This renovated foodservice operation uses a compact and efficient kitchen to support a room service program for patients and a college-campus-style marketplace.

The 27-year-old Banner Thunderbird Medical Center in Glendale, Ariz., is one of the fastest-growing hospitals in the northwest valley, having grown from just 75 beds in 1983 to more than 500 today. In addition to increasing demand for inpatient medical care from the community, Banner Thunderbird is experiencing a growing number of outpatients, visitors and staff at the 32-acre campus.

To ensure that the hospital would be able to meet the needs of a growing population in the booming northwest metropolitan Phoenix area, Banner Health, the nonprofit organization that owns and operates Banner

Thunderbird, approved a $290 million expansion project that included the construction of a 200-bed patient tower. When fully occupied, the tower will boost the number of patient beds at the hospital to 563. In addition to the new patient tower, the project involved the massive renovation and expansion of many existing spaces, including a new main lobby, chapel, gift shop, patient/family library and operating rooms, as well as a spacious, high-tech heart and vascular center and a second inpatient unit for children.

The project also included the addition of a 23,000-square-foot kitchen and cafeteria. Completed in August 2010, the foodservice facility features a 12,000-square-foot, full-service kitchen that made possible a new room service system for all patients, catering for medical center events, galley services for more than 35 areas in the hospital, vending services and the ability to support Café 5555's 3,500-square-foot servery and a 5,000-square-foot dining room with 250 seats (125 inside; 125 outside). A 2,000-square-foot physicians' lounge was also built as part of the project.

"The north lobby and south tower were designed to elevate the level of care for patients and elevate the overall experience for patients, staff and visitors," says Russ Combs, senior associate and senior project designer at NTD Architecture in Phoenix. "We wanted this medical center's highly visible public spaces to resemble those of a high-level resort, which is also a healing environment where people come to feel good. The dining facilities are an important part of the lobby's atmosphere, providing energy to the lobby spaces."

Café 5555 sits on the lower level of the main north building of the hospital and is visible from the spacious, airy lobby where mobiles and other artwork are suspended from the ceiling. The lobby's natural wood panels, terrazzo floors, glass tiles and stainless steel accents extend into the cafe. "The café is designed to be a destination restaurant to attract staff and visitors as well as local residents," Combs says.

The logistics of designing the foodservice facility were challenging for the architects, the staff led by Julie Spelman, MBA, RD, director of culinary and nutrition services at Banner Thunderbird, and the project's foodservice design consultant, Richard Dieli, FCSI, principal of Dieli Murawka Howe, who was brought in to the project by NTD. The kitchen and servery renovation followed the main lobby project. The new servery is the size of the old servery and dining area. The total kitchen now occupies about 12,000 more square feet than the old facility.

In order to provide continuous foodservice during construction, space in the dining area doubled as an eating area and a temporary servery. Mobile trailers were lined up on a concrete and asphalt lot behind the hospital, which had previously served as the hospital's helipad.

"In order to keep providing food to patients, the kitchen project was delayed a year to free up the former helipad, which was relocated on top of the new six-story tower, to install a 6,000-square-foot temporary kitchen," Spelman says. "The temporary kitchen — consisting of 11 trailers — was designed to provide a year of off-site production and patient tray service. This meant transporting patient carts and food 500 extra feet through an outside corridor to all patient towers and the two temporary cafeteria locations."

During the conversion period, Spelman's four-member management team received some help from one chef for two days. "The team had no additional management staff or consultants to assist with the room service conversion or move," Spelman says. "However, we benefited from a sister hospital sharing the room service menu and database, along with IT corporate staff, who helped with the information systems facet of the project. We never closed down foodservices, and moved the kitchen without adding additional staff. It was challenging, to say the least."

"The logistics created an intense situation," adds Dieli. "Even the temporary trailers housing the kitchen equipment had to be health-department approved and earthquake safe."

Another challenge faced by Spelman and her team was changing the menu after the kitchen design was completed. "We designed a patient menu, but soon after the kitchen plans could not be changed, all the culinary and nutrition services departments in each of the nine Banner Health hospitals in the greater Phoenix metropolitan area converged to the same room service menu and database," Spelman says. "This consolidation of menus is creating significant savings for Banner Health in IT support costs, general supply costs and menu costs.

