Teaming Up for Transition

THE FOODSERVICE SENIOR MANAGEMENT TEAM (l. to r.): Lynn Moore, RD, LD; Maureen McAndrews, MPH, RD, assistant director, clinical nutrition services, director of the dietetic internship program; Lynne Ometer, MS, MHA, RD; Ronnie Gee; Arlene Bennett, MA, RD; David Horning; Barbara Fussell, RD; and Liz Kustin, MMSc, RD.

Walk through the marquéed entrance of Crawford-Long Hospital's Seasonings café and you will see a retail operation equal in every way to that of the most successful casual dining commercial chains. From the larger-than-life environmental graphics at the entrance to the ambience inside, the Seasonings experience is attractive, comforting and immediately inviting. A half-dozen points of service are apparent at first sight; others appear on both sides as you walk along the café's wide and flowing traffic pattern around a central service and display core.

High daily volume supports a broad variety of offerings, and a customer's attention is directed with lighting and displays, even as the sense is one of self direction and choice. Grab-and-go, made-to-order and self-service options blend together in an ongoing experience of abundance, selection and place.

Behind the scenes, the highly merchandised polish and sense of casual abundance that characterizes Seasonings' front of the house belies its tiny kitchen and systemic efficiencies. Many station counters double as prep tables during morning hours and setup times, and the café takes full advantage of the central, advanced production facilities (cook-chill) at the main Emory University Hospital a few miles away.

In many ways, Seasonings is not only highly effective on the retail front, but also metaphorical. It is a testament to the many foodservice goals that Emory was able to reach over the past decade, as well as to others that are less visible or still being sought.

Looking beneath the surface

Like that of many healthcare systems today, Emory's foodservice story is one of mergers, integration, a continuing search for greater efficiency and the kinds of retail and patient services that would drive revenue and benchmarking scores. With each merger, administration change and advance in Emory Healthcare's overall evolution, food and nutrition services and its staff had to flex and find new ways to manage day-to-day processes.

If you wanted a single phrase to describe that process, you couldn't do much better than to say the department operates with a sense of continuing and managed transition. That is, with continuing change, but also with a view of what it is trying to accomplish in the medium and longer term.

And while she will take pains to remind you her role is primarily that of a coach, much of the credit for the team's results lie with Lynne Ometer, RD, who joined Emory in 1997 after an earlier career at Geisinger Medical Center in Danville, PA. That was shortly after Emory University Hospital (EUH) and Emory Crawford Long Hospital (ECLH) had merged after a long alliance, and when both facilities had operated for almost a year with only acting foodservice directors.

“To me, the story here has always been how we came together from different facilities to become a true system,” she says. “Foodservice was one of the last departments to undergo that integration — as you would guess, there were initially two extremely distinct cultures.

“The culture at EUH was very structured and formal. It had developed more of the layered, organizational complexity typical of academic medical centers. ECLH was less formal and more team-based; it had focused more on managing costs.”

Very little communication or sharing between the two took place on a regular basis at the time she arrived, Ometer recalls. “The foodservices operated completely separately. It actually took quite a while to figure out the dynamic of what was really going on underneath the surface at each location.”

Initially, she was stymied. As an outsider at Emory, “you had the sense that if you didn't ask the right question, you wouldn't get the right answer. There was a lot of underlying uncertainty.”

Although ECLH had a lower cost structure, “equalizing the financials of the two operations was not the primary task at first. The main objective was to bring the two groups together so they shared common practices, procedures and systems.”

Turning a human face to visitors

Ometer began that process by establishing small management teams that included members from both facilities, charged with working together to develop common processes in areas like purchasing and production. The two hospitals had different prime vendors and different purchasing contract terms; both would be reconciled over time. On the production side, both used a cook-to-serve model and the same menu management software, but had much different menus and employed different clinical nutrition practices.

Lynne Ometer, Emory Hospital’s director, food and nutrition services, shown in the new physician’s dining room recently opened at EUH.

As the combined operations represented a much larger combined production volume, Ometer saw a chance to create efficiencies by centralizing production. When ECLH announced in 1999 that it would build a major facility addition to the downtown campus, she took that opportunity to propose a dramatically different approach to foodservice there.

