Journal of Cleaner Production 429 (2023) 139594

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Journal of Cleaner Production

journal homepage: www.elsevier.com/locate/jclepro

A combined evaluation of energy efficiency, customer satisfaction and food

waste in the healthcare sector by comparing cook-hold and
cook-chill catering
Christian Bux a, *, Giuseppe Zizzo b, Vera Amicarelli a
a
University of Bari Aldo Moro, Department of Economics, Management and Business Law, Largo Abbazia Santa Scolastica 53, 70124, Bari, Italy
b
Vivenda SpA (formerly La Cascina Srl), Via Francesco Antolisei 25, 00173, Rome, Italy

A R T I C L E I N F O A B S T R A C T

Handling Editor: Cecilia Maria Villas Bôas de The healthcare sector greatly impacts the environment through energy, transport, product use, disposal and food
Almeida service. This requires significant interventions to reduce energy consumption and waste generation and increase
customer satisfaction simultaneously. Considering the need to investigate food waste amounts and energy
Keywords: consumption in hospitals, the present research has a triple goal. First, it evaluates energy consumption and ef­
Healthcare sector
ficiency by comparing cook-hold and cook-chill catering. Second, it estimates the customer satisfaction of the
Foodservice
served meals and third, it assesses the food waste quantities at lunch and dinner among hospital patients.
Hospital catering
Energy efficiency Specifically, the research combines (a) the evaluation of the energy consumption, based on primary data
Food waste collected in a cooking center with a production capacity of 1590 meals per production cycle; (b) the investigation
Customer satisfaction of the consumers’ behavior among 984 patients located in nine different hospital units in Southern Italy; (c) the
measurement of food waste based on questionnaire-survey data. Results highlight the reduction in diesel con­
sumption (– 42%) and in electricity consumption (– 93%), as well as the reduction in food waste (– 85%) when
comparing cook-hold with cook-chill catering. This research illustrates a guideline in the field of efficient
catering. It helps identify sustainable pathways and interventions toward energy efficiency, customer satisfac­
tion, and food waste minimization for policymakers, healthcare professionals, catering companies or patients.

1. Introduction gas emissions associated with anthropic activities (European Commis­

sion, 2023), estimated at 0.3 Gigatons (Gt) of CO2eq per year (FAO,
Material flow measurement plays a central role in tackling food 2015; Amicarelli et al., 2021). Further, food waste is responsible for
waste at the final consumption stage, and despite the growing body of freshwater consumption, with an estimated water footprint of 250 km3,
research on sustainable development in the healthcare sector and for land loss, approximately 1.4 billion hectares of land (Poore and
(Berniak-Woźny and Rataj, 2023; Xu et al., 2021), the analysis of hos­ Nemecek, 2018; Our World in Data, 2020).
pital food waste and catering waste is still under-researched. The To minimize food waste, tackle unsustainable consumption patterns
healthcare sector affects human health and the environment via energy and switch from a linear to a circular economy, the United Nations
consumption and pollution (Sherman et al., 2019), accounting for about implemented the 17 Sustainable Development Goals (SDGs) in 2015,
5% of global greenhouse gas emissions (NHS, 2020). In the European introducing specific targets for food waste reduction and sustainable
Union (EU), it is estimated that more than 84 million tons (Mt) of food consumption behaviors. Considering the growing social inequalities,
waste was generated in 2018 from agricultural production to final conflicts, the COVID-19 pandemic and climate change, which under­
consumption, which represents approx.—13% of the food produced in mine food security on the global scale and enhance malnutrition, Goal 2,
the European boundaries (Caldeira et al., 2023). Specifically, 56–80% of “Zero Hunger,” requires ending hunger, achieving food security and
the entire amount is generated at the household and food service levels, improving nutrition by promoting sustainable agriculture. Moreover,
which means 47 to 67 Mt (Caldeira et al., 2019, 2021). Such material Goal 12, “Responsible Consumption and Production,” aims to cut per
amount corresponds, on average, to over 6% of the entire EU greenhouse capita food waste in half at the retail and consumer level and reduce

* Corresponding author.
E-mail addresses: [email protected] (C. Bux), [email protected] (G. Zizzo), [email protected] (V. Amicarelli).

