The freshly made menu and locally sourced ingredients that define the display kitchen and European cooking suite shared between a full-service restaurant and room service, along with a gourmet-style market with a coffee shop, distinguish this hospital's foodservices from its competitors.

A quick-speed oven sits at one end of the European cooking suite used for both the restaurant and room service. At right, combi ovens provide cooks with much versatility in planning diverse menus.Castle Rock Adventist Hospital fills the need for a full-service hospital with an emergency room to serve the growing communities sitting between Colorado Springs and Lone Tree at the south end of Denver. The four-story facility currently features 50 beds on 1 floor with the capacity to double when the fourth floor opens as needed in the future.

Unlike many hospitals across the country, where visitors and staff must trek through long corridors to find foodservice options, at Castle Rock Adventist Hospital in Castle Rock, Colo., a hybrid-style full- service restaurant with a display kitchen and a gourmet-style market with a coffee shop reside within steps of the facility's entrance. Nearly 75 percent of the restaurant's customers reside in the community, and tables are full each day. The market buzzes with customers — mostly staff — from its opening at 7 a.m. until it closes at 9 p.m.

The prominence of the restaurant and market, as well as their focus on inexpensive, healthful menu items, support the hospital's wellness focus, which emphasizes Adventist's program CREATION Health. "Hospital administrators are working to shift the hospital paradigm from a facility people think of exclusively to treat illness to a place to go to support their wellness," says Lisa Poggas, MS, RD, director of nutrition and environmental services for the 50-bed Castle Rock Adventist Hospital and its sister facility, 141-bed Parker Adventist Hospital located 15 miles away. "As far as we know, we're the only hospital in Colorado offering a full-service restaurant. We're quite proud of that."

Financial acumen was also factored into the foodservice operations. Positioning the restaurant and market near the entrance encourages customers to walk in and buy impulsively as well as arrive with the destination in mind.

In addition to featuring a restaurant and market, the foodservice operation, designed through close collaboration between Daniel Skay, nutrition manager and executive chef, and William "Billy" Inman, president of Inman Foodservices Group LLC in Nashville, supports patient room service. All of these dining options feature fresh foods made from locally sourced ingredients. Castle Rock also offers wellness classes on topics such as diabetes, weight loss and cooking (with Skay). A community garden opened in June 2013 and features 90 raised garden beds available for rent. A 13,000-square-foot adjacent garden currently supplies Manna with fresh herbs and vegetables including peppers, carrots, tomatillos, pumpkins, onions, cucumbers, zucchini and summer squash.

To enter the restaurant, visitors and staff first walk into an entrance for the market. The Italian stonework in the flooring and on walls, as well as artwork from local artists, adorn the space, letting customers know they have entered an atypical hospital foodservice establishment.

To the left of the entrance, a firewall with a double fireplace warms the lobby and brings light. Straight ahead customers see another prominent fire element, the restaurant's hearth oven. Once at the restaurant, guests are seated at booths or standard tables by a host. "The dining room is very soothing to help promote an atmosphere of healing," Poggas says. "This setting allows the visitors, staff and patients to feel as if they are getting away from the everyday hurry-up-and-eat, generic servery."

In the dining room, interactive inlaid lighting filaments appear to move within the stone tables, helping to entertain children dining at the restaurant. In addition, a 10-seat community table provides diners with close-up views of the culinary staff working at an island cooking suite in the kitchen.

Behind the Scenes

"One of the convincing arguments we presented to administrators for using a restaurant concept in a hospital was we can serve harried staff effectively within 30 minutes," says Poggas. "The menu items can all be prepared and cooked within 5 to 10 minutes. We will also allow staff to preorder their food for pickup at a specified time."

The operation's efficiency begins at the loading dock where drivers off-load pallets that go into dry storage. Foodservice staff move products and place them on freezer shelves, in the long-term walk-in cooler or in the adjacent walk-in dairy cooler. At the far end of the cooler closest to the kitchen, staff open glass doors to access products. "The dry and refrigerated storage spaces were located towards the back of the department to allow product to be off-loaded faster and also to prevent staff and vendors from traversing product through the prep areas," says Rick Palmer, vice president of healthcare services at Inman Foodservices Group.

"The refrigerated storage area has both an entrance door for receiving product and an exit door for product distribution/daily usage," Palmer continues. "The glass doors on the dairy cooler replace what would have been an upright refrigerator so staff members don't have to stand inside the cooler wondering where to find their products. The whole system allows rotation of product and maintenance of maximum freshness."

"We're using as many locally sourced ingredients as possible and changing the menu seasonally, so we had to have a system of delivery, storage and preparation that takes the seasonality into account," Skay says.

Cold prep sits adjacent to both the storage areas and also the room service and bulk cooking areas. This creates the natural flow to both the servery and the room service assembly areas. In cold prep, staff use hand mixers to make salad dressings. In addition to production tables, this area contains a blast chiller for quickly cooling soups, salads, gelato and cooked products.

