Healthcare foodservice directors look positively toward the future. This outlook goes hand in hand with alterations in the way they conduct business. Finding creative ways to hire and retain staff and implementing technology solutions to mitigate labor challenges and maintain menu quality consistency contribute to the new normal, as does supporting catering and events.

The Ohio State Wexner Medical Center’s Julie Meddles, Uma Chaudhary, and Chris Basmagy inspect the robotic cafe. Photo courtesy of The Ohio State University Wexner Medical Center“We’re seeing a resurgence in demand for high-quality foodservices. I see this year as a rebirth of foodservice,” says Steve Cerullo, senior director of Hospitality Services, Geisinger Medical Center, Danville, Pa. The Hospitality Services team supports nine acute care hospitals; an addiction treatment center; a college and office buildings; and surgery centers. “Let’s forget what we did going all the way back to 2016. We’re finding new ways to be creative with everything from staffing to operations. We’re sharpening our swords to become more efficient and more focused on serving menu items we do well.”

For instance, centralizing recipe development and standardizing menu ingredients for all Geisinger operations increase staff efficiencies and costs to purchase ingredients. “We’re doing 95% scratch cooking, so this helps us maintain consistent quality of ingredients at all hospital operations,” Cerullo says.

These practices also extend to holiday menus and cultural events. In the past, culinary teams at each acute care hospital created their own menus for these specific events. Now, teams submit menus for consideration, and after a selection process, one menu is rolled out for all sites. “A committee headed by a chef and program manager examines menus submitted by different operations three months before an event,” Cerullo says. “The committee selects the menu, and the chef conducts a taste test and tweaks the menu items. Then, we roll out the same menu at all sites.”

Changes like the ones happening at Geisinger are happening throughout the healthcare foodservice segment. “As they find new ways to recruit and retain staff, healthcare foodservice operators must be more intentional than ever [before] about how to use the space they have or build for services, including retail and room service,” says Tarah Schroeder, FCSI, LEED AP, vice president, Ricca Design Studios, Greenwood Village, Colo. “And they’re examining how to use technology to their greatest advantage.”

Staffing

Hiring and retaining labor remains the number one challenge looming over the entire healthcare industry — and hospitals in particular. “Having enough labor affects every facet of operations,” Cerullo says.

BistrOH!’s kitchen design supports efficiency for staff preparing a large menu. Photo courtesy of The Ohio State University Wexner Medical Center Foodservice volume at Geisinger sits at 80% of what it was pre-COVID-19. Labor is 30% less. “So there’s a gap, and we’re giving sign-on bonuses and financial retention incentives, though we’ve found retention incentives don’t always work very well. Foodservice is a way for people to climb the culinary and healthcare ladders, and it is a feeder department, which is great for employees but lessens our pool.”

As competition for labor intensifies, Cerullo says some healthcare organizations now use foodservice as a “sweetener” for employee retention. “Plus, there’s a greater focus on delivering nutrition to staff in a more timely manner,” he says. “Overall, food is being used to drive staff engagement, but we have to provide quality food around the clock.”

Giving new employees a positive start works at Tower Health Reading Hospital in West Reading, Pa., where dining services provides menu items for a cafeteria and patient room service. “We have a process with new employees that we call them once a week before they start to make sure they have what they need to start, but more importantly to let them know how important their success is to our success,” says Joseph Ludwig, CDM/CFPP, senior supervisor of retail services. “We want them to know as much as possible about us before they start — to make the transition easier.” In addition, Ludwig’s team enacted a second interview for potential hires where they observed the workplace for one to two hours so they had a chance to see the operation and ask questions they may not have thought about in the initial interview.

Staffing levels now match where they were pre-COVID-19 at ProHealth Care locations in Wisconsin. Randy Sparrow, director, Food and Environmental Services at ProHealth Care, says he needs more staff, though, because ProHealth Care keeps expanding. Sparrow oversees food and environmental services for three hospitals, a hospice facility, an ambulatory cancer center and 20 urgent care facilities.

Julie Meddles, MS, RDN, LD, director for the health system nutrition services and gift shops at The Ohio State University (OSU) Wexner Medical Center in Columbus, reports a “much better” labor situation now. Hiring is stronger, and turnover is down. Meddles says the vacancy rate and first-year turnover are both down by 7%, and open positions have decreased by 40%. “We’ll never get back to the low number of open positions, 15 to 20 like we were pre-pandemic,” she says. “We’re still busy recruiting chefs, but we’re better. We also utilized sign-on bonuses to recruit many of our titles over the last year, which was hugely beneficial both for recruitment and retention.”

