Foodservice Equipment Reports

Anatomy Of A Pod

The assembly line is so 20th Century. Henry Ford had a great idea when it came to lowering the cost of putting together a complex piece of machinery like a car. And it’s worked well in manufacturing plants around the world for nearly 100 years. But even car companies have wised up to more efficient ways of getting product out the door.

One of those ideas—the Japanese concept of kaizen, or “improvement”—has made its way from the factory floor of companies like Toyota to healthcare kitchens. What car makers such as Toyota discovered was that giving teams of assembly workers more autonomy and more responsibility reduced mistakes, improved quality and efficiency and gave employees more of a sense of ownership in their work.

Hospital kitchens are learning that tray line assembly systems often propagate the same problems automakers face—inflexibility and mistakes—so many are rethinking the process.

Instead of setting up eight or 10 stations down the length of a tray line and assigning each employee a single task toward completion of the tray, they’re setting up all the tasks within easy reach of one or two employees who take responsibility for putting together the entire tray according to the order slip.

Reasons for switching from tray lines to a pod assembly system are as diverse as the operations themselves, but most have found the benefits well worth the change.

A Flexible Approach

“There are three hospitals in town,” says Sandra Ray, production and conference dining manager, WakeMed Health & Hospitals, Raleigh, N.C. “When a competitor started a room service program, we talked about doing the same thing. We brought in a consultant who told us we’d have to remodel the kitchen to implement room service, so we looked at other things we could do to provide a more personal touch.”

The hospital realized that as it had grown over the years, its tray line was taking longer to serve patients, running nearly three hours at lunch. The kitchen also wanted more accountability from its employees. On the old tray line, eight or nine hands touched each tray, increasing the chances for mistakes.

The hospital had made recent changes to the menu and wanted to keep the new items and its production system. To give patients the more personal service it was looking for, the hospital implemented a host/hostess program with spoken menu and a selection of “all-time favorites” to complement the regular menu cycle. The host/hostess takes orders from an average of 40 to 50 patients, personally visiting each one and noting choices on a laptop computer.

Along with those changes, Ray and other team members thought the timing was right to try pod tray assembly.

“In a pod, everything is compressed into stations where everything you need to assemble a tray is within reach,” Ray says. “We have four pods, which is the equivalent of eight tray lines.”

At each pod, one server works with two hosts/hostesses, dishing up entrees while the hosts/hostesses assemble the rest of the tray. Once trays are assembled and loaded on carts, hosts/hostesses deliver them to patients. Since carts only hold about 20 trays, some meals can be delivered while others are still being assembled. That’s shortened tray assembly time to between 60 and 90 minutes, less than half the time of the old tray line.

“Multiple assembly stations allow you to serve many areas of the hospital at once; you don’t have to wait for one floor to be completed before the next floor’s trays begin as you would with one tray line,” says Bill Notte, director of foodservice at Huntsville Hospital, Huntsville, Ala. That means that most patients receive their meals faster than they would from a traditional tray line.

Notte implemented a pod tray assembly system at his former facility, Shands Hospital at the University of Florida, Gainesville, due to a number of quality issues and the fact that the kitchen’s circular tray line was decades old and constantly breaking down. Patients weren’t getting what they ordered, didn’t receive meals in a timely manner, missed some meals entirely, and complained that food quality was poor. Patient satisfaction was below the 60th percentile. The pod tray assembly system dramatically improved efficiency and patient satisfaction.

Equip Yourself

Pods basically put everything a server needs to assemble a meal tray within easy reach. Trays, flatware, tableware, cold food, hot food, beverages and condiments are all racked, accessible and ready to put together quickly.

Facilities lay out these pods in ways that best suit their needs, often due to space configurations or based on how many hosts work with each server. Some operations lay pods out in “C” formation, others a “T” and still others an “L.”

Manufacturers now design and build specialty equipment to make pods as effective as possible, but off-the-shelf equipment can work, and to save money some operators have jury-rigged their exiting equipment into pod stations.

WakeMed, for example, left its existing tray line in place because of its electrical lines, and worked pods around it. The department created another pod using a mobile hot cart from the cafeteria. The kitchen purchased an additional $20,000 worth of new equipment. Each pod has a serving station with heat activator, plates, domes and lids; two air curtain refrigerator units; a hot holding cabinet; and two starter stations (basically a work station with bins for condiments, napkins, utensils, etc.).

