects his/her

area of operation.

Recruitment, Development and Evaluation of Staff

The recruitment process in the hospital follows a strict compliance that is bound by laws

and regulations in handling all applicants with the unbiased opportunity at applying for a job. The

hospital has its own Human Resource Department that follows these steps:

1. Defining the job description and specification in the pre-recruitment strategy.

2. Reviewing the applicant’s credentials diligently.

3. Interview of qualified candidates.

4. Employment testing which may include cognitive tests, personality tests, and medical

tests among others.

5. Background investigation or reference checking.

6. Final selection in coordination with NDS.

7. Final employment decisions/ job offer or placement to successful applicant.

The hospital strictly follows the steps above to ensure that the organization will be able to

hire the most suitable applicant for the vacant position. As per Staff A’s statement on selection

process:

“During the selection process we look into the applicant’s minimum requirement.

HR makes sure they qualify for the position being applied and we together with the

HR conduct document review for further evaluation.”

According to the DOH manual, opportunities for government employment shall be

available to all qualified individuals. All positive efforts shall be done by the HR to encourage the

most qualified applicants to enter the service. Moreover, employees shall be selected in the basis

of fitness determined by the proper authority as per its duties and responsibilities of the position

based on the merit as provided by the Civil Service Commission (CSC) rules and regulations. The

qualification and appropriate examinations shall be required from the applicant in accordance with

the Civil Service Rules and as embodied in PD 1286 (Hospital Nutrition and Dietetics Service

Management Manual, 2010).

Current Staffing Pattern of NDS

The NDS currently has all its positions filled however, current staff has urged management

to open more positions due to lack of adequate manpower that prevents the NDS from completing

the tasks at hand more effectively. In addition, one staff who is supposed to be assigned or working

for NDS is instead working for a different department. Despite the lack of manpower, NDS

considers the current staff pattern as very efficient in accomplishing their tasks.
As stated by Staff Dietitian A:

“One staff is to two hundred patients (1:200) ratio during early duties and incase of

absences.”

And Staff Dietitian C added:

“So the ideal ratio is around one is to fifty (1:50) especially because we serve 800 patients

per shift ideally 16 staff per shift but now we are currently operating with 8-9 staff

excluding special functions of NDS like additional guests, employees, meetings, and

seminars.”

As mentioned above, NDS occasionally caters food service on certain special occasions

like in-house seminars, hospital meetings and to other additional guests.

As per DOH standard, this table shows the hospital’s standard requirement for personnel

for the NDS. It indicates the total number of personnel, which varies according to the bed capacity.

The higher the bed capacity of the hospital, the more employees are needed. As for Hospital A,

the bed capacity is 500.

Table 1. 2008 Proposed Nutrition and Dietetics Staffing Pattern

Position Bed Capacity

10-15 25 50 75 100 150 200 200 300 400 500

(Level (Level

3) 4)
Nutritionist- 1 1 1 1

Dietitian V

Nutritionist- 1 1 1 1

Dietitian IV

Nutritionist- 1 1 1 1 1 1 1

Dietitian III

Nutritionist- 1 1 1 1 2 2

Dietitian II

Nutritionist- 1 1 1 1 2 3 2 3 5

Dietitian I

Food Service 1 1 1 1

Supervisor III

Food Service 2 1 1 1 1

Supervisor II

Food Service 2 2

Supervisor I

Cook II 1 1 1 1 2 2 3

Cook I 1 1 1 2 1 2 3 3 4 6 7
Administrative 1 1 2 4 6

Aide IV (Food

Server)

Administrative 1 1 2 3 4 6 7 7 10 12 14

Aide III (Food

Server)

Grand Total 3 3 4 7 10 14 18 18 26 34 42

Personnel

Based on the proposed organized Nutrition and Dietetics Service Staffing Pattern for

hospital with a capacity of 500 beds, the required personnel for hospital A is 42 but the current

staff of NDS is only at 17 and has a daily meal serving of 800 per day. This proposed staffing

pattern was based on the data gathered from the survey conducted from different health care levels

under the Department of Health (DOH).

Employee Development

NDS is divided into two groups: first are the cooks/servers, which caters to the actually

cooking and serving of meals and the other one are the registered nutritionists and dietitians which

serves as the supervisors, planners and professionals on the nutritional requirement of patients.

