The Big Idea 2008

Moving to a Restaurant-Style Menu

By moving to a restaurant-style menu, Emory is setting the stage for an eventual transition to room service.

Until this spring, patient meal service at both EUH and ECLH has been based on a spoken “select” menu model. Patients choose breakfast and lunch from cycle menu options one day in advance of service and select their daily dinner options each morning.

Ometer currently has a room service program proposal under consideration by the Emory administration. If approved, that change is at least 18 months away and would involve some major capital investments. In the medium term, both EUH and ECLH are looking for other ways to upgrade the patient meal experience. A major initiative is the department's planned move to a restaurant-style menu that will be be introduced early this summer.

The present meal system is based on a seven-day cycle menu that offers each patient a choice of three entrees. The restaurant style menu will offer more choices — five or six standard menu entrees as well as daily lunch and dinner specials to provide additional variety.

The new menu has been designed as a transitional system that will convert easily to room service once kitchen and delivery systems are upgraded to permit on-demand service. In practice, the goal is for over 75 percent of patients to choose the daily special — that would maximize the department's overall cost and production efficiencies. At the same time, the daily special items have to satisfy sometimes conflicting goals: broad appeal to patients; targeted production costs; visual appeal; nutrient and flavor targets; and the ability to re-therm consistently.

The menu planning project team included members from both EUH and ECLH who had vested interests in each of these areas. It also included two dietetic interns who had been tasked with surveying patients at both hospitals about their menu preferences.

Each team member brought his or her own concerns and ideas to the series of brainstorming sessions used to finalize the menu. For example, Barbara Fussell, who oversees patient food services at both hospitals, focused on meal assembly and delivery issues.

“We already have a fully-developed host/hostess system that is fully scripted, and we think it will help us achieve the volume goal for the specials,” says Fussell. “But some of the other areas I was concerned about had to do with the impact the menu might have on how many trays are produced a minute, whether the number of choices might increase error rates and the re-thermability of the particular items we are offering.”

In practice, this meant items like bone-in chicken were evaluated closely, both because boned product takes longer to re-therm and because juice released in that process is problematic unless the plated meal features a side that can absorb any leakage. Various plate “bundles” were designed to optimize color, texture and flavor combinations.

Dozens of similar issues faced the group as it planned for the new menu system. Maureen McAndrews, MPH, RD, assistant director of clinical nutrition services, and Liz Kustin, MMSC, RD, the senior systems application development analyst who is the expert on the department's menu management software, critiqued choices from a clinical and nutrition point of view.

On the cost side, purchasing manager Miriam Gilbert weighed in on the effect particular ingredients would have on plate costs. Other team members argued for ingredients that would increase visual plate appeal. The survey results helped the team evaluate the comparative appeal items might have among target patient populations. David Horning viewed the menu options from an advanced production system standpoint.

“The restaurant style menu should mesh well with our process and may help improve its efficiency,” he says. “Standard items will be based on cook-chill product that is always in inventory, rather than our producing them in advance of their periodic occurence on a cycle menu. We'll likely produce somewhat fewer items in bulk, but in larger volumes.”