The warm meal ?foodprint? of the UMCG - Rijksuniversiteit Groningen

University of Groningen 

CIO, Center for Isotope Research 

IVEM, Center for Energy and Environmental Studies 

Master Programme Energy and Environmental Sciences 

The warm meal “foodprint” of the UMCG 

Environmental impact of a hospital food system 

Eline Politiek 

EES 2013-168 M

Master report of Eline Politiek 

Supervised by: Prof.dr. A.J.M. Schoot Uiterkamp (IVEM) 

Drs. R. Eenkhoorn (Royal HaskoningDHV) 

L.H. Tamming (UMCG) 

B. Bennema (UMCG) 

Prof.dr. H.C. Moll (IVEM) 

University of Groningen 

CIO, Center for Isotope Research 

IVEM, Center for Energy and Environmental Studies 

Nijenborgh 4 

9747 AG Groningen 

The Netherlands 

http://www.rug.nl/fmns-research/cio 

http://www.rug.nl/fmns-research/ivem


Environmental impact of a hospital food system 

Master Thesis Energy and Environmental Sciences 

Author: E.T. Politiek 

Published: March 2013 

Performed under supervision of Royal HaskoningDHV 

Commissioned by the Universitair Medisch Centrum Groningen

Table of contents 

I. Acknowledgements ................................................................................................................. 5 

II. Samenvatting ........................................................................................................................... 7 

III. Summary .................................................................................................................................. 7 

1 Introduction ........................................................................................................................... 11 

1.1 Problem setting ...................................................................................................................... 11 

1.2 Research questions ................................................................................................................. 13 

1.3 Methodology .......................................................................................................................... 13 

1.4 Boundary setting .................................................................................................................... 14 

1.5 Structure of thesis .................................................................................................................. 14 

2 About the UMCG .................................................................................................................. 15 

2.1 Introduction ........................................................................................................................... 15 

2.2 The energy policy and energy use of the UMCG .................................................................... 15 

3 Hospital food systems ............................................................................................................ 19 

3.1 Three commonly used food systems ....................................................................................... 19 

3.2 Current UMCG food system ................................................................................................... 20 

3.3 Future UMCG food system .................................................................................................... 21 

3.4 Hospitals and food-waste ....................................................................................................... 22 

4 Results ................................................................................................................................... 23 

4.1 Introduction ........................................................................................................................... 23 

4.2 Inflow side ............................................................................................................................. 23 

4.3 Inside the hospital .................................................................................................................. 23 

4.4 Outflow side .......................................................................................................................... 26 

4.5 Environmental impact of the food system ............................................................................... 29 

4.6 Outlook to the future: change to decoupled cooking ............................................................... 34 

5 Potential hot-spots for the UMCG to reduce their ‘foodprint’ .............................................. 35 

5.1 Policy measures ..................................................................................................................... 35 

5.2 Technical measures ................................................................................................................ 37 

6 Conclusions ........................................................................................................................... 41 

7 Discussion .............................................................................................................................. 43 

7.1 Research recommendations .................................................................................................... 44 

8 References ............................................................................................................................. 45 

9 Appendix A – A Belt Cart ..................................................................................................... 49 

10 Appendix B – The Autumn Menu 2011 ................................................................................ 51 

11 Appendix C – Product categories and product groups .......................................................... 57 

12 Appendix D – Methane calculations ..................................................................................... 59 

13 Executive summary – The warm meal “foodprint” of the UMCG ....................................... 61

I. ACKNOWLEDGEMENTS 

First and foremost I want to my express my gratitude towards my supervisor at Royal HaskoningDHV, 

Ronald Eenkhoorn, for enabling me to perform this research. In the past five months, the office at the 

Griffeweg in Groningen felt like a second home, thanks to the pleasant interaction with my supervisor and 

all the colleagues at RHDHV. I would also like to express my deep gratitude towards Professor Ton 

Schoot Uiterkamp for his warm support. He was always very quick with answering questions and giving 

feedback at parts of this thesis. Without his effort, this thesis would not have been finished at this 

moment. And I would like to thank Professor Henk Moll, who was willing to act as a second supervisor at 

short notice. 

I would also like to thank my supervisors from the UMCG: Bertha Tamming and Bart Bennema. Their in 

depth knowledge about the UMCG was essential for this thesis. They helped me with data gathering and 

arranged the necessary permissions. Since no one had looked at the UMCG food system from an 

environmental perspective, I find it very courageous of them that they have trusted me in performing this 

research. In my view, the experiment has been a great success! 

A special thanks to the employees of the UMCG kitchen. During the two days that I observed the 

processes in the kitchen, they showed me around and answered all my questions. They have given me a 

wonderful insight in the UMCG kitchen that is run by a multicultural and diverse crew, under the 

supervision of Marina Stojanovic. I also want to mention the head of the kitchen, Aat Wartena, who has 

helped me tremendously with data gathering. Thanks! 

Finally I would like to show thank my fellow students. They have been a great support and contributed to 

the joy I had in studying during the past two and a half year. 

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II. SAMENVATTING 

De productie van voeding levert de op twee na grootste bijdrage aan de door de mensheid veroorzaakte 

milieu-impact (FAO, 2009). CO2 uitstoot, energiegerbruik, landgebruik en watergebruik zijn allemaal 

voorbeelden van die impact (FAO, 2009). Wereldwijd wordt 30% tot 50% van al het voedsel verspild 

(Gustavsson et al., 2011, Institution of Mechanical Engineers, 2013). Voor elke calorie voedsel is een 

investering van zeven calorieën nodig om het te produceren (Institution of Mechanical Engineers, 2013). 

Voedselverspilling kan overal in de voedselketen voorkomen en ziekenhuizen zijn hier geen uitzondering 

op. Hoewel het voedingssysteem in ziekenhuizen onderzocht is in de literatuur en in Nederlandse 

(algemene) ziekenhuizen, zijn er geen studies beschikbaar (bij mijn weten) die zich richten op de milieuimpact 

van het voedingssysteem in een ziekenhuis. 

Dit onderzoek heeft als doel om meer inzicht te krijgen in de milieu-impact van de voedsel-gerelateerde 

stromen naar, binnen en uit het Universitair Medisch Centrum Groningen (UMCG). De hoofd 

onderzoeksvraag is: "Wat zijn de mogelijkheden om de milieu-impact als gevolg van het huidige 

voedingssysteem van het UMCG te verminderen?" De nadruk ligt op de warme maaltijden voor de 

patiënten. Omdat het voedingssysteem zal worden gewijzigd in maart 2013, biedt dit onderzoek een basis 

voor vergelijkingen tussen het huidige en het toekomstige voedingssysteem. 

In 2011 werd er 300 ton voedsel ingekocht door het UMCG voor warme maaltijden ten behoeve van de 

patiënten. Elke dag worden er ongeveer 700 warme maaltijden bereid. Het voedsel voor deze maaltijden 

legt de volgende route af: van de opslag, naar de keuken (waar het koken en portioneren plaats vindt) en 

uiteindelijk naar de afdelingen. Op de afdelingen consumeren de patiënten de maaltijd. Het voedselafval 

wordt gedeeltelijk op de afdeling weggegooid, de rest gaat terug naar de spoelkeuken. In 2011 werd er 

175 ton voedsel (gerelateerd aan de warme maaltijd) weggegooid. Dit is ongeveer 58% van de ingekochte 

hoeveelheid met een waarde van € 0,6 miljoen. De warme maaltijden vertegenwoordigen een indirect 

energiegebruik van 8900 GJ en een CO2-eq-uitstoot van 789 ton; dat is 1% van de totale CO2-voetafdruk 

van het UMCG. Naast voedselafval heeft het UMCG een reststroom vet van ongeveer 100 ton jaarlijks. 

De mogelijkheden om milieu-impact gerelateerd aan de warme maaltijden te verminderen zijn 

samengevat in de vorm van 'hot-spots'. Dit zijn ofwel beleids- of technische maatregelen, verder 

onderverdeeld in korte en lange termijn maatregelen. Deze 'hot-spots' zijn: 

Beleidsmaatregelen 

• Relatief eenvoudige en korte termijn maatregelen 

o Voedsel themadagen organiseren 

o Vleesconsumptie verminderen 

• Complexe en lange termijn maatregelen 

o Overgebleven voedsel doneren aan de voedselbank 

Technische maatregelen 

• Relatief eenvoudige en korte termijn maatregelen 

o Afvalkosten verminderen 

o Meters installeren in de keuken 

• Complexe en lange termijn maatregelen 

o Gebruik maken van milieu benchmarks 

o Een Pharmafilter in gebruik nemen 

Al deze maatregelen hebben voordelen op gebied van People (bijv. een groen imago, gezonde voeding), 

Planet (milieu) of Profit (verminderen van de kosten). De beschreven maatregelen zouden goed passen bij 

het voornemen van het UMCG om meer nadruk te leggen op maatschappelijk verantwoord ondernemen. 

7

III. SUMMARY 

Food is the third largest contributor to human-caused environmental impact (FAO, 2009). Food has an 

environmental impact on fields like: CO2 emission, energy use, land use, and water use (FAO, 2009). 

World-wide 30% to 50% of all food is lost or wasted somewhere along the food-chain (Gustavsson et al., 

2011, Institution of Mechanical Engineers, 2013). For every calorie of food, approximately seven to ten 

calories of energy are embodied in that food (Institution of Mechanical Engineers, 2013). 

Food-waste can occur everywhere in the food chain, and hospitals are no exception to that. Although the 

hospital food system is the subject of research both in the literature and among Dutch (general) hospitals, 

there are no studies available (to the best of my knowledge) that focus on the environmental impact of the 

food system of a hospital. 

This research aims to get more insight in the environmental impact from the food streams flowing in, 

within and out of the University Medical Center in Groningen (UMCG). The main research question is: 

“What are possibilities to reduce the environmental impact resulting from the current food system of the 

UMCG?” The focus lies on the warm meals served to patients. Because the food system will be changed 

in March 2013, this thesis gives a baseline for future comparisons between food systems. 

In 2011 300 ton food was purchased by the UMCG for warm meals served to the patients. Each day 

approximately 700 warm meals are prepared. The food for these meals travels from the storage, to the 

kitchen (where the cooking and portioning takes place) and eventually to the wards. At the wards, the 

patients consume the food. The food-waste is partially discarded at the ward and partially returned to the 

kitchen. In 2011, 175 ton of food attributed to the mean meals was wasted. This is about 58% of the 

purchased food, representing a value of €0.6 million. The warm meals served in the UMCG account for 

an indirect energy use of 8900 GJ and a CO2 eq emission of 789 ton, which is 1% of the total CO2 

footprint of the UMCG. Additional to the food-waste, the UMCG has another waste stream in de form of 

grease from grease traps. This is approximately 100 ton each year. 

The possibilities for reducing the environmental impact are summarized in the form of ‘hot-spots’ which 

are either policy or technical measures, divided in short term and long term measures. These ‘hot-spots’ 

are: 

Policy measures 

• Relatively easy and short term measures 

o Initiate food theme days 

o Reduce meat consumption 

• Complex and long term measures 

o Donate left-over food to food banks 

Technical measures 


o Reduce waste-costs 

o Install separate meters at the kitchen 


o Use environmental benchmarks 

o Install a Pharma filter 

All these measures have benefits either on the People (e.g. green image, healthy diet), Planet (benefits the 

environment) or Profit-side (reduces the costs). All the described measures would fit well into the 

intentions of the UMCG to put more emphasis on Corporate Social Responsibility in managing the 

hospital. 

9

1 INTRODUCTION 

1.1 Problem setting 

Food is the third largest contributor to human-caused environmental impact (FAO, 2009). Food has an 

environmental impact on fields like: CO2 emission, energy use, land use, and water use (FAO, 2009). 

World-wide 30% to 50% of all food is lost or wasted somewhere along the food-chain (Gustavsson et al., 

2011, Institution of Mechanical Engineers, 2013). First of all this is a waste of nutrients, while in certain 

parts of the world suffer a shortage of nutrients (WUR, 2012). The production of food world-wide is 

currently high enough to provide all the people on this planet with their nutritional needs (WUR, 2012). 

But largely due to distribution problems, a part of the world population is undernourished while another 

part of the world wastes food or consumes too much (WUR, 2012). Secondly, it is a waste of resources 

like energy, water, land, fertilizer and so on used to produce the food (Institution of Mechanical 

Engineers, 2013). These resources are invested in the food in multiple stages: from planting the crops till 

the cooling trucks that transport the end-product. So for every calorie of food, approximately seven to ten 

calories are invested in that food somewhere along the chain (Institution of Mechanical Engineers, 2013). 

