Patient foodservice in healthcare continues to trend toward offering room service, which allows patients to choose items from an a la carte menu and receive their trays on demand during a several-hour period each day.

Restaurant-style, a la carte, on-demand patient room service programs at various hospitals share many similar components but they function slightly differently to meet stakeholders’ needs and expectations — including administrators, nursing and food and nutrition staff and, of course, patients and their families. Variables include availability of physical space, labor, and monetary investment in everything from cooking equipment to software for patient meal ordering to tray delivery.

“Make sure you have the type of equipment that will allow for changing the menu to cater to patients’ changing preferences,” says Dave Reeves, system director, Food and Nutrition Services, Lee Health in Fort Myers, Fla. Reeves is developing a master plan to transform the food and nutrition program at Lee Health.

“The advent of high-speed ovens has made the greatest impact on room service lines and menus,” says John Egnor, managing partner, JME Design, Columbus, Ohio. “They allow staff to remain flexible with menu preparation and produce menu items quickly.”

Reeves agrees. “Accelerated ovens are definitely helpful because you can produce small amounts of food quickly, and the quality of the food is excellent,” Reeves says. “With room service, you have to consider speed in order to meet the 30- to 45-minute time frame promise.”

Also, tray delivery carts are much more sophisticated and practical, making them easier for everyone to transport them through the hospital, says John Herzog, director of business development, DM&A, Chula Vista, Calif., which provides project management for room service transformations. “Many are quieter, as well.” Many carts hold only 10 to 15 trays so they can be transported quickly through the hospital to ensure optimal food temperatures and delivery times. Some of the useful delivery cart features include drains for easier cleaning, integrated ergonomic door handles, hinged doors with magnetic closures and vents to promote consistent and even airflow for hot and cold food.

Room service was introduced this past spring at Lt. Col. Luke Weathers, Jr. VA Medical Center in Tennessee with the support of DM&A and Rick Palmer, DRS Foodservice Design, Brentwood, Tenn. The center, licensed for 200 beds, features a tray line assembly area with a chef’s counter, hot and cold wells, a toaster oven, a microwave oven, an induction cooktop and a salad prep station. Two combi ovens, a six-burner range and double-stacked rapid cook ovens also support patient meal service.

The tray line at VA New York Harbor Healthcare System gives staff shelving and prep boards to assemble orders from the extensive menu.

Room Service Models

At JPS Health Network in Fort Worth, Texas, which is licensed for 582 beds, Neal Lavender, executive director of Food and Nutrition Services, and his staff designed a system with components of room service with an emphasis on delivering hospitality. Patients call in their orders or an ambassador takes their orders on a tablet. Orders are called in a meal ahead. “Our patient satisfaction is extremely high because we offer great homestyle foods with alternative selections our patients like,” Lavender says. “Giving patients attention is key to satisfaction, as well.”

No one knows about being flexible and the commitment to continuous improvement better than Jill Wedeen, assistant director of Clinical Nutrition and Patient Service, at Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, NJ., which is part of RWJBarnabas Health. RWJUH introduced on-demand patient room service with a restaurant-style menu in October 2003 under the direction of Wedeen and then Director of Food and Nutrition/Environmental/Host Services Tony Almeida. Foodservice colleagues around the world have since visited to learn how this staff handled on-demand dining.

“The biggest change since we started room service has been increasing the number of meals we serve because the number of patients increased,” Wedeen says. Over the years, staff updated the menus to stay current with patients’ dining preferences and a more diverse population that wants vegetarian, halal and Indian cuisines in addition to traditional American fare. Room service is currently available from 7 a.m. until 7 p.m. A main kitchen supports room service and retail foodservice with a tilt skillet, one 60-gallon kettle, one 40-gallon and two 20-gallon kettles, steamers, combi ovens and convection ovens.

Each of the two assembly lines contains three air-curtain refrigerators for salads, juices, milks, sodas, cakes, fruit and gelatin; an ice cream freezer; a coffee machine; wells for condiments; and shelving for bread and non-perishable foods, such as cookies and chips. The hot line provides menu items for both assembly lines and contains undercounter refrigerators, a flattop grill, a charbroiler, a six-burner range that serves as a saute station, a bain marie, four steamers, two double-stacked combi ovens and rapid-speed ovens.

After room service started, the amount of labor increased about 10% to provide tray delivery to patients. “Rather than hiring ambassadors to visit rooms and take orders, leadership assumes that role. We have excellent service recovery,” Wedeen says.

Most important, Wedeen says, “we make sure the food temperature is correct and the quality is high. We’re always rethinking processes to see what’s working. Subcommittees meet to evaluate the whole system.”

For example, soon patients will have access to a mobile ordering app on their phones. “This will allow them to bypass the diet office, which takes the strain off the diet office for answering so many calls,” Wedeen notes. Patients have more independence because they can order all their meals for a day at one time if they like. This will likely translate to greater patient satisfaction. Not all patients can use the app because they have more complicated diet orders, which requires speaking with a live agent.

Dan Henroid, director, Nutrition and Food Services and Sustainability Officer at University of California San Francisco (UCSF) Health, and his team continually adjust room service for 3 medical centers, which total 872 beds. Patients order from 7 a.m. until 8 p.m. daily, though Henroid’s staff is weighing the benefits and drawbacks of shortening hours and reducing menu items to maximize labor.

The UCSF Health Nutrition and Food Services team is working on a low-friction meal ordering strategy to provide patients with multiple pathways to place meal orders. “Our latest solution leverages an integration with a patient mobile application with our electronic health records and our food information system that allows patients to order meals on their own mobile device similar to the other solutions,” Henroid says. “Patients will have a better experience.”

