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In this article, we critically discuss a Swedish hospital foodservice reform by puttingfoodservice in a historical and social context and analyzing a case, “the most flexiblepatient foodservice system in Sweden,” by using Bacchi’s what’s the problem representedto be (WPR) approach. We show how hospital foodservice governance in Sweden hasbecome more focused on the individual patient as a consumer. Our analysis points outhow in political protocols and related policy materials freedom of choice, flexibility,and efficiency were articulated as drivers of change. Freedom of choice was argued toenhance quality, increase food intake, diminish demand for special diets and lower costs.This can be seen as empowering patients, but also shifting part of the responsibility ofnutrition care and health over to individuals, whether they want it or not. Flexibilitywas seen as beneficial for patient logistics regarding medical treatment and argued toimprove allocation of staff resources. Inefficiency was a characteristic attributed tothe old system, while the reform was an opportunity to modernize and be more costefficient.The new organizational structures may lead to tensions between foodserviceand healthcare. The changes, system flexibility and patient freedom of choice, are salientwithin a broader neoliberal discourse.

Aim: The aim of this study was to explore patient satisfaction with hospital foodservice in the Swedish setting, using a validated instrument, adding this context to the existing body of research.

Methods: The study was carried out at three hospitals employing cyclic menus and conventional cook-serve foodservice systems with centralised tray assemblies and hot-trolley distributions to the wards for service. Patient satisfaction was explored using a translated version of the validated Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Groups were compared with Mann-Whitney U-test and Kruskal Wallis test with a set significance level of P < .05.

Results: Questionnaires from 439 patients were included in the analysis. The majority (80%) reported an overall satisfaction of "good" or "very good." Questions related to Staff and Service received mostly the highest possible ratings, while questions related to Food Quality and Meal Size had slightly lower ratings and higher variation. Comparisons between groups showed that differences were small even when statistically significant. Low appetite and a long hospital stay had an adverse effect on overall satisfaction and food quality-related questions. Men and younger patients reported more often being hungry after and between meals.

Conclusions: Hospital foodservice faces the challenge of catering to multiple patient needs. Monitoring patient satisfaction is crucial to ensure that foodservice operations remain evidence based. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire provided a general overview that indicated foodservice areas with potential for improvement, although patient satisfaction overall was high. However, patient satisfaction is a complex measure and reflexivity is required when interpreting empirical results.