Market and Coffee Shop

The market and coffee shop areas, designed by Inman, operate from 7 a.m. until 9 p.m., opening three hours earlier than the restaurant. In addition to offering to-go foods, the market features meals for staff to pick up prior to heading home. A flat-bottomed warmer holds food items such as rotisserie chicken at the proper temperature, while a pizza warmer keeps pizzas at the proper holding temperatures. Soups sit in wells at a circular unit.

A serpentine-like salad bar displays fresh ingredients so customers can make their own salads. A full beverage station dispensing smoothies, coffee and tea sits nearby.

A barista at the coffee shop receives and fills orders for a variety of coffee and tea drinks. Customers take condiments at the end of the line before leaving the shop.

Washing Trays and Dishes

To avoid cross contact between clean and dirty dishes coming from the patient areas and restaurant kitchen, the dishroom contains two entrances. A dividing barrier separates clean and dirty dishes, carts and pots and pans. Soiled carts come in from patient rooms and sit in a scrapping area where staff off-load the dishes, plates, glasses and serviceware onto a breakdown dishtable. The dishtable features belts that make for easier loading of dish racks and rollers for glass and cup racks, all of which moves into the four-tank, water-efficient flight-type dishmachine. Staff wash carts at an adjacent station. The large dishwashing area also contains a large pot and pan wash/soaking area. A clean storage area nearby (but separated from the dirty area) holds smallwares until needed for the next production cycle.

In addition to the high-efficiency, low-flow dishmachine, the kitchen uses energy-efficient refrigeration equipment. The computerized hood system contains variable-speed air systems that monitor the exhaust emitted from the food and adjust the cubic feet per minute (CFM) accordingly.

In order to cut down on disposable usage, foodservice staff encourage customers to bring the hospital's logoed mugs to the market and receive free coffee. The market uses eco-friendly disposables, and the restaurant serves meals on china.

Lessons Learned

"We learned from the Centers for Medicaid and Medical Services (CMS) that we can't dry broom anything," Poggas says. "And how do you do that in a kitchen? We're working with the state health department to find a solution that meets both our needs."

Poggas advises other healthcare foodservice operators to "always have back-up [PRN – as needed] staff." She says more soft openings would have been preferable. "We could have done more work with the cooks and waitstaff to quicken meal preparation and delivery," Poggas says. "Success depends on training, training, training and communication. And having as-needed folks in the wings because unexpected things happen, like staff going on leave. We were behind the eight ball and opened up with low staffing." (Pogga expected bo have a full staff in place by the end of December)

Fiscal responsibility was a priority from the project's inception. "We had to be sure the project is fiscally sound," Poggas says. Due to the popularity of the food and style of service, Poggas and Skay say the project remains on budget.

To meet future needs, Castle Rock can expand the kitchen's walk-in freezer and coolers into space that sits adjacent to the existing equipment. Restaurant seating also can expand to outdoor space.

Customer satisfaction remains strong since the opening despite some snafus and the expected problems that come with a new operation. The main complaint Poggas receives is that the restaurant prices are too low. "We must cater to staff, and they expect affordable food," she says. "I don't like to offer discounts because nonstaffers end up paying for staff meals."

In coming months, incentives for employees to minimize their healthcare insurance costs will continue. As part of the Café Well project, everyone who takes the hospital's insurance receives a biometric screening to check body mass index (BMI), cholesterol, blood pressure, weight, blood sugar and smoking habits. If these are out of range or if an employee doesn't take the screening, they pay more for insurance. If they participate in activities such as weight management or wellness coaching, however, they receive credits toward decreasing their premium costs. In addition, the hospital is part of Partnership for Healthier America and will continue to reach goals of cutting out all fried food, eliminating sugary beverages and keeping sodium levels for entrées at less than 800 milligrams, a very challenging task.

Also in coming months, Poggas, Skay and the culinary team will have a clearer sense of which menu items are most popular and how to make the best use of their seasonal ingredients. With the array of equipment they have to work with, making changes is only a matter of imagination and willingness to be flexible. These are in great supply along with a strong desire to add a new dimension to the changing healthcare paradigm here and across the country.

