Table 1 Factors that promote or inhibit optimal nutritional carefrom the perspective of the production kitchen, the ward and the hospital management.

Frequent contact to the nursing staff and patients

Lack of contact to the nursing staff and patients

That the kitchen follows the food right until it is served to the patient

That the kitchen does not follow or have any influence on how the food is served

High visibility within the organisation and hence the possibility to enhance knowledge of and respect for the kitchen staff's work from other professional groups

Low visibility within the organisation with the result that other professional groups know little about the kitchen staff's work.

Lack of economic latitude

The hospital ward's perspective:

That a professionally trained person works actively with nutritional care and has the necessary time to do so in practice

Lack of time for nutritional care, which is therefore accorded low priority

The presence of key personnel or committed individuals

That responsibility for the practical implementation of nutritional care is collective, but that only few are actively engaged

That the hospital ward can provide different types of food 24 hours a day, and that the staff serve these food items to the patients

That formal responsibility for nutritional care lies with the physicians, who rarely involve themselves in nutritional issues

The availability of cross-disciplinary guidelines for tracing patients at risk and for implementing nutritional care of various categories of patient

That the clinical dietician's expertise is underutilised

That the nursing staff are unable to provide food outside the fixed mealtimes

The hospital management's perspective:

Clear signals from management about the importance of optimal nutritional care

Weak or lacking signals from management about the importance of nutritional care

Access to management tools for quality assurance, support and assessment of nutritional care

Absence of management tools for obtaining the insight to be able to assess nutritional care at departmental level

Resources to follow-up and support implementation of nutritional care guidelines