DESIGN: Spaulding Masters Space Challenges

Thomas Wagstaff faced a tall order when he signed on as director of nutrition and food services at Spaulding Rehabilitation Hospital, Boston, in the summer of 2012. Spaulding, the facility that aided victims of the Boston Marathon bombings, is a high-profile and well-respected member of Partners HealthCare, Boston’s largest healthcare group.

For starters, Wagstaff would be in charge of finalizing the details of Spaulding’s half-finished kitchen, then under construction in the hospital’s brand new $140 million, LEED Gold-certified facility in the Charlestown Navy Yard overlooking Boston Harbor.

He also would be expected to manage the foodservice needs during Spaulding’s single-day move from its old building to its new building scheduled nine months down the road. Ultimately, he would be heading the foodservice operations at the new Spaulding.

The new hospital’s 96-seat Constitution Cafe—and its seasonal 100+-seat patio dining area—represented a 40% increase to his retail foodservice business, but his staff would be preparing food in a kitchen that included some oversights in the early planning stages and is roughly half the size of the old facility’s foodservice area.

Design Changes Add Functionality

Wagstaff’s first task was to make Spaulding’s new kitchen operational while following the administration’s guidelines: create a patient-centered foodservice model focused on customer satisfaction, healthy dining and sustainability. The kitchen would produce about 300 patient meals per day from a tray line, plus enough food for 300-500 meals per day in the retail cafe.

When Wagstaff toured the partially completed kitchen, he found it decidedly small. At only 1,756 sq. ft., “you can take 30 giant steps in any direction to reach every corner of the kitchen, servery and receiving dock,” he says. The original design team loaded as much productivity into the kitchen space as possible, mostly along a 35-ft.-long cook line, the kitchen’s centerpiece. The line is equipped with double-stacked ovens, a six-burner-range-topped oven with a salamander above, hot top, griddle, charbroiler, steamer, two steam-jacket kettles and a double-stacked combi oven—the cooks’ most-used piece of equipment, Wagstaff says. He also incorporated some much-needed equipment to the original lineup, including two fast-cook ovens.

The exhaust hood is a variable-speed unit that adjusts exhaust rates according to the amount of heat being generated on the equipment below. A prep/support line runs parallel to and between the cook line and the tray line. Above the prep line, ceiling-mounted racks hold kitchen tools within easy reach. Because pots and pans are used primarily on the cook line, the original designers tucked a dedicated pot-wash area into a space nearby.

The tray line and its supporting equipment fills the remaining space. The area is equipped with multiple outlets and equipment that is mounted on casters, allowing the tray line to be reconfigured as needed; the line has been reconfigured several times during the past year to boost efficiency.

At one end of the tray line, the original designers put in a small vegetable prep area, equipped with wash sinks. Nearby, and conveniently close to the service entrance from the kitchen into the cafe, are salad coolers, a blast chiller (which Wagstaff also added) and an ice machine. Walk-in coolers, freezers and dry storage, warewashing, offices and dock access complete the kitchen.

“When I arrived, the kitchen was already built, although some pieces of equipment were still in crates and other pieces were still arriving,” Wagstaff says, recalling his initial visit to Spaulding’s new culinary digs.

The tour exposed a number of areas in need of creative solutions, including the patient-meal-delivery system and dishroom layout. A lack of adequate storage space became apparent, as well.

In the months leading up to the new facility’s opening, Wagstaff worked closely with contacts from dealer/designer firm Boston Showcase and manufacturers’ reps to reconfigure equipment and order some additional pieces, such as the blast chiller and fast-cook ovens.

High-Tech Meal Delivery

Drawing on experience from his previous posting at New England Sinai Hospital, Stoughton, Mass., Wagstaff decided to use new technology to make Spaulding’s patient-meal delivery system run smoothly. He partnered with Burlodge USA to bring in nine all-in-one hot/cold tray-delivery carts called Optima II RS.

The plug-in carts feature glass doors, a heated compartment on one side and a refrigerated compartment on the other. Trays, loaded with hot foods on one side and cold on the other, slide into the cart. Down the center of the cabinet, a gasket seals off the two sides of each tray, keeping the hot side hot and cold side cold. Once properly charged, “the carts can hold food for up to two hours without suffering quality issues,” Wagstaff says.

The hot/cold cart rollout did come with a learning curve. “In order to serve the food at the right temperature, the carts need 10 minutes of recharging time once they reach the patient floors. But since patients wanted to eat as soon as the carts arrive on the floors, we were missing out on the 10-minute recharge, and meals weren’t being served at optimum temperatures initially,” Wagstaff says.

The solution came from Burlodge’s support expert and dietitian, Helen Scott, who spent a day at Spaulding analyzing the kitchen. “She pointed out that by switching positions on the tray line to achieve a better balance of slow tasks and quick tasks, assembly would go faster and the time we gained would allow us to do the 10-minute recharge in the kitchen instead of on patient floors,” Wagstaff says. Timers added to each cart count the recharge time.

Supplementing the hot/cold carts, Wagstaff added an induction-heated base system for special-order trays, including late trays and pediatric patients. The special meals are delivered room-service style.

He also added a missing component to the delivery equation: soiled-tray pickup. “Our supplier custom-built a cart that could collect two sizes of soiled trays, octagonal trays used in the retail cafe and those used in the Burlodge carts for patient foodservice, which are larger. And it’s pass-through, so you can load or unload from either side.”