At the time of writing this thesis, food-waste became a popular topic in the Dutch and international 

media. For example, the Centraal Bureau voor de Statistiek (Central Statistics Bureau) calculated the 

food waste per person in the Netherlands (CBS, 2011). They expressed the amount of food waste in euros, 

to make it more tangible. Many international organizations like the United Nations are cooperating in a 

website called “Think, Eat, Save”. The goal of this website is to reduce food-waste worldwide (UNEP, 

2013). 

The Netherlands has an elaborate waste policy. In the Landelijkafvalbeheerplan 2 (LAP2) the goals to 

reduce waste are specified for multiple kinds of waste (Ministerie I&M, 2010). The Dutch government 

aims to reduce all food-waste with 20% in 2015 compared to the reference year 1995 (Ministerie I&M, 

2010). It is important that this reduction is reached along the entire food-chain: from agricultural 

production to the consumer. In total 9.5 million tons of food is wasted in the total agri-food sector 

(Ministerie EL&I, 2012, WUR, 2012). By minimizing the food-waste and optimizing the use of foodwaste 

streams, the environmental pressure of the total food-chain can be reduced. In order to optimize the 

use of food-waste streams, a scale is made that is called the “Moerman’s Ladder” (Ministerie EL&I, 

2012). The options for food-waste are (in order of desirability): 

1. Prevention (avoiding food-waste) 

2. Use for human food (example: food banks) 

3. Conversion to human food 

4. Use in animal feed 

5. Raw materials for the industry (biobased economy) 

6. Processing to make fertilizer through fermentation (and generate energy) 

7. Processing to make fertilizer through composting 

8. Generate sustainable energy 

9. Burn the waste (objective: destruction of the waste, and if possible generate power and heat) 

10. Dumping in a landfill (this is prohibited for food-waste) 

Food-waste can occur everywhere along the food chain, and hospitals are no exception to that. But foodwaste 

is not necessarily a focal point for hospitals, since its direct link with the care for patients is not 

obvious (Sonnino and McWilliam, 2011). Food itself is a very important issue in the hospital, because it 

is associated with the recuperation of the patients. Although food is important for recuperation, the 

prevalence of malnutrition among hospitalized patients is at least 20% ((Barton et al., 2000, Grieger and 

Nowson, 2007). During hospitalization, the nutritional status of many patients deteriorates, making 

11

malnutrition an even larger problem (Barton et al., 2000). This means that the patients do not eat enough 

to meet their nutritional needs and (involuntarily) lose weight (Goeminne et al., 2012). The deterioration 

of the nutritional status of hospital patients often results from a limited appetite of the patient. This can 

either be due to illness, but also the quality of the meals, the knowledge of the staff and the atmosphere in 

the hospital can influence the appetite of the patient (Snels and Wassenaar, 2011, Sonnino and 

McWilliam, 2011). Hospitals often have a patient-oriented view on the food system: the hospital food 

system should provide enough nutrients for the patients to recover (Sonnino and McWilliam, 2011). 

It can be concluded that hospitals focus mainly on the People-aspect of their food system. On top of that, 

the Profit-aspect is important for hospitals. Hospitalization is very expensive and therefore it is very 

important to keep the costs as low as possible (Sonnino and McWilliam, 2011). Recently, Sonnino et al. 

(2011) claimed that the Planet-aspect should become equally important for hospitals. Hospitals are part of 

the public sector and many scientists claim that the public sector should set the example when it comes to 

corporate social responsibility (CSR), sustainability and environmental citizenship (Sonnino and 

McWilliam, 2011). Of course, enhancing the sustainability of a hospital can be accomplished in many 

ways. Reducing the environmental impact of the hospital food system is only one of the options. 

Although the hospital food system is the subject of research both in the literature and among Dutch 

(general) hospitals, there are no studies available (to the best of my knowledge) that focus on the 

environmental impact of the total food system of a hospital. Most studies are patient-centered: how can 

the food intake of the patients be improved? Reducing the amount of waste seems an additional effect, but 

is never the sole purpose of a study. So especially in determining the environmental impact of the whole 

food system in a hospital there is scientific progress to be made. It is important to note that the 

organization of a hospital food system is very complex and influenced by many decision makers (Sonnino 

and McWilliam, 2011). Therefore the social (and financial) context of the environmental impact of the 

food system should also be taken into account in such a research. 

In February 2013 a Dutch journal called ‘Food hospitality’ published the results of a food-waste research 

at a general hospital in the Netherlands. It reported that in 2011, the amount of food-waste had a value of 

€215,000 (Soethoudt and van Garmeren, 2013). Again, the focus of this research was not on the 

environmental impact of the food system. But this research does indicate an increased interest in hospital 

food-waste and the improvements (both financially as for the environment) that can potentially be 

achieved with optimizing the hospital food system. 

This thesis gives the results of a study of the environmental impact of the food system at the University 

Medical Center in Groningen (UMCG). The UMCG aims to formulate CSR goals for the coming years 

and a more sustainable organization of the hospital food system might fit well in these goals. Besides that, 

the UMCG has made a multiyear agreement (meerjarenafspraak) with other university medical centers to 

reduce their CO2 equivalent emissions with 30% in 2020 (Agentschap NL, 2012, UMCG, 2012c). A CO2 

footprint analysis was performed to identify all CO2 emissions from the hospital (DHV, 2011). Till now, 

the CO2 emission of the food system was not included in this footprint. The research done for this thesis 

provides knowledge about the CO2 emission of the food system. Possibly, changes in the food-system or 

in the use of the food-waste stream can contribute to the goals for CO2 emission reduction. 

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1.2 Research questions 

This research aims to get more insight in the environmental impact from the food streams flowing in, 

within and out of the University Medical Center in Groningen. The focus lies on the warm meals served 

to patients. In March 2013 the UMCG will switch to another food system, therefore this study is a 

baseline study of the current situation. 

The main research question is: What are possibilities to reduce the environmental impact resulting from 

the current food system (focused on the warm meals served to the patients) of the UMCG? 

This leads to the following sub questions: 

1. What is the quantity (weight) and quality (which products) of the inflow of food to the 

hospital? 

2. What are the different routes that the food travels within the hospital? 

3. What is the quantity (weight) and quality (which products) of the food-waste leaving the 

hospital? 

4. What is the environmental impact of the current UMCG food system? 

5. Which possibilities are there to reduce the environmental impact of the hospital food system 

from the inflow-side? 


within the hospital? 


form the food-waste (outflow-side)? 

1.3 Methodology 

Observation and informal questioning of staff was used to examine how the food system in the hospital 

works. Quantities of the inflow of food in the hospital are retrieved from staff that takes care of the 

purchase of the food. Less knowledge from the staff is expected about the quantity and quality of the 

food-waste leaving the hospital. So especially on the field of outflow, observation is very important. 

Measuring all the waste streams by weighing is not a realistic option; this would take too much time. 

When the food flows to, through and out of the UMCG are known, the products were divided into product 

groups for an in-depth analysis of the environmental impact. The environmental impact per product group 

is calculated with the help of tables available in literature. The processing of these results is performed 

with the use of Excel. See for a more elaborate description of the methodology chapter 6 (Results). 

The last thee sub questions focus on the potential to reduce the environmental impact from the hospital 

food system. These questions are answered with the help of literature and (informal) interviews with 

experts within Royal HaskoningDHV, the UMCG and staff of other hospitals. 

Eventually, this research leads to an insight in the environmental impact from the food-system of the 

UMCG. The results are expressed in the CO2 equivalent (further referred to as CO2eq) emission and the 

(indirect) energy use of the food system. Besides that, there is some attention the indirect land and water 

use footprint of the food system. The environmental impact of the food system is referred to as the 

“foodprint”. 

13

1.4 Boundary setting 

This research is based upon a time investment of 30 credits of the European Credit Transfer and 

Accumulation System (equivalent to 21 workweeks of 40 hours). So in order to make research fit within 

this period of time, the boundary was set at the main (warm) meals for the patients. Of course, this gives 

but a limited view of the hospital food system. Nevertheless, this thesis does provide a methodology that 

could be used in further research. This thesis gives a baseline indication of the environmental impact of 

the food system of the UMCG. Future changes of the food system in the UMCG can therefore be 

compared to the baseline that this thesis provides. This thesis can be seen as the potential start of a series 

of researches performed either by the UMCG or by external experts on the hospital food system. 

All food-streams (restricted to the warm meals served to the patients) within the hospital gate (entrance 

and exit) are within the research boundaries. Outside the hospital gate, information about (products and 

processes at) the supplier and the end destination of the waste is also of importance. The extent to which 

this information is necessary for this research was determined during the study of the food system in the 

UMCG. The data is from the year 2011, since that was the most recent year from which data was 

available. Observations are conducted in 2012. Note that all products or product groups are assessed for 

their entire lifetime impact, from cradle to grave. 

1.5 Structure of thesis 

After this introduction chapter, information about the UMCG is given in the second chapter of this thesis. 

This information concerns the facts and figures of the UMCG, information about the environmental 

policy of the UMCG. In chapter 3, more information is given about the food system of the UMCG and 

more general information about hospital food systems. In chapter 4 the results of the research are 

discussed. Next some hot-spots for improving the hospital “foodprint” are discussed in chapter 5. In the 

following chapters 6 and 7, a conclusion and discussion are given. 

14

2 ABOUT THE UMCG 

2.1 Introduction 

The UMCG is one of the largest hospitals in the Netherlands. It has 1339 beds available and the average 

time spent in the hospital is 9 days (excluding patients that are hospitalized for day care only; UMCG, 

2012a). The UMCG is one of the biggest employers of the northern part of the Netherlands, providing 

jobs for over 10,000 people. All Dutch University Medical Centers like the UMCG have three main 

functions: care, education and research. It is understandable that the function ‘care’ takes an important 

role within the UMCG. Not only do local and regional inhabitants visit the UMCG for their regular 

hospital appointments, but people from a larger area visit the hospital for more complex interventions. On 

top of that, people from all over the Netherlands visit the UMCG for certain specialties. 

The part ‘University’ in the hospital name indicates a role in education and research for the UMCG. As 

the name of the hospital already indicates, the hospital is affiliated with a university: the Rijksuniversiteit 

Groningen (RuG). The UMCG provides the education of 3400 students from the University of 

Groningen, mainly medical students. Other programs that are supported by the UMCG are dentistry and 

human movement sciences. Besides these studies, expert training for several medical specialties is offered 

at the UMCG. There are approximately 450 physicians in training at the UMCG. In addition, the UMCG 

has a role in providing vocational training of nurses, nutritional assistants and other professions that are 

operational within the hospital environment. 

Together with the RuG the UMCG performs a broad variety of research. Both clinical and fundamental 

research is done in collaboration, from molecular biology till long-term population studies. The UMCG is 

positioned high in international rankings for research. The main focus point for the combined research 

between the UMCG and the RuG is ‘Healthy Aging’ (RUG, 2013, UMCG, 2013). 

2.2 The energy policy and energy use of the UMCG 

The UMCG aims to reduce its energy use with (at least) 30% in 2020 compared to 2005 (Agentschap NL, 

2012). This is part of a multiyear agreement among all UMCs in the Netherlands together with the Dutch 

government, focused on energy efficiency. In order to realize such an emission reduction, a road map is 

made for all UMCs (Agentschap NL, 2012). This road map includes a forecast towards 2030 (with an 

energy reduction goal of 50% compared to 2005), but this is an aspiration for the future and not part of an 

agreement. 

One of the actions that the UMCG plans to undertake is to develop an energy management vision, which 

is scheduled to be released in the end of 2013 (UMCG, 2012c). By working out in detail which actions 

have to be taken by which departments or persons in the hospital, the energy efficiency goals can be 

achieved. The focus will shift from the technology (abstract) towards the entire chain (practical). At the 

moment of writing this thesis, the UMCG works on a greater awareness of the energy ambitions among 

employees. 

