Will Innovate for Results

Mike Buzalka

Walter Thurnhofer is a busy man and, clearly, he aims to stay that way.

As director of food and nutrition services for the University of Washington Medical Center (UWMC) in Seattle, he is responsible for dining operations at a 450 bed hospital, a $5 million retail operation and onsite catering services. The department serves up to 6,000 meals each day.

With that kind of volume, Thurnhofer has developed a firm faith in results-oriented management, and his department has shown how a large organization can still innovate effectively. Among the highlights:
• an automated, comprehensive, first-inthe-healthcare-segment HACCP monitoring system;
• the use of dishes brought in by chefs from local restaurants to bolster retail cafeteria menus;
• offering patient meal service in nontraditional locations like the emergency room and the outpatient surgery ward; and
• the use of a mobile cart that trolls the campus in the wee-wee hours of the night, giving night staff and visitors another food and beverage option besides the vending machines.

But there's more! In July, UWMC will debut a new room service patient dining program that will replace its current preorder system. The new service will come with a considerably upscaled menu designed to boost patient satisfaction. This menu will be available in five languages in addition to English, targeting the most numerous ethnic populations the hospital serves.

On the retail front, Thurnhofer is exploring the feasibility of putting in an upgraded, electronic POS system that would tie the medical center foodservices into the University of Washington's Husky Card campus debit program. It would be a move that could boost retail revenues even further, building on an already impressive track record in that area.

Meanwhile, there are the possibilities posed by the opening in 2009 of a new wing to the medical center that may allow Thurnhofer to realize his long-cherished dream of decoupling the retail and patient dining production areas in order to give both adequate space and capacity to meet present and future needs. In any case, the new wing will provide additional retail sales opportunities as well as 75 additional beds to feed.

It's quite a flurry of activity, but one over which Thurnhofer has steadfastly maintained solid financial control. Indeed, the food & nutrition department's contribution margin has exceeded budget in each of the four years of his tenure at UWMC.

A Life in the Business
Walter Thurnhofer is a healthcare foodservice lifer. He began work in St. Helena Hospital in Northern California's Napa Valley as a teenager, washing dishes. "I didn't enjoy washing dishes that much, but I did enjoy the business and they trained me to be a server in the cafï¿´´, then a cashier, then to work on the tray line, working in the cold food prep area, and finally as a relief cook," he recalls. "That was when I got excited. The person who trained me, Joe Sauly, was a European chef, a big round guy who took me under his wing."

Three-plus years of Sauly's tutelage extended into young Thurnhofer's tenure at nearby Pacific Union College. Eventually, he landed a job on campus in the dining commons as a cook and baker, learning skills like wedding cake decorating.

In college, Thurnhofer studied for a dietetics degree, aiming at the administrative side. He completed his degree at Loma Linda University where they had an internship program (and where his academic adviser was future ADA president Dr. Kathleen Zolber).

With his degree in hand, the former dishwasher returned to St. Helena Hospital, this time as assistant director. "For some of the old timers, this was something that took some adjustment!" he laughs.

The St. Helena post was just the first in a journey that took Thurnhofer through a career path with the Adventist Health West system. He eventually rose to a vice presidential post in charge of food and nutrition services in 25 hospitals. But by this point he was getting tired of the "corporate travel" so he took a position as a regional director at Portland Adventist Medical Center in 1987. He was there until 2002 when he received an offer from the University of CaliforniaSan Francisco Medical Center to serve as a consultant as they transitioned to self-operated food services. It was irresistible.

"I continued to live in Portland and commuted there each week for eight months," Thurnhofer says. "They had appointed me interim director and wanted me to take the position on a permanent basis, but I loved the Northwest and didn't want to relocate."

So when the UWMC job opened up, Thurnhofer had no hesitation in applying. He was hired and started on April 1, 2003.

"When I got here, this place was in pretty good shape operationally," he says. "Nothing needed to be ‘fixed,' but they did want it upgraded, front to back, with new production and service equipment."

Thurnhofer got down to work, putting some $400,000 into renovating the production kitchen. More recently, the retail Plaza Cafes dining areas received a cosmetic overhaul, with new flooring and furniture. The big changes weren't structural, but philosophical.

Tapping Local Talent
Over Thurnhofer's tenure at UWMC', retail revenues have steadily risen. They increased 13.9 and 6.2 percent, respectively, in the past two full fiscal years and are on track to grow another 5 percent in the 06-07 period. In dollar terms, sales have gone from about $3.3 million to $5 million.

"A small component of that is price increases," Thurnhofer admits, "but mostly it is more volume from improved merchandising and promotion. We have added lots of new choices in the Plaza Cafe, both in the hot deck and the cold food area, as well as a grill where we make sandwiches to order."

More choices came from a new branded chicken concept and Thurnhofer has also not been afraid to turn to local culinary talent to boost the attraction of his menu. "We occasionally will have a local chef come in and we'll feature him or her either on the hot deck or at the grill. For instance, we have a Mediterranean chef people really like who comes in and does a largely vegetarian program for us."

This chef comes in every couple months, but several others are much more regular. One is a local Asian chef who brings in Vietnamese sandwiches as well as various other Asian specialties each day to augment the inhouse offerings.