https://doi.org/10.1016/j.jclepro.2023.139594
Received 16 May 2023; Received in revised form 17 October 2023; Accepted 31 October 2023
Available online 1 November 2023
0959-6526/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
C. Bux et al. Journal of Cleaner Production 429 (2023) 139594

food loss along with agricultural production and industrial trans­ generates food waste from 11.5 to 35.7%. In contrast, optional menus
formation by 2030. It underlines the nexus between avoidable food can increase consumption and decrease food waste but implementing a
waste reduction and safe food waste management, highlighting the need flexible rather than an inflexible ordering system depends on the hos­
to enhance sustainable valorization pathways for unavoidable food pital’s budget and financial aid.
waste (United Nations, 2022).
Like the SDGs, the EU implemented the Farm to Fork Strategy in 3. Materials and methods
2018, which aims to create a fair, healthy and environmentally friendly
food system by dropping environmental impacts, protecting biodiversity 3.1. Research framework, goal and scope
and achieving food security (Nicastro and Carillo, 2021). Furthermore,
the same year, the EU developed the monitoring framework for the The research considers the definition of catering service included in
circular economy, addressing one specific indicator of food waste and the minimum environmental criteria introduced by the Ministerial De­
highlighting the need to acquire suitable data and develop relevant cree n. 65 of March 10, 2020 (n. 90 of 4 April 2020, art. 4), namely: “the
methodologies (European Commission, 2018). Hence, the EU has activity that includes the purchase of food and drinks, the preparation of
obliged member states to measure and report food waste by introducing meals with the foodstuffs purchased, the transport and administration of
the Commission Delegated Decision 1597/2019, which requires mem­ meals, the cleaning of the canteen, the premises of the cooking center
ber states to measure food waste at least once every four years for each and the equipment and crockery used, as well as the management of
stage of the food supply chain (Official Journal of the European Union, food surpluses deriving from the preparation and administration of
2019). meals” (Gazzetta Ufficiale Repubblica Italiana, 2020).
The Waste Observatory of the Apulia Region (Regione Puglia, 2023), In the light of the definition, and considering the main variables of
with references to data on municipal solid waste in Apulia in 2021, has “transport of meals,” “administration of meals,” and “management of
estimated a total amount of waste of over 1.1 Mt. Of such an amount, food surpluses deriving from the administration of meals,” the present
more than 22% is composed of food waste from kitchens, canteens and research has a triple goal: (i) First, it evaluates the energy consumption
catering (255 000 t), which constitutes 98% of the overall organic by comparing two different catering services, namely cook-hold and
fraction collected at regional level (260 204 t). Based on these data, it is cook-chill ones, based on primary data collected in a cooking center with
necessary to improve the performance of canteens and food services a capacity of 1590 meals per production cycle (i.e., lunch and dinner)
regarding food waste minimization and management towards sustain­ per day; (ii) Second, it investigates the customer’s satisfaction among
ability. Moreover, such interventions would align the canteen and 984 hospitals’ patients; and (iii) Third, it measures food waste at lunch
catering sector with the SDGs, the New Circular Economy Action Plan and dinner in nine different hospital units located in Southern Italy,
and the European Union Delegated Decision 2019/1597 on food waste highlighting the main drivers towards food waste reduction.
measurement.
In light of these premises and considering the definition of “catering 3.1.1. Study area and system boundaries
service” as outlined by the minimum environmental criteria (Section The study area is the Azienda Sanitaria Locale Bari (ASL BA), served
3.1.), the present research has a triple goal: (i) First, it evaluates the by four cooking centers and composed of nine hospital units and 60