Table 1 - Energy and water use of the UMCG in 2011 (UMCG, 2012c) 

Total (direct) energy use 673,5 TJ 1 

- Natural gas 14 x 10 6 m 3 

- Electricity (purchased) 25 x 10 6 kWh 

CO2 equivalent emission 79 x 10 3 ton CO2 eq 

Total water use 31 x 10 4 m 3 

1 Energy contents as used by the UMCG. Natural gas: 31,7 MJ per m 3 . Electricity: 9,0 MJ per kWh. 

15

The UMCG has its own gas-fired power plant. The gas is converted to electricity, steam, and warm and 

cold air. The total energy use of the UMCG is depicted in table 1. From table 1 can be concluded that the 

gas-fired energy plant of the UMCG does not produce all electricity for the whole hospital. The reason for 

this is a financial one: it is cheaper to buy electricity at night at a reduced rate. However, the gas-fired 

power plant can supply enough electricity, e.g. in case of a power failure. 

To put the energy use of the UMCG in some perspective, the total direct energy use (electricity and 

natural gas) can be compared to the direct energy emission of an average (Dutch) household. An average 

Dutch household uses approximately 3500 kWh electricity and 1600 m 3 natural gas each year (Milieu 

Centraal, 2013). This corresponds with 82 GJ in total 2 . A quick calculation shows that the UMCG uses 

approximately as much direct energy as 8,300 Dutch households every year. 

All UMCs have commissioned a CO2 footprint analysis in 2010. This CO2 footprint analysis is the basis 

of the road map towards 50% energy reduction in 2030. The CO2 footprint analysis is performed by 

experts from Royal HaskoningDHV (at that time the company was called DHV). The CO2 footprint 

analysis is done for each UMC individually. Because this CO2 footprint analysis is relevant for the results 

of this research, it is described here. 

All energy used by the UMCG was calculated by using the three scopes that are defined by the 

Greenhouse Gas protocol for CO2 accounting (WRI and WBCSD, 2012). These three scopes are: 

1. Direct emissions by energy use. 

2. Indirect emissions caused by electricity use. 

3. Indirect emissions caused by activities of the company. 

All greenhouse gas (GHG) emissions were included and converted to CO2 eq emissions using the 

greenhouse gas protocol (WRI and WBCSD, 2012). Table 2 gives an overview of the sources of emission 

that are included in the three scopes for the specific CO2 footprint study of the UMCG. 

Table 2 - Sources of emissions for the CO2 footprint analysis of the UMCG (UMCG, 2012c) 

Scope Source of the emissions 

1 Natural gas 

Fuels for transportation (hospital vehicles) 

2 Electricity 

3 Transport movements of patients 

Transport movements of visitors 

Commuting transport of students and employees 

Cleaning textile 

Business travel by air 

Waste processing 

Production of materials/items purchased by the UMCG 

2 Note that the same energy contents are used as in table 1. 

16

Figure 1 - The share of each of the three scopes in the CO2 footprint of the UMCG (UMCG, 2012c) 

The total CO2 eq emission by the UMCG was 79 x 10 3 ton CO2 in 2010 (and it is assumed that this has 

remained about the same in 2011). The third scope accounts for 51% of all CO2 eq emissions of the 

UMCG, as can be seen in figure 1. In principle the production of all purchased items should be included 

in a CO2 footprint analysis. But this is not done for this specific CO2 footprint analysis. Therefore the 

hospital food system is excluded from the calculation. The reason given for this was the expectation that 

food would not significantly contribute to the CO2 footprint (this would apply to all purchased items). But 

this expectation is not yet substantiated by research. 

Within households food products contribute approximately 10% of the total household CO2eq emissions 

(Kramer et al., 1999, Munksgaard et al., 2000, Kerkhof et al., 2009). Although a hospital has totally 

different (energy) expenditures than a household, it is expected that food items do have a significant 

impact on the total CO2 footprint, at least for scope 3. 

Since all purchased items are excluded from this CO2 footprint analysis one may assume that the CO2 

footprint gives an underestimation of the actual CO2 eq emitted by the UMCG. The UMCG strives to 

complete the CO2 footprint as soon as possible. The results from this thesis will be used by the UMCG to 

come one step closer to the completion of the CO2 footprint research. 

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3 HOSPITAL FOOD SYSTEMS 

This chapter describes the range of possible food systems in healthcare facilities like hospitals that are 

currently operational in the Netherlands. After the description of the hospital food systems, the current 

system that is operational in the UMCG is explained in more detail. The UMCG will switch to another 

system in March 2013; this system is explained in the third subsection. Lastly, an overview is given of the 

swill (another word for food-waste) produced by all University Medical Centers in the Netherlands. 

3.1 Three commonly used food systems 

In general, a food system in a healthcare facility exists of two separate parts: the back-office and the 

front-office. The back-office concerns all actions that are carried out without any interference with the 

patient. This corresponds with everything that is conducted in the kitchen (the cooking, the portioning, 

and so on). The front-office is focused on the client: this corresponds with the delivery of the meals to the 

patient. In this thesis, the focus is on the back-office since only procedures in the kitchen have been 

observed. 

There are three commonly used (back-office) food systems in the Netherlands in healthcare facilities. All 

three are explained below and their characteristics are summarized in table 3. The systems are: 

1. Coupled cooking (in Dutch “gekoppeld koken”) 

2. Decoupled cooking (in Dutch “ontkoppeld koken”) 

3. Assembled cooking (in Dutch “geassembleerd koken”) 

With coupled cooking the cooking and the portioning (plating of the food) succeed each other directly, as 

the name indicates. The prepared food is warm at the moment of plating. The benefit of this system is that 

the food is microbiologically safe, because of the small period between cooking and portioning and the 

high temperature of the food. One of the big disadvantages of this system is the peak pressure for the 

chefs. All food items have to be prepared at a certain time. This makes timing crucial: if items are ready 

too soon the temperature of these items will drop (which can promote bacterial growth) and when items 

are ready too late, these items cannot be plated. 

Decoupled cooking dissociates the cooking from the portioning. Immediately after cooking, the food is 

cooled and after cooling, the food items can be stored 72 hours. After portioning, the food can be 

regenerated (heated) at any moment necessary. Before the food is regenerated, it is kept cold. This system 

releases the peak pressure from the chefs and all kitchen-work can be divided more equally over time, 

which makes the overall work of the chefs (and other staff) more efficient. In a coupled system, the chefs 

need to cook every day of the week. In a decoupled system, it is possible to cook five days a week. 

Especially in labor costs, this can be a great saving. Another advantage of the decoupled system is that up 

scaling is very easily achieved. It is possible to cook at one location for multiple healthcare facilities. A 

disadvantage of the system is that it requires a large investment to make the kitchen suited for decoupled 

cooking. Next to that, the energy use in the kitchen might rise due the extensive cooling of the food and 

the areas in which food is portioned. 

The third possibility is assembled cooking. In this system, there actually is no cooking at the health care 

institution. Instead the meal components are prepared by an external company. The only things the staff at 

the health care facility have to do is portion the food components and regenerate the meals. Although the 

price per food item might be higher for an assembled component, there is a possible reduction in staff 

costs. This makes it attractive to switch to assembled cooking. A disadvantage of the system is that the 

food is no longer prepared at the healthcare facility itself, which minimizes the control over the quality 

and safety of the meal components. Decoupled and assembled cooking are suited for a combination, since 

the meals have to be regenerated in both systems. 

19

Table 3 - Summary of key points of the three commonly used hospital food systems in the Netherlands 

Coupled cooking Decoupled cooking Assembled cooking 

Meals prepared in own kitchen Yes Not necessarily No 

Meals need regeneration No Yes Yes 

Peak pressure in the kitchen Yes No No 

3.2 Current UMCG food system 

In order to analyze the potential hot-spots for improvement from an environmental point of view, it is 

necessary to understand the relevant aspects of the system. In this section the current food system at the 

UMCG is described, from the moment the food arrives at the hospital till the moment the food is either 

consumed by a patient or leaves the hospital in the form of food-waste. All information in this subsection 

is based on personal observation, informal interviews with the kitchen staff and communication with two 

hospital food-experts (Bennema, 2012, Wartena, 2012) 

The UMCG currently uses coupled cooking to prepare all warm meals that are served to the patient. Both 

breakfast and the evening bread meals are not prepared in the kitchen, but at the wards. Each day, the 

kitchen of the UMCG produces approximately 700 warm meals. 

Every morning (except on Sunday), fresh food arrives early at the UMCG. The suppliers deliver their 

foodstuffs into a cooling cell. The kitchen staff starts every morning around 7:00AM. They start with 

cooking various components of today’s menu. How much of every component is needed is estimated the 

day before, when the meal choices of all the patients are administrated. 

The cooking ends at about 10:30AM, then everything is prepared for the plating. A conveyor belt is used 

for plating the patient meals. The meal choice of every patient is reflected on a ‘bandkaart’, translated as 

‘belt cart’. This is a chart with the meal choice reflected in a simple way. See Appendix A for an example. 

Different colors reflect different meal components (e.g. starch, salad, vegetables, dessert). Within these 

colors, a code together with a number reflects the choice (e.g. starch: potato, rice or pasta) together with 

the portion-size (e.g. one serving or two). Along the conveyor belt there are multiple stations manned by 

one employee, each responsible for one of the components. The plated trays are checked by a supervisor 

and then placed in a trolley. These trolleys have a system for contact heating and a separate compartment 

for cooling (salad, dessert). The cooling is done by adding a cooling gas (CO2) to the cooling 

compartment of the trolley after the trolley is stacked. The trolleys are brought to the basement of the 

UMCG, to which all buildings are connected. An electrical vehicle brings the trolleys from the kitchen to 

the right department and there nutritional assistants distribute the trays to the patients. Note that the warm 

meals are served around noon. 

When the patients finish their meals, the trays are returned to the kitchen in the trolleys. There, the food 

waste is collected. The dishes are done and the kitchen staff does some preparations for the meal of the 

next day. Around 04:00PM everything is cleaned and the staff goes home. 

20

Figure 2 – An employee of the UMCG portioning the main warm meals (van Dinther, 2011) 

Although the above described logistics might be understandable, there are more factors that are 

influencing the food system. First and foremost is the nutritional composition of the meal. The meal 

should provide enough nutrients and energy for the patients. On top of that, it should be healthy. 

The menu consists of four seasonal cycles. Within a seasonal cycle there is a menu cycle of two weeks. 

This means that within a period of two weeks, a patient has a different warm meal each day. And within 

the menu of the day, there are multiple choices for all the different meal components. So even if a patient 

stays in the hospital more than two weeks, he or she can make different meal choices. Some basic 

components are offered each day (like chicken breast, mashed potatoes and apple sauce) because of their 

general popularity. Not only the type of food can be chosen, but also the portion in which it is served. 

And on top of the menu-variety, certain diets influence the menu as well. Diabetes, food allergies and a 

prescribed low sodium intake are only three examples of nutritionally-related disorders that influence the 

menu choice. Some patients have problems swallowing solid foodstuffs; they receive soft or mashed 

foods. Patients that are malnourished receive an additional set of beverages and foodstuffs in order to 

facilitate their recuperation. So on an average weekday the menu consists out of 15 components that each 

offers choices with regard to diet and proportion. A summary of the meal choices in the autumn menu 

(used in 2012) can be found in Appendix B. 

3.3 Future UMCG food system 

The UMCG will switch to decoupled cooking in March 2013. The chefs will cook five days a week, while 

the other kitchen staff will experience small changes in their working hours. In the future system, the 

patients can hand in their meal choice the same day he/she receives the warm meal. The warm meal will 

be served in the evenings (around 06:00PM). It is predicted that the operational costs will decrease due to 

multiple factors: 

• The chefs can work more efficiently and therefore in fewer hours. 

• The quantity of wasted food is predicted to decrease, because all meal components can be used 

two to three days after cooking. 

21

At 01:30 AM the food will be portioned. A difference with the current system is that the food is plated 

when it is cold and the plating-room has to be chilled. The trays are placed in the same trolleys as before. 

The trolleys are cooled with CO2 and programmed to heat the food 55 minutes before the trays are served 

to the patients 3 . The heating will be done at the patient wards. After the warm meals are consumed by the 

patients, the trolleys are returned to the kitchen where the food waste is collected and the dishes are done. 

3.4 Hospitals and food-waste 

Literature shows widely diverging percentages for food-waste in hospitals, but the reported food-waste 

lies mostly between the 30% and 40% (Barton et al., 2000, Almdal et al., 2003, Sonnino and McWilliam, 

2011, Goeminne et al., 2012). The percentage food waste is calculated by dividing the total amount of 

purchased food items (in kilograms) by the amount of swill (in kilograms). This information is not readily 

available for all hospitals in the Netherlands. Instead, the quantity of swill can also be expressed per bed. 