The dining staff assembles as they roll out room service at VA New York Harbor Healthcare System. Photos by Erika Rosendahl, MS, RDN, CDN

Part of UCSF’s meal ordering strategy is to reduce the number of phone calls by roughly 40% with the use of self-service ordering technology, Henroid says. “It may or may not reduce the amount of labor needed but should shorten wait times for people to answer the phone with fewer calls. This too will improve the meal ordering experience.” He is looking to optimize the call center technology to better integrate electronic health record data through artificial intelligence to expedite meal order solutions.

Another work in progress is a web-based patient dining portal that allows as many menus as possible to be available to patients. “Many hospitals won’t publish their menus and recipes, but we think it is important,” Henroid says. “We provide our menus, including menus in other languages and nutrition details, along with as much information as possible about our dining programs.”

For patient tray delivery, UCSF Health devised more of a pull than a push model for meal delivery, Henroid says. Typically, delivery zones are created, and trays are pushed to someone on the team who catches them and delivers them to patients in a designated zone. “In contrast, staff here pull trays from the line and deliver them to floors that have patients who need trays at any given time,” he says. “We are relentless on tracking how we do this, how fast we deliver, how many units receive meals and whether this system meets our delivery standards.”

UCSF Health will feature room service in its 682-bed tower that is expected to open in 2030.

Margaret Cochran Corbin VA Campus in New York City went live with its new room service program in October 2023. The program serves up to 125 patients three meals a day under the direction of Mimi Wang, MA, RD, CDN, chief, Nutrition & Foodservices, VA New York Harbor Healthcare System.

DM&A worked with Wang, Erika Rosendahl, MS, RDN, CDN, informatics dietitian for VA New York Harbor Healthcare System and the staff to develop a new restaurant-style menu featuring fresh foods cooked to order, determine which pieces of equipment were needed for production and tray delivery and help train staff on using the menu software system and customer service. “This is an enormous change from the former system,” says Steve McKenna, project manager at DM&A. “Previously the hospital received food from a cook-chill commissary in Queens, N.Y. The hospital heated the cycle menu items and placed them with cold items on trays — and delivered at specific hours for each meal. With the new system, Manhattan doesn’t receive food from the commissary.”

Program development and training interfaced closely with nursing, especially for tray delivery. Patients place orders by calling into a call center or giving their orders to ambassadors in their rooms. “If patients don’t call in, ambassadors visit the patients and help them place their orders,” McKenna says. Room service is offered from 6:30 a.m. to 6:30 p.m. Meals arrive at patients’ rooms within 45 minutes after submitting orders to the call center.

“Though room service can be more labor intensive than a standard tray line program, VA NY maintained labor neutrality because staff were repurposed,” adds Stephen Chow, RD, CDN, south commissary chief, VA VISN2 South Commissary, Jamaica, N.Y., worked with an equipment manufacturer rep to specify equipment for the project. “Before the equipment could be installed, all the mechanical, electrical and plumbing work had to be completed. We had to reconfigure the entire kitchen area under the existing hood to accommodate cooking equipment.”

Six staff members from the department’s 37 employees work on two lines arranged in a T configuration to put together trays. The hot line contains a 12-gallon kettle for cooking soups, gravy and sauces. The hot line also contains a flattop griddle for cooking burgers and French toast, a rapid-cook oven, a multicook oven with four independent ovens in one, a six-burner range, a hot steam well and a pasta cooker. Staff also use two combi ovens for cooking proteins and vegetables.

Staff add hot menu items to trays arranged at the cold tray line assembly area, which contains two air curtain refrigerators, a reach-in refrigerator, cold wells, a refrigerated rail and
coffee and tea machines.

Tray line staff place completed trays in carts that nutrition and foodservice ambassadors deliver to patient rooms throughout the day. Response to the room service program exceeds staff expectations. “Veterans have responded extremely favorably to the new service and menu,” Rosendahl says. “Patients’ pleasure results in increased employee morale.”

Waste reduction is another benefit of the room service program. “Waste is reduced because patients are selecting menu items they like and placing orders when they want to eat,” Rosendahl says.

The hot line that supports room service at Lt. Col. Luke Weathers, Jr. VA Medical Center in Tennessee. Photo by Cheyanne Kelly

Advice for Room Service Providers

Steve McKenna, DM&A: “The three keys to a successful room service program are a collaborative relationship with nursing staff, properly engaged foodservice staff and engaged leadership in the building and foodservice. If room service is done right, staff is visibly more engaged than before room service was put in. They feel good about what they are serving.”

Jill Wedeen, Robert Wood Johnson University Hospital: “Continuously make sure equipment functions properly, so you’re getting optimal performance.”

Michael P. Salvatore, CEC, senior director, Ruck-Shockey Associates Inc., New York: “Change cookery to improve food. Rather than steaming cod and holding it for hours, for instance, why not cook it in a convection microwave and serve it roasted. Add color, textures and flavor. Think about every detail: For example, make eggs the best they can be. Use clarified butter, not vegetable oil. If you wake up in a hospital bed, wouldn’t you want the food to be the best it could be? You have to have the attitude that you are personally responsible for your guests’ happiness while they are under your roof. That drives the effort to get to the highest level of service. They aren’t patients, they are guests in our homes.”

Dave Reeves, Lee Health: “Whatever the model is, simple or more extravagant, do it well and execute to standards of quality you’ve set. Design menus for demographic demand. The right menu is not the volume of items, but rather whatever is offered must be done well. Make sure trays are delivered within your promised time. Many of our patients are accustomed to dining in fine restaurants, staying in hotels with exceptional service and following trends online and in social media, so they have very high service expectations.”

Stephen Chow, VA VISN2 South Commissary: “Prepare for the unexpected and communicate to the C-suite about labor costs being higher and food costs being lower.”