energy consumption by comparing two different catering services, hospital wards, including: Altamura (12 wards), Corato (four wards), Di
namely cook-hold and cook-chill, based on primary data collected in a Venere (13 wards), Molfetta (five wards), Monopoli (ten wards),
cooking center with a production capacity of 1590 meals per production Putignano (five wards), San Paolo (eight wards), Terlizzi (two wards)
cycle (i.e., per lunch and dinner); (ii) Second, it investigates the cus­ and Triggiano (one ward). Fig. 1 illustrates the study area referring to
tomer’s satisfaction among 984 hospital patients; and (iii) Third, it the hospital units and the cooking centers.
measures food waste at lunch and dinner in nine different hospital units The energy consumption analysis is based on primary data collected
located in Southern Italy, highlighting the main drivers towards food in the cooking center in Bari, which responds to all principles identified
waste reduction. To the best of the authors’ knowledge, no studies by the Regulation of the European Commission n. 853/2004 on the
combine three approaches, namely the energy consumption analysis, the hygiene of foodstuffs (Official Journal of the European Union, 2004) and
customer’s behavior investigation and the food waste measurement in the Regional Regulation n. 2108/2020, entitled “Guidelines for Hospital
hospital canteens, highlighting the originality of the current research Catering” (Bollettino Ufficiale Regiona Puglia, 2021). Further, it in­
and its utility for either practitioners involved in food service or public cludes a specific area addressed to the production of cooking meals for
authorities. celiac users, inside “a room totally separate from the other rooms,
equipped with dedicated tools and facilities” as required by the Delibera
2. Literature review on food waste in the healthcare sector di Giunta Regionale Puglia n. 890/2012.
Regarding the supply chain under research, the research applies a
The healthcare sector significantly impacts the environment through gate-to-consumer approach, starting from the meal distribution to the
energy consumption, transport, product use and disposal. Hence, hospital units (after meals cooking) until the final consumption among
selected studies focus on both solid and organic waste from a holistic users. The cook-hold and cook-chill catering has common steps, namely
perspective (Alharbi et al., 2021). In the field of food waste, Carino et al. ingredients supplying, storage, preparation and cooking, but different
(2021) have investigated current sustainable practices in hospital food steps follow cooking. Specifically, meals are prepared using the same
provision, as well as barriers, enablers and recommendations for appliances, technologies and recipes, regardless of the method of ser­
implementing sustainable practices in the future through qualitative vice. In addition, employees with the same skills and competencies carry
inquiry and semi-structured interviews. This research highlighted the out meal preparation and logistics.
need to improve communication between units, implement employee Fig. 2 illustrates the system boundaries of the energy consumption
training opportunities and enhance infection control restriction, as analysis, highlighting the main differences between cook-chill and cook-
hospital waste is subject to higher safety and hygiene risks than standard hold catering. In the field of the cook-chill, five steps are included in the
canteens. Further, Paiva et al. (2022) have quantified food waste by system boundaries, as follows: (i) blast freezing at +10 ◦ C; (ii) storage in
comparing a flexible (i.e., choice menu) and an inflexible (i.e., basal cold rooms at +3 ◦ C; (iii) energy consumption to keep the cold tem­
diet) ordering system by applying direct measurement. One of the main perature during packaging; (iv) transportation with cook-chill trucks at
characteristics of the hospital’s food service is the design of the patient +3 ◦ C; and (v) use of warm trays to boost temperature up to 120 ◦ C for
menus according to their pathology. However, often, patients do not 50 min. As regards the cook-hold, the subsequent phases are considered:
consume the entire menu. Adopting inflexible ordering systems (i) warm storage and transportation with non-refrigerated trucks at