In this way, hospitals of different sizes can be compared. Because of the specific function of a University 

Medical Center, it is best to only compare these hospitals with each other and leave the general hospitals 

out. There are 8 UMCs in the Netherlands, but the data of two UMCs was not available for this 

comparison. From figure 3 can be concluded that the VUMC and the UMCG st.Radbout score very low 

on their amount of swill per bed compared to the other UMCs. Because the data for this graph was 

delivered by all UMCs individually, it is possible that the VUMC and the UMCG st.Radbout use a 

different way of measuring or reporting their swill (e.g. a part of the swill is discarded with the normal 

waste). 

22 

Figure 3 - Swill from UMCs in 2011 (DHV, 2011) 

3 The heating of the trolleys is done with three phase electric power (380 Volt/16 Ampere)

4 RESULTS 

4.1 Introduction 

This chapter discusses the answers to the first four (sub) research questions. The first three research 

questions focus on the food streams in, trough and out of the hospital. The environmental impact of the 

food system is determined as an answer on the fourth research question. This chapter ends with an 

outlook to the future: what could possibly change in the results described in this chapter when the switch 

is made to decoupled cooking? 

4.2 Inflow side 

The research question that is associated with the inflow side is: “What is the quantity (weight) and quality 

(which products) of the inflow of food to the hospital?” 

The complete purchase list of food items in 2011 by the UMCG can be delivered upon request at the 

IVEM. A summary of the quantity and costs of the products can be found in table 4. “Total food” 

includes all food items purchased by the UMCG, for every meal and for patients, staff, and students. The 

quantity food items in total is very large compared to the warm meals only, but this is due to the large 

number of staff, visitors and students that consume their meals at the UMCG each day. Next to that, all 

meals and diet products served to the patients additional to the warm meal are included in “Total food”. 

The UMCG has set a budget (2011) of €7,01 per patient per day (Wartena, 2012). This includes all meals 

and diet products (if necessary) and adds up to a total of €1.8 million in 2011. Note that next to that, there 

are expenses for the food consumed by the staff, students and visitors in the UMCG. These expenses are 

reflected in ‘total costs’ in table 4. 

To put this in somewhat in perspective: The UMCG had a budget of € 961,7 million in the year 2011 

(UMCG, 2012b). The purchased food items for patients only represent 0.2% of the total budget. For 

comparison: the total costs of energy in the same year were €9.0 million (0.9% of the total hospital 

budget; (UMCG, 2012b). 

Table 4 - The quantity and costs of all purchased food items, total and warm meals only (2011) 

Warm meals only Total food 

Quantity Costs Quantity Costs 

Long shelf live 0.07 x 10 6 kg €0.6 million 1.5x 10 6 kg €2.1 million 

Fresh products 0.2 x 10 6 kg €0.7 million 1.1 x 10 6 kg €1.4 million 

Total 0.3 x 10 6 kg €1.1 million 2.6 x 10 6 kg €3.5 million 

All processes associated with the inflow of the food items are described in chapter 5.1 (Day to day 

activities). 

4.3 Inside the hospital 

This subsection answers the research question: “What are the different routes that the food travels within 

the hospital?” The day to day activities in the kitchen are described in chapter 5.1. Here a summary is 

made of the routes that the foot items for the warm meal travel in the hospital, with a focus on the foodwaste 

that arises along the way. 

The food enters the hospital in the cooling cells or storage rooms. The food is delivered there by multiple 

suppliers, which all have a different origin. When the food is needed, it is used in the kitchen to prepare 

the warm meals. Some of the items do not need any processing: fruit, desserts, and so on. These are stored 

23

in the cooling cell until they are plated during portioning. A small portion of the food items in storage are 

thrown away before they are actually used, as a result of poor inventory control. 

Generally, there is a large amount of food left after portioning. Although this food is suited for human 

consumption, it is discarded in the swill tank. The plated food goes to the patient wards on trays in 

trolleys. There the meals are eaten by the patients. If all patients have finished their meals, the trays are 

stored in the trolley again. Although it could not be confirmed by observation or research, it is assumed 

that a small part of the food waste is discarded at the ward. The largest part of the food-waste or other 

waste (e.g. plastic from the dessert cup) is left on the trays. When the trolleys are returned to the kitchen, 

they are unpacked by employees. Most of the food-waste ends up in the swill grinder (connected to a 

swill tank). A few specific foodstuffs are not discarded in the swill shredder: banana peels, whole pieces 

of fruit, bread and plastic-wrapped food (e.g. desserts, pre-packed salads). Because plastic cannot be 

digested, it is logical that wrapped food items are not discarded in the swill shredder. Banana peels, fruit 

and bread are left out because they would clog the shredder according to the staff on the floor (Various 

employees UMCG, 2012). 

Approximately 10% of all the trays are returned to the kitchen untouched (Bennema, 2013). The UMCG 

monitors the number of untouched returned trays each year. A patient that does not touch his/her food at 

all is a signal for malnourishment, which the hospital wants to prevent as much as possible. Figure 4 is a 

picture of an untouched meal that was returned to the kitchen. As can be seen, the fruit (an apple in this 

case) is mostly served in a plastic cup to prevent rolling on the tray. 

Figure 4 - An untouched tray returned to the kitchen. Food items on the tray: a plate (chicken breast, potato, vegetables), 

an apple, two side-salads, dressing and a dessert. 

All the food items that are returned to the kitchen are discarded (either in the swill shredder or in a normal 

waste bin). This includes untouched desserts, pre-packed salads, salad dressing and so on. Because these 

products have reached a temperature above 7°C they are no longer guaranteed to be safe for consumption 

and the UMCG is obliged to discard the items (Wartena, 2012). 

24

Observation showed that there are four points along the food-chain in which food-waste may potentially 

arise: 

1. At the storage rooms and cooling cells 

2. During cooking 

3. During or after portioning 

4. After the meal: 

a. At the ward 

b. Returned to kitchen 

A part of the food-waste is unavoidable, for example potato peels. But as much of the vegetables enter the 

hospital peeled and chopped, the portion unavoidable food-waste is only small. In this research, no 

distinction is made between avoidable and unavoidable food-waste, because it all ends up in the swill 

tank. 

Figure 5 gives an overview of the food streams to, through and from the hospital. The four points at 

which food-waste arises are expressed in their physical location: central storage, central kitchen (during 

cooking, after portioning and after the meal returned to the kitchen) and at the patient wards. The largest 

part of the waste is discarded with the swill, but another portion is discarded with the normal waste. The 

quantity of these waste-streams is discussed in the next subsection. 

Figure 5 - A flow chart of the food streams towards, through and out of the UMCG 4 (situation 2012) 

4 For an explanation about the additional waste-stream “grease”, see the next subsection. 

25

4.4 Outflow side 

This subsection answers the research question: “What is the quantity (weight) and quality (which 

products) of the food-waste leaving the hospital?” The quantity of the food waste for is published each 

year in the annual report of the UMCG. In 2011 this was 182 tons of swill. The quality (which products) 

is not known. Observations in the kitchen made showed that a little bit of everything is discarded (see also 

previous subsection). In order to make a proper qualitative analysis a sorting analysis should be 

performed (but it was not feasible to do a sorting analysis during this research). 

The swill from the UMCG is digested with the purpose of producing biogas (van Slochteren, 2013). The 

swill tank below the kitchen of the UMCG can contain maximal 8000 Liters swill (van Slochteren, 2013). 

The tank is emptied every week. It is transported to Heerenveen, where it is digested. The UMCG has 

tenders with different waste management companies for their different streams of waste. Each tender is 

contracted for four years (van Slochteren, 2013). The UMCG pays the contractor (which is SITA in the 

case of swill) to retrieve and digest the waste. For swill alone, the UMCG pays approximately €15,000 

per year (van Slochteren, 2013). 

A discussion with a waste expert from the UMCG led to the discovery of another biodegradable stream of 

waste (on top of the swill): grease (fat) from grease traps (van Slochteren, 2013). The grease is a byproduct 

from cooking that ends up in the waste water (sewerage) and the traps collect the grease before 

the water is flushed away with the sewerage. The grease does not have to be monitored and registered. 

Therefore it is not mentioned in the annual report. The quantity of grease per year is comparable with the 

quantity of swill (approximately 100 tons is assigned to the warm meals; van Slochteren, 2013). And, just 

like the swill, the grease is digested. See table 5 for the (theoretical) methane yield of both the swill and 

grease. 

Table 5- Theoretical methane yield from the swill and grease produced at the UMCG in 2011 (Steffen et al., 1998, 

Biowattsonline, 2013) 

Swill Grease from grease trap 

Total weight (wet) 182, 000 kg 100,000 kg 

Total methane 15,500 m 3 7,500 m 3 

Total energy content 0.6 TJ 0.3 TJ 

See appendix D for an elaboration on the calculations used in table 6. The potential energy yield from 

digesting the swill represents approximately 0.13% of the annual use of the UMCG . As a reference, an 

average Dutch household uses annually 1600 m 3 natural gas in total (Milieu Centraal, 2013). This 

corresponds with 1300 m 3 methane (Milieu Centraal, 2013). So the methane generated by the digestion of 

the swill and grease yields enough methane to supply 17 households in their (direct) natural gas need. 

Not all food-waste is discarded with the swill. A part of the food-waste (as described in the previous 

subsection) is discarded with the normal hospital waste. This normal hospital waste is incinerated; all 

hospitals in the Netherlands are obliged to incinerate their waste (van Slochteren, 2013). The incineration 

yields electricity and heat. 

With all the food and waste streams known, it is possible to expand the flow chard in figure 5 with 

quantities. These quantities originate from a combination between the reported quantity swill and 

assumptions. Below, a short summary and a visual representation of all food-waste streams are given. 

26

Rounded off there was 180 ton swill reported by the UMCG in 2011. It is assumed that 20% of this 

amount is water that is added to the swill tank (e.g. during dishwashing). Next to the food-waste 

discarded with the swill, it is assumed that an additional 20% is discarded with the normal hospital waste 

(e.g fruit and pre-packed food items). These assumptions lead to 175 ton ‘actual’ food waste in 2011. 

During observation in the kitchen, it became clear that all the swill the UMCG produces can be attributed 

to the main meals served to the patients. All other food-waste (e.g. from the breakfast and bread meal for 

the patients, and from the food served to the staff, students and visitors) is discarded with the normal 

waste. This means that from the 300 tons purchased food items for the warm meals; 175 tons or 58% was 

wasted in 2011 5 . With 700 meals served each day, this corresponds with approximately 650 gram waste 

per meal every day in 2011. This amount of food-waste has a value approximately €2.30 per warm meal. 

Reducing the amount of food-waste per patient means that the budget per patient can be spent more 

efficiently on warm meals. 

Figure 6 - Food waste at the UMCG, converted in the weight of food and waste per meal (2011) 

Table 6 - Value of the food (warm meals for the patients only) and food-waste in 2011 

Weight in 2011 Associated costs in 2011 

Food items for meals 300 tons € 1,1 million 

Food-waste 175 tons €0.6 million 

Knowing the amount of food waste is known and the places at the hospital where it arises, the flow chart 

from figure 5 can be expanded with the quantity of the food-waste. First, the assumptions are summarized 

in table 7. These percentages are used to make figure 7. In this figure, all places where food-waste arises 

are present along with the amount of food-waste (in percentages) that arises at this place. 

5 Note that the total percentage of food waste from the UMCG will be lower, because all other food waste is not 

registered (so the total food waste does not increase) and the total quantity of foot items purchased by the UMCG is 

higher than 300 tons. 

27

Table 7 - Summary of assumptions about the origin and destination of the food-waste 6 

Swill Normal waste 

Storage - 5% 

Kitchen (cooking) 10% 

After portioning 50% 

At the ward 5% 

Returned to the kitchen 20% 10% 

Total 80% 20% 

28 

Figure 7 - Indication of where the food-waste originates and the quantity of the food waste in percentages. 

The abbreviation N.W. stands for Normal Waste. 

6 There is no actual determination of the weight or statistical analysis involved with these assumptions. All 

assumptions are based on observations.

5 ENVIRONMENTAL IMPACT OF THE FOOD SYSTEM 

This last subsection answers the fourth research question: “What is the environmental impact of the food 

system?” First, the methodology for calculating the environmental impact is explained. The results are 

given in the next subsection. Next to the calculation of the indirect energy use and the CO2 eq emission, 

the indirect land en water use by the UMCG food system is determined. The latter two analyses are not 

explicitly included in the research questions, but during the research it was assumed that the analysis of 

the indirect water and land use would add value to the calculation of the environmental impact. The 

results of those two analyses are given in the last subsection. 