"Similarly, the ultimate savings will be in future kitchen design with equipment standardization based on the standard menu, not unlike chain restaurants around the country," she continues. "But at the time when we were getting the kitchen up and running, changing the menu and using the equipment to fit the new menu wasn't easy because the assumptions we had made on the size of the equipment and the placement of equipment changed with the new menu. For instance, the new menu had a much larger selection of cold items, therefore necessitating the purchase of more air-curtain coolers."

Foodservice Work Flow
When food arrives at the loading dock, staff distributes it to two walk-in coolers, two walk-in freezers and dry storage. Catering and grab-and-go items are placed in another designated freezer and small walk-in cooler located in the catering and prep areas near the dishroom. "Nearly 50 percent of the kitchen space, excluding the cafeteria and seating, is dry and cold storage, the employee lounge and lockers, and administrative offices," Dieli says.

In the adjacent baking/prep area, roll-in refrigerators, a 60-quart mixer and ingredient bins allow staff to prepare baked goods such as cookies, muffins and sweet rolls, as well as sliced meats, which are thawed from a frozen state, for the 500 sandwiches made daily.

In the large production area, staff use the cookline to prepare food for patient trays, the servery stations and catering. Executive Chef Jamie Palenque and his cooking staff use two steamers to cook potatoes and other vegetables, rice and meat. Products that have been cooled in a blast chiller, located to the west of the production area near the chef's office and walk-in coolers, are also rethermalized for use on the daily menu. A steamer with a trunnion kettle is used for prep work, cooking small amounts of gravy and sauces, and sautéing ingredients for soups, entrees and other cafeteria items. A combi oven is programmed for roasting pork, beef and chicken.

"When we roast a tenderloin or chicken breasts in a combi oven, for example, we have steam and dry heat, so we can have a product that's brown on the outside and moist on the inside," Palenque says. "In addition, the same racks used in the combi oven are rolled into the blast chiller, which is extremely convenient, sanitary and time saving."

Staff working in this area also use three convection ovens to bake everything from cookies to meats. The 60- and 25-gallon tilting kettles cook soups (two are served daily) and sauces; the 40-gallon tilting braising pan sears meats, sautés rice and vegetables and cooks eggs and pancakes. The adjacent 24-gallon tilting pressure braiser cooks lamb, vegetables, beef bourguignon and stews. The pressure braiser sits high on Palenque's list of favorite pieces of cooking equipment. "This performs as a pressure cooker and gives us a very tender product," he says. "Cooking time is minimal. For example, it is possible to make a chicken stew from the frozen state to fully cooked in 15 minutes."

"We're very fortunate to have all this equipment," Spelman says. "We even have a system in which the water is automatically measured as it fills the kettles. The only thing I'd refine about this area is to put in larger drains in front of these pieces of equipment to accommodate spillage, which is inevitable."

The hood system in this prep area, as well as in the servery, requires the staff to clean the exterior only. "There are no filters to clean," Spelman says.

In another cooking area, used primarily for room service preparation, staff use another combi oven for meat and vegetables; a 34-inch broiler for cooking chicken breasts, hamburgers, cheeseburgers and salmon; and a 34-inch griddle for cooking chicken breasts, fish, quesadillas and cheese sandwiches. An open-burner range heats pots holding baskets of vegetables, while the adjacent pasta cooker is activated when staff push a button to start the one- to two-minute cooking process. At the end of the line, fryers sizzle french fries and chicken tenders. Roll-in freezers and undercounter refrigerators hold products until needed for this area so cooks have everything they need within a short reach.

Staff use a nearby cold-prep area for preparing chef's and side salads. Also in the tray makeup area, a convection microwave quickly heats personal pizzas, finishes grilled fish and chicken, and brings meatloaf up to temperature. A four-well warmer keeps sauces and soups warm during plating. A mobile refrigerated sandwich table/refrigerator maker holds garnishes for menu items such as pork, chicken, breakfast eggs and other menu items. The trayline also contains a permanent table that holds a coffee maker, juice maker, ice tea brewer and toaster.