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C. Bux et al. Journal of Cleaner Production 429 (2023) 139594

Fig. 1. Study area.

Source: Personal elaboration by the authors.

Fig. 2. System boundaries.

Notes: Dashed lines identify the system boundaries of the analysis. Source: Personal elaboration by the authors.

+65 ◦ C and (ii) use of cook-hold warm trays at +65 ◦ C. Guidelines for Use” (ISO, 2018), as well as from the technical specifi­
cation of the facilities used to transport and serve meals (e.g., insulated
3.2. Data collection and analysis vehicle with MASTER tail lift, Renault; single and with double fridge
thermal trays with customized trays, Burlodge; porcelain dishes, steel
3.2.1. Energy consumption evaluation cutlery, unbreakable glass). Moreover, additional information has been
Primary data related to the energy consumption evaluation has been acquired from the dashboard provided by the integrated computer sys­
collected from one cooking center located in Bari, which has a produc­ tem (so-called NOVA), developed in cloud-based technology and deliv­
tion capacity of 1590 meals per production cycle (i.e., lunch and dinner) ered in SaaS (Software as a Service) mode. The NOVA system has been
and produces 990 cook-chill meals per day. Primary data related to realized for managing meal reservations and their reporting, as well as
cook-chill production, as well as data associated with cook-hold pro­ for managing the cooking centers and their traceability. Among the
duction, have been retrieved from the latest energy analysis, developed services offered in the field of food tracking and traceability (defined as
in line with the International Organization for Standardization (ISO) E-Trace), the software includes data related to the receipt of goods and
50001:2018 on the “Energy Management Systems - Requirements and storage, warehouse withdrawals, production and packaging, as well as