5.1.1 Methodology for environmental impact calculations 

Because the UMCG already had information about the total energy use at the hospital (expressed in MJ) 

and the CO2 footprint of the hospital, it was a logical choice to express the environmental impact of the 

food system in MJ (indirect energy) and CO2 eq. Both were calculated by using the purchase lists over 

2011, only using the products that were consumed during the warm (patient) meals. 

Note that not all direct energy use related to the food system (e.g. in the kitchen, at the wards) is included 

in this research. The same holds for the way the food waste is processed. Both direct energy use by the 

UMCG and waste processing are already included in the CO2 footprint analysis. Next to that, transport of 

food and waste is not taken into account. This is omitted from the CO2 footprint that was made for the 

whole UMCG and therefore also omitted in this research. 

The purchase lists contained information about specific aspects of a product (most of the times this 

included the weight or volume), the quantity in which it was bought and the price of the products. 

Because the methodology for the calculation of the environmental impact required the weight per product 

(group), the weight of each item was derived from the product information. Drinks and supplementary 

diets products were excluded from the list. Fruit and desserts were included, because these products are 

served to the patients during the warm meal. 

After this, the list was categorized in seven product categories. Each product category exists of either one 

or multiple product groups. These are listed in table 8. The complete purchase list of the UMCG can be 

delivered upon reques at the IVEM. This list is in Dutch, because it was delivered in Dutch and 

translating would not add significant value to this thesis. 

By means of tables derived from literature, it was possible to calculate the indirect energy use in MJ and 

convert this to the CO2 eq emission (Gerbens-Leenes, 2003). In order to explain the methodology 

thoroughly, it is described step by step accompanied with an example. 

1. All food products for the main meal were selected and categorized in seven product categories 

and subsequently in a product group (see table 8). 

Example: product category 2, potatoes vegetables and fruit. From this category, the product 

group “Potatoes” will be used in this example. This product group adds up to a mass of 35 x 10 3 

kilogram. 

2. For each product group, an equivalent is searched for in the table provided by Gerbens-Leenes 

(2003). 

Example: the item “Potatoes (plastic bag)” is used for the product group “Potatoes”. The 

corresponding value from the table provided by Gerbens-Leenes (2003) is 1.9 MJ/kg. 

3. The indirect energy use of the product group is calculated by multiplying the total weight of the 

product group with the value from Gerbens-Leenes (2003). 

Example: for the product group “Potatoes”: 35 x 10 3 x 1.9 = 66.7 x 10 3 MJ 

29

30 

4. The amount of indirect energy is converted to CO2 eq emission. The indirect energy is assumed to 

be diesel used in agriculture or transport 7 . The conversion factor is recommended by an expert 

from the Groningen University (Benders, 2013). Each MJ indirect energy represents a CO2 eq 

emission of 0.09 kilogram. 

Example: for the product group “Potatoes”: 66.7 x 10 3 MJ x 0.09 = 6.0 7 x 10 3 kilogram CO2 

eq. 

Appendix C shows all choices from the list used by Gerbens-Leenes. The indirect energy use and CO2 

results are given in the next subsection of this chapter. 

Table 8 - Product categories and product groups used to calculate the environmental impact of the UMCG food system 

Product categories Product group 

1. Bread, pastry and flour products Flour (including bread) 

Rice 

Pasta 

Potato starch 

2. Potatoes, vegetables and fruit Dutch fruit (apple, pear) 

Tropical fruit (incl. canned fruit) 

Greenhouse vegetables 

Open ground vegetables 

Potatoes 

3. Beverages and products containing sugar Sugar, sweeteners, sugar syrup 

Honey 

Fruit juices (used for cooking) 

4. Oils and fats Vegetable oils and fats 

5. Meat, meat products and fish Pork 

Beef 

Poultry 

Fish 

Other meat (e.g. lamb) 

6. Dairy products and eggs Desserts 

Cheese 

Cream 

Eggs 

7. Other products Salts, herbs, broth powder 

Sauces 

Meat substitute 

Composed meals ready-to-eat 

Canned tomatoes 

Remaining products (no category applicable) 

7 This assumption might not be entirely correct, but justified because it gives a representative indication.

5.1.2 Lifetime energy use and CO2 emission 

The results expressed in indirect (primary) energy use and CO2 eq emissions are listed in table 9. Because 

the CO2 eq emission is calculated directly from the indirect energy use, all graphs using percentages are 

expressed in CO2 eq emission (percentages would be equal for indirect energy and CO2 eq emission). The 

CO2eq emission is compared to the CO2 footprint of the UMCG. 

The total indirect energy used by producing the food items that are used for the mean meals for patients at 

the UMCG is 9 TJ. This is 1.3% of the total (direct) energy use of the UMCG in 2011. The CO2 eq 

emission is 798 ton, corresponding to 1% of the CO2 footprint analysis of the UMCG. 

The food items should be classified in the third scope of the CO2 footprint (indirect emissions caused by 

activities of the company). The food items account for 2% of the third scope, as shown in figure 8. 

Table 9 - Total indirect energy and CO 2eq emission from the warm meals served to the patients at the UMCG in 2011 

Total indirect energy 8914 GJ or 9 TJ 

Total CO2eq emission 798 ton 

Figure 8 Scope 3 from the UMCG CO 2 footprint including the warm meals (2% of total in scope 3) 

31

The CO2 analysis of the different food categories used in this thesis can be seen in figure 9. The left-hand 

panel shows the food categories in weight, displaying that category 2 (vegetables and fruit) has the largest 

share. The right-hand panel shows the CO2 emission in the different categories. Now category 5 (meat) 

has the largest share in the total. This is to be expected, since the environmental impact from meat 

products is relatively high compared to other food products (de Vries and de Boer, 2010). 

The results from the environmental impact analysis do not correspond with the expectation that the food 

items could possibly account for up to 10% of the total CO2 eq emissions of the UMCG. The possible 

explanations for this discrepancy are elaborated upon in chapter 9 (Discussion). 

Figure 9 - The product categories for the warm meal divided by weight (left) and CO 2 footprint (right). 

5.1.3 Environmental impact: land and water footprint 

Environmental impact is broader than CO2eq emission only. In addition to the indirect energy (and CO2eq 

emission) research, information about the land and water footprint of the food items for the warm patient 

meals are collected. Information about the land use was available in the same source that was used to 

determine the indirect energy use (Gerbens-Leenes, 2003). The information about the water use is 

obtained from a website specialized in water footprint of food (and other agricultural) products 

(Mekonnen and Hoekstra, 2010). For direct land use, the total surface area of the UMCG is used (UMCG, 

2012a). The direct water use by the UMCG is also given in the annual report (UMCG, 2012a). 

32

Table 10 -The land use and water footprint for the UMCG, both direct (whole UMCG) as indirect (food only) in 2011 

UMCG (direct) Food footprint (indirect) 

Land use 35 x 10 4 m 2 90 x 10 4 m 2 

Water use 31 x 10 4 m 3 50 x 10 4 m 3 

As can be concluded from table 10, the food footprint for land use is approximately equivalent to three 

times the (surface) area of the UMCG. The water footprint is almost twice as large as the direct water use 

by the UMCG. Category 5, meat, has the biggest contribution to both the indirect water use as the indirect 

land use. See figure 10 for a representation of all the product categories in the water and land footprint. 

Figure 10 - The product categories for the warm meals divided by indirect water use (left) and indirect land use (right). 

33

5.2 Outlook to the future: change to decoupled cooking 

The UMCG is to switch to decoupled cooking in March 2013. In this subsection presents an outlook into 

the future, what could possibly change in the results described in this chapter when the switch is made to 

decoupled cooking? 

Less food-waste 

Because all prepared food components will be cooled and therefore preserved for a longer period, it is 

expected that the amount of food-waste after portioning will drop significantly. The food that is left over 

after portioning can be used again the other day or at another location (e.g. the kitchen that prepares meals 

for staff, students and visitors). 

Higher energy use in the kitchen 

The energy use at the kitchen is predicted to rise. This rise is attributed to the cooling of the food 

components and the area used for portioning. There are other changes in the kitchen that might reduce the 

energy need of the kitchen (e.g. cooking with steam instead of natural gas), but these reductions are 

forecasted to be smaller than the increase in energy use at the kitchen (Bennema, 2012). 

Higher energy use at the wards 

Because the food is going to be regenerated at the wards for 55 minutes, the energy use at the ward will 

rise due to the change to decoupled cooking. 

Increased capacity of the kitchen 

Shortly after the switch to decoupled cooking, the UMCG kitchen will increase the production of warm 

meals with approximately 25% (Bennema, 2012). All warm meals for the rehabilitation facility 

‘Beatrixoord’ in Haren (part of the UMCG) will be produced at the UMCG kitchen. This increase in 

capacity will increase the energy use at the UMCG. But since the kitchen at Beatrixoord shall be closed 

and a higher efficiency can be realized due to the increased capacity, the net energy use per meal is not 

predicted to rise. The amount of food-waste produced at the UMCG does possibly rise as a consequence 

(but again, the net amount of food-waste per meal will probably decrease because of the higher 

efficiency). Because all the meals have to be transported from the UMCG to the Beatrixoord, the transport 

will increase (with the corresponding energy use and CO2 eq emission). 

In chapter 7 recommendations for further research are made. Part of this recommended research is 

focused on studying the environmental impact of the future food system at the UMCG. 

34

6 POTENTIAL HOT-SPOTS FOR THE UMCG TO REDUCE THEIR ‘FOODPRINT’ 

This chapter answers the main research question: “What are possibilities to reduce the environmental 

impact from the current food system (focused on the warm meals to the patients) of the UMCG?” The 

contribution of the CO2eq emission from the food system is relatively small compared to the UMCGs’ 

total CO2 footprint. But this does not mean that any actions lowering the environmental impact from the 

food system will have no result. First of all, environmental impact consists of more parameters than 

CO2eq emission only. The indirect water en land use footprints from the food system are quite high and 

can be lowered. Secondly, if one looks at the food system and the UMCG from a sustainability point of 

view, there are more actions that can be taken. Some actions might enhance the People-side (e.g. more 

healthy meals, a ‘green’ image) whereas other actions might lower the costs (Profit-side). Both actions on 

the People and the Profit side can benefit the environment (Planet side). Below is explained how these 

three sides can work together to create a healthy and environmentally friendly UMCG without rising 

costs. The potential hot-spots are divided in policy measures and technical measures. Both types of 

measures can be further divided in easy measures, that can be accomplice on the short term (< 5 years) 

and more complex measures that take a longer time to be implemented (> 5 years). The hot-sports are 

summarized in figure 11. 

6.1 Policy measures 

Policy measures are measures that require either a change in the UMCG policy or an intention towards a 

certain hospital image (e.g. a sustainable hospital). The more complex and long-term measures involves a 

measure that is harder to establish because of the current laws and regulations in the Netherlands. 

6.1.1 Relatively easy and short term measures 

Food theme days 

Food theme days were organized previously in the UMCG, e.g. meal prepared by chef Dick Soek (van 

Dinther, 2011). He used local products to serve all patients in the hospital a healthy and mainly organic 

meal. More and more healthcare professionals are worried about the food served to their patients 

(Hermens, 2012). Although food is only a small percentage of the total budget, it has to be as efficient 

(money-wise) as possible (van Dinther, 2011). And especially food can be very important for the health of 

a patient. In the light of ‘Healthy Ageing’, one of the research pillars of the UMCG, food is very 

important (RUG, 2013, UMCG, 2013). Healthy food can work preventive for many lifestyle diseases like 

diabetes or obesity (Popkin and Gordon-Larsen, 2004). Regional products can contribute in a healthy diet 

(van Dinther, 2011). There is no conclusive scientific evidence that organic and regional products have 

specific health benefits, but often regional products taste better, are fresh and organically or otherwise 

environmentally friendly grown (Hermens, 2012). Especially the taste can help to reduce the quantity 

food that is returned to the kitchen (Hermens, 2012). If a meal is very tasty, patients are more inclined to 

finish their plate. 

These benefits are on the People-side and the regular organization of theme days with regional food with 

give the UMCG a more sustainable image. This can further improve the way patients (and health 

insurance companies) appreciate the UMCG. 