In the bulk-cooking area, staff use four combi ovens to prepare a variety of menu items including short ribs, chicken, chips and hot pastrami that is cured in house. "We're also using the combis for frying peppers," Skay says.

Culinary staff use the kettle for making soups and stocks; the steamer for blanching vegetables and making eggs for breakfast burritos; and the flattop for heating smaller quantities of soups and sauces. "I can't believe I was previously doing without the combis and a flattop," Skay says. A convection oven cooks hand-stretched garlic bread. A warming oven holds items such as backup soups and short ribs for the restaurant

Staff are just growing into the baking/catering area. A full-time baker will soon join the staff. Now, staff use a floor-model and countertop mixers to make cookie dough as well as meatloaf and mashed potatoes. This space also serves as a prep area for breakfast catering. In this area staff will soon also make pizza dough, bread, dinner rolls, baguettes and pastries. A gelato maker is another popular piece of equipment in the back-of-house production area.

"In this area, our hands are always covered with flour and baking products," Skay says. "The sinks have floor pedals, which helps us enormously."

Also in the prep area, a utility distribution system allows staff to unplug equipment so they can easily clean the floors and back walls.

"Another very useful item is a wall-organization system with racks that have multiple attachments and hooks to hold equipment," Skay says. "This is another item I don't know how I've lived without."

More Efficiencies at the European Cooking Suite

At the European-style cooking suite, staff prepare food for the restaurant, market and room service. "With Chef Dan, Billy Inman and I looked at hotels where the room service and restaurants serve off of the same line to help streamline equipment and lessen the amount of cooks needed," says Palmer.

"By cross-utilizing the room service and restaurant equipment, we can save on equipment and labor," says Skay. "Instead of having different stations in a cafeteria, which require one or two cooks to prepare items at each station, we have the cooking island where we only need two to three cooks total depending on the volume of customers. And, we don't duplicate equipment."

Thanks to a layout in which equipment crosses over from one side of the suite to the other, staff prepare restaurant items on one side and room service items on the other. During slow periods for either the restaurant or room service, cooks can take over production at stations for either service.

At the suite, culinary staff use the griddle to make breakfast items such as pancakes, French toast and sandwiches such as a Monte Cristo, a patty melt on a toasted bun or an open-faced meatloaf burger. Overhead pass-through broilers heat soups and melt cheese on sandwiches.

Using the charbroiler, staff cook hamburgers, steaks, chicken, vegetables and eight-inch grilled pizzas.

At the plancha, staff sear vegetables and prepare ahi tuna, beef tips, turkey scallopine and barramundi served with corn risotto, Chimayo chile sauce and micro-corn shoots.

On the six-burner range, staff sauté pasta dishes and heat small amounts of sauces, as well as put finishing touches on entrées.

An adjacent pasta dipping station allows staff to prepare pasta and vegetables prior to placing them in a sauté pan to make Thai coconut udon noodles with Indonesian soy, baby bok choy, shitake mushrooms and fresh salmon or chicken. One well contains regular pasta, and the other, a gluten-free variety.

"Undercounter refrigeration is beneath each station, so we have access to all of our ingredients during production and avoid unneeded steps," Skay says.

Also in the kitchen, a pizza prep area and oven are strategically located, making them visible from the main entrance. A hearth oven bakes pizzas with creative ingredient combinations such as beef Italian sausage, tomato, caramelized onion and fennel pollen. The oven also bakes hand-stretched garlic bread and cedar-planked salmon.

Staff also make specialty salads at this station, as well as sandwiches that can be heated in quick-bake ovens.

With the preparation of food items complete, staff pick up orders at a counter with overhead heat lamps and take the plates to customers. "We have a system in which waiters' tips are donated to a local charity," Poggas says. "We've donated more than $5,000 in three months. Employees are paid well, and they enjoy giving back to our community's nonprofit agencies, so they are okay with this."

Room Service

Patients can call in their orders between the hours of 7 a.m. and 7 p.m. An attendant in a call center located in the Parker facility types up each order and presses a button to send the order ticket to Castle Rock. The order appears at the tray assembly line where nutrition service workers prepare the cold food and place it on chilled plates while staff working on the cooking suite prepare hot items to order and place them on plates with magnetic induction to keep food warm. "We use dome covers like you'd see in a hotel so the trays don't look institutional," Poggas says.

Culinary staff place all meal components onto plates, and a runner assembles each meal on a tray and delivers it to the patient's room within five minutes. When delivering more than one tray, staff place them in carts. A dedicated service elevator significantly helps to facilitate quick delivery.

"We have only one runner at Castle Rock working the room service," says Poggas. "For backup in case the power goes out at either facility or the entire IT servers go down — which they did recently — we set up a hotline phone so the runner can talk directly to the diet clerk to get patients' orders filled. When this happens, the diet clerk either faxes the order to Castle Rock or dictates the order over the phone to the nutrition services worker."

In order to make the most of staffing, at night when room service isn't offered, the runner helps clean dishes for the restaurant.