This chef, who has a restaurant in downtown Seattle, was contacted after one of Thurnhofer's staffers ate there once and loved the food. "She suggested we see if he could bring some of his food out to us, so we did. It has been a great success."

No kidding. The cafe sells 15 to 20 dozen of the sandwiches each day. "And we didn't seem to cannibalize other volume," Thurnhofer adds. "It seemed to be additional."

Another vendor brings in Mexican graband-go wraps every day, while still another delivers Japanese food, especially sushi, which is very popular.

"The vast majority of what we sell is made internally," Thurnhofer emphasizes, "but this is a way to get more variety and push more volume through."

Thurnhofer credits longtime Retail Operations Manager Edith Cachero-Willard with the success of the program. "She has a great retail mentality and she runs this retail operation like it is her personal business. She's always looking for opportunities to bring in new things, to increase volume, to increase satisfaction."

In addition to the outside offerings, Plaza Cafï¿´´ features a big assemble-your-own salad bar, a make-your-own-cold-sandwich deli bar, as well as a separate deli counter with pre-made specialty salads. The main hot deck will usually have between four and five entree selections, plus sides and soups.

Thurnhofer says lots of choice is key. "We offer a good variety," he says. "If you want to eat really well, you can. There are lots of choices for a good, healthy diet. On the other hand, if you want more traditional American fare, we have that as well."

Plaza Cafe is only open from 6:30 a.m. to 7 p.m. To serve staff and visitors who must be around overnight, Food & Nutrition deploys a late-night service that minimizes costs while maximizing revenue opportunities by being mbile (see sidebar below).

The cart shows a commitment to serving customers wherever they are, and this philosophy extends to patient dining as well. In addition to the traditional meal service (which will morph to a room service model this summer--see sidebar below), the department has also expanded to various nontraditional areas: the post-anesthesia recovery room, the emergency department, the surgery pavilion for outpatient surgery and even the various outpatient units scattered around the medical center.

To serve these far-flung regions (the surgery pavilion, for example, is half a city block away from the production kitchen) Thurnhofer uses small tray delivery carts and a heat-on-demand system (which will also serve the room service patient dining system when it debuts).

The volume is not great—several dozen trays a day, perhaps. The motivation is service. "You may have patients in the emergency room for an extended period for observation, or people waiting for outpatient services who can't get to the cafe," Thurnhofer explains. "In those cases, if they are there for a while, the nurse will call down and ask for a tray to be sent up for the patient."

Managing Labor
As a manager, Thurnhofer seems to have the confidence, loyalty and even affection of his associates. Employee satisfaction surveys routinely give his department some of the highest scores in the institution and turnover is low—reportedly 6-10 percent a year over the past four years. (And some of that due to employees moving up after benefiting from Thurnhofer's encouragement of professional development training.)

All this was accomplished even as Thurnhofer took a rigorous handle on overtime hours, reducing that source of budgetary hemorrhage by 80 percent, to an average of about 0.1 percent of regular paid hours, a reduction he has been able to sustain.

"I spend about 20,000 hours of labor a month, and we have an average of about 20 twice a month of overtime now," he says proudly. "That is close to zero. Previously, we were running 200 plus hours of overtime."

The secret? "Tighter management controls," he says simply. "Getting people out of here on time."

Getting a handle on labor costs (the FTE count has not increased in his three years, despite increases in the number of meals served and the additional services he has implemented) has allowed UWMC food & nutrition services to reduce the net cost per meal equivalent by over 12 percent in the past three years.

A New Wing and a Prayer
For the near-term future, Thurnhofer is busy getting the planned room service program off the ground in a few months. Then, in 2009, a planned new wing with 75 more beds is slated to open.

"Because of this project, we will have to consider the possibility—the possibility, not certainty—of building a new kitchen in this area designed just to serve the patients," he says. "It would be much more efficient than where we are now, in the middle of a huge kitchen that serves everybody and everything. We want to move patient service out of the existing kitchen so we can expand retail operations.

"If we get the space that is currently in the plan, we'll have more dry and freezer storage as well as a catering room, a separate kitchen for patient dining room service and expanded retail serving room space, plus additional dining space on top of the main cafeteria area we already have. This will grow us from 450 to 700 seats and will allow us to add four new conference rooms, which means more catering opportunities.

"Frankly, we are now at capacity retailwise," he says. "We could increase volume 25 percent overnight if we had more physical space for serving and dining. We also need more retail production space. We currently have about 2700 sq.ft. and we need at least 3,500 to 4,000."

The additions would enhance the department's catering operations, which currently generates under a million dollars in revenue. A dedicated catering staff of four now manages up to 20 events a day, most of them small staff meetings. However, the department is also very capable of handling much larger events—the annual Winterfest celebration, which can draw up to 4,000, for example, or a summer picnic by the UWMC campus's picturesque lake for several thousand staffers.

In addition to the new wing and the introduction of room service, the other anticipated big change Thurnhofer would like to effect is the introduction of the University of Washington's Husky Card declining balance system to the medical center.

"We've never had that here because we've always had our own system," he says. "Right now it's either cash or credit cards, and we're dealing with way more cash than I'd like for safety and speed-of-service reasons. Widespread use of the Husky Cards would also allow us to do promotions because we'd have more information on who our customers are."

PHOTOS BY RICK DAHMS AND JOHN LAWN