Design Capsule

• Ownership: Centura Health
• Opened: August 1, 2013
• Scope of Project: New 4-story, 50-bed hospital with a 4,800-sq.-ft. kitchen, hybrid systems for patient room service (Bedside Manna); a full-service restaurant (Manna) with a 1,300-sq.-ft. kitchen; and a 1,000-sq.-ft. market with a coffee shop (Manna Market). The hospital's expansion to the fourth floor will add 50 more beds. A community garden provides neighbors with 90 raised garden beds and water to help grow and harvest their own produce. The hospital also supplies Wellsprings Community with large plots where they educate their special needs adults about all aspects of gardening and becoming self-sufficient. Manna has a 13,000-sq.-ft. garden that supplies the restaurant with fresh organic herbs and vegetables. Manna is working toward approval for an on-site greenhouse.
• Seats: 90 inside, 48 outside
• Average Check: $7.77 at Manna and Manna Market
• Total Anticipated Annual Sales: $750,000 for Manna and Manna Market
• Daily Transactions: 546 for Manna and Manna Market
• Hours: Manna, 10 a.m. to 9 p.m.; Manna Market and coffee shop, 7 a.m. to 9 p.m.
• Menu Specialties: Boneless beef short rib with ragout and polenta fries, hot lamb pastrami baguette, lemongrass udon noodle bowl, Maui poke with wakame and chile mayo, and hearth-baked pizzas
• Staff: 21.5 FTEs
• Total Project Cost: $138 million
• Equipment Investment: $2 million
• Website: www.castlerockhospital.org

Key Players

• Owner: Centura Health
• Key Officers: Todd Folkenberg, CEO; Jeremy Pittman, CFO; and Mike Selvage, CNO
• Nutrition and Environmental Services Director for Parker Adventist Hospital and Nutrition Services Director for Castle Rock Adventist Hospital: Lisa Poggas, MS, RD
• Nutrition Manager/Executive Chef for Parker Adventist and Castle Rock Adventist Hospitals: Daniel Skay
• Chef de Cuisine: Adam Freisem
• Architect: Hunton Brady Architects, Orlando, Fla.; Aurelio Posada Sr., architectural designer, and Paul Mascheske, director of healthcare design
• Interior Design: Ashleigh Pfluger, PJNG Partners, for front of house; Hunton Brady for back of house, Francisco Sierra, senior project coordinator
• Foodservice Design Consultants: Inman Foodservices Group LLC, Nashville, Tenn.; William "Billy" Inman, president; and Rick Palmer, vice president, healthcare services
• Foodservice Equipment Dealer: Great Lakes Hotel Supply, Denver; Tom Schneider
• General Contractor: GE Johnson, Denver

Meet the Players

Lisa Poggas, MS, RD, Nutrition Services Director, Castle Rock Adventist Hospital and Parker Adventist Hospital

Poggas also serves as the environmental services director for Parker Adventist Hospital. Previously, Poggas served as the interim director/manager for Porter Hospital in Denver. In 2009, Poggas and executive chef, Dan Skay, won the gold medal in the HFM culinary competition. Poggas is active on the Dietitians in Business and Communications Board and received the Circle Award in 2011. She also sits on AHF's conference planning committee and chairs multiple leadership committees at Parker Hospital and for Centura Health.

Daniel Skay, Nutrition Manager and Executive Chef, Castle Rock Adventist Hospital and Parker Adventist Hospital

Skay has worked for 30 years in restaurants, hotels, bed-and-breakfasts, catering and hospitals. His many accolades include being named a top hospital chef by the Wall Street Journal and winning the Great Chefs of America culinary competition and the Custom Foods Golden Recipe competition. Photo by Adam Friesen

William "Billy" Inman, President, Inman Foodservices Group LLC

A designer for more than 30 years, Inman's portfolio includes large and small kitchens, patient tray delivery systems and retail centers throughout the country in both commercial and noncommercial facilities.

Rick Palmer, Vice President, Healthcare Services, Inman Foodservices Group LLC

Palmer joined the group as a project manager in 1997. In his current role he manages projects from the conceptual design through the opening of a facility. In addition, Palmer trains and manages the CAD operators, project coordinators and project managers.