Staff marry cold and hot items onto trays. An expediter checks each plate to match menu requests with items placed on the trays. A starter places the trays into an induction heating system to heat the spot where the plate lies. Each tray heats for seven to 10 seconds and can be kept hot for 30 to 45 minutes. After the trays are placed on the trayline, the tray rolls by a cold station where the beverages, puddings and supplements are located. At the end of the line the staff member checks each tray for accuracy and may add a hot beverage if necessary. The staff member places the tray in the appropriate cart. The carts are positioned around the end of the line according to their final destination in the hospital. When room service associates come back from their deliveries, they take the next cart of seven trays immediately or when the 10-minute buzzer goes off.

Though Spelman is pleased with the room service concept, she doesn't believe the current trayline is as efficient as she would like. She plans to modify it slightly to resemble the line installed at Banner Desert Medical Center. "This will give more room at the end of the line for carts," she says. "It will also add more space for trays in progress around the tray-heating area and will eliminate some of the soup portioning from the cooks' duties."

For the catering and cold-prep area, the kitchen contains worktables as well as a walk-in cooler, walk-in freezer, floor mixer, buffalo chopper and food processor. Staff working in this area prepare all catering menu items, make all salad bar mixed salads from scratch, prep for the salad bar, portion desserts and bag cookies. "In addition, staff here make grab-and-go sacks with a bottled water, cereal bar, yogurt and apple for busy moms who want it all in a bag for their kids to go," Spelman says. "We package hundreds of grab-and-go items per day."

Nearly 25 percent of the kitchen space is dedicated to washing trays, ware and dishes. "The tray drop-off area had to be adjacent to the servery, and we had to have a designated area for carts coming from the rooms," Dieli says. "The tray drop off is set up so the dirty dishes and trays come in directly where the staff works. The cart wash area is nearby. As with all healthcare operations, extreme care is taken so soiled zones are separate from clean zones."

When trays are received, staff place waste into a trough filled with water that leads to the pulper, which pulverizes all the excess food and removes excess water, thereby cutting down on the volume of trash. The water used for transferring the waste to the pulper via the trough recirculates so that new water is not wasted. All other plastics that come into the dishroom are placed in a recycling bin by the staff for pickup by a local waste management company.

Kitchen designers selected a flight-type dishmachine and a tray accumulator system for their speed and durability. "To keep up with the dirty dishes and trays from nearly 563 rooms and the dining room, and a cafeteria that sees 1,600 people a day, we had to be able to get them loaded quickly and minimize the wash-cycle time," Dieli says. "We only have an hour and a half to get washing done in between cycles."

In the pot and pan washing area, Spelman refers to the soaking and cleaning sinks for the pots and pans as the kitchen "Jacuzzi." A retractable hose assists staff in maintaining high sanitation standards. Walls are made of washable PVC board.

"I wish we had 1,000 more square feet for cart storage," Spelman says. "For a 400-to 600-bed hospital, we should have a minimum 1,000 square feet for carts, but have only 250 square feet. We were land-locked by public and patient corridors and wanted the kitchen to be next to the cafeteria. So, there were trade-offs. With the space we have, we are required to look at the details of every purchasing and process decision in order to be much more efficient with our space."

In Café 5555, named after the medical center's address — 5555 W. Thunderbird Road — multiple stations positioned in a scatter-system arrangement create a college-marketplace-style atmosphere, offering myriad contemporary choices that will attract customers who come in one to five times a week. "We used many different types of lighting, including LED and recessed and pendant lights, to keep the space interesting and vibrant," says Combs. "We also wanted to have a very open flow throughout the servery so people could move easily through the space."

Customers entering the servery see a large LED television monitor that uses colorful graphics and animation to display the day's menu. Next, they notice Café Ole, a gourmet coffee bar with a southwestern twist. Offerings include specialty coffee, iced teas, smoothies, juices and pastries from a local Latino bakery, and French pastries, breakfast pastries and cookies baked on site.

The servery also features many grab-and-go selections including sandwiches and salads. Dessert items are available at three areas, one of which contains a display cabinet with offerings made in the café's kitchen that are similar to those in a local upscale market. Retail items, such as bottled olive oils and other oils offered at the salad bar, are also available for purchase.

