How the VA foodservice system adapted to COVID-19

The Veteran’s Health Association is the nation’s largest integrated healthcare system, operating 171 medical centers across the country. So when it came to helping the system’s foodservice program—which employs some 10,000 staffers and serves an average of 32 million meals per year—deal with COVID-19, leadership at the national office knew there couldn’t be a one-size-fits-all approach.

“We tried to issue guidance as quickly as possible in March of 2020. But from the national level, we were very sensitive to make it flexible with recommendations instead of prescriptive directions,” explains Veterans Health Association National Director of Nutrition and Food Services Anne Utech, PhD, RDN, LD.

With different parts of the country experiencing different transmission rates, the goal was the provide guidance that would help foodservice teams at individual hospitals best manage their own situation—and decide on their own when to make changes as needed. After all, “the foodservice workers were the ones that needed to be agile and work with local command for their daily changing situation,” says Utech.

Utech and her team met with the CDC early on to make sure the VA had a clear understanding of the CDC’s recommendations and protocols. “At the time they didn’t have anything specific for healthcare foodservice, but they did have recommendations linked to disinfectants, PPE use,” Utech says. “We wanted to serve as a translator between our hospitals and the CDC to fill the gaps of what our workers might be wondering about.”

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Photo: Photo of U.S. Navy Veteran Rocky Thomas imitating the Rhoda Nyberg “Grace” painting as part of a VA Nutrition and Food Service photo contest. Photo taken by Julie Augustyn, dietitian at the VA Community Living Center in Martinez, Calif. 

That meant providing guidance on disinfection protocols and PPE use for foodservice workers in direct contact with patients versus workers who didn’t interact with patients. “We listed some alternatives for the kitchen, like rubber gloves, face shields and rubber aprons that weren’t medical grade. We wanted foodservice areas to realize there were alternatives if they weren’t in direct patient care,” says Utech.

The guidelines also encouraged supervisors to conduct refresher training for workers who weren’t used to delivering food to at-risk populations. “We directed supervisors to be sensitive to that and do compliance checks as needed,” Utech says. The Orlando VA Healthcare System, for instance, opted to ensure that 100% of their Food and Nutrition Service staff were ServSafe certified to ensure safe foodservice handling to veterans.

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The national office also served as a coordinator to help individual hospitals navigate their changing situations, like diverting staff from areas where transmission rates were low to areas that were experiencing surges. When New Orleans was hit hard in the beginning of the pandemic, the local hospitals were paired with an administrative dietitian from Sioux Falls, S.D. “While the staff of New Orleans was busy caring for the onslaught of patients, the admin dietitian could virtually manage updating menus, and making subs on ordering,” Utech says. “We arranged for some short-term transfers too.”

Speaking of updating menus and making substitutions, the VA was fortunate to experience minimal supply disruptions. “Our subsistence contract is a strength,” Utech explains. “Having a large national distributor and supplier like US Foods meant we had no curtailment or stoppage of service.”

When certain items were in scarcer supply, the national office worked with US Foods to keep hospitals updated so the hospitals could make their own decisions. “US Foods would provide a weekly merchandise report that we shared across the country that would list by category items that were running short and a list of alternatives,” says Utech. “While some hospitals may have needed to make menu changes, we didn’t have to manage it as a crisis nationally because the sites were given specific alternatives they could choose.”

Providing logistical guidance and support was essential, of course, but it wasn’t everything. Utech and her team made a dedicated effort to keep up worker morale with events like a national Nutrition and Food Service photo contest, staff and patients were invited to recreate their favorite food-related art or painting.

The recommendations-over-rules approach has proved effective. “I’m proud our guidance is still helpful, and I can still reference back to it, and that we wrote it in a way that didn’t cause a lot of complaints or constraints,” Utech says. “Trust your people to execute, that was a lesson learned.”

Weekly merchandise and substitution reports are still going out too. But as signs of hope and change continue popping up around the country, the VA has an indicator of its own that things are getting better. “We haven’t had any national need to move staffing around in a few months,” Utech says.