Forward Thinking

Anyone in healthcare foodservice knows that when your organization green-lights a facility renovation, it’s usually a once-in-a-career experience. When the foodservice team at Northwest Community Hospital (NCH), Arlington Hts., Ill., got the go-ahead in 2001 to renovate its main kitchen (and retail cafeteria), it faced a major decision: take the leap into then-emerging room service, or continue with its traditional tray-line meal service?

“Room service was just beginning back then,” says Forbes Borthwick, director of nutrition and food services at the time, now retired. “We really didn’t know if it was going to be the flavor of the month or the future of patient feeding.”

The foodservice department enlisted the aid of foodservice facility design consultants Robert Rippe & Associates, Minnetonka, Minn., who came up with an innovative plan that precluded any possibility of renovation remorse.

Principal Bob Rippe, FCSI, and Project Manager Christine Guyott, RD, LD, implemented a design that enabled the department to continue with traditional patient meal service until it was ready to make the switch to room service. That switch took place six years later in December, 2009, and took–in terms of equipment and utilities–just two nights to complete.

A Little Background

From 2000 to 2001, NCH built a state-of-the-art surgery in a new addition to the hospital. The location that was occupied by the old surgery–a huge, ground-floor area in the original part of the hospital–became prime real estate once dust from the extensive demolition cleared.

At the time, hospital foodservices consisted of an antiquated, straight-line cafeteria and a small kitchen that supported the cafeteria, catering operations and patient feeding. With the hospital’s new addition, foodservices clearly needed to upgrade and administrators ultimately determined that the vacated area was the ideal space for it.

“Our old kitchen was very cramped,” says Linda Foster, systems manager, who has been instrumental through all the department’s incarnations. “There was too much crossover between functions, from receiving to storage to food preparation, and even to dishwashing.”

Taking over the old surgery’s area tripled the foodservice department’s space, housed a brand new, scatter-style cafeteria and dining room, and allowed for separate kitchens to support retail needs, catering needs and patient meal needs. Each kitchen was designed with its own equipment for hot and cold food prep, as well as dedicated storage. The new floor plan also included a dishroom with separate access (so that no soiled trays or refuse crossed food prep areas).

Timing Is Everything

As the design process began, the consultants worked with Borthwick and his team to tackle the patient-feeding challenge. “We needed to find a way to equip the department to produce the traditional, limited-selection menu they were serving, but design the area in such a way that they could revisit room service in the future without prohibitive construction costs or equipment expenditures,” Guyott says.

At the time, NCH distributed paper menus for the following day’s meals at breakfast and picked them up at lunch. The limited-selection, cycle menu typically offered two hot entrees, two hot sides, a starch and a cold plate consisting of a premade sandwich or entrée salad. Everything, hot and cold, was prepared in bulk and in advance.

In the kitchen, Rippe designed a traditional bulk-food hot line, with combi ovens, roasting oven, tilt skillet, 40-gal. kettles and range required to prepare and cook such items as roasts, soups, gravies, sauces, potatoes, vegetables, rice and more. The equipment lines up along a 54″-high wall.

On the other side of the wall, back to back with the bulk-food hot line and parallel to the tray line conveyor, the Rippe team designed a batch cooking line, a concept new to the facility.

“With the batch cooking equipment, cooks were able to prepare single portion items that patients ordered ‘off’ menu,” Guyott says. Examples include burgers, garden burgers, grilled cheese sandwiches, grilled chicken, and French fries. Cooks could also prepare small quantities of vegetables, egg dishes, pancakes and other breakfast items that typically wouldn’t hold well if made in bulk and in advance. In the meantime, the bulk items that did hold well sat ready in steam wells located across the aisle from batch cooking.

Equipment the designers specified for batch cooking is typical in a short-order line: reach-in freezer, steamer, six-burner range, chargrill/flat griddle on a refrigerated base, fryers and another reach-in freezer. Across the aisle from the batch cook area, in addition to the steam wells, is a garnishing station for cheese, peppers, lettuce, tomato, onion and pickles.

“Essentially, the short-order cook line the department would need to go to room service was in place for the future,” Guyott says.

The Big Switch

Prior to the change to room service last year, NCH’s tray line ran like any other. The tray conveyor ran down the center between batch cook/hot holding on the hot side and cold holding on the other. For the years between 2003 and 2009, cold holding cabinets, which were filled with pre-made sandwiches, salads, ice cream, puddings, fruit cups, juices, etc., abutted the tray line perpendicularly to form stations for tray makeup personnel.

