Lisette Coston is executive director of support services for Saint Francis Health System in Tulsa, Okla. She is also president-elect of the Association for Healthcare Foodservice (AHF).
In her position at Saint Francis, Coston heads the nutrition and foodservice operations for the 972-bed healthcare system that includes 4 hospitals and 7 retail operations. She also oversees environmental, laundry and transportation services.
FE&S: Congratulations on winning this year's IFMA Silver Plate Award in healthcare. What do you think are the keys to your success in this industry?
LC: I'm not afraid of change. I see every challenge as an opportunity and try to live my life that way. The word 'no' isn't in my vocabulary. I believe in the passion of providing patient care and service. We're here to provide excellent foodservice for patients. At the same time, I must support physicians and staff as well as administrators, volunteers and visitors. I believe in being fiscally responsible to my work. All of us in healthcare foodservice must work more efficiently, reduce costs and maintain quality of care in every service we offer. And we must support and coach our staff so they can be successful.
FE&S: You started in healthcare foodservice in 1987. How has the industry changed over the years?
LC: When I first started, there was just one 550-bed hospital on this main campus. In the late '90s, we purchased a community hospital, Broken Arrow Hospital, and took over the management of our psychiatric hospital, Laureate Psychiatric Clinic and Hospital. We reduced costs by implementing cook chill at both hospitals to reduce FTEs and mazimized our GPO incentives. We purchased a refrigerated truck and transported food supplies for both hospitals along with assembled meal trays to Laureate.
In 2007, in the main hospital, we opened Tower Café, a retail operation featuring branded concepts and grab-and-go items. In the spring of 2008 Saint Francis Health System purchased the other half of Saint Francis Heart Hospital. When Saint Francis took over completely, we converted the foodservice from a contract operation to self-op, renovated the kitchen, expanded the dining area, built a new physician lounge and implemented room service. Patient satisfaction then averaged 95.5 percent and today it's 95.8 percent. The cost savings from eliminating the contract in the first 6 months was $134,524.
FE&S: You also expanded room service to the entire system.
LC: Yes, we put in room service at the new 162-bed Children's Hospital in 2008, which increased patient satisfaction to up to 100 percent. Positive results have continued with satisfaction levels in the 90 percentile. At that time, Children's Hospital also added P.J. Snax, a small coffee, smoothie and grab-and-go operation.
The important aspect of our conversion in general was that we did it in stages. In 2008, we converted from a rethermalization meal delivery system to room service and patient satisfaction scores rose from an average of 59 percent to 90 percent. We also experienced a $239,108 decrease in food cost in the first 19 months. Eight positions were added but savings in food costs and guest revenues compensated for most of the additional expense.
FE&S: Did cook-chill continue?
LC: No. The Laureate was the last area to remove this type of meal delivery service; we renovated the dining rooms to accommodate a family-style buffet meal service and prepared food in bulk and transported it to the units for service.
FE&S: How are you measuring results of the delivery service?
LC: We use PRC, HCAHPS and a custom support services survey, which encompasses all of our service lines, laundry, maintenance, environmental and foodservice. I round once a week with the environmental services director on patient care units to see what's going on because that affects how the patient views his/her overall experience. With HCAHPS, there are no foodservice questions but foodservice impacts the overall experience. In foodservice we did replace the wheels on all of our meal carts so they don't make so much noise. We also added magnets to the latches so the doors close more quietly.
FE&S: In 2013, you supervised a $1.25 million renovation at the hospital. What did this include?
LC: That included a new entrance, grab-n-go beverage cooler, Starbucks coffee kiosk, digital signage highlighting nutrition facts and allergens and the "Go Health!" service island providing healthy meal combinations and snacks. We also added new cashier counters, custom snack and over-the-counter medication displays, and built-in refrigerator/freezer grab-and-go storage. The dining area was transformed with banquette seating, a bar-height counter, new carpet, updated lighting, paint, paper and new upholstery for dining chairs. The existing food court serving area was updated with new quartz counters and custom fronts on all existing islands. With a new entrance and exit, the food court can be sectioned off in three locations, which will allow different service options throughout the day.
FE&S: What are you doing in 2014?
LC: In March, we opened a renovated kitchen and dining room for the eating disorder program at Laureate. For the program, all meals are prepared on-site by a trained chef who specializes in gluten-free preparation and catering to multiple food allergies. Satisfaction scores range from 75 percent to 90 percent.
This fall, we'll open a new 150-bed tower. The entire kitchen is under renovation to be expanded to accommodate the added volume of patients, and a second room service line was completed in April. We have mirroring room service lines so we can split the volume among the 22, soon to be 25, patient care units. We designed the flow of the room service lines to accommodate fewer employees. Last spring we implemented a tray monitoring program to track the progress of the tray from the time of order to delivery, which nursing staff can also monitor.
FE&S: Did you add new equipment?
LC: We added a steamer to the room service line because our cooks were taking too much time walking around the corner to use the steamer. For the second line, we've purchased a longer, 71-inch, griddle. And we've incorporated a bain marie in the expediter tables to improve efficiency. In addition, we'll add a new retail venue, along with a new full-scale catering and banquet area.
Also this year, in September, a new banquet space will open in the new tower. Each service area at the meeting and event rooms is equipped with a beverage cooler, refrigeration, coffee makers, ice and water machine, warming plates, sneeze guards, and heat lamps so everything is self-serve. All we need to do is transport food to these areas.
FE&S: What other equipment choices have you made over the years that stand out?
LC: We've purchased combi ovens for multiple locations, replaced our 100-gallon kettles and ice bank cook-chill equipment.
In the ingredient room, we use carousels similar to what you see in dry cleaners to manage the inventory on a first-in, first-out basis. It's all automated and tells us where to store and remove the items from inventory. We've also added a huge new freezer in the storeroom.
Our dish room is being completely renovated and will house a new flight type dishmachine.
Facts of Note: Saint Francis’ Nutrition and Foodservice Operations
- Retail operations: 400-seat food court; 80-seat Redbud Café; 80-seat Tower Café in a nearby physician office building; P.J. Snax located in the Children's Hospital, Heart Hospital Coffee Kiosk, Café Francisco; and Zone Appetit located in SFHS fitness center
- Annual revenue: $6.19 million
- Annual budget: $10.6 million
- Meals served daily: 13,760
- Annual retail transactions: 1.16 million
- Annual catering sales: $588,000
- Staff: 175 full time and 17 part time in foodservice; 500 total; and Saint Francis accepts up to 15 dietetic internship students from Oklahoma State University and the University of Oklahoma