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C. Bux et al. Journal of Cleaner Production 429 (2023) 139594

distribution. Specifically, to the distribution of meals, the E-Trace en­ smile to make understanding among patients easier. Considering the
compasses data related to (i) delivery traceability via electronic shipping reasons for disliking, respondents could select the subsequent answers:
documents, (ii) traceability of food trays, (iii) personalized tray trace­ bad taste, bland, overcooked, little seasoned, al dente, cold, salty, as
ability to the bed of the patients, (iv) polibox traceability; and (v) outlined by previous research (Piciocchi et al., 2022; Donini et al.,
traceability of the transported meals. The energetic baseline has been 2008). Furthermore, results distinguish customer’s satisfaction with
developed according to primary data related to the timeframe July cook-hold and cook-chill meals.
2021–June 2022, in line with the period of administration of the Questionnaire surveys have been administered using tablets supplied
customer satisfaction analysis (Section 3.2.2.). to researchers and expert staff, and data have been cataloged in the
Specifically, in the evaluation of the energy consumption, the sub­ NOVA system, a user-friendly management software that provides users
sequent variables have been considered: (a) kilometers traveled by with flexible and modular data and catalogs results in a transparent
trucks; (b) hours of operation of the various machines used in the dashboard.
different service steps, for instance, hours of blast freezing facilities or
hours of cold rooms functioning; (c) load factors of trucks, storage rooms 3.2.3. Food waste analysis
and trays; and (d) meals capacity per truck, blast freezing and storage In light of the Commission Delegated Decision 1597/2019, the
room, and trays. questionnaire administered to explore customer’s satisfaction has also
Table 1 summarizes the variables included in the energy consump­ investigated food waste quantities by asking each respondent how much
tion evaluation in the baseline, namely 990 meals in the cook-chill food was consumed using the subsequent scale: (a) the entire dish,
catering and 600 meals in the cook-hold one. Further, the research which means no waste; (b) three-quarter of a dish, which means one-
provides prospective results in the case of an entire production (i.e., quarter of food waste; (c) half a dish, which means half food waste
1590 meals) in the cook-hold or the cook-hold catering. and (d) no consumption, which means total food waste. The question­
All estimates have also been investigated in terms of tons of oil naire graphically identifies such quantities using a circle divided into
equivalent (toe) to allow comparison between diesel consumption four equal segments. Table 2 illustrates the menu related to the sampled
(expressed in liters) and electricity (expressed in kilowatt-hour, kWh). week, distinguishing per meal (i.e., lunch and dinner) and providing
details related to the main course, the second course and the side dish.
3.2.2. Customer satisfaction analysis and questionnaire development Meals have been summarized inhomogeneous food categories, as fol­
The questionnaire survey addressed to investigate customer satis­ lows: (a) fruit and vegetables; (b) meat and meat products (e.g., ham,
faction represents an essential tool to measure and evaluate, on the one meatballs); (c) fish and fish products; (d) dairy products; (e) pasta and
side, the organization’s efficiency and, on the other side, the needs, and baked products (e.g., bread, bread balls); (f) legumes; (g) potatoes; and
the expectations of the customers (Alaimo et al., 2022), namely the (h) rice and cereals. It should be considered that each course weighs on
hospital’s patients. The questionnaire survey has been developed in line average 200 g (equal to 600 g per meal), which is a mean of the weights
with the documents identified by the Region to determine the cus­ foreseen by the Regional calls of cooked first course, cooked and cold
tomer’s approval rating and has been administered weekly from second course, cooked and cold side dishes.
November 22 to November 29, 2021. Anonymous interviews among As to highlight differences in food waste generation according to the
patients have been carried out by researchers and experts in the field (i. catering service, it is possible to distinguish between hospital units with
e., hospital dietary staff). The sample has been composed of patients cook-hold meals (i.e., Di Venere, Molfetta, Putignano) and hospital units
admitted to the ASL BA on selected days per department to avoid with cook-chill meals (i.e., Altamura, San Paolo, Monopoli, Corato,
addressing patients subject to therapies or hospitalizations without meal
delivery, for an amount of 984 respondents. Table 2
Regarding meals, respondents have been required to evaluate their Menu distinguishing between lunch and dinner per each day.
satisfaction rating at lunch and dinner, distinguishing between main
Day Meal Main course Second course Side dish
course, second course and side dish, using a 3-point Likert scale from 1
to 3 (1 = bad, 2 = medium, 3 = good). This value is represented by a Monday Lunch Rice, pasta, Meat, fish Legumes,
vegetables, vegetables
potatoes
Dinner Legumes, pasta, Cheese, fish, Vegetable,
Table 1 broth meat potatoes
Variables included in the energy consumption evaluation. Tuesday Lunch Pasta, vegetables, Meat, cheese Vegetables
rice
N. Cook-chill catering Hours or Unit Load
Dinner Legumes, Vegetables, Legumes,
km cons.1 factor
vegetables, pasta meat vegetables
1. Blast freezing 7.50 h 6.40 kW h 70% Wednesday Lunch Pasta, legumes, Meat, fish, Vegetables,
2. Storage in cold rooms 24.00 h 7.50 kW h 30% cheese cheese potatoes
3. Energy cons. to keep 4.00 h 7.50 kW h 30% Dinner Pasta, legumes, Meat, fish Vegetables
temperature vegetables
4. Trans. with refrigerated trucks 190 km 7 km/L 100% Thursday Lunch Pasta, cheese, rice, Vegetables, Vegetables
5. Use of cook-chill trolleys 0.83 h 8.00 kW h 85% potatoes meat, cheese
Dinner Pasta, rice, Cheese, meat Vegetables
N. Cook-hold catering Hours or Unit Load vegetables
km cons.1 factor Friday Lunch Pasta, vegetables, Fish, vegetables, Vegetables
1. Trans. with non-refrigerated 190 km 12 km/L 100% fish, rice cheese
trucks Dinner Pasta, vegetables, Meat, cheese, Vegetables,
2. Use of cook-hold tray trolleys 0.25 h 6.20 kW h 40% rice, legumes fish potatoes
Saturday Lunch Pasta, vegetables, Meat, vegetables Vegetables,
Notes: Trans. = transportation; cons. = consumption; cap. = capacity; req. = legumes legumes
requirement. 1 The “Unit cons.” refers to the liters or electricity consumption of Dinner Pasta, legumes, Cheese, fish Vegetables
each vehicle or each facility. For instance, considering each vehicle contains 180 vegetables
meals, six vehicles are required to transport meals (i.e., 990/180 = 5.5 = 6 Sunday Lunch Pasta, rice, Meat, cheese Vegetables
vehicles). The values in the Table consider the km traveled by all vehicles vegetables
Dinner Pasta, vegetables Meat, fish Vegetables,
(identified by their license plate) per month, the average quantity of diesel
legumes
consumed by each vehicle, and the number of meals transported. Source: Per­
sonal elaboration by the authors. Source: Personal elaboration by the authors.