On the Planet-side, there are also benefits from purchasing regional foods. These food items have a 

shorter transporting distance to the hospital, which lowers the CO2eq emission (Pretty et al., 2005, 

Hermens, 2012). Although the transporting distance is not (yet) included in the CO2 footprint, this should 

be an item of interest in the future. Next to that, most regional products are from open ground cultivation, 

which has less CO2 eq emission compared to greenhouse cultivation (Gerbens-Leenes, 2003). Mostly, 

regional products have an additional benefit for the environment: they are mostly cultivated extensively 

(Hermens, 2012). This can either mean organically grown or another method that is focused on the most 

35

environmentally friendly way to cultivate (instead of intensive agriculture, which is focused on 

maximizing the yield; Gomiero et al., 2011). 

In short, food theme days could result in improvements on both the People and Profit-side. Although not 

mentioned yet, the Profit side does not have to be compromised (Hermens, 2012). Regional products do 

not have to be more expensive than conventional products, because they can be bought from the farmer 

directly (instead of from a retail company) so it saves in overhead costs (van Dinther, 2011). 

6.1.2 Complex and long term measures 

Reduce meat 

All offered portions for the meal components are ordered in half size portions 8 . Twice such a portion is a 

normal serving of for example meat, potatoes or vegetables. One half size portion of meat is 65 grams. 

Most people order a complete serving, which adds up to 130 gram. The Dutch center of nutrition advises 

a serving of meat of 100 – 125 grams a day, including meat cuts that are served on bread, fish and eggs 

(Voedingscentrum, 2012). Next to that, they state that it is perfectly acceptable (from a health 

perspective) to exclude meat from the main meal once or twice a week (Voedingscentrum, 2012). 

The reduction of meat in the meals could be done in multiple ways. Some examples are: 

• Encourage patients to only take half a serving of meat each meal. 

• Reduce the half serving of meat to for example 50 gram. One complete serving would then weigh 

100 gram, which can be supplemented with meat cuts on bread. 

• Encourage patients to order fish twice a week. 

• Encourage patients to not order any fish or meat with their warm meal once a week, for example 

by offering a healthy alternative based on vegetable proteins. Use the same day for this every 

week, e.g. Meatless Monday (in Dutch: Plantaardige Maandag; Meatless monday, 2013). 

The dietary advice to the UMCG to reduce the meat consumption of the patients might be a sensitive 

advice. This is mainly due to malnourishment of some patients. Especially malnourished patients can 

benefit from the protein in meat (Barton et al., 2000, Goeminne et al., 2012). So although the general 

advice is to reduce the meat consumption of the patients, the nutritional assistants should keep in mind 

that malnourished patients might need another approach. As with the previous hot-spot, reducing meat 

might have benefits on the field of ‘Healthy Aging’ (UMCG, 2013). 

Reducing the meat consumption of the patients has benefits on the field of People, Planet and Profit. First 

of all, it can be healthy (especially in overweight patients) to reduce the intake of animal protein (Popkin 

and Gordon-Larsen, 2004). Secondly, meat has a high environmental impact per kilogram compared to 

vegetable proteins (Gerbens-Leenes, 2003). So by reducing the amount of meat bought by the UMCG, the 

CO2 footprint from the food system can be reduced. Third, meat is quite expensive per kilogram. 

Reducing the amount of meat will also reduce the costs per meal. 

Donate left-over food to food banks 

There are two distinct streams of food waste that could have potential benefit for a food bank. These two 

streams are: 

1. The food that is left over after portioning and is discarded with the swill. 

2. The untouched pre-packed foot items that are returned to the kitchen. 

The first stream will theoretically be minimized by the decoupled cooking, which will be implemented 

shortly after the publication of this thesis. Families that are affiliated with the food bank in Groningen 

could come to the hospital when the portioning is finished. If they bring microwave containers, they could 

fill these containers with enough food for one evening meal for their family. Observation in the kitchen 

8 With the exclusion of pre-packed components like salads, desserts and fruits. 

36

led to the assumption that approximately 50 people can be fed daily with the food that is left over after 

portioning (provided that they do not have any preferences for certain food items). 

The second waste-stream is more difficult to use for consumption according to the laws and regulations in 

the Netherlands. The untouched pre-packed food could be collected when the food trolleys are returned to 

the kitchen. But this food items have all reached a temperature above 7°C and are therefore excluded 

from consumption. Besides that, all products that have been at the wards should be incinerated according 

to the Dutch law (van Slochteren, 2013). This makes the use of the second waste-stream a bit more 

challenging, but it could certainly be worth investigating the possibilities. 

Using the waste-stream of food for human consumption is the highest that can be achieved according to 

the Moerman's Ladder (see Chapter 3, Introduction). So this hot-spot has potential benefits on the Planetside. 

But also on the People-side, because donating leftover food to the food banks can mean a lot to the 

less fortunate people in Groningen. 

6.2 Technical measures 

6.2.1 Relatively easy and short term measures 

Reduce waste costs 

Some streams of waste can be very valuable, like the swill and grease from the UMCG. Both are used to 

generate sustainable energy (biogas or/and electricity). With this knowledge, the UMCG could use the 

next waste-tender negotiations to negotiate about a reduction of the waste costs (and maybe even 

eliminate the costs). 

This measure only has a benefit for the UMCG on the Profit-side. 

Install meters 

At this moment, there are no separate meters for gas, electricity and water use installed at the kitchen. 

This means that the specific energy and water use by the kitchen cannot be monitored. Installing meters 

would not only give insight in the use of energy and water, but would also be a good base for reducing the 

use of energy and water. When it is known how much the kitchen uses, future goals can be made to 

reduce the use of energy and water. There are many systems available that make it relatively easy to 

install digital meters, e.g. Plugwise (Plugwise, 2013). 

This measure has benefits on the Planet-side (reduction in the use of resources) and Profit-side (the costs 

will be reduced if the energy/water use is reduced). 

6.2.2 Complex and long term measures 

Use environmental benchmarks 

All hospitals in the Netherlands have to report each year about the state of their hospital in the past year. 

Not only financial, but also environmental and social. Although all hospitals have to report roughly on the 

same parameters, these annual reports differ very much between hospitals. 

A more transparent way would be that all hospitals use the same format or benchmarks in their annual 

report. The UMCG could choose multiple benchmarks in which it wants to express their influence on the 

environment (for example: energy use per m 2 or water use per m 2 ). Some of the parameters could be 

expressed per hospital bed (e.g. the swill, see figure 4). The University of Groningen already uses this 

methodology to monitor their environmental performance (de Jager et al., 2003). The Global Reporting 

Initiative can provide guidelines on reporting the sustainability parameters (GRI, 2013). These guidelines 

are clear, available online and based on the principle that all companies and institutions world-wide 

should adopt a similar way of’ sustainability reporting’. 

Some other hospitals use a benchmark that is called the “Milieu Thermometer Zorg” (Environmental 

Thermometer Care), which is a special program developed to decrease the environmental impact of a 

hospital (Milieuplatform Zorg, 2012). It is a possibility for the UMCG to participate in this benchmark. 

37

Comparisons between the participating hospitals are very clear, since all participating hospitals have to 

report in the same format (Milieuplatform Zorg, 2012). 

This measure is complex and long-term because this measure is only fully effective if all UMCs (and 

even better, all hospitals) use the same way of monitoring their environmental impact. In that way, UMCs 

can compare their performances with the performances of their peers. The way the environmental 

performances are monitored now is not very insightful (UMCG, 2012c). The reason for this is that it all 

remains rather abstract. Using the same benchmarks between hospitals could give more practical and 

tangible view on the performances of a hospital. 

Installing a pharma filter 

The Pharma filter is the name for a collection of measures in and outside of the hospital that has as a main 

goal the purification of hospital waste water (van den Berg, 2013). This waste water is often contaminated 

with drug residues (ranging from hormones to cytostatic drugs) which end up in the common municipality 

sewer. Since the concentrations of the drugs in the sewer water are very low because of dilution in the 

sewer, most of it cannot be retrieved again from the water at water treatment plants (van den Berg, 2013). 

The Pharma filter is based on a closed loop, and all waste water is purified before it is eventually 

discharged on the common sewer (van den Berg, 2013). Next to that, almost all waste (even hazardous 

and hospital waste) can be discarded with the sewerage as well. There are two different processes in the 

Pharma filter: 

1. Purification of the waste water 

2. Digestion of the waste and decontamination of the residual 

A feasibility study of the Pharma filter was performed by an employee of the UMCG (Tamming, 2013). 

A summary of her conclusions: 

• The digestion of the waste would not yield enough energy to keep the Pharma filter running. 

Additional energy would be needed. 

• Overall there is no net saving in energy or CO2 eq emission. 

• The Pharma filter would require a area of 1,300 m 2 , with a maximal height of 6 meters. 

• The theoretical payback time would be around 10 years. 

Although the energy use and CO2 eq emission could rise slightly theoretically when installing a Pharma 

filter, there are some other advantages for the environment. The most substantial one is the purification of 

the waste water (van den Berg, 2013). At the moment of writing this thesis, there are no guidelines about 

the amount of certain toxins in waste-water (e.g. estrogens). It is expected that guidelines will be 

introduced in the near future (van den Berg, 2013). So Then, the theoretical payback time is predicted to 

drop. Besides this, the feasibility study does not go into detail about the importance of other sustainability 

criteria other than energy use and CO2 eq emission (e.g. Corporate Social Responsibility). 

38

Figure 11 - Potential measures the UMCG could take either on the People-side, Planet-side or Profit-side. 

39

7 CONCLUSIONS 

This chapter discusses all conclusions in the same order as the research questions, followed by the answer 

on the main research question. 

1. What is the quantity (weight) and quality (which products) of the inflow of food to the hospital? 

In the year 2011 the UMCG purchased 300 tons of food to provide a warm meal to approximately 700 

patients daily. These products are classified in seven product categories; each category is further divided 

in one or multiple product groups. This classification can be seen be in table 8, chapter 4 (Results). 

2. What are the different routes that the food travels within the hospital? 

Inside the hospital the food travels along the following route: 

1. Storage rooms and cooling cells 

2. Kitchen for cooking 

3. Portioning 

4. Patient wards 

5. Returned to the kitchen for dishwashing 

The end-destination of the food is either the patient (42%) or it is discarded (58%). 

3. What is the quantity (weight) and quality (which products) of the food-waste leaving the hospital? 

In 2011 the UMCG reported approximately 180 ton of swill. Observations at the UMCG made it clear 

that this quantity is entirely attributable to the warm meals served to the patients. Besides that, a fraction 

of the biodegradable waste is discarded with the “normal waste”, which is incinerated. After subtraction 

of the amount of water added to the swill and addition of the amount of food-waste that is discarded with 

the normal waste, the quantity of food waste in 2011 is assumed to be 175 ton. Food-waste arises at all 

locations along the way the food travels through the hospital. Next to food-waste, there is an additional 

stream of waste: grease from grease traps. This stream accounts for 100 tons each year. For a visual 

representation of where the food-waste arises and with which quantity, see figure 7, chapter 4 (Results). 

4. What is the environmental impact of the current UMCG food system? 

The food items for the patient warm meals accounted for an indirect energy use of 8,900 GJ and a CO2 eq 

emission of 789 ton. The latter represents 1% of the total UMCG CO2 footprint. This means that the CO2 

eq emission is not very visible compared to the total CO2eq emission by the UMCG. Despite that, the 

amount of indirect land and water used for cultivating these food items is respectively 250% and 160% of 

the total direct land and water use of the UMCG. 

Note that currently 58% of all food assigned to the warm meals for the patients is discarded. This equals a 

value of €0.6 million. Independently of the size of the environmental impact (expressed either in indirect 

energy use, CO2 eq emission, land or water use), a reduction of 58% of the environmental impact is 

possible. This is significant and should be addressed by the UMCG. 

Part of this reduction is already addressed in March 2013, when the UMCG switches to a decoupled food 

system. This change will probably reduce the amount of food-waste. Besides the change in the food 

system, there are other possibilities to reduce the environmental impact from the food system. These 

possibilities are the answer to the remaining three research questions. The remaining three research 

questions are summarized by the main research question of this thesis is: “What are possibilities to reduce 

the environmental impact from the current food system (focused on the warm meals to the patients) of the 

UMCG?” To answer this question, multiple hot-spots are identified that could help the UMCG to reduce 

their “foodprint”. These hot-spots are: 

41

Policy measures 


o Food theme days 

o Reduce meat consumption 


o Donate left-over food to food banks 

Technical measures 


o Reduce waste-costs 

o Install separate meters at the kitchen 


o Use environmental benchmarks 

o Install a Pharma filter 

These measures all have benefits either on the People (e.g. green image, healthy diet), Planet (benefits the 

environment) or Profit-side (reduces the costs). All proposed measures do not ask for an additional 

investment, except from the Pharma filter. Research by an employee of the UMCG showed that the 

Pharma filter would have a return on investment of 10 years. This might drop in the future, due to 

changing regulations for the discharge of wastewater. 