At Shands, Notte and his staff spent $171,000 on the conversion to three, two-sided, T-shaped pods, which included $15,000 for electrical work and some equipment purchases from Aladdin Temp-Rite. Each pod contains a five-well hot food counter forming the top of a T, two worktables on either side of the T stem, heat activator, dish heater, two air curtain refrigerators, a hot food holding cabinet, plus food delivery carts and storage racks for trays and domes.

In his new job at Huntsville, Notte inherited a pod system implemented by the contract feeder the hospital used before he arrived. The company basically took two steam tables and faced them toward the straight tray line to create serving pods. This year Notte plans to rip out the old tray line and set up new pods based on his Shands model, adding a third.

The William Osler Health Centre’s Etobicoke General Hospital outside Toronto, put in an early version of a Burlodge BLean pod system when the kitchen was undergoing renovations recently. Once the system was up and running properly, the foodservice department liked it so much it switched to pods in its new Brampton Civic Hospital, Brampton, Ont., which was completed in 2007.

“Between Ebiticoke and Brampton, Burlodge worked with us to enhance the system at our new hospital,” says Anne Marie MacKinnon, RD, director of patient food service. “The original pod system at the first facility was somewhat difficult to fit together and to streamline because it was made up of independent pieces that were not designed specifically to work together for a lean tray assembly set-up.”

MacKinnon and her staff consulted with Burlodge reps, and the pieces for the new installation were refined. The new pieces are flexible, easy to move, ergonomic, easy to clean and fit together in a variety of combinations, she says. Beverage slides and condiment bins, for example, gravity-feed supplies to the front. The cold food tables are designed as reach-in wells directly below the tray slides, all making tray assembly as compact and ergonomically efficient as possible.

Getting Up To Speed

Typically, pods don’t require more manpower than traditional tray assembly lines, and often they’ll save labor. At Shands and WakeMed, for example, the change to pods was cost neutral from a labor standpoint. Both hospitals shifted personnel around to accommodate the new system.

“We used dishroom staff and some cooks as servers on the pods,” Ray says, “and reassigned the former tray line personnel as hosts and hostesses. Now we have people taking ownership and being proud of their floors.”

St. Michael’s Hospital, Toronto, put in a Burlodge BLean pod assembly system as part of its efforts to find cost savings while maintaining quality of service. “We planned our implementation to correspond with a staff retirement,” says Heather Fletcher, RD, manager of patient food services. “By not replacing our retiree, we saw an FTE reduction of 1.4.”

Operators say that about 30 to 40 patients per host/hostess is a good average. More than that, and the personal touch is lost because hosts don’t have enough time to spend with each patient. Any fewer and you’re losing efficiency. Pods typically can handle up to 120 trays per meal period depending on how they’re laid out and how many servers are stationed at each (usually only one, but sometimes two).

A new way of assembling trays and the fact that staff may be reassigned to unfamiliar tasks makes training important.

“When we implemented the original system in our first facility, we had a tight timeframe,” McKinnon says. “We did have some setbacks that required us to go back and retrain. Initially the staff wanted to take the equipment apart and rearrange it back into the straight tray line! We looked for staff who would champion the new concept because we’d rushed through the initial training. They helped us bring the rest of the staff on board. We learned to do that from the beginning of the process in the second installation at Brampton Civic.”

At WakeMed, the biggest piece of training was spent teaching employees how to take orders from patients and making them comfortable talking to patients.

Getting servers used to assembling entire trays instead of placing just one item on a tray as it passes on a traditional line also requires some training.

“Staff training really focused on getting the most from the system and ensuring that staff were familiar with where products were placed in the pods,” St. Michael’s Fletcher says. “We labeled where items were to go on the pods and made sure that all staff follow the same set-up. Once the staff could predict the product placement, we really started to see efficiency during meal assembly.”

“One of the things I stress is that items are stocked in the same places so that staff could pull them blindfolded,” MacKinnon agrees.

Buy-In Speeds Process

Getting employee buy-in early on not only can speed the process of adopting pods, but also generate ideas on how to maximize its effectiveness in your operation.

“We knew that we could be more efficient based on benchmark data,” says Tony Pagliara, general manager of foodservice at Orlando Regional Medical Center, Orlando, a Sodexo account, “but we weren’t exactly sure how.”

The foodservice staff was producing an average of 1.615 trays per minute from two traditional tray lines for a combined 3.23 trays per minute. But Pagliara knew that industry, and Sodexo, standards are 2.25-3.0 trays per minute per tray line. Another hitch was that the hospital’s two tray lines weren’t standardized.

“First, we looked at forms of waste as part of our Greenbelt/Lean initiative,” says Pagliara, “and saw lots of it on our existing tray lines. So I visited several other sites in the area. I brought two of our supervisors to see sites in Boca Raton and Port Charlotte, and they said, ‘Wow, we can do this, and we can do it better.’”

