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Today's hospital boards and foodservice directors obviously agree, since many facilities have revamped their outdated traditional cafeterias or plan an update soon. Bland and limited food choices have been replaced with seasonal menus, ethnic fare and dishes touting high-end ingredients. Gone are traditional cafeteria lines, and in their place sit state-of-the-art food courts, upscale restaurants and trendy gourmet coffee shops.
Even in this soft economy, many facilities continue to make the investment because retail foodservice represents big business in hospitals. According to The National Society for Healthcare Foodservice Management's (HFM) culinary trends survey of healthcare foodservice operators, approximately 55 percent of member survey respondents reported that retail meals represent more than half of what they serve. Of those, 57 percent report an increase in this number during the last year.
Other HFM surveys found that, not only do hospitals offer a variety of trendy, healthy and ethnically diverse menu items, but that many facilities continue to provide details on retail meals' nutritional content just as they do for patient meals. The society reports that 88 percent of the healthcare foodservice professionals surveyed have seen an increase in requests for healthy meal options at their retail dining facilities.
In addition, most hospitals employ executive chefs to oversee menu planning and development, with 83 percent using cycle menus for retail foodservice, according to HFM.
Similar to their popularity in today's restaurants, grab 'n go meals have become big business in hospitals. With longer commute times and work hours, hospital personnel seek convenient, quality options at the workplace. HFM's survey found that 53 percent of respondent facilities offer made-on-site meals for takeout.
Along with creating more grab 'n go programs, updated and upscale menus also have revitalized many hospital catering programs. HFM reports that catering trays for both small and large events are being purchased, not just by hospital employees, but also by visitors and customers.
Leo Dorsey, director of food and clinical nutrition at Johns Hopkins Hospital and Health System in Baltimore, describes his facility's 16 retail foodservice outlets as extremely diverse. “It's about giving people a choice,” he says.
The approximately 1,000-bed hospital system is in the process of creating a new food court that will include Einstein Brothers Bagels, Subway, Freshens Smoothies, Noble Romans Pizzeria, AFC Sushi, and Flamers Grill. A unique logo will clearly mark each brand's healthy options, chosen by Johns Hopkins' clinicians.
The brands contract through Sodexo in partnership with the hospital. Dorsey says the cooking, prep and holding will take place at each food court site, although shared storage space is available in the main kitchen. “We have four production kitchens, three holding kitchens and a 30,000-square-foot production kitchen currently being built that will mainly support our patient foodservice program,” he says.
This fall, Johns Hopkins will institute Freedom Pay, where customers can load money onto a card, which will be deducted as it is used in any of the facility's restaurants. “This allows customers to better manage their money based on a budget,” Dorsey explains.
With its three retail foodservice locations, Sinai Hospital, also in Baltimore, has kept the focus on food quality and variety to successfully cater to its clientele. The 466-bed facility has one main kitchen for producing both retail and patient meals.
Its Greenspring Café menu works on a four-week menu cycle that changes seasonally, says Laure Sullivan, director of food and nutrition. Nutritional information is listed for all menu items. “We take customer requests into consideration. For example, during Lent, we offered a seafood bar on Fridays that included crab cakes, calamari, clams and fried fish. It was so popular, that we decided to continue it,” she says.
The 300-seat café also is well-known for its Philly cheesesteaks made on the grill, pizza and sushi. “We contract our sushi out, but it is made on-site by the company,” she says. In addition, exhibition cooking stations offer different items daily.
Sinai's other retail options include the 35-seat Café Shalom kosher deli, certified by the Orthodox Union, and Marketplace, a coffee shop under construction that will open in 2010.
The hospital's kitchen is segregated, with patient meals prepared in the front and retail dishes in the back. While the patient line contains a grill, steamer and flat top to accommodate Sinai's made-to-order room service program, the retail side includes an ingredient control room for prepping, a bakeshop and a kosher kitchen that separates meat and dairy products. Equipment used for retail menu items was updated and includes a smoker, flat-top grill, steam kettle, combi oven and blast chiller.
