FE&S: How does Restaurant Delivery work?

AM: We produce foods in the retail units that are sent to the main patient kitchen. Over time, we know approximately how many food items from a particular branded restaurant patients will order. But in general we increase production by about 5 percent in each branded restaurant. For example, we'll make 350 burritos, which is about a dozen more than we plan to sell in retail. This production doesn't incrementally increase food costs or staff requirements.

Patient orders come into the main kitchen, where staff plate them. Plates are then sent up to the patient. This way, we leverage the labor, purchasing and storage that we already have.

FE&S: How do you handle special diets?

AM: Our menu is different than a traditional room service menu because we don't identify special diets with carrot icons and carb counts. Our menu has only hearts to indicate food items that are lower sodium and fat. Only a small number of patients need special menus, and when they do, we suggest items that they can have.

When they call the call center, our software identifies the patient and tells the call receiver what diet the patient is on. Recommendations are made, and if they chose items that go over the amounts of nutrients they should have, we talk to them and ask them to choose other selections. This method is very good for education and for customer acceptance.

FE&S: How are you measuring results of the delivery service?

AM: We're doing it with 20 fewer FTEs than if we ran a traditional room service program, because of the way in which production is done in coordination with the retail units. We also have a 6 percent decrease in the department's overall food costs ($400,000) because the program cross-utilizes all items between the patient and retail programs. This allows items not served during peak patient meal periods to be sent to retail venues to avoid waste. In terms of patient satisfaction, we started in the 82nd percentile with Press Ganey; and within months we reached the 99th percentile, and we have remained there.

FE&S: How does technology support your operations?

AM: Right now we're using traditional equipment and making everything the same day of service. For some items such as pizzas, we'll make it, chill it and take it to the retail line and finish it in a high-speed oven. Eventually we may add cook-chill production.

For the patient foodservice, my executive chef and patient services' associate director and I spent six months deciding how to make the production line work. We did a Google sketch-up and mapped out the kitchen. We looked at other facilities, such as Robert Wood Johnson where Tony Almeida directs the foodservice. We launched two separate areas: The pods have steam tables and hot food holding cabinets. The other has 3 steam tables, 3 make stations, a grill, charbroiler and high-speed oven, all with 12 refrigerated drawers underneath. We have 830 patients, so we serve about 600 patients from Restaurant Delivery and 200 patients who are in specialty units from pods. The entire project cost $200,000. We know of a nearby hospital that will offer a room service model, and it cost them $15 million to install a system.

FE&S: Did you buy new equipment?

AM: Yes, a cold-make station, fabricated equipment such as stainless steel tables, a freezer, steam tables, quick-speed ovens, a 2-burner candy stove, refrigerators and carts that hold 10 versus 36 trays that we used in the past.

FE&S: Do you have dedicated elevators?

AM: No, and the hospitals are spread out across campus. For example, the cancer hospital is a 12-minute walk from the main kitchen. We created zones for delivery, and staff take carts to the floors and then to the rooms. We use bar code scanners to track trays.

FE&S: You're also using sous vide, making yours among the first healthcare facilities to use it for your patient meals. How is this working out?

AM: Great. This slow-cooking process that places food products in vacuum-sealed bags has several advantages over traditional cooking methods: increased product yield, quicker finishing time, consistent product quality; and reaching the final temperature without sacrificing quality. We started daily use with a small amount of salmon, about 50 hamburgers and 35 chicken breasts, and we plan to launch these items in retail venues in 2013.

For example, with the hamburgers, we're making a 1.5-inch-thick pub burger, bagging it and cooking it sous-vide style to 155 degrees F to kill the E. coli. We keep it refrigerated in the tank, and then we just need to charbroil it for a couple of seconds to bring it back to temperature and add the grill marks before serving. We'll experiment with vegetables and pork tenderloin next.