Kitchen Equipment Adjustments

Wagstaff was able to bridge the gap between the administration’s healthy dining goals and the production requirements of a 21-day patient-menu cycle by adding and subtracting several pieces of equipment.

An Irinox blast chiller was the first piece added. “That technology was not as common in commercial kitchens when planning first began for Spaulding’s new facility,” Wagstaff says. The foodservice team can use the unit to blast chill, blast freeze, defrost, proof and even slow cook.

Wagstaff eliminated a couple of fryers—one from the kitchen, the other from the cafe—to better follow Spaulding’s healthy-dining directive. The fryers were replaced with fast-cook ovens capable of baking fries and other previously fried foods.

Wagstaff recently added portable induction cooktops to the cafe to use for display cooking; the cooktops made their debut in February for a Chinese New Year special meal serving made-to-order stir-fry dishes.

Dishroom And Storage Adjustments

When the hospital opted to use disposable plates and bowls in the cafe, the original designers eliminated the dining area’s pass-through tray drop-off station; this, in turn, rubbed out the dishroom’s soiled-tray sorting area. Also not accommodated in the dishroom: space for storing clean dishes and trays from patient feeding.

“We rearranged the layout so that soiled trays could be stripped on the soiled side of the dishmachine,” Wagstaff says. “Then we added mobile dish caddies for stowing clean dishes for patient meal service.”

The original kitchen design allotted little space for deploying countertop equipment or storing pots, pans and smallwares.

“I kept asking, ‘Where do clean pots go? Where do we plug in the mixers? Where do we stow smallwares?'” Wagstaff recalls. The eventual solution required downsizing the kitchen equipment list. “They’d specified a pizza oven to serve the cafe, but we ended up deleting it from plans because we needed pot-and-pan storage and countertop space so badly. We’re using our convection ovens with pizza stones to bake pizzas instead.”

Additional ceiling racks were installed to hang all of the clean utensils, pots and pans within easy reach of staff. “We also added pot racks and additional wall shelves to help store items,” he says.

Acting on advice from Boston Showcase, the Spaulding team was able to gain needed extra space in the dry-storage area by installing Eagle Group high-density track shelving, i.e., shelves on wheels that roll back and forth along a fixed track, eliminating the need for space between shelving units.

Not every storage issue could be fixed, however. “The original design team went back and forth about where to place the diet office and storeroom,” Wagstaff says. “They finally opted to put the diet offices near the kitchen entrance, next to the receiving dock, and the dry storage on the far side of the kitchen. Now we have vendors wheel dry storeroom deliveries across the kitchen and keep our paper supplies along the walls of the indoor loading dock. It’s not ideal, but somehow we’ve made it work.”

Spaulding’s Big Move

Once all of the pieces were in place, there was no soft opening for Spaulding’s new kitchen. The hospital administration had determined that the entire operation—all patients and staff—would be transferred from the old building in Boston to the new Charlestown location in a single day. The fact that many of Spaulding’s patients included victims of the Boston Marathon bombing eight days earlier only added to the pressure.

“On April 27, 2013, we ran two complete foodservice operations while all 130 patients were safely transferred from the old to the new facility between 6 a.m. and 3 p.m.,” Wagstaff says. “As patients flowed to the new hospital, the menus, food-delivery equipment and staff flowed with them. We kept both cafes open, serving free meals to all comers. It was a long, challenging day, but a successful one.”

Spaulding’s zero-to-60 opening was not without glitches. “New equipment training was done ‘just in time,’ which led to some challenges in the new kitchen,” Wagstaff adds. “And a few pieces of equipment had startup issues that required vendor support. We had plenty of help, though, from Boston Showcase and the manufacturers’ rep firms we used, which helped get us through the early challenges.” 

Cool Green Elements

As part of a LEED Gold facility, Spaulding’s foodservice operations include a number of sustainable elements in addition to Energy Star-certified kitchen equipment. Of particular note: the dock, waste handling and grease traps.

Spaulding’s food-delivery dock is fitted with two 12-ft.-x-12-ft. hydraulic-lift platforms that raise and lower to match the level of any delivery truck, a convenience that helps speed unloading for trucks lacking lift gates or when items need to be moved by the pallet.

Positioned next to the dock, a food-waste dehydrator helps reduce weekly tipping fees by keeping vegetable and fruit scraps out of the waste stream. Instead, they’re converted into lightweight biomaterial that will be used on the hospital’s therapeutic gardens.

In the pot-wash area and dishroom, recirculating-plume scrapping sinks from Salvajor save on water use. Low-flow pre-rinse spray nozzles also help conserve water. Below the scrapping area, an external grease trap captures grease before it enters the sewer system. The unit skims grease from the wastewater stream for recycling by a local fat renderer, extending the life of the hospital’s plumbing and reducing the need for expensive chemicals or snaking clogged drains.

A Look Ahead

As Spaulding Rehabilitation Hospital begins year two in its beautiful waterfront home, Wagstaff has plenty of items still on his foodservice to-do list, all part of his mission to exceed customer expectations.

“We’ll be adding tablets, laptops and interactive TV menus to our meal-selection options for patients as part of our conversion to a paperless system,” Wagstaff says. Hopeful kitchen upgrades and enhancements include adding a remote, digital temperature-monitoring system for all refrigerators and freezers, acquiring additional food processors and upgrading the Constitution Cafe’s POS system.