New employees especially employees who applied for regular positions are given six

months probationary status. New employees during this period are given proper training with

regards to NDS’ operations and policies. Moreover, new employees are provided with some basic
background information about the NDS’, culture, and the job itself. This is called as ‘Socialization’

which is defined as the process when an employee learns the norms, values, goals, work

procedures, and patterns of behavior that are expected by the organization (Goldstein and Gilliam,

1990).

Nutritionists rarely undergo official trainings or attend seminars as per interview. They

only had one (1) training in the last three (3) years. This is far from the planned and ideal trainings

and seminars required per employee which should include a minimum of forty (40) hours per

employee per six (6) months. Moreover, nutritionists admitted that they are having a hard time

complying with the required CPD activities under the Continuing Professional Development

(CPD) Law Republic Act No. 10912 of 2016.

As pointed out by Staff Dietitian C:

“Unless if it is a government sponsored trainings/seminar like DOH. However, if we would

want to attend other trainings not sponsored by the government, we have to pay out of our

pockets to attend these trainings and seminars.”

For cooks, they are given occasional trainings not only solely on cooking but also trainings

on handling leftover food and minimizing food waste.

According to the DOH manual, continuous training and development of personnel in the

NDS is essential for efficient food service operation in the hospital. With trainings, employees

would gain effectiveness in their present work and also for his/her future work through

development of appropriate thoughts, habits, actions, skills, attitude etc. towards his/her job.

Moreover, the manual emphasizes continuing education as one of the main concerns in the

management of food service. This includes training programs for new employees, on-the-job
training or in-service trainings for both old and new employees and training for supervisors and

managers. Here are some examples of seminar packages that should be conducted on separate

occasions, depending on the availability of the participants and other factors to be considered most

especially budget:

Seminar I- Basic Foods and Nutrition

Seminar II- Basic Principles of Food Preparation and Sanitation

Seminar III- On the Job Orientation

Seminar IV- Basic Diet Therapy

Seminar V- Health Emergency Feeding

Seminar VI- Food Service Principles

Seminar VII- Energy and Water Conservation

Seminar VIII- Team Building Activities

Seminar IX- Stress management

Seminar X- Spiritual activities

Seminar XI- Value Formation and Integrity Development

Staff Evaluation

One of the most crucial activities of a HR manager in an organization is maintaining and

enhancing the workforce. Performance review is the process in which an employee is assessed and

evaluated carefully by the management (Turacano, 1992). Moreover, performance management is

defined as the ongoing communication process, undertaken in a partnership between an employee

and his/her supervisor (Bacal, 1999).

The hospital conducts performance reviews or evaluation twice a year to all of its

employees. Bonuses will be given to those employees exerting beyond expected performance

during the end of the year. The form used by the hospital is called the Individual Performance

Commitment and Review (IPCR) which monitors the performance of an employee.

However, there are a few employees who are underperforming but were not removed by

the hospital due to powerful inside connections. As mentioned by Staff Dietitian B:

“We submitted several complaints, but no action was done by our HR. We cannot do

anything about it since the employee is well connected with someone powerful in the

hospital.”

Staff Dietitian A also added:

“We also cited a civil service rule because the employee was incurring excessive absences.

We recommended and hopeful that this employee would be sanctioned but nothing really

happened.”

According to the revised DOH Performance Evaluation System under Administrative

Order No. 132-A s.2002 is consistent with the Revised Policies on Performance Evaluation System

embodied under CSC Resolution No. 991792 and CSC MC No. 3 s.1999. The new DOH-PES

adheres to the principle of performance-based security of tenure. This would provide the fair basis

of incentive for performers and applies corresponding sanctions to non-performers. Hence, would

enhance productivity by using performance targets, standards and goals that are attuned to the

organizational mandate (Hospital Nutrition and Dietetics Service Management Manual, 2010).
Hospital A strictly complies with the scheduling of the performance evaluation which is

done every six (6) months ending on June 30 and December 31 of every year.

The DOH manual highlights the importance of performance ratings which shall be used

as the basis for promotion, training and scholarship grants and other personnel actions. Only

employees who can achieve Outstanding and Very Satisfactory Performance Ratings shall be

considered for personnel actions and other related matters. However, employees who obtained

unsatisfactory ratings for two rating periods and Poor rating for one evaluating period may be

dropped or be considered for termination (Hospital Nutrition and Dietetics Service Management

Manual, 2010).