Retro-Grill, which includes a second LED menu board, is another station that customers encounter soon after entering the café servery. Here staff use a 72-inch griddle, a range, a 34-inch broiler and fryers to turn out a variety of menu items ranging from hamburgers to fries. Four hot wells display dishes such as old-fashioned macaroni and cheese, meat loaf and stew. "Food shields here and at other stations are adjustable so we can change serving styles," Spelman says.

Keeping labor costs down was a serious consideration throughout the design process. Self-service is offered at all the stations, while staff are involved in display cooking at three stations.

The original design allowed for positioning the stations so only part of the servery would be open during the third shift and also to avoid as much bottlenecking as possible. "We wanted to be able to close off part of the servery for the late evening hours, but didn't want the area to look closed off," Dieli says, "so we used roll-in barriers, made of wood and glass laminates, that stand six feet tall." After the operation opened, Spelman says, the third shift staff wanted access to all areas. "So, the movable walls were repositioned in the servery, and their shelves are used for storage."

Creations features weekly rotating offerings. Staff exhibit their culinary skill when preparing dishes on induction cookers for "Beyond Spaghetti" week. The showcase piece of equipment is a Mongolian grill, a rare sight in U.S. healthcare operations. Vegetables and meats are displayed in refrigerated wells; and after placing their selections into colorful bowls, customers pass them to a cook. The cook then sizzles the ingredients on the Mongolian grill, adds sauces and returns the finished product to the customers. Customers can make their own burritos, which are also cooked on the Mongolian grill.

At Fusions, customers see a wood-burning-style brick oven that cooks pizza, casseroles, calzones, naan and pasta dishes. "Julie wanted to get away from a motorized conveyor pizza oven to make this area fresh and exciting and be equipped to present the higher-quality items that Chef Jamie wants to produce," Dieli says. This station also features a carving station and entrees made from organic, sustainable or locally grown produce and other ingredients, and the menu attracts health-conscious customers. These menu items are displayed in four hot steam wells in oval and round stainless steel serving dishes that conveniently fit into templates designed for the steam wells. Items are kept warm under heat lamps.

The salad bar sits between Creations and the long beverage counter. Ingredients and premade salads presented in oval, round and curved contoured shapes add an intriguing visual component to the display.

At the three cash registers, display merchandisers hold cold and ambient point-of-sale items.

Opened August 24, 2010, Café 5555 replaced a 27-year-old kitchen, cafeteria and dining room to address the demands of adding beds to Banner Thunderbird Medical Center and modernize employee and visitor foodservice. With the addition of the new seven-story (six above grade), 200-bed south tower, the new bed count will be 563 in the future. The entire 370,000-square-foot, $290 million project includes the bed tower and, in the north building, a new lobby entrance, chapel, spacious patient/family library, heart and vascular center, 16-bed inpatient pediatric unit, emergency department, medical imaging area and foodservice facility as well as surgical suites. The foodservice cost was approximately $10 million. The equipment investment was $3 million. The 23,000-square-foot foodservice project includes a 12,000-square-foot kitchen (including storage and administrative offices), the 3,500-square-foot Café 5555 servery and a 5,000-square-foot dining room with 250 seats (125 inside; 125 outside). In addition to the 12,000-square-foot space, a 2,000-square-foot doctors' lounge was also built. The kitchen provides room service to patients from 7 a.m. until 7 p.m. From 7 p.m. until 7 a.m. kitchen staff accommodate special orders and requests. In Café 5555, the average check is $4.13 with a staff discount. Annual sales are anticipated to be $2.5 million with 44,000 transactions a month. Hours of operation are 6 a.m. to 9 p.m. and 12 a.m. to 3 a.m. seven days a week. Stations include Fusions, which offers healthy and organic entrees and pizza; Creations, featuring a Mongolian grill and weekly rotating offerings; Retro Grill, offering traditional grilled menu items; Café Ole, which serves coffee and juice; and chef's specials, desserts, salads and beverages. The new kitchen provides room service to four patient buildings (one tower is six stories; three towers are three stories). Staff includes 99 FTEs. The culinary and nutrition services team from the nine Phoenix-based Banner Health hospitals, known as the Enterprise, is merging menus and databases. Three of these hospitals are under conversion from contracted foodservice to self-op.