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C. Bux et al. Journal of Cleaner Production 429 (2023) 139594

Terlizzi, Triggiano). Further, results are expressed in weight, consid­ Table 4

ering the number of courses distributed daily with the cook-hold (287 Energy consumption evaluation in the prospective scenario.
meals, composed of 861 courses) and the cook-chill (697 meals, con­ N. Cook-chill catering (n ¼ Daily Daily cons. Percentage
sisting of 2091 courses) catering. 1590 meals) cons. (toe)

1. Blast freezing 67.20 kW 0.01 4%

4. Results and discussion h
2. Storage in cold rooms 108.00 0.02 7%
kW h
4.1. Energy consumption results
3. Energy consumption in 18.00 kW 0.00 1%
packaging h
In light of the energy consumption evaluation, the current energy 4. Trans. with refrigerated trucks 244.29 L 0.20 69%
consumption associated with 990 meals in the cook-chill catering is 0.19 5. Use of cook-chill tray trolleys 299.13 0.06 19%
toe, 282.85 kW h of electricity and 162.86 L of diesel. On the side of the kW h
Total (1 + 2 + 3 + 4 + 5) 0.30 100%
cook-hold, catering consumes about 0.08 toe, 12.40 kW h of electricity
and 63 L of diesel. Considering the energy consumption per meal, the N. Cook-hold catering (n ¼ Daily Daily cons. Percentage
1590 meals) cons. (toe)
current cook-chill production consumes 0.28 kW h and 0.16 L of diesel
per meal, whereas the cook-hold production consumes 0.05 kW h and 1. Trans. with non-refrigerated 142.50 L 0.12 95%
trucks
0.15 L per meal. Table 3 illustrates the energy consumption results by
2. Use of cook-hold tray trolleys 32.86 kW 0.01 5%
comparing the cook-chill (i.e., 990 meals) with the cook-hold (i.e., 600 h
meals) production in the baseline scenario. Total (1 + 2) 0.12 100%
Table 4 illustrates the prospective results in the case of an entire
Notes: Trans. = transportation; cons. = consumption. Source: Personal elabo­
production in the cook-chill and the cook-hold catering, considering the
ration by the authors.
production capacity of the cooking center of 1590 meals.
Cook-hold catering is more efficient than cook-chill one. If all 1590
3.81% “bad”. As regards the main reasons for discarding, the vast ma­
meals were catered using cook-hold rather than cook-chill, diesel con­
jority of the sample revealed that the meals had a bad smell (22.63%),
sumption would be reduced by 42% (from 244 to 142 L) and electricity
whereas 19.26% declared that meals were bland and 17.23% that food
consumption would be reduced by 93% (from 492 to 32 kW h). It also
was overcooked.
highlights the economies of scale, which can be achieved by maximizing
Table 5 illustrates the consumption rates distinguishing per day and
the production of cook-hold meals compared to cook-chill ones in the
meal (i.e., lunch and dinner). It provides information related to the
cooking center. By producing only cook-hold meals per cycle, it is
different catering, namely the cook-hold (n = 242) and the cook-chill (n
possible to consume 0.09 L of diesel and 0.02 kW per meal, compared to
= 697), which is a somewhat representative sample size compared to the
0.15 L of diesel and 0.31 kW h per meal in the cook-chill production.
number of meals distributed weekly. The highest satisfaction rate is
Regarding toe, the overall energy reduction by switching from cook-chill
associated with the cook-hold catering, being on average 97.88%
catering to cook-hold one is 56%.
compared to the 86.21% recorded for the cook-chill meals.
Although determining and interpreting patients’ satisfaction is a
4.2. Customer satisfaction results complex process since many variables should be considered (e.g., hos­
pitalization time, state of health, personal tastes, ongoing therapies),
The customer satisfaction questionnaire highlights the main trends under the theoretical perspective, the analysis of customer’s satisfaction
related to food consumption and the main drivers for food discarding. with food service represents an essential tool (Piciocchi et al., 2022;
The most preferred course is the dry breakfast (100%), followed by the Naithani et al., 2008). The education for sustainability among patients
dessert (93.5%) and the second course (89.8%), whereas the least fa­ and the adoption of cook-hold catering rather than cook-chill one can
vorite is the first course. Out of the sample, 79.41% of the patients have lead to reducing food waste and its related environmental consequences.
defined the weekly menu as “good,” whereas 16.78% “medium” and
4.3. Food waste analysis
Table 3
Energy consumption evaluation in the baseline.
Healthcare food service must provide meals that satisfy the clinical
N. Cook-chill catering (n ¼ 990 meals) Daily cons.1 Daily cons. (toe) and nutritional needs of patients, as well as guarantee pleasant and
1. Blast freezing 33.60 kW h 0.006 satisfying foods, blending nutritional needs and emotional desires.
2. Storage in cold rooms 54.00 kW h 0.01 Clinical and nutritional needs are satisfied only if patients consume the
3. Energy consumption in packaging 9.00 kW h 0.002 entire meal, which is determined in terms of quantity and composition
4. Trans. with refrigerated trucks 162.86 L 0.14
by express predictions of health nature (Piciocchi et al., 2022; Wall and
5. Use of cook-chill tray trolleys 186.25 kW h 0.036
Total (1 + 2 + 3 + 4 + 5) 0.19 Berry, 2007). Food waste undermines the environment due to the
quantity of wasted natural resources (e.g., energy, water), as well as the
N. Cook-hold catering (n ¼ 600 meals) Daily cons.1 Daily cons. (toe)
patients’ chance of healing and rehabilitation.
1. Trans. with non-refrigerated trucks 63.33 L 0.08 As outlined by the “Guidelines addressed to bodies managing school,
2. Use of cook-hold tray trolleys 12.40 kW h 0.004
workplace, hospital and social canteens and community, to prevent and
Total (1 + 2) 0.08
reduce the waste associated with the administration of food” by the
Notes: Trans. = transportation; cons. = consumption. 1 In the light of the vari­ Italian Ministry of Health, the measurement of food waste and plate
ables included in Table 1, the results of the daily consumption are given for the waste can be conducted by quantitative and semi-quantitative methods,
diesel consumption by applying the subsequent equation: “(190 km/12 km per
such as the questionnaire administered by the present research, which
liter) x 100% × 4 units”, or for the blast freezing electricity consumption, as
has been defined as a validated tool (Ministero della Salute, 2018).
follows: “(7.50 h x 6.40 kW h x 70% × 1 unit)”. The meal capacity (i.e., unit) is
expressed in terms of meals; for instance, one vehicle transports about 180 Table 6 illustrates the weight of food waste distinguishing per day and
meals, whereas one blast freezing facility contains 1000 meals. The units meals service, considering the number of meals distributed per day in
required refer to the number of vehicles or facilities required to supply meals, the ASL Bari (i.e., 939 meals, distinguishing between 242 in the
namely 990 cook-chill meals per production cycle and 600 cook-hold meals per cook-hold and 697 in the cook-chill catering, whereas 45 breakfast is out
production cycle. Source: Personal elaboration by the authors. of the analysis). At first glance, cook-hold meals generate a lower