Ometer offered a combined proposal that involved converting the EUH kitchen to an advanced production system to serve both hospitals. Shifting some ECLH production to EUH would permit ECLH to build an expanded, truly contemporary, retail servery.

“Our idea was to design and locate the servery to give it a great deal more visibility than it had before. We thought the new café could help the hospital turn a much more human face to its patients and visitors,” says Ometer.

Even at the peak of the lunch rush, customer queues tend to wrap alongside <i>Seasonings</i> stations and avoid blocking traffic in the main walkway.

“We also knew we could do a lot more with a retail operation if it had that visibility. Obviously, this was not a decision that could be driven only by the food and nutrition department. But our administration was receptive to these ideas and saw that they could really support its larger goals.

“The hospital wanted Emory Crawford Long, which has a 100-year history in downtown Atlanta, to have a greater presence,” she says. “It also wanted to address the perception some had that there was an inequality between the downtown facility and the EUH campus. There were many forces at work, and in the end dining benefited from them.”

Just getting support for the idea was only the beginning. Ometer turned to Lynn Moore, RD, associate director, retail and purchasing/production at ECLH, to lead the team that would bring the new ECLH facilities on line.

“In making the transition to a retail model, one of our biggest challenges was developing the new staff,” says Moore, a former management company employee. The old facility had not been geared to the retail merchandising, grab-and-go and made to order services available in the new one and completely new employee skill sets were required. Some existing employees were re-trained for retail operations and others were hired to fill new positions.

“We were moving into a completely new and much smaller kitchen as well as a much larger new servery,” she says. “Every system we had or knew had to change in a matter of 24 hours. When it happened, it was like being thrown into a cold water bath. We weren't even able to train staff until the new building opened.”

To ease the transition, existing menus were used for the first few weeks and service was limited to the grill and main serving line areas. As additional stations were opened, menus and prep procedures were modified to introduce items that had visual appeal, grab-and-go packaging and the kind of retail presentation value Seasonings had been designed for. The impact of the new style of service was quick and dramatic: existing sales more than doubled within a few months.

A move to advanced production

Meanwhile, equally dramatic changes were taking place at the EUH campus, where the kitchen was undergoing a complete re-configuration.

“Advanced production promised to provide us with many efficiencies, but also a steep learning curve,” says Ometer. The tray delivery system was also going to change dramatically as both hospitals moved from the existing cook-serve approach to a re-therm model.

David Horning, EUH associate director, production and purchasing, headed up the team for that transition. A 20-year veteran at EUH, he had watched the implementation of a less than successful cook-chill conversion at another hospital early in his career and was intent on making sure Emory's went smoothly.

“When we joined the two hospital production teams we had two complete kitchens based on cook-to-serve production and were duplicating a lot of effort,” he observes. On the other hand, “the conversion required us to remain operational here at EUH even as the kitchen was completely re-engineered. We did it in 10 successive phases during which a different area was sealed off, gutted and re-built.”

That process took nearly two years to complete. It included the installation of four new steam kettles, two pump/fill stations, two tumble chillers/cook tanks, two blast chillers and additional refrigerated storage space for advanced production. The operation kept two tilt-skillets but replaced its fryers and ranges. In the end, an entirely new kitchen had been installed in almost the same footprint that had existed previously.

Developing new service models

Patient services were also undergoing a transition. That job fell to Associate Director Barbara Fussell, RD, another ECLH veteran who now has responsibility for patient dining services at both facilities. Ometer describes her as a “change agent.”

Grab-and-go, made-to-order and customer self service options blend easily together as customers move from one <i>Seasonings</i> station to the next.

It's a characterization with which Fussell agrees. “If we're doing things the same way two weeks in a row, we are not doing our job,” she says. “Constant change is the job in this business!”

As the department prepared for a transition to advanced production, Fussell's team began meeting with nursing staff to develop common standards that would address issues that both groups faced.

