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Healthcare Foodservice: The Pressure’s On

Under pressure to contain costs and increase accountability, healthcare foodservice providers are focusing on improving patient and retail customer satisfaction. Innovative solutions to gargantuan challenges are appearing in operations nationwide.

ben Swedish green room The food quality at hospital retail outlets, like Cafe 1910 at Swedish/Issaquah Medical Center near Seattle, has improved so much that members of the community come there for the food alone.As healthcare costs continue to rise and the inevitability of healthcare reform nears, foodservice directors and their staffs are under greater pressure than ever to transform their departments' patient and retail foodservice programs. The following seven paradigm shifts are reshaping the way business is conducted in hospitals and medical centers large and small.

1. New Forms of Payment for Quality Service

With new forms of payment for quality performance through Centers for Medicare & Medicaid Services and payments based on measures from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), foodservice will change the way it measures customer satisfaction. "We're going to have to find ways to balance our decisions between providing high levels of services that will bring customer satisfaction and the reality of the costs for these services," says Bruce Thomas, vice president of Guest Services at Geisinger Health System in Danville, Pa. "Financial pressures will continue and we'll be held accountable for our decisions."

2. Patient-Centric Foodservice

No doubt room service is a popular response to increasing patient satisfaction for new and existing facilities. For example the newly built Elmhurst Memorial Healthcare (page 16) features patient room service and Self Regional Healthcare (page 12) converted to this style of service.

Yet the scope of a room service program can vary greatly from one facility to the next. "In the future, we'll have the haves and the have nots," says Dan Henroid, MS, RD, CP-FS, director of food and nutrition services and sustainability officer for the University of California, San Francisco Medical Center. UCSF will feature room service in a new $1.5 billion, 289-bed hospital it is building. "The haves will receive capital and have the labor to operate on-demand meal programs. The have nots will not be able to support labor-intense services. For instance, hospitals that lose percentage points if their HCAHPS scores aren't high enough may lose patients and the subsequent loss of revenue will trickle down to foodservice."

"Hospitals have to find systems that work for their situations," says Paul Hysen, principal of The Hysen Group, a consulting firm in Northville, Mich. "If they can't afford room service or logistically can't make it work, room service can fail. For example, in hospitals with single patient rooms, this means bigger building footprints, more travel distance, more temperature problems and more labor."

A popular hybrid system providing individualized, personalized attention is a spoken menu with a pod system for tray assembly in the kitchen. St. Joseph's Hospital in Tampa, Fla. uses such a system.

At New York University (NYU) Langone Medical Center in New York City, obstetrics patients receive room service along with concierge service, amenities that started in January 2012. A colorful menu not only lists offerings but also nutritional analysis. For the other patients, room service isn't feasible because there are only four service elevators for 18 floors, says Betty Perez, RD, DHCFA, senior director, food and nutrition services at NYU Langone Medical Center.

At a facility Geisinger is building room service will be available for all patients, but perhaps 30 percent won't be able to order their own food because they are incapable or have diet restrictions, Thomas says.

Another more traditional tray line is in place at Rush University Medical Center in Chicago. Daily census runs 500 to 600 beds and due to the age of the facility and logistics, room service is not a viable solution. However, Mary Gregoire, PhD, RD, director, food and nutrition services, and chair, clinical nutrition, says personalized service is offered to patients to help them with meal selections as close to mealtimes as possible.

In Rush's new 300-bed patient tower, galleys equipped with a refrigerator, freezer and high-speed oven allow staff to assemble hot and cold meals for patients who are absent at regular meal times, eliminating the need for the kitchen to accommodate missed meals. Patients can use bedside call stations to place orders for meals and snacks directly to foodservice staff in the kitchen.

3. Retail Expansion

Retail services continue to expand in healthcare facilities. Revenue generated often helps offset costs of other services, including patient meal service. Retail services also contribute to the transformation of hospitals into wellness centers for the staff and visitors.

"Many retail operations are now situated a few steps from the front entrance so they are easily accessible and visible," Hysen says. They are also beautiful, using natural materials, windows and bright lighting to create an inviting, relaxing environment one might expect in a high-end commercial restaurant.

Along with accessibility and visibility comes contemporary display cooking and an array of menu choices once found only in restaurants.

Some medical center cafes, such as Café 1910 at Swedish/Issaquah Medical Center near Seattle, do a stellar job attracting community members who aren't necessarily at the hospital to visit a patient or receive medical services.

Also, secondary foodservices — coffee and grab-and-go kiosks — continue to grow in number and popularity in healthcare facilities. Robert Wood Johnson University Hospital in New Brunswick, N.J., reports positive results at its Express Station grab-and-go operation, according to Tony Almeida, DHCFA, director of food and nutrition. "Customers appreciate having an option to come here instead of waiting in café lines for salads and deli sandwiches," he says.

4. Showcasing Culinary Talent

"Executive chefs are replacing home grown head cooks," says Hysen. "Hiring an executive chef can be extremely cost effective because they bring professional expertise to food selection, purchasing, menu development and production."

Chefs, along with dietitians, bring yet another addition to hospital services — demonstration areas for classes in gourmet cooking and education about nutrition and food preparation at home.

5. Emphasis Grows on Health and Nutrition

In recent months, cafes are providing more choices and information that help employees and visitors meet their health and wellness goals.

"We serve only 'ovenable' fries. And at the new facility we may not serve any type of fries," adds Geisinger's Thomas. "This presents a challenge for the foodservice team to think outside of the box about what is served."

At Swedish/Issaquah Medical Center, not only are fryers not in the equipment package but neither are soda fountains. Replacing the popular soda fountains is a water fountain with a spigot that dispenses ambient or refrigerated carbonated water.

6. Searching for More Effective Equipment

Geisinger uses a cook-chill system to supplement patient and retail foodservice operations so staff can prepare items such as soups and sauces in advance and do more cooked-to-order food. The benefits, Thomas says, are consistency and cost controls.

Hand-in-hand with cook-chill equipment, but not exclusive to it, are blast chillers. "We see a lot of use of walk-in blast chillers that are economical to use, extend food shelf life and reduce labor," Hysen says. He and other consultants are also recommending equipment with electronic monitors and controls, temperature recording capabilities in refrigeration, remote refrigeration, high-speed single portion ovens, and hot holding equipment that doesn't dry out food.

In San Francisco, Henroid is investigating using sous vide equipment for the new operation. This technology, used extensively in Europe, is finding its way into upscale restaurants such as Per Se and Danube in New York City, and now into healthcare operations.

7. Going Green

In many healthcare facilities, going green and adopting sustainable practices is part of the institution's mission. Some institutions are going for system-wide LEED certification like Swedish/Issaquah and Kaiser Permanente. Others are simply taking on small tasks such as composting, energy savings, reducing, reusing and recycling. They are also purchasing from local producers and sourcing more environmentally friendly products.


As healthcare reform evolves, so too will healthcare foodservices to meet more rigorous demands to control costs and improve customer satisfaction. Directors and their staffs are proving that when the pressure's on, they can dig deep into their professional resources and find innovative solutions to very challenging situations.