They took the best ideas from the sites they visited then looked at several potential tray line configurations in their own kitchen and analyzed the flow. While still a work in progress, the team picked a double-T configuration with two Dinex hot food counters (one 5-well and one 6-well) flanking an existing L-shaped 6-well steamtable, two Dinex induction table chargers and Smart Therm induction heaters, four air-curtain refrigerators and four pass-through tray carts plus work tables, also from Dinex, and two freezers.

After six months, Pagliara says project reduced staff by about 6 FTEs, giving the roughly $98,000 project a six-month ROI, and just as importantly reduced patient complaints.

Making The Most of The Menu

Menu changes are minimal for most operations that switch to pods. The number of hot entrée selections is really limited to the size of the steam table you put with the pod.

Often, operators find that they can simplify the menu somewhat when they switch to pods. At William Osler, staff discovered they were offering five different kinds of milk in different sizes. They’ve reduced the number of choices.

St. Michael’s also uses lean principles to see if the kitchen can reduce the number of multiple offerings at a meal such as jams or salad dressings. Staff also changed the sequence in which some items were offered to improve efficiency. If apple juice is the main beverage at one meal, for example, it might become the alternate beverage at the next so that leftover juices can be used up; that facilitates set-up between meals.

Some operators say that the system also allows patients to customize orders more easily than a tray line would permit. Shands, for example, chose to offer a fixed menu cycle of its most popular items, or chef’s specials (since most patients don’t stay long enough to see repeats), and augment it with a limited selection of just-made, short-order items such as grilled cheese or deli sandwiches, burgers, pizza, grilled chicken sandwiches, etc., held in food warming cabinets. At Huntsville, Notte says that as long as pods are close to the kitchen, he also can offer grilled-to-order items. In fact, if it’s close, staffers could conceivably customize a tray with items from the retail café. Pods essentially increase the department’s ability to please patients.

“Assembling meals from a cook-chill system might be more efficient,” Notte says, “but it’s essentially reheating cooked food. At the high end is room service where food is ordered and prepared on demand as in a hotel. In between is cook-serve service where you cook food, hold it and serve it on demand. Multiple pod serving stations are ideal for that because they cut down on the time between cooking and delivering the meal.”

MacKinnon even suggests that you could offer a modified room service off of pods because the tray assembly is so efficient. In fact, most of the operations that have switched to pods now take orders today for meals served today, rather than the day before as is the norm with traditional tray lines. Under a modified room service, patients could call orders in for assembly, or place them with hosts/hostesses as they do now.

Do Your Homework

The benefits of assembling trays in pods can be dramatic. Shands saw patient satisfaction scores rise to almost the 80th percentile from the 60th along with a corresponding decrease in patient complaints. At the same time, the hospital saw the number of trays assembled rise from a rate of between 2.9 and 3.9 per minute to between 4.7 and 5.8 per minute. Many other operations have experienced similar results. After all, on a tray line, the belt can only move as quickly as the slowest employee.     

Whether or not you can see such dramatic improvements in both efficiency and patient satisfaction obviously depends on your situation and the solutions you propose. The best way to find out if pods will work and which systems and equipment might work best in your operation is to do your homework.

Several manufacturers, including Aladdin Temp-Rite, Burlodge and Dinex, make equipment that can work well in a pod assembly system, some expressly designed for that purpose.

“Call people for ideas,” Ray recommends. “Talk to equipment purveyors, read trade journals, and most important, go on site visits. We did several before we put in our pods, and we’ve hosted a number of visits from other hospitals since. You have to network with people to discover best practices.”

Remember that just because Henry Ford had a good idea back in the day doesn’t mean there isn’t a better way to do things.

Benefits of Pods

  • Tray assemblers are responsible for every aspect of the meal. They can check and double check that the tray is right and complete immediately. If there’s a mistake, they are responsible and the fix is immediate, too.
  • Typically trays can be assembled faster than they are on a tray line, especially if you put your fastest workers at the stations. That makes it possible to take orders the day of meals rather than the day before for lunch and dinner. That, in turn, greatly increases patient satisfaction.
  • If you run two or three, two-sided pods, you can flexibly run anywhere from one to six stations depending on meal demand. Shut all but one side of a pod down for late trays; this is a vast improvement over keeping the tray line running after the shift or making due with alternative meals.
  • If the census increases, it’s not a problem because you’re only adding a few trays to each of the pods, which only take a few minutes each to make up. Adding all additional trays to an already long-running, single tray line can really extend service times.

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