All the described measures would fit well into the intensions that UMCG has for making Corporate Social 

Responsibility a more important focus of the hospital. 

42

8 DISCUSSION 

At the start of this research, it was assumed the purchased food items might have a significant 

contribution to the total CO2 footprint of the UMCG. One of the conclusions of this thesis is that this is 

not the case: the food items only represent a contribution of 1% to the total CO2 footprint of the UMCG. 

Can the discrepancy between the assumption made in advance and the conclusion be explained? 

First of all it should be mentioned that the assumption was made based on household orientated literature. 

The UMCG is a large hospital which has a completely other expenditure end energy use pattern than an 

average household. This alone could already explain the discrepancy. But there are four additional 

reasons that suggest that the indirect energy use and CO2 eq emission calculated in this thesis could be 

higher or lower in reality. 

The first reason is that all the ingredients used for the patient warm meals had to be selected by hand from 

a total purchase list. It was not always clear which products were used for patients-only and which were 

also used to prepare meals that are for the staff, visitors and students. So it is possible that the purchase 

list used contains either too many or too few food items. All the items that were fresh (vegetables, meat, 

and so on) were on a separate list. Here, a separation was possible. The fresh items have the largest 

portion of the total, so this makes any effects of misclassification very small from an environmental 

impact point of view. 

Second, a more complete picture of the CO2eq emission of the food system in the hospital can be obtained 

if all food items are included in the research. This does not only mean the other two (bread) meals for the 

patients, all their drinks and diet supplements. Also all the other food consumed by staff, visitors and 

students inside the hospital should be added to the analysis. This may increase the visibility from the 

CO2eq emission of the food system in the whole CO2 footprint of the UMCG. So the research performed 

for this thesis is only part of the total research that should be done in order to picture the complete CO2 eq 

emission of the food system. Despite that, the methodology described in this thesis can easily be used for 

expanding the research. So although further research would give a more complete picture, the foundation 

for further research is provided by this thesis. 

Third, the (indirect) energy use and the CO2eq emissions of transport for food and waste are not included 

in this research. Both are also not included in the CO2 footprint analysis of the UMCG. This means that 

the actual CO2 eq emission from the food system can only increase. But with what quantity and whether it 

would make a significant change with respect to the total CO2 footprint is not known. 

Fourth and last point of discussion is the level of detail in the CO2 eq emission analysis of the food 

system. In order to perform a very detailed cradle-to-grave assessment for the environmental impact for 

food items, more information is needed. For this thesis, the food items are gathered in larger food groups 

which are assigned to one of the seven product categories. Assessing each product individually would 

give a more complete (and correct) picture of the environmental impact. In this research he origin of the 

products, the agricultural method and the transporting distance were not taken into account specifically. 

Instead, averages were used per product group. Although this method is justified because of the limited 

impact the foodstuffs have compared to the impact of the whole UMCG. 

43

8.1 Research recommendations 

The research done for this thesis sheds light on possible other subjects for research linked to the 

environmental impact of the UMCG. One of the objectives for this study was a baseline analysis of the 

UMCG food system, which can be used for comparison in later studies. This follow-up study could be 

expanded with additional research in several ways, described below. 

Study the bread meals served to the patients 

These meals are prepared at the wards and all food-waste is discarded there. But as bread can be digested 

efficiently, it could be interesting to add the food-waste of the bread meals to the swill tank. Because 

bread clogs the swill tank, more water should be added. This would result in a further dilution of the swill 

and maybe a higher frequency of emptying the swill tank. So a study into the possibility to add the foodwaste 

from the wards to the swill tank might give interesting results. 

Study the food-waste in more detail 

This research worked with assumptions about quantity of food-waste and the location where this waste 

arises. It is possible to perform a detailed study of the food-waste by weighting all food-streams in a 

certain period (e.g. one week). This can be combined with a study on the incidence of malnourishment at 

the UMCG, because one of the results of such a study is the quantity of food consumed by patients. This 

study can be performed in great detail, using separate weightings of the different meal components. The 

article published by Snels and Soethoudt gives a methodology for such a research, specifically applied to 

a hospital (Snels and Soethoudt, 2012). 

Next to the expansion of a follow-up study, there are other studies possible that shed a light on the 

possibilities to reduce the entire environmental impact of the UMCG. 

Complete the CO2 footprint 

There are several items missing from the CO2 footprint of the UMCG. The items that could be added are 

(but not limited to): 

• A complete analysis of the food system, including all patient meals and the meals served to staff, 

students and visitors. 

• All purchased items (e.g. bandages, operation materials, etc.) 

• The CO2 emission caused by transporting food, waste and other materials. (CO2 emission of the 

vehicles owned by the UMCG are included) 

Perform a waste sorting analysis 

The waste sorting analysis will show how much biodegradable waste is disposed at certain places in the 

hospital. A waste sorting analysis could also help estimating the added value of a Pharma filter. If a 

Pharma filter is installed, all the waste will be discarded with the sewerage. The higher the fraction 

biodegradable waste is, the more energy the digestion process will yield. 

44

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Pretty J.N., Ball A.S., Lang T. and Morison J.I.L., 2005. Farm costs and food miles: An assessment of the 

full cost of the UK weekly food basket. Food Policy, 30:1-19. 

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Accessed:30-01-2013. 

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Agrobiotechnology Tulln, University of Agricultural Sciences Vienna,2012. 

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30-01-2013. 

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https://www.umcg.nl/NL/UMCG/publicaties/Jaarverslag_2011/Pages/default.aspx 

UMCG, 2012b. Financieel jaarverslag 2011. Retrieved online: 

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UMCG. Date: January 2013 

Various employees UMCG, 2012. Personal communication with various employees that worked in the 

kitchen on 11 and 12 December 2012. 

Voedingscentrum, 2012. Webpage: www.voedingscentrum.nl. Accessed: 10-11-12. 

47

Wartena, A., 2012. Personal communication with A. Wartena, head of the kitchen at the UMCG. Date: 

November 2012 - January 2013 

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10-2012 

48

10 APPENDIX A – A BELT CART 

Figure 12 - A belt chart (side used by staff to portion the meal) 

49

11 APPENDIX B – THE AUTUMN MENU 2011 

First week autumn 

cycle code General Food Vegetarian food 

Monday vla pork sausage lentil dish/ sultanas 

day 1 vlb bovine meat 

vle cheeseburger/meatball 

10-Sep jsa gravy curry sauce 

24-Sep jse curry sauce 

8-Oct gra 

22-Oct grb Brussels sprouts 

5-Nov grc beetroot 

19-Nov ara autumn mash 

3-Dec nga vanilla custard 

ngc peach compote 

efa apple 

efa fruit of the season 

evrk tomato salad 

Thursday spa couscous salad couscous salad 

day 2 vla veal-curry ragout curry ragout 

vlb chicken breast 

11-Sep vle veg.nuggets / grillburger 

25-Sep jsa 

9-Oct jse 

23-Oct gra iceberg lettuce/dressing 

6-Nov grb chicory 

20-Nov grc green beans 

4-Dec ara white rice 

nga tangerine custard 

ngc pineapple compote 

efa banana 

efb grapes 

evrk fennel/cheese salad 

Wednessday vla cod fish kaassoufle 

day 3 vlb beef meat 

vle vegetable burger/fish sticks 

12-Sep jsa ravigotte sauce 

26-Sep jse bell pepper sauce 

10-Oct gra Mexico mix 

24-Oct grb carrots 

7-Nov grc Romano beans 

21-Nov ara Parisian potatoes 

5-Dec nga semola pudding/ red berries 

ngc stewed pears 

efa apple 

efb melon salad 

evrk white cabbage salad 

gaa mayonnaise 

51

52 

Thursday spa Italian salad Italian salad 

day 4 vla Bolognese sauce (biological) Bolognese sauce (biological) 

vlb turkey breast 

13-Sep vle cheese croquette/ "frikandel" 

27-Sep jsa 

11-Oct jse 

25-Oct gra daikon/carrot/pickle 

8-Nov grb cauliflower 

22-Nov grc garden peas 

6-Dec ara spaghetti (biological) 

nga vanilla yoghurt (biological) 

ngc fruit cocktail 

efa banana 

efb orange 

evrk zucchini salad 

gaa parmesan cheese 

Friday vla chili stew chili stew 

day 5 vlb pork steak 

vle tofu balls / grilburger 

14-Sep jsa … 

28-Sep jse 

12-Oct gra garden peas 

26-Oct grb steamed Chinese cabbage 

9-Nov grc carrots 

23-Nov ara parsley potatoes 

7-Dec nga chocolate custard 

ngc rhubarb compote 

efa apple 

eaf orange 

evrk corn/bell pepper salad 

Saturday vla salmon ragout corn and eggs ragout 

day 6 vlb turkey minced meat 

vle veg.chiliburger / fish sticks 

15-Sep jsa 

29-Sep jse 

13-Oct gra broccoli 

27-Oct grb Breton vegetable mix 

10-Nov grc spinach 

24-Nov ara penne 

8-Dec nga custard with Dutch amaretti 

ngc cherry compote 

efa banana 

efb fruit of the season 

evrk cucumber salad

Sunday vla chicken Marrakech tahoe Marrakech 

day 7 vlb beef meat 

vle French stirred egg / meatball 

16-Sep jsa 

30-Sep jse mushroom sauce 

14-Oct gra corn/ fruit salad 

28-Oct grb red cabbage 

11-Nov grc string beans 

25-Nov ara couscous 

9-Dec nga strawberry bavarois cherry custard 

ngc compote of the day 

efa apple 

efb tangerine 

evrk carrot/ apple salad 

Second week autumn 

cycle code general food vegetarian food 

Monday vla steamed whiting bell pepper stuffed with risotto 

day 8 vlb beef 

vle quorn burger / chicken nugget 

17-Sep jsa dill sauce …. 

1-Oct jse pesto sauce 

15-Oct gra carrots 

29-Oct grb celery 

12-Nov grc cauliflower 

26-Nov ara baked potato 

10-Dec nga caramel custard 

ngc peach compote 

eaf banana 


evrk white cabbage/tangerine salad 

gaa mayonnaise 

Tuesday spb tuna salad vegetable salad 

day 9 vla ……. 


