The Current World of Healthcare According to Dan Henroid

The 2012 IFMA Silver Plate winner in healthcare discusses foodservice and sustainability challenges at the University of California, San Francisco Medical Center.

Dan-HenroidDan HenroidFE&S: What are three of your recent accomplishments?

DH: First, being selected as the 2012 IFMA Silver Plate winner in healthcare. Second, the successful renovation of our retail venues in tight economic times. We created four new, small outlets from scratch, plus planned and supervised a massive renovation of the main retail operation, Moffitt Café, and a remodel of the Mount Zion Café, a small café at the Mount Zion campus three miles from the main facility. Third, we improved confidence in and the reputation of the nutrition and food services department. We are now known as an innovative department that is customer-centric. We are often the first to participate in a new project or pilot and usually push the envelope of what can be done.

FE&S: What challenges do you face?

DH: We're challenged with innovating to stay competitive. We don't have a captive audience for our food outlets, and we have a lot of direct competition for food at our main campus. We must continue to offer quality food and services that compete in the marketplace.

In addition, we face limited capital and compression of our labor budget. While waiting to see how the federal healthcare reform will impact us, we are trying to absorb a massive new pension expense and remain in a strong financial position to pay for our new $1.5 billion, 289-bed hospital that will open in February 2015 while maintaining our main 550-bed hospital with two 15-story towers. We're planning to put in room service for all patients, a convenience store, a full café, a 2,700-square-foot conference center, an 80-seat outdoor amphitheater and much more.

Also, like most leaders, I find having the ability to change a culture to improve operations is very challenging. The culture shift is even tougher if the workforce has been in place for quite some time, which is the situation here.

Another challenge is an aging workforce. We can't design jobs like we used to because many of our older workers have a tougher time performing at the same level.

FE&S: How do these challenges affect your foodservice equipment selection and purchases?

DH: We look for foodservice equipment to help make our work easier and are now getting a lot more directly engaged with manufacturers about our needs. We spend a lot of time evaluating foodservice equipment. We are also always looking for equipment that will fit into tight spaces and allow us to be efficient. For example, we installed a rear-loading walk-in refrigerator with glass doors in the Moffitt Café Express.

FE&S: Please elaborate on your need for equipment to help make work easier.

DH: Our labor rate is $22 per hour plus benefits for a foodservice employee. Because of this high labor cost, we're looking for ways to do more with less and want foodservice equipment that will give us maximum flexibility to produce a wide range of menu items.

One area that would help is having more equipment tied to the NAFEM Data Protocol. For example, we just put in blast chillers and have to install many new network devices to help meet regulatory demands. The core function of what the equipment does is fine. But it only reports the cooling temperature without much detail and doesn't tie in with UCSF's systems. We need actionable information. I have a vision of a computer maintenance program that ties in with our installed base of equipment so at a moment's notice I, or someone from our staff, can look at all of the systems and see how much power and gas they are using. The faster something can be done to make more actionable decisions about power and utility consumption — about the range of power utilization for each piece of equipment — the better off many of us will be.

Also, to help us, refrigeration manufacturers need to pay attention to how equipment operates in certain environmental conditions. A lot of us healthcare operators must put in automatic temperature monitoring systems so we know in detail what is and isn't working in all of our units so we can troubleshoot immediately. We've struggled with air curtain refrigerators and people need to understand the expected level of functionality needs to maintain 41 degrees F and below and those assumptions are built on certain conditions, such as humidity and average ambient temperatures. The automated systems will drive behaviors for refrigerators and holding ovens. I'm spending more on refrigeration than I was five years ago. I just spent $1,500 on equipment for a small dorm-room size refrigerator, because when the surveyor walks in the door, I can't say I didn't have the budget to buy what is right.

FE&S: Is there anything else you'd like to receive that you're not getting?

DH: Yes, specification sheets on equipment. The information manufacturers provide ranges from very good to horrible. We are particularly sensitive to this issue in California with our seismic requirements. Manufacturers need to make their websites more accessible and utilize the web to better sell their equipment. We always appreciate people who let us try their equipment before buying.

Useful information for our operation includes height, weight, power and use of chemicals, and it's a lot harder to get that information than it should be in this day and age of the Internet. If I don't get it, I have to pick up a phone and call and get routed to a local rep. The process of equipment acquisition can be terribly clunky.

Consultants can get this information because they know who to talk to in an equipment company and companies realize consultants are the gatekeepers to big projects. That makes sense but I can't hire a consultant for every piece of foodservice equipment we purchase. At hospitals in California, it's arduous to get equipment replaced. If our foodservice operation buys anything that weighs more than 20 pounds we have to pay a structural engineer to tell us how to seismically brace it and an electrical and mechanical engineer to be sure we have the utility support. All this must be put together in an architectural package that I must send to the State of California for approval. All of these drawings add up to phenomenal amounts of money and time — and that's if we even have capital to start with. So, many times I'm looking for one-off purchases to solve an immediate need, and I am not always going to call a foodservice consultant. I can't afford to pay for an opinion on one piece of equipment.

FE&S: Manufacturers won't provide this information to you?

DH: Many will, but because any purchase of more than $50,000 must be publicly bid in the University of California system, a big challenge we face is writing bid specs that get to the meat of good selection and provide the lifecycle cost. It's a full-time job. When I came here, because of purchasing restrictions, equipment was purchased only through one source. We didn't always make the best equipment decisions. We're doing better now, but we don't buy from one source.

FE&S: What new types of equipment interest you?

DH: I'm a fan of ventless equipment, such as convection-microwave ovens that cook food quickly. This allows us to heat menu items in a confined space, such as the 600-square-foot convenience store. I also saw some food warmers that inject steam into the holding cabinet so product doesn't dry out. We just ordered one and are looking forward to being able to hold food longer while maintaining high quality.

Though combis aren't necessarily new, many people don't know how to use them. We replaced one, but aren't using it very much because many members of our culinary staff have been here a long time and don't want to use equipment they aren't familiar with.

FE&S: Your trash room operation has been transformed. What have you done?

DH: We had a scrape room, which is like a college and university dirty tray collection point, adjacent to the exit from the café. I wanted to do something else with this prime location, which has windows and is near the main elevator lobby. So we turned it into a convenience store that now runs from 6 a.m. to 11 p.m. daily. We partnered with a popular coffee company to add that product offering to this area. Now, the store grosses $1.6 million. We built the trash room in a different, less prominent space.

FE&S: You have a sustainability action plan...

DH: Oh, yes. Because of limited labor, we don't move reusable dishes in retail operations. We actually collect post consumer waste in our scrape room and sort landfill, recyclables, and compostables for our customers behind the scenes. We've grown from making 8.5 percent sustainable food purchases a few years ago to 16 percent now. We've integrated sustainability standards into nearly every purchase we make, whether for food and packaging yields to equipment, to determine its environmental impact. We have an icon on our menu boards that indicates sustainable food.

FE&S: And what does that mean?

DH: We use the criteria from University of California, including fair trade, local, organic and so forth.

FE&S: What do you see happening in your future operations that will affect your equipment selection?

DH: We are evaluating a large-scale sous vide cooking system. We'll be having more rigorous inspections by Centers for Medicaid and Medicare Services, a funding agency that oversees these programs. So we'll have to be more concerned about our record keeping to be sure it's beyond reproach, validation of our controls and how we're executing infection control in our department. We'll have to be more rigorous with our food safety and sanitation. With our new hospital, the future will be quite exciting and, of course, challenging.

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