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Table 5
Consumption rates per meal in percentage and frequency (number of observations).
Day Meal Cook-hold (n ¼ 242) Cook-chill (n ¼ 697)

DV. Mo. Pu. Mean A. SP. Mon. Co. Te. Tr. Mean

Monday L. 100 (7) 96.88 (15) 100 (12) 98.62 97.22 (12) 86.25 (15) 91.36 (15) 92.73 (25) 75.63 (21) – 87.2
D. – 100 (16) – 100 – 83.47 (16) 63.64 (11) 92.5 (16) 95.39 (19) – 86.41
Tuesday L. – 97.78 (21) 100 (5) 98.21 86.14 (20) 95.31 (20) 74.05 (21) 98.61 (9) – – 86.74
D. – 97.43 (18) 100 (5) 97.99 – 87.8 (21) 63.64 (22) 51.74 (10) – – 70.97
Wednesday L. – – – – – – – – – – –
D. – – – – – – – – – – –
Thursday L. 96.88 (8) 96.25 (20) 100 (3) 96.78 88.47 (37) 96.09 (16) 85.42 (25) 96.15 (4) – – 89.40
D. – 100 (21) 100 (2) 100 – 97.01 (17) 85.6 (7) 94.74 (6) – – 93.89
Friday L. – 93.75 (14) 90.91 (3) 93.25 92.5 (10) 95.49 (18) 100 (3) 92.80 (15) 72.89 (21) – 87.56
D. – 95.52 (16) 90.91 (3) 94.79 – 93.01 (17) 76.75 (8) 73.72 (19) 87.5 (19) – 83.47
Saturday L. 99.31 (9) 98.44 (17) – 98.74 – 95.83 (24) – 75.00 (8) – 100 (4) 80.55
D. – 100 (25) – 100 – 90.91 (24) – 97.73 (11) – – 93.05
Sunday L. – – 87.5 (2) 87.50 – 94.26 (16) – 81.82 (21) 86.27 (18) – 86.90
D. – – – – – 95.15 (17) – 93.52 (21) 79.85 (18) – 89.62
Mean – – – 97.88* – – – – – 86.21*

Notes: L = lunch; D = dinner; DV = Di Venere; Mo. = Molfetta; Pu. = Putignano; A. = Altamura; SP. = San Paolo; Mon. = Monopoli; Co. = Corato; Te. = Terlizzi; Tr. =
Triggiano. Table 5 identifies in brackets the number of observations per meal. “Mean” is the weighted average of daily cook-hold and cook-chill units. The consumption
rate identifies the percentage of meal consumed by each patient and its completion at one corresponds to food waste. The t-test has been used to test differences
between the means of the cook-hold and the cook-chill units and to understand whether the differences are statistically significant. The null hypothesis (H0) states that
there is no significant difference between the means of the two groups, whereas the alternative hypothesis (H1) assumes a significant difference. * Considering the
significance at p-value < α = 0.05, the null hypothesis must be rejected, and it can be assumed that there is a significant difference between means.