• Website: www.BannerHealth.com/thunderbird
• Owner: Banner Health (a nonprofit healthcare system), headquartered in Phoenix, Ariz.; 22 hospitals
• Banner Health CEO: Peter S. Fine
• Banner Health Arizona West Region President: Kathy Bollinger
• Banner Thunderbird Medical Center CEO: Tom Dickson, FACHE
• Director, Culinary and Nutrition Services: Julie Spelman, MBA, RD
• Executive Chef: Jamie Palenque
• Director of Design and Construction, Banner Thunderbird: Jim Lucas
• Senior Project Manager, Banner Thunderbird: Pradeep Dugar
• Architect: NTD Architecture, Phoenix; Russell Combs, AIA, senior associate/senior project designer
• Interior Design: NTD Architecture
• Foodservice Consultant: Dieli Murawka Howe (DMH) Foodservice Designers, San Diego; Richard Dieli, FCSI, MA, MBA, principal
• Equipment Dealer: R.W. Smith & Co., Orange County, Calif.; Scott Roczey, director of sales

{besps}2011-03/f1103_FacDesign|caps=1{/besps} {besps_c}0|FES1103Facility1.jpg| Banner Thunderbird Medical Center's new 200-bed patient tower will bring the licensed bed count (all private rooms) to 563 in the future.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility2.jpg|Café 5555 offers a variety of indoor and outdoor seating options to accommodate single diners and small and large groups. The earthtone palette creates a relaxing, contemporary atmosphere.|Photography by Eric Spelman{/besps_c}

{besps_c}0|FES1103Facility3.jpg|At Creations station, a Mongolian grill provides eatertainment. The hood design contributes to the overall interior design and becomes a key showpiece in the servery.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility4.jpg|Cook Jeff Delgado helps customers select ingredients displayed in refrigerated pans.|Photography by Brad Armstrong.{/besps_c}

{besps_c}0|FES1103Facility5.jpg|Delgado cooks customers' ingredient selections on the Mongolian grill.| Photography by Eric Spelman{/besps_c}

{besps_c}0|FES1103Facility6.jpg|Clinical manager Carol Daniels and clinical dietitian Dominica Dieffenbach select salads, fruit, cheese and other upscale packaged foods at a display tower. Spelman and the designers used AJ's, a local upscale market, as a model for retail merchandising.|Photography by Brad Armstrong.{/besps_c}

{besps_c}0|FES1103Facility7.jpg|At the salad bar, the oval, round and curved contours of the wells add an intriguing visual component to the display. The selection offerings are mirrored on two sides. During slow traffic periods, one side of the station is closed.|Photography by Brad Armstrong.{/besps_c}

{besps_c}0|FES1103Facility8.jpg|Spelman refers to the soaking and cleaning sinks for the pots and pans as the kitchen "Jacuzzi." A retractable hose assists staff in maintaining high sanitation standards.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility9.jpg|In the dishroom, a pulper pulverizes all the excess food and removes excess water, thereby cutting down on the volume of trash. The water used for transferring the waste to the pulper via the trough recirculates so that new water is not wasted.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility10.jpg|Durable shelving and containers hold food in the walk-in cooler until staff retrieve it for production.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility11.jpg|Back-of-house support for Café Ole includes an ice bin for smoothies, a blender and a coffee maker.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility12.jpg|Staff use combi ovens and convection ovens for preparation of meats, poultry and myriad menu items.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility13.jpg|Back-of-house production equipment includes a pressure cooker, a tilting skillet and trunnion kettles. The hose on the stainless steel wall behind the equipment connects to a faucet device that automatically measures water for the cooking vessels.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility16.jpg|In the servery next to the cashier station, metal baskets display packaged house-made cookies next to the condiment refrigerator.|Photography by Julie Spelman{/besps_c}

{besps_c}0|FES1103Facility17.jpg|A display merchandiser at the grab-and-go station allows customers to see the food items they would like to take out.|Photography by Julie Spelman{/besps_c}