Like Sinai Hospital, St. Clair Hospital, a 265-bed hospital in Pittsburgh, has a coffee and snack shop under construction, says Chris Vitsas, general manager. When completed, this will include a prep kitchen in back and three open-air merchandisers containing a large variety of grab 'n go products out front. Offerings will include upscale, made-to-order deli sandwiches, paninis, soup, gourmet coffee and baked goods. “Grab 'n go is big business,” he says.
When the snack shop opens at the end of the year, St. Clair's main cafeteria will undergo a major renovation. Although the details have not yet been finalized, the plan is to create updated branded concepts and replace much of the outdated equipment.
Currently, the cafeteria offers a salad bar, an entrée station, deli bar and pizza station. A floating three-week menu focuses on fresh, rather than frozen, ingredients.
Rob Coyne, St. Clair's executive chef, says the new concepts will include the Sequoia Grill, offering grilled-to-order burgers, chicken, hot dogs and fish; East Street Deli, featuring New York-style deli sandwiches and paninis; and Showcase Salads, providing a variety of fresh salad bar ingredients.
The hospital's Farm Source program, which obtains locally grown and produced food items, will run across all of these concepts, Coyne says.
Equipment upgrades also play a part of the foodservice program's renovation. Along with replacing the hood system, Coyne says plans call for updating the 35-year-old fryers, in addition to purchasing new charbroilers and tilting skillets.
“I'm also pushing for a wood-burning or open deck oven for our pizza program,” Coyne says. Hospital staff use a small conveyor oven to produce its current pizza offering, which features fresh dough. “We're currently doing a modified pizza program. A new oven will not only enhance the quality and aroma of these products, but also help expand our offerings.”
Grand Rapids, Mich.-based St. Mary's Health Care added a grab 'n go program that includes upscale sandwiches, wraps, salad, soup, snacks and parfaits. According to Mary Jaskowski, director of nutrition services, the hospital brought on an executive chef last year with a strong hotel foodservice background. “One of the reasons we did this was to enhance our catering operations, which are geared toward staff and physicians,” she says.
As a result, St. Mary's in-house catering revenue has increased from $5,000 to $24,500 a month. “More than 95 percent of the catering is done in-house now, with 2,000 meal equivalents prepared monthly,” Jaskowski says. The 325-bed hospital operates a main cafeteria, a coffee shop located in its cancer center and small cafeterias in the nearby medical office building and patient facility.
Staff prepare much of the food in the main cafeteria's kitchen using a cook-chill system. The staff transport the food to the other retail foodservice locations. This cook-chill setup, located in a separate room that is 20 feet from the main cafeteria prep area, includes two 50-gallon steam-jacketed kettles and a water-jet tank to produce soup, sauces, gravies and bulk meat.
St. Mary's main kitchen also includes two double-stack combi ovens, prep tables, a tilting skillet and new 12-foot by 12-foot walk in freezers. “We were trying to expand our retail menus and bring in new product, but it was difficult to do with limited storage space. By taking out existing office space and replacing it with the walk-ins, we have more menu flexibility and can better capitalize on our space,” Jaskowski says.
While the main kitchen mainly handles retail prep and patient feeding, an adjacent smaller finishing kitchen contains a steamer, deep-fat fryer, grill top and convection oven for preparing hot entrées, grilled items, sandwiches, pizza and vegetables.
The 200-seat main cafeteria looks out onto a courtyard that contains picnic tables for outdoor summer dining. A large, two-tank propane burner grill in this area facilitates St. Mary's summer grilling program. “We try to be creative with our grilling menu, offering steaks, burgers, brats and fish. Recently, we introduced a barbecue rib special and had our highest daily sales volume ever,” Jaskowski notes.
Piedmont Hospital, a 458-bed facility in Atlanta, has three retail foodservice operations. Mark Galvin, director of nutrition and foodservices, says his customers' expectations are the same as with a typical restaurant. As a result, ingredients are fresh, branding is big and entrées are healthier. “We are doing whole wheat pasta, vegetarian entrées and fresh vegetables,” he says.
The 280-seat cafeteria, which opened in November of last year, is an upscale, full-service restaurant that offers signature dishes, such as Thai Crunch salad, Greek lemon chicken, London broil with mushroom gravy, meatloaf and fajitas. The eatery's Light Side dishes provide heart-healthy options that are low in fat and sodium.