allow a reduction in food waste per year of about 25 149 t (– 85%). From
Table 6
the empirical perspective, the higher amount of cook-chill meal waste
Food waste per day distinguishing between cook-hold and cook-chill catering.
depends on the inadequacy of some food categories to be chilled, such as
Day Meal Mean FW/meal/ Mean FW/meal/ meat and meat products, as well as rice or tomato-based foods. It results
CH. day CH. CC. day CC.
that meat-based meals, once cooked, blast chilled, stored in cells for 24 h
Monday L. 1.38% 0.008 kg 12.80% 0.077 kg at +3 ◦ C, and then recovered to 120 ◦ C for 50 min, lose their organo­
D. 0 0 kg 13.59% 0.082 kg leptic qualities, such as color, shape, smell, or taste Engelund et al.
Tuesday L. 1.79 0.011 kg 13.26% 0.080 kg
D. 2.01% 0.012 kg 29.03% 0.174 kg
(2007); Gomez et al. (2020). In contrast, meals served soon after being
Wednesday L. – – – – prepared are more likely to preserve the characteristics that patients
D. – – – – require, such as the smell and the taste, which makes their satisfaction
Thursday L. 3.22% 0.019 kg 10.6% 0.064 kg higher (Section 4.2.) and allows for reducing food waste.
D. 0 0 6.11% 0.037 kg
Some additional aspects, although outside the focus of the research,
Friday L. 6.75% 0.041 kg 12.44% 0.075 kg
D. 5.26% 0.032 kg 16.53% 0.099 kg should be remarked, specifically in terms of organizational and mana­
Saturday L. 1.26% 0.008 kg 19.45% 0.117 kg gerial aspects. Regarding cook-hold catering, some microbiological risk
D. 0 0 6.95% 0.042 kg is associated with hot holding, and failures to hold foods hot have his­
Sunday L. 12.50% 0.075 kg 13.10% 0.079 kg torically contributed to foodborne disease outbreaks in food service
D. – – 10.38% 0.062 kg
Total – 0.205 kg – 0.985 kg
establishments worldwide (Bryan, 1990). Moreover, it is not suited and
efficient for large-scale food production, as it allows to produce of fewer
Notes: CH. = cook-hold; CC. = cook-chill; FW = food waste. Food waste data dishes due to a limited dietary gastronomic proposal and a certain ri­
distinguish between daily meals and are aggregated per site per method. “Mean
gidity in the production system (Engelund et al., 2007). In contrast, in
CH.” identifies the weighted average of food waste recorded in all sites that use
cook-chill catering, the microbiological hazards are negligible (Wilkin­
the cook-hold method, whereas “Mean CC.” identifies the weighted average of
food waste recorded in all sites that use the cook-hold method. “FW/meal/day”
son et al., 1991), the nutritional values are preserved, and the gastro­
illustrates the amount of food waste generated per meal per day. The total nomic proposal is higher compared to the cook-hold (Engelund et al.,
amount represents the amount of food waste generated per patient per week. 2007), suggesting that cook-chill catering is safer than conventional
catering (Wilkinson et al., 1991). Moreover, it allows for a relatively
amount of food waste (2.12%) compared to cook-chill meals (13.79%). high flexibility in the production process, making it possible to prepare
The cook-chill method recorded the highest peak at dinner (29.03%). and manage meals with more leeway over time (Greathouse et al.,
These amounts are lower compared to those identified in Italy by the 1989). However, the cook-chill catering is not a cure-all since it cannot
environmental minimum criteria report (Gazzetta Ufficiale Repubblica produce as many dishes as cook-chill as it permits fewer meal options
Italiana, 2020), which has estimated an average amount of food waste at and requires greater rigidity in the production process (Light and
the hospital level of about 30% of the meals served in terms of weight, Walker, 1990), due to vitamin losses, for instance (Lassen et al., 2002).
which correspond to 27.8% in terms of calories. Regarding food waste Therefore, it is necessary to identify strategies that manage and
per meal, the weekly amount of food waste per patient has been 0.21 kg balance food safety and quality, production process flexibility, energy
in the cook-hold method and 0.99 kg in the cook-chill method. efficiency and customer satisfaction (to reduce food waste). In the scope
Comparing an average production of 359 160 meals per year, it re­ of sustainable development and the ecological transition, the nexus
sults that: (a) If all meals are distributed in the cook-hold catering, the between these variables is a challenge that needs to be faced without
amount of food waste would be 4.56 t; (b) If all meals are distributed in delay.
the cook-chill catering, the amount of food waste would be 29.71 t. Such
a considerable difference highlights the higher efficiency and sustain­ 5. Conclusion
ability, under both environmental and nutritional perspectives, of
adopting cook-hold meals compared to cook-chill ones, which would The research has proposed a combined evaluation of energy

6
C. Bux et al. Journal of Cleaner Production 429 (2023) 139594

efficiency, food waste and customer satisfaction in the hospital food Acknowledgements
service in Bari (Southern Italy) province by comparing cook-hold and
cook-chill catering. Specifically, it has developed an energy consump­ The authors would like to express sincere gratitude to the dieticians
tion analysis considering one cooking center with a production capacity Grazia Amoruso, Lucia Bolognini, Filippa Cannito, Daniela Di Stefano,
of 1590 meals per production cycle day. Moreover, it evaluated the food Orsola Lorusso, Nicoletta Promutico, and Cesaria Volpe for their
waste quantities based on 2952 courses distributed daily in nine hospital essential role in the administration of the questionnaire on the customer
units and 60 different hospital departments. Last, it investigated con­ satisfaction and the food waste analysis. In addition, the authors would
sumer behavior among 984 patients to highlight the nexus between like to thank the editor and the anonymous referees for the insightful
customer satisfaction and food waste reduction. Results have high­ and constructive comments.
lighted the reduction in diesel consumption (– 42%) and in electricity
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