Among them: procedures for receiving diet orders; a system for determining that patients were “meal ready;” and ways nursing and foodservice could more effectively ensure that the patient meal experience would contribute to raising hospital Press-Ganey scores. Foodservice undertook a complete review of its host/hostess program with a special emphasis on training staff to help them continually assess the level of patient satisfaction and to teach them proactive techniques for service recovery.

High quality merchandising allows customers to eat with their eyes while waiting for service.

Last year, the opening of a new intensive care unit at EUH gave Fussell an opportunity to experiment with another new service model. Among other changes, the ICU model moved away from the traditional practice of delivering all unit meals at a designated time. While that remains an option, the floor clerks also can call for partial service, with trays delivered on an as-needed basis.

As finally refined, that dining services model now operates at all three Emory acute care hospitals. It combines a spoken, advance-select menu with host/hostess delivery and is fully scripted, says Fussell.

“Our goal was an inter-disciplinary approach,” says Ometer. “We wanted to create teams at the unit level that would permit service customization.”

In practice, “we tell our host/hostesses they are actually members of two separate teams,” she adds. “On one hand, they operate as our liaison to the unit, keeping us in touch with what is happening there. On the other, they are part of a unit-level team focused on the overall patient experience, of which foodservice is just one part.”

Extending the Brand

As the integration of operations at EUH and ECLH moved forward, the hospitals have continued to expand, providing additional challenges for Ometer's department. Foodservice at Wesley Woods Geriatric Hospital was brought under its umbrella in 2001 (foodservices at Wesley Woods' independent living and skilled nursing facilities remain separately managed).

“Again, there was a need to establish commonalities that would help the facility work more effectively within the system,” Ometer says. The associate director of food and nutrition at Wesley Woods geriatric hospital — Arlene Bennett, MA, RD — runs a customized operation there but takes advantage of Emory's advanced production where it is appropriate. She also gets assistance with catering and other needs as part of the larger department.

In the spring of 2005, Ometer's department was asked under short notice to design and open a new physicians' dining room at EUH. Ronnie Gee, EUH's assistant director of retail food services, and Margie Richardson, RD, EUH's retail F&B manager, worked with facilities management to pull that off in 60 days, a fast track time frame required by physical re-construction activities at the Emory Clinic. The new dining room is now located behind the main EUH café, allowing for efficient staffing and production.

Other initiatives are organic to the department. For example, as the Seasonings café has become a highly successful brand for the nutrition department, Ometer has looked for ways to extend that brand to other services. The department's current master plan calls for it to be applied to Emory's proposed room service program as well as to selected menu items, packaging and catering services across the system.

Today, the Emory Health System produces about twice the number of meals it did ten years ago with seven percent fewer staff. Seasonings has become a prominent Emory brand that will be extended across the system in future years; and the department's central production capacity is helping undergird a variety of patient and staff services that have been added or are now on the drawing board.

Among other longer term goals, Ometer plans to add a financial analyst to the staff to use POS and other financial data to better guide retail and operational strategy. A new cashless payment system,has the potential to bring greater retail efficiencies and volume. And the department is evaluating ways to incorporate more sustainable food choices into its retail program in the coming year.

Some <i>Seasonings</i> station counters double as prep tables during morning setup times. They then become merchandising and display space during meal times.

New integration challenges also lie ahead. Last year, Emory acquired Northlake hospital, which is undergoing reconstruction and will re-open this fall. Her staff will again be flexing to support the new retail and patient services to be offered there.

“We've slaughtered a lot of sacred cows over the last decade, one at a time,” says Ometer, looking back. “Every now and then, the team still finds a few hiding in the fringes. The difference is that now, we go after them together.”

At a Glance

Emory Hospitals: Four primary facilities, including Emory University Hospital (EUH) and its Center for Rehab Medicine, Emory Crawford Long Hospital (ECLH), Wesley Woods Geriatric Hospital (WWGH), and Emory University Hospital Northlake (EUHN).

No. of Licensed Beds*: 1304

No. of Budgeted FTE*: 254.9 (includes clinical nutrition staff)

Annual Catering Revenue*: $917,226

Annual Retail Sales*: $5,756,948 (cash and non-cash)

Total Annual Meals*: 4,112,600

* FY 2007; does not include EUHN