IMPLEMENTATION AND EVALUATION OF POLICIES AND PROCEDURES

The NDS policies and procedures implemented in the hospital are intended to be in line

with DOH Hospital Nutrition and Dietetics Service Management Manual (2010). Such policies

and procedures form the backbone of nutrition and dietetics service and must be made aware to all

the employees of the service. Hospital A has institutionalized customized nutrition and dietetics

policies in the hospital operations. This can be attributed to the need for the hospital to be

accredited to the International Organization for Standardization (ISO).

These customized policies however are simplistic and do not fully conform with the

detailed policies set forth it the manual. Subsequently, the nutrition and dietetics services of the

office needs to be further improved for all of the hospital’s clients.

Policy Awareness

Policies and procedures are important aspects when addressing relevant issues in any

organization whether it would be from public or private organizations.

Policy awareness in this paper is defined as the knowingness of the staff on all the Nutrition

and Dietetics Department’s policies and procedures. Examples are the code of conduct, diet

counseling, garbage disposal, handwashing, hiring, food production etc.

Key informants stated that policies are disseminated to employees of the NDS and are

ensured that monitoring and evaluation tools are used to measure their compliance with the

Mission and Vision and Commitment of Employees

Mission and Vision is essential in aligning everyone in the organization in working on a

single purpose or goal. However during the focused group discussion, the Nutrition and Dietetics

Section (NDS) has their section’s own goals, objectives, mission and vision aside from that of

Hospital A’s. Their main objective is to deliver safe and quality food to patients, staff and other

stakeholders.

Moreover, all the staff under NDS are committed to its mission and vision and it is clearly

being manifested at the workplace. As stated by Staff Dietitian B in the interview:

“Before we start our day, we make sure all things are ready and prepared which includes

all raw materials or ingredients. We double check the quality and reject those ingredients

that are of less quality and return it back to our suppliers. Moreover, we make sure all our

staffs follows strict proper hygiene and are of proper health to handle food or go to work.

We do not allow sick employees to go to work to avoid food contamination.”

Staff Dietitian A also added in the interview:

“We dietitians use a monitoring tool in a form of a checklist like for example if a certain

food handler smell something unusual, or wears mask, hair nets, or if he or she uses a

measuring cup while cooking.”

Implementation of Policies on Administration and Management of Nutrition and Dietetics

Despite having DOH manual to be followed by all hospitals, hospital A is not fully

complying with the standard given its stature.

Lapses on staffing in relation to the number of patients per day put strain to the overall

operations of NDS of Hospital A. Furthermore, the NDS staff are sparsely given opportunities to

attend trainings and seminars relevant to their jobs primarily due to budget constraints, thus

hindering their professional growth and development. As the key informants would note, the

higher ranking employees are prioritized to be sent to trainings related to nutrition and dietetics

subsidized by the hospital while other employees have to use their personal resources to attend

trainings in order to earn CPD units required by the Professional Regulation Commission (PRC).

Moreover, their building and facilities need improvement and upgrading. Immediate

repairs on outdated equipment and rehabilitation of facilities would aid in the ease of food

preparation of the hospital. A newly constructed facility, complete with updated equipment, is

currently being constructed and due to be finished in 2020.

Policy on Clinical Nutrition

The rationale behind this policy is to assist outpatient adhere to the diet regimen provided

by the registered Nutritionist-Dietitian.

Clinical Nutritional policy is as follows:

1. The Nutrition Clinic shall set specific schedule for its operation in each department.

2. Patients shall have the physician’s referral for diet instructions. The hospital referral

slip should have the diagnosis of the patient, pertinent data and diet prescription of the

physician.

3. Patient’s caregiver or family shall be encouraged to participate in the discussion of the

meal plan.

4. The Nutrition Clinic shall provide special lane for senior citizens, pregnant women and

persons with disability.

5. The Nutrition Clinic shall give immediate attention to all clients in the special lane.

However, during the interview it was discovered that certain data or diagnosis essential in

making a proper and accurate diet plan coming from physicians are sometimes lacking

information. As stated by Staff C during the interview:

“This is one of our limitations because we wanted to assess the patient from the start like

in the emergency room so we can access accurately what the patient needs, like we have

instances when we ourselves personally check the history chart of a patient. Some doctors

would say “this patient is for soft diet” but the patient is actually anemic which requires a

specialized diet, added vitamins or adjustment with the diet.”

Being unable to fully perform such policy on patients incapacitate the NDS to its major

role of providing nutritional advises to the patients of the hospital. Furthermore, due to such

limitation, the NDS personnel are restricted to being food managers as one of the key informant

notes.