Piedmont also has a 24-hour food court that offers self-serve fast food, including burgers, pizza, sandwiches, quesadillas, stir-fry and fried chicken. It also focuses on healthier fare and includes ethnic dishes. “We recently had a carving station with turkey breast and sweet potato fries,” Galvin says.
The hospital's gourmet coffee shop/bakery is similar to a Starbucks, offering hot and cold beverages as well as pastries. What makes it unique is the grab 'n go rotisserie chicken and side items sold daily between 3 p.m. and 6 p.m. for evening commuters. “We started this program in January of this year. It is a nice convenience for the staff and has been very well-received,” Galvin says.
While staff prepare the food court entrées in the main kitchen along with patient meals, they put together the remaining dishes in display cooking areas.
The cafeteria's large kitchen includes a bakeshop with a mixer, four ovens, proofing box, French-top stove and deep fryer. Around the corner sits a 55-gallon soup kettle, two 5-gallon countertop kettles, four steamers, another traditional gas stove and two convection ovens. Scattered throughout the back of the house are multiple hot boxes and refrigeration units.
Galvin says hospitals face challenges and demands that differ from other foodservice operations. “Being from the medical field, our customer base is more in tune to food safety issues. Also, HACCP is huge for hospitals, so all of our recipes are designed to accommodate these requirements,” he says.
Massachusetts General Hospital, an approximately 900-bed facility in Boston, also caters to its medical personnel. Its eight retail foodservice facilities bring in close to $23 million annually, according to Susan Barraclough, director of nutrition and foodservices.
The hospital's Be Fit program includes a booklet for staff members on how to navigate the facility's menus and choose healthier food. “This program integrates into our corporate wellness program in which both nutrition and foodservice play a critical role,” Barraclough says.
Mass General has held employee focus groups to determine what staff members want in terms of the facility's foodservice programs. Its most recent survey of 220 night-shift employees led to a renovation of the hospital's Coffee Central limited beverage service operation. “Originally, we were going to change the setup to include display preparation, with made-to-order sandwich and salad areas. However, after sitting down with the staff, we determined that they are typically in a hurry and don't want to wait for their food to be prepared,” Barraclough says.
This changed the direction of the hospital's plans, which will now include fresh pre-prepared offerings for Coffee Central.
The hospital has one central kitchen for all food production, although most facilities cook food on-site in front of customers. “We have a truck that transports items made in bulk like soup, roasts, casseroles, chicken dishes, sandwiches and salad. Delivery is twice daily on average,” Barraclough says.
Equipment in the central kitchen includes a large grill, broiler, flat top, wok for stir-fry and flash-cooked products, flat-top grill for producing grilled sandwiches and areas for panini sandwiches and pizza. “We sell more than 400 pizzas a day, both sliced and whole, which are delivered throughout our facility,” Barraclough says.
Mass General also has a deli bar with made-to-order sandwiches; a grab 'n go area that includes pre-made sandwiches, yogurt and dessert; a hot food station that offers one sliced meat of the day and three other entrées daily, along with vegetable and carb side dishes; a large salad bar with 43 selections; and an ice cream area that features hand-scooped sundaes and high-end desserts.
The hospital's outpatient facilities include grab 'n go offerings, such as made-to-order pizza, entrée salads and panini sandwiches. “We have a major catering area, where we do about $2.5 million in business annually,” Barraclough says.
She adds that there is a lot of opportunity for growth and new business in retail hospital foodservice. “The key to success is to stay close with customers and employees. We are always willing to listen and change our direction,” Barraclough notes.
• Tilting skillet
• Combi oven
• Flat-top grill
• Convection oven
• Conveyor oven
Food Safety: Medical personnel are more aware of food safety hazards, so equipment that is easily cleaned, offers easy temperature monitoring and adheres to HACCP requirements is crucial.
Flexibility: Menus in hospitals' retail food operations tend to be cyclical and seasonal. Catering also has become more common and extensive. Consequently, flexible equipment that can adapt to different preparation requirements and volumes is well-suited for these facilities.
Appearance: With the proliferation of grab 'n go meals and display cooking, equipment appearance and aesthetics is important. Glass merchandisers that attractively showcase products, stainless-steel grills and woks, and eye-catching reach-in refrigeration add to food and beverage appeal.