During the past three years, the team created many operational efficiencies to compensate for a reduction in the number of staff positions. “The number of staff was lower, but we never had actual layoffs because of the commitment by senior leadership and our management team’s relentless work to control budget, productivity [and] food and supply costs. We met this challenge by consolidating patient kitchens and combined the closed kitchen into the ones that remained open. However, we’re actively working toward reopening these kitchens as we budget for staff for these operations,” Meddles says.

Catering and Special Events

Fresh food, through a vending machine at ProHealth Care in Waukesha, Wis., supports employees working all day — especially from 7 p.m. to 7 a.m.Catering has picked up at Tower Health Reading Hospital, which has had to make some changes to deal with its current operating parameters. “We have a limited menu of options and require some orders, such as bottled beverages and pizza, to be picked up by customers,” says Ludwig. “Our catering staff was cut and not replaced, so we are limiting more upscale catering. The majority of what we do are box meals, coffee service and continental breakfast. We order the sandwiches premade from a vendor.”

Catering is also making a comeback at Geisinger. “Like most everyone in healthcare, we took a financial dive during the pandemic. Now, hunger for catering is huge, especially for meetings,” Cerullo explains. “The struggle is around staffing and cost. We don’t have a dedicated catering staff, so we’ve cross-trained employees. We’re back to about 60% of what we were pre-COVID.”

One way Geisinger’s dining department supports employee retention in all departments is by working nearly every month with the hospital’s Employee Resource Groups (ERGs), which are part of Geisinger’s Diversity, Equity and Inclusion initiatives, to highlight a culture’s traditions, including its food and flavors.

Technology

“Healthcare foodservice, like all other hospitality segments, is using technology in more ways than ever,” says Schroeder.

ProHealth Care, for example, will soon add robots. Two will deliver trays for nonpeak meal periods to patient floors and two machines will vacuum and mop floors. “These will save us three full-time-equivalent employees between the four robots,” Sparrow describes. “The robots won’t have any days off and will work seven days a week. This will allow us to allow employees to work where they can bring the human touch.”

At Prospera Hospitality headquartered in Sewickley, Pa., and Presbyterian Senior Living, headquartered in Dillsburg, Pa., cafe guests order food and drinks via robots. The robots deliver these orders and carry dirty dishes back to the kitchens. They also navigate crowded rooms, plan the most dynamic routes and even plan alternate routes using smart-sensing technology. When the robots deliver menu items, such as desserts to customers, they can sing happy birthday.

Robotics at The OSU Wexner Medical Center is also creating a buzz — literally — via a fully automated coffee kiosk in The James Cancer Hospital and Solove Research Institute that uses a robotic arm to make and fulfill orders.

The coffee system can make up to 250 different types of coffee shop-type drinks, including iced coffee, chai tea and lattes. “Without robotics, a 24/7 coffee shop like this would require 10 team members,” Meddles says. “With robotics, it only requires 12 hours per week by a human for daily cleaning, supply stocking and problem-solving when necessary.”

Guests place their orders via a smartphone app or by using a kiosk in the lobby. The kiosk accepts payments via credit card, Apple Pay, Payroll Deduct or Google Pay. Meddles believes the system to be fully up to expected service levels soon now that the team has worked through the installation learning curve.

Meddles’ team locally sources coffee beans from an Ohio-based, woman-owned roaster. “Customers love it, and they often put videos on social media,” Meddles says. “Lattes are the most popular order and about 75% of the customers order foam drinks with latte art.”

As one might expect with any new technology, Meddles’ team had a learning curve. Lessons learned, for instance, include cleaning the coffee shop and equipment late in the afternoon to avoid interfering with service during the busier hours. The team also learned to keep up with refilling coffee beans and condiments the robot dispenses.

The system did not completely eliminate the need for a human; a staff member is now on call if customers need help. “During the day, a team member can answer calls and meet customers at the coffee shop … at night, a person working in the nearby convenience store helps out,” Meddles explains.

Meddles advises anyone installing this technology to be sure electrical requirements, water pressure and other facility-related considerations are sufficient and met. Also, since the transactions are done via a cloud server, the Wi-Fi needs to be strong and consistent.

Overall, the installation of the robotic barista has helped fill a round-the-clock need for coffee-shop quality beverages to serve The OSU Wexner Medical Center team and visitors.

