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

From: Nutritional care of medical inpatients: a health technology assessment

Promotive factors Inhibitory factors
The production kitchen's perspective:
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