18-Sep vle vegetable balls/ meatball 

2-Oct jsa 

16-Oct jse 

30-Oct gra tomato olive salad 

13-Nov grb euro mix 

27-Nov grc Romano beans 

11-Dec ara macaroni fantasy 

nga vanilla yoghurt 

ngc fruit cocktail 

efa apple 

efb grapes 

53

54 

gaa parmesan cheese 

evrk iceberg lettuce/ dressing 

Wednessday vla ajampangang quornpangang 

day 10 vlb beef meatball 

vegetarian loempia / 

vle 

"frikandel" 

19-Sep jsa pangang sauce tomato sauce 

3-Oct jse 

17-Oct gra atjartjampoer 

31-Oct grb endive 

14-Nov grc beetroot 

28-Nov ara mie fang goreng (egg noedles) mie fang goreng (egg noedles) 

12-Dec nga rice pudding with cherries 

ngc stewed pears 

efa banana 

efb tangerine 

evrk cauliflower/ bell pepper salad 

chicken/walnut/ pineapple 

Thursday spa 

salad celery salad 

day 11 vla bacon steak (biological) vegetarian sausage 


20-Sep vle rice burger/ grill burger 

4-Oct jsa gravy onion sauce 

18-Oct jse ginger/pineapple sauce 

1-Nov gra 

15-Nov grb leek/cheese sauce 

29-Nov grc haricots verts 

mash with sauerkraut 

13-Dec ara 

(biological) 

nga orange yoghurt (biological) 

ngc pineapple compote 

efa banana 


evrk beetroot/apple 

Friday vla omelets, farmers style stirred egg 

day 12 vlb pork schnitzel 

vle mushroom burger /fish sticks 

21-Sep jsa tomato sauce tomato sauce 

5-Oct jse broccoli sauce 

19-Oct gra queen mélange 

2-Nov grb steamed green cabbage/ curry 

16-Nov grc broccoli 

30-Nov ara white rice 

14-Dec nga strawberry custard 

ngc rhubarb compote 

efa apple 

efb melon salad 

evrk chicory salad / dressing

Saturday vla meat stew stew 

day 13 vlb ham 

vegetable croquette / 

vle 

"frikandel" 

22-Sep jsa 

6-Oct jse 

20-Oct gra red cabbage 

3-Nov grb green beans 

17-Nov grc carrots 

1-Dec ara mashed potato 

15-Dec nga pudding of the day 

ngc cherry compote 

apple 

efb pear 

evrk cucumber salad 

Sunday vla pork medallion steamed bell pepper/tomato 

day 14 vlb minced beef 

Javanese disk / chicken 

vle 

nuggets 

23-Sep jsa cream sauce cream sauce 

8-Oct jse 

22-Oct gra broccoli 

5-Nov grb Spanish salsify 

19-Nov grc garden peas 

2-Dec ara backed potatoes 

16-Dec nga chocolate bavarois 

ngc compote of the day 

efa banana 


evrk daikon/carrot/cucumber 

55

12 APPENDIX C – PRODUCT CATEGORIES AND PRODUCT GROUPS 

2011 Purchase list Product group table A1 designation weight in CO2 eq 

kg total 

Product category 

1. Bread, pastry and flour products 

Flour Flour (paper bag) 1.1E+03 1.3E+03 

Rice Rice (plastic bag) 7.1E+03 1.3E+04 

Pasta (incl. mie) Pasta (plastic bag) 2.4E+03 2.9E+03 

Potato starch Potato starch (cardboard box) 6.3E+02 8.9E+02 

2. Potatoes, vegetables and fruit 

Fruit (Dutch: apple, pear) apples (plastic bag) 4.9E+03 4.6E+03 

Fruit (tropical) bananas 1.1E+04 1.4E+04 

Fruit (canned) fruits in juice (can) 4.3E+03 1.0E+04 

Vegetables other leaf vegetables (open air) 4.3E+04 3.0E+04 

Tomato, salad and cucumber chicory and lettuce (greenhouse) 7.9E+03 3.3E+04 

Potatoes Potatoes (plastic bag) 3.5E+04 6.0E+03 

3. Beverage and products containing 

sugar 

4. Oils and fats 

5. Meat, meat products and fish 

Sugar, sugar syrup, sweeteners sugar (paper bag) 4.4E+03 6.9E+03 

Honey honey (glass pot, plastic lid) 9.0E+01 2.7E+02 

Fruit Juice orange juice (cardboard package) 1.2E+03 1.5E+03 

Olive oil, frying oil, margarine vegetable oil 4.3E+03 1.1E+04 

Pork pork (fresh, chops) 1.4E+04 1.1E+05 

Beef beef (fresh, streaky) 2.2E+04 2.2E+05 

Fish fresh fish (e.g. cod) 1.5E+04 1.1E+05 

Lamb other sausages and meat products (package) 1.9E+02 1.7E+03 

Poultry chicken filet (fresh) 9.9E+03 7.7E+04 

57

6. Dairy products and eggs 

7. Other products 

58 

Desserts 

fruit yogurt (skimmed, liter, cardboard 

package) 3.5E+04 3.7E+04 

Cheese cheese (48+, ripe) 5.1E+02 3.6E+03 

Cream cream (cardboard package) 6.7E+02 2.4E+03 

Eggs eggs (cardboard box) 2.2E+02 4.9E+02 

Salt, herbs, broth powder Median of Table A1 2.2E+04 3.8E+04 

sauces sauces and relish (25% oil, plastic bottle) 1.9E+04 6.5E+04 

Tinned tomato (concentrated) vegetables (can) 1.9E+03 2.1E+03 

Other NES Median of Table A1 2.8E+03 4.9E+03 

Composed meals (loempia, lasagna) main coarse dishes (cooled, plastic tray) [2] 2.7E+02 1.4E+03 

Meat substitute 8.0E+02 4.1E+03

13 APPENDIX D – METHANE CALCULATIONS 

Table 11 - Theoretical methane yield from the swill and grease produced at the UMCG in 2011 (Steffen et al., 1998, 

Biowattsonline, 2013) 

Swill Grease from grease trap 

Total weight 182, 000 kg 100,000 kg 

% dry weight (DW) 26% 36% 

% volatile solids (VS) 90% 98% 

Total volatile solids 42,915 kg 35,280 kg 

Biogas yield per kg VS 0.48 m 3 0.35 m 3 

% methane 75% 61% 

Total methane 15450 m 3 7532 m 3 

Total energy content 0.6 TJ 0.3 TJ 

The total yield in methane is calculated as follows: 

Weight x DW% x VS% = total volatile solids 

Total VS x biogas yield in m 3 = Biogas yield 

Biogas yield x % methane = m 3 methane 

(M 3 methane x caloric value methane) /1000,000 = total energy content in TJ 

The caloric value of methane: 35.88 MJ/m 3 (Agentschap NL, 2011) 

59

14 EXECUTIVE SUMMARY BEHOREND BIJ: 


Afstudeeronderzoek in opdracht van het UMCG 

Onder begeleiding van Royal HaskoningDHV 

Auteur: E. T. Politiek, maart 2013 

Samenvatting 

Voeding veroorzaakt een flinke belasting op het milieu. CO2 uitstoot, energie verbruik, water en land 

gebruik zijn allemaal voorbeelden van die belasting. Voor elke calorie voedsel is een investering van 

zeven calorieën nodig om dit voedsel uiteindelijk op tafel te krijgen. Ondanks de milieubelasting van 

voedsel, gaat zo’n 30 tot 50% van het voedsel verloren of wordt het uiteindelijk weggegooid. 

Met dit onderzoek is geprobeerd na te gaan wat de milieubelasting is van het voedingssysteem in het 

UMCG. Om het overzicht te behouden is er voor gekozen om dit onderzoek te beperken tot de warme 

maaltijd voor de patiënten. Met het oog op de verandering naar gekoppeld koken (in maart 2013) is dit 

onderzoek een nulmeting van de huidige situatie. Er is voor dit onderzoek gewerkt met data uit 2011. 

Wanneer het voedingssysteem in de toekomst opnieuw onderzocht wordt, kan het direct vergeleken 

worden met de oude situatie. De milieubelasting wordt uitgedrukt in tonnen CO2 uitstoot. Op deze manier 

is het in te passen in de CO2 footprint analyse die eerder al is gemaakt. 

Figuur 1 - Alle voedselstromen (gerelateerd aan de warme maaltijd) naar, door en vanuit het UMCG in 2012 

61

14.1 Conclusies 

Figuur 1 is een visuele weergave van alle voedselstromen gerelateerd aan de warme maaltijd. Een deel 

van het voedingsafval wordt niet in de swill tank gegooid, maar belandt bij het gewone ziekenhuisafval. 

Het gaat dan om brood (maar dit is zeer gering ), fruit en voorverpakte etenswaren (fruithapjes, salades, 

toetjes enz.). Het is opvallend is dat er naast de stroom swill (voedselresten) ook een stroom vet is uit 

vetputten. Jaarlijks wordt er ongeveer 100 ton vet afgevoerd van het UMCG. Deze stroom staat niet 

vermeld in het jaarverslag 2011, maar wordt net als de swill vergist om er energie mee op te wekken. 

Zowel swill als vet zijn waardevolle reststromen. Zie ook de aanbevelingen hieronder. 

In 2011 is er voor ongeveer € 0.6 miljoen aan voedingsproducten (voor de warme maaltijd) weggegooid. 

Dit betreft ca 58% van de producten die ingekocht zijn voor de warme maaltijd. In figuur 2 is de 

voedselverspilling per maaltijd weergegeven. Het grootste gedeelte van de voedselverspilling vindt plaats 

na het portioneren en treedt op in de opslag (derving), na het koken, op de afdeling zelf en bij retour naar 

de keuken. Ongeveer 80% van het voedingsafval gaat naar de swill tank. De overige ca 20% beland in 

gewone ziekenhuisafval. Per patiënt wordt er ongeveer 1.2 kilogram ingekocht waarvan ca 650 gram 

wordt weggegooid. 

62 

Figuur 2 - Verdeling voedsel en afval per warme maaltijd (totale hoeveelheid 1,15 kg) 

De milieu-impact van het voedingssysteem uitgedrukt in CO2 uitstoot is amper zichtbaar op het totaal van 

het UMCG in 2011. Voeding vertegenwoordigt slechts 1% van alle CO2 uitstoot van het UMCG. Toch is 

het interessant om na te gaan van welke productgroepen deze uitstoot afkomstig is. Dit is te zien in 

afbeelding 2, waarin links het gewicht van de productgroepen is afgebeeld en rechts de CO2 uitstoot van 

dezelfde groepen. Vooral vlees leidt tot een grote milieudruk.

Figuur 3 - Productgroepen voor de warme maaltijd, verdeeld per gewicht (links) en per milieu-impact 

14.2 Aanbevelingen 

De aanbevelingen van dit onderzoek zijn verdeeld in beleidsmaatregelen en technische maatregelen. De 

aanbevelingen beogen de duurzaamheid van het UMCG te versterken: met de maatregelen zijn 

verbeteringen te behalen op het gebied van het milieu (planet), financiën (profit) of sociaal (people). De 

aanbevelingen zijn samengevat in figuur 4. 

Beleidsmaatregelen 

Relatief eenvoudige en korte termijn maatregelen 

• Voedsel themadagen 

Organiseer themadagen waarop bijvoorbeeld lokale voedselproducten centraal staan. Lokale 

producten komen uit de nabije omgeving (minder transport) en zijn vaak duurzaam geproduceerd. 

Maak een koppeling met het onderzoeksthema ‘Healthy Aging’ waarbij voeding een belangrijke rol 

kan spelen. 

• Vleesconsumptie verminderen 

De huidige portie vlees is aan de ruime kant vergeleken met de aanbeveling van het voedingscentrum. 

Op verschillende manieren kan men de vleesconsumptie verminderen. Dat is vaak nog gezond ook. 

Denk aan: een dagje geen vlees, een minder grote portie vlees of het stimuleren van twee keer vis per 

week. 

Complexe en lange termijn maatregelen 

• Overgebleven voedsel doneren aan de voedselbank 

Vooral na het portioneren is er veel voedsel over van prima kwaliteit. De verwachting is wel dat deze 

stroom zal afnemen na het overgaan op ontkoppeld koken. 

63

Technische maatregelen 

Relatief eenvoudige en korte termijn maatregelen 

• Afvalkosten verminderen 

Zowel met swill (keukenafval) als met vet kan men energie opwekken. Het zijn dus kostbare 

reststromen. Bij de nieuwe aanbesteding van contracten voor de afvalverwerking verdient het 

daarom aanbeveling om dit gegeven te betrekken bij de onderhandelingen. 

• Meters installeren in de keuken 

Er is nu weinig inzicht in het energie en water verbruik in de keuken. Dit valt eenvoudig op te 

lossen door extra meters te plaatsen, dit zou ook een digitale meter kunnen zijn (bijvoorbeeld 

Plugwise). Met de extra metergegevens kan men realistische, plaatsgebonden besparingsdoelen 

formuleren. 

Complexe en lange termijn maatregelen 

• Gebruik maken van milieu benchmarks 

Alle ziekenhuizen in Nederland rapporteren nu nog op hun eigen wijze over hun milieuprestaties. 

Om deze te kunnen vergelijken, zou het praktisch zijn als dit wordt gelijkgetrokken. Er bestaan al 

enkele milieu benchmarks, zoals de ‘Milieuthermometer Zorg’ van het Milieuplatform Zorg. 

• Een Pharmafilter in gebruik nemen 

Recent onderzoek toonde aan dat een Pharmafilter bij het UMCG niet tot CO2 of energiereductie 

zou leiden. Wel zouden allerlei medicijnresten uit het geloosde afvalwater kunnen worden 

gezuiverd. Hoewel een Pharmafilter nu (financieel) nog niet uit kan, is het verstandig om de optie 

voor de toekomst open te houden. Zeker op het gebied van afvalwater wordt verwacht dat de 

wetgeving strenger zal worden in de toekomst. De terugverdientijd van een Pharmafilter zal 

daardoor omlaag gaan. 

64 

Figuur 4 - Samenvatting van alle aanbevelingen

The warm meal ?foodprint? of the UMCG - Rijksuniversiteit Groningen

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