Room Service

Tower Health Reading Hospital abandoned room service in September 2021. “We are down five to eight positions in patient service in our current traditional delivery model,” Ludwig admits. “We would need another 15 to 20 employees to reinstate room service. The culinary team is short as well.”

Staff from Naf Naf Grill serve food at ProHealth Cafe in Waukesha, Wis. Fooda arranges restaurants to come into the hospital. Photos courtesy of ProHealth Care, photo by Tricia SnopekLudwig’s team must wait three to four weeks for background checks to clear, which delays hiring. In addition, nearby warehouses pay the same wages but don’t have a wait time, so employees can start immediately.

ProHealth Care’s patient foodservice hasn’t changed from its 6:30 a.m. to 7:30 p.m. offering. Sparrow’s team, though, has overhauled the hot food line and purchased a new charbroiler, a 6-burner gas range and refrigeration to enhance staff efficiency and improve food consistency.

After operating for a year with a designed menu, Geisinger’s room service team realized some changes were necessary and made some modifications in September 2022, according to Cerullo. Patients find menus in their rooms listing regular and a la carte menu items. Patients who are satisfied with receiving the regular menu and coffee with every meal do not call the diet office. Patients who want changes call the diet office and order menu items from the a la carte menu. Foodservice staff delivers trays to each floor at a designated time, so everyone on the floor eats at the same time.

“Much of the change was made because it was getting impossible to recruit and train skilled staff to learn diet orders, fluid restrictions and allergens,” Cerullo says.

Cerullo adds, “The staff that had mastered the diet orders were moved to the foodservice diet order call center as diet assistants, and the tray-delivery role was changed to regular foodservice workers who deliver trays but don’t need to be highly knowledgeable about diets.

“So, we focused on placing the skilled employees into the call center talking to patients and non-skilled employees for delivering trays. This is helpful for foodservice staffing and staff such as nurses who had to juggle meal service with patients’ other tests,” Cerullo says. “This actually had a positive impact on Press Ganey scores for courtesy, quality and temperature because the system is easy for patients, and meals don’t wait in carts to be delivered, which helps with temperature control.”

Geisinger Wyoming Valley Medical Center’s Goodness Bar operates from 9 a.m. until 4 p.m. and offers a consistent base menu and two options that rotate quarterly.

New Attractions

As they adapt and evolve, healthcare foodservice operators continue to reach into the community in a variety of ways, as well as leverage their existing platforms.

For example, Sparrow’s team entered into an agreement with Fooda, which arranges for local restaurants to bring food and labor to the retail cafe on Tuesdays. “Menu items complement what we’re offering daily,” Sparrow says. “I can reduce my staff by one to two employees, who are then assigned to work in other areas,” he adds. After ordering, customers receive a receipt from the restaurant and take it to a cashier.

Meddles’ team added another BistrOH! To Go at the system’s new Outpatient Care in Dublin, Ohio. This operation, open on weekdays, serves grab-and-go sandwiches, pizzas, signature salads, hot and cold sandwiches and entrees, as well as no-sugar-added smoothies, tea and hot and iced coffees. With another opening in July, the enterprise has a total of 3 full-service cafes and 13 BistrOH! To Gos, for a total of 16 retail operations.

At Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pa., the Goodness Bar opened in May 2022. Open from 9 a.m. to 4 p.m., sales averaged between 75 to 90 transactions the first year. “We have a consistent base menu but run two additional options that rotate quarterly,” says Keith A. Kemmerer, manager III.

One to four employees rotate in and out throughout the day at the Goodness Bar. During low-volume times, these employees perform other department tasks, Kemmerer adds. Ninety-eight percent of prep work for everything from bowls to smoothies takes place here, and only 2% of prep that involves cooking or heating is completed in the main centralized kitchen.

This unit’s design supports efficiency with only a few pieces of equipment set up in a line for minimal staff movement. It contains blenders for smoothies and smoothie bowls. Staff use frozen and fresh fruit kept refrigerated on the line for smoothies, while they top smoothie bowls with berries, nuts and seeds. Customers order from a kiosk, receive a ticket for their menu items, and pick up their order when the order number is called.

Convenience and to-go stores also support many other healthcare foodservice operations. Sparrow’s team provides a vending machine that offers freshly made food, such as entree salads and smoothies in mason jars. The vending machine company stocks the machine. “This is particularly popular with staff during hours the cafe isn’t open, from 7 p.m. to 7 a.m.,” Sparrow says. “We receive a small commission from sales.”