For Barb Richardson, it's the very definition of comfort food.
An in-patient at UHN's Princess Margaret Cancer Centre, Barb has been undergoing chemotherapy over the past four months in her treatment for brain lymphoma. Such a stay means a lot of hospital meals.
"I was concerned when I first came in, thinking oh no, it's going to be bland, it's going to be Cream of Wheat every day," Barb says with a smile. "But it's really good food, exceptional choices."
Implemented as a trial in fall 2024, CBORD Room Service Choice — part of UHN Nutrition Services' improvement initiative, which is known as myPlate — gives in-patients such as Barb at the Princess Margaret, Toronto General Hospital, Toronto Western Hospital and Toronto Rehabilitation Institute sites, an opportunity to choose their meals with the UHN Nutrition Services team.
A dietary aide visits daily to take the patient's orders for the next day's lunch and dinner, and the following day's breakfast, using a digital tablet to access CBORD Room Service Choice, which is linked to the Epic health information system. The menu choices, which are appropriate for the type of diet ordered by the patient's care team, are prepared and delivered at mealtime.
The result of a partnership between Nutrition Services, UHN Clinical Nutrition and UHN Digital, the system replaces one where in-patients received standard food trays or ticked choices on paper menus. The goal is to enable patients across multiple UHN sites to make menu selections to improve patient satisfaction, promote food consumption and reduce overall food waste.
An app for patients to make their choices independently, is underway as part of the myPlate rollout.
"When people can select what they want to eat, they're typically going to like it, so they're going to have the proper intake and that helps in their recovery," says Dylan Xu, Nutrition Services Manager for Patient Food Delivery at TGH, TWH, the Princess Margaret and the Princess Margaret Lodge.
A registered dietitian, Dylan helped implement the CBORD Room Service Choice program at BC Children's and Women's Hospital in Vancouver. When he joined UHN in September 2023, he was able to bring the knowledge of that project to the work being done here.
"This is restructuring and revolutionizing the provision of hospital nutrition," Dylan says. "People have long talked about hospital food as non-appetizing, but this is changing the perspective on that."
UHN is looking at a phased plan to improving both the food and the service provided to patients. The four-phase initiative, launched in 2023, was named myPlate to represent the level of customization and control patients said they want.
The first phase, which was completed in the spring of 2024, was the revamping of the in-patient menu to incorporate more fresh entrees, salads and sandwiches. The second phase was split into two parts: the initial one was the launch of CBORD Room Service Choice last fall, offering patients choice at meals with the assistance of UHN Nutrition Services staff; the second is rolling out the app, which will allow patients to make meal selections independently.
The third and fourth phases will focus on improved levels of service.
"Our goal is to continuously make our food and the service we provide better for our patients in order to contribute to better health outcomes," says Laura Bernstein, Director of UHN Nutrition Services.
Madhvi Sharma, a dietary aide at the Princess Margaret for more than 20 years, has been using the tablet to collect patient menu choices over the past five months. She says not only are patients happy with the food selections, they also like having the daily interaction with her.
"There's much more communication now than there was when I just came in and delivered their tray," Madhvi says. "We talk about food, but sometimes we talk about their family and other things, too."
Madhvi says she and other dietary aides also feel more a part of the patient care team with myPlate.
"I talk with the doctors, nurses, physiotherapists and others more now," she says. "They will see me working with patients, helping them make their food selections and often will join the conversation."
Barb Richardson's husband, Wayne Burnett, says his wife "absolutely loves the food and the choices are terrific." As the person who did most of the household cooking and made her favourite meals before Barb was admitted to the Princess Margaret, he says there was concern about her diet when she came to the hospital.
"But I've been here enough with Madhvi to know the food is really good and that is very comforting," says Wayne, who still sometimes brings in breakfast for variety or some of his wife's favourite homemade treats such as a ginger cake. "Barb really appreciates the work Madhvi and the others who take care of the meals do for her everyday."
On a recent visit, as Wayne watched on, Madhvi spent about five minutes talking with Barb about the choices for her next three meals. Lunch featured squash soup and barbecued beef and cornbread, while dinner was herbed chicken, vegetable couscous and broccoli. The following day's breakfast choices included a hard-boiled egg, bran muffin and blueberry yogurt. Tea was the chosen drink with each meal.
The menu selections complete, Madhvi says goodbye until the next day, then moves to the next room.
"It's so nice to see her familiar face everyday," Barb says of Madhvi. "What I like is when I tell her I need to figure out what I'm going to have for lunch tomorrow, she'll rhyme off all of the things I really like because she knows.
"I can't compliment her enough. Same for the whole team. They're great."