When the department switched to room service, all the cold equipment was turned side by side to run in a line parallel to the tray conveyor. The items stocked in the cold cabinets changed, too. In the room service model, they’re used to hold soda, thick liquids, juices, gelatin, desserts, cold pasta salads and house salads, ice cream and other items patients order. But sandwiches and salads are no longer made in advance.

“On the hot side, we replaced one of two steam well units with a new, refrigerated salad/deli cold prep table to make those items fresh,” says Frank Scriven, director of support services.

“We also purchased a TurboChef oven, and we had to buy about 30 Dinex room service carts, new trays and 9″ plates,” he adds. Aside from adding an extra water line and moving some electrical outlets, the traditional tray line area turned into a complete room service production center over the course of two nights. “We kept the tray conveyor,” Scriven adds. “It just moves at a snail’s pace now and is more of a work surface to assemble room service orders.”

Operational Transitions Take More Time

While the equipment layout and design enabled a switch to room service over two nights, getting the foodservice department ready for room service took months. The department called on Management Advisory Services specialist, Georgie Shockey, principal, Ruck-Shockey, Woodlands, Texas, and her partners, to help guide the department through the transition.

“We took a look at the number of FTEs, labor distribution, skill sets and the logistics of room service to figure out how to make the transition,” says Shockey. “We developed training manuals for staff in the call center, in the various food production areas, tray assembly stations and for room service assistants, who were in charge of delivering trays.” Shockey also helped develop and refine the new room service menu.

Vision Software Technologies, NCH’s diet office software provider, stepped in and stepped up to transition the department’s software to a room service model. “VST is incredibly patient-focused, very good to work with,” Foster says. Any system will need tweaking to fulfill the particular needs of the host facility, however, and that’s to be expected.

“For example, we realized early on we needed to add a couple of codes to the ordering system,” Foster explains. One is “add to tray” for when someone calls to say they forgot to order something, such as extra ketchup. Another is “missing from tray;” that means something major is missing and must be sent up immediately. A third is “check the tray” that prompts checkers to double and triple check that the order is accurate for more difficult-to-please patients. The next step will be to add time stamps to the orders to help ensure patients are receiving meals within a 45-min. window.

The foodservice team learned a few other valuable lessons in the process of transitioning to room service. “We had a printer by the grill cook, and as soon as an order came in, the cook would prepare the hot item,” Foster explains. “The problem was that there could be six cold orders ahead of that hot item, entrée salads or sandwiches for example, that needed to be made first.” As a result, hot food sometimes sat while orders caught up.

The department turned off the printer by the grill cook and instead trained a “caller” to start the line and coordinate the timing of orders. Now the grill cook waits until the “caller” calls out an order to begin cooking. “These are things you learn as you go,” Foster says. “There’s just no way to anticipate.”

“The operational logistics are extremely complex in their own right,” Shockey agrees. “What I love about this project is that forward-thinking facility design saved the department the huge headache of undergoing a crazy physical renovation on top of an operational renovation. It was really well done.”

Menu Matters

Shockey, Foster, Scriven and others looked at hundreds of menus to develop the hospital’s new room service menu. “Georgie looked at our first version and told us to cut 20 percent of the items or we’d risk overwhelming the staff,” Foster says. Ultimately, the department settled on a main menu with more than 70 selections (about 90 percent of which are made from scratch), a gluten-free menu, and a menu for pediatrics.

“We struggled with how to handle restricted diets on the menu,” Scriven adds. “We were insistent on having a single, main menu, but patients on restricted diets don’t like seeing what they can’t have.” Heavy symbolizing–hearts for heart healthy, for example–can help guide patients to the right choices. Employees in the call center also are trained to walk patients through menu swaps if they order items their diets restrict.

Language is a consideration for menus, as well. Despite its location in the heart of the Midwest, near Chicago, Scriven says NCH is host to a number of patients who speak Russian, Polish, Spanish, Chinese, Japanese and more. “We have a language line in the call center and translators on call, but language can still be a challenge,” he says.

Shockey wondered why the language barrier seemed to become more pronounced under room service than it had under the old paper menu system. That prompted the department to wonder now if non-English speakers just circled items on the old menu. If that was the case, the practice could have wasted a lot of food. Shockey has suggested they move to a pictorial menu to bridge all language barriers, and the NCH team is considering the option.

Until then, the new menu is working. “Patients order when they’re hungry, and they don’t over order, which is a tendency when you order a day in advance,” Foster says. “There’s no question our food costs have declined and our satisfaction numbers are up.”


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