Operating a successful healthcare dining operation is like waging a multi-front war. Your offerings have to be nutritionally sound and — increasingly — environmentally sustainable, yet customer-pleasing within rigid cost parameters. And you have to achieve that while meeting your institution's requirements for an affordable and convenient in-house foodservice that not only satisfies the basics of feeding employees, visitors and patients, but, ideally, also serves as a positive community relations tool.
On all those fronts, Milwaukee-based Aurora Health Care system has produced impressive results. The system, which encompasses 14 acute care facilities and dozens of smaller clinics, pharmacies and specialized treatment centers across Wisconsin, has developed a high-quality, customer-friendly dining service for both patients and retail customers, and one that balances the healthy, the trendy and the traditional.
It offers room service dining at almost every acute care site (one remains to be converted), while its retail cafeterias serve a daily array of choices adapted to the tastes of each specific site population. Costs in both areas are controlled, despite a somewhat decentralized food management structure (more on that below), through a centralized recipe database and centralized purchasing, monitored at the retail end by computerized site-wide POS registers that interface with the central system.
AT A GLANCE
Dept. Budget: $19.8 million
But beyond the core mission of feeding patients, staff and visitors in a cost-effective, customer-friendly system, Aurora's food management department offers a variety of services designed to generate goodwill and satisfaction all around. Among some of its many initiatives are…
an “Adopt-a-Floor” program that sends chefs and even low-level back of house kitchen staff to patient floors to build relationships;
the use of local brands in the cafes to connect the dining service to the community and highlight Aurora's support of local businesses;
efforts to encourage community and collaboration among the system's unit chefs through a “chef's club” that meets regularly, not only to network and share best practices, but also to participate in a variety of community service activities;
enhancing retail dining convenience with credit card and debit account payroll deduction payment options;
the use of monotony-breaker and team- building events like outdoor cookouts and celebrity chef visits;
the promotion of healthy dining through loyalty cards, posted nutritional information, onsite farmers markets, and regular special events like Wellness Wednesdays, “no fry zones,” and a “first fruit of the month” discount program;
a commitment to sustainability through composting, recycling, a new rooftop herb garden, local sourcing of ingredients and the promotion of reusable beverage cups;
serving the broader community through cookouts, partnerships with local charities and a longstanding involvement in a community mobile meals program in conjunction with the area's Visiting Nurses Association.
Finding the Efficiencies
Aurora's self-operated foodservice department uses a semi-centralized management structure that consolidates oversight of its main acute care facilities — those in the greater Milwaukee area — under a regional director, while leaving community hospitals in the smaller markets under the direction of individual site managers.
At the hub of this system is John Riegler, regional director for Aurora's five hospitals (plus a psychiatric facility) in metro Milwaukee. Riegler has direct operational oversight over the unit managers in his region and also serves an informal consulting role to the other regions.
“I'm like a conductor,” he says, “the one who knows where the music's supposed to come from and gets it to come from that spot.” He also describes his role as a “resource” managers can turn to if they run into especially difficult problems.
Stepping back, Riegler sees his key role in the organization as the one best positioned to facilitate synergies across the system. “I want to make sure that there's consistency from site to site where it makes sense and that we take advantage of best practices,” he explains.
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Because Riegler also oversees all foodservice purchasing, he has effective influence over those “best practices” in terms of what is being served. It is a responsibility that he takes seriously and to which he brings impressive credentials.
A former chef, Riegler joined Aurora in 2000 after a career that included stops in the lodging and corrections segments as well as a stint as a foodservice broker. The multi-segment experience equipped him with an “out-of-the-box” perspective as well as loads of operational experience, making him the natural point man for balancing synergies and individuation across the network.
Riegler says his goal is not to bring total uniformity to sites that have various shades of customer expectations, but to find synergies where they naturally exist. He wants his unit chefs to feel they have “buy-in” on what they are serving while taking advantage of the efficiencies of centralization.
For example, while all the Aurora hospitals with room service have the same core menu, each menu comes with its own individual insert that details specials formulated by the onsite chef. This both helps tailor the menu to regional/population preferences and also gives those site chefs a way to get their own input on what is served. (It also offers patient diners variety and the chefs an outlet for using seasonal locally produced fruits and vegetables.)
On the retail side, the point-of-sale system installed at all locations maintains consistent, system-wide pricing and standardized selections prepared (and portioned) from a centralized recipe database. Unit managers have discretion over the day-to-day menu mix to accommodate local preferences, but the centralization streamlines food costs and makes value-added services like posted nutritional information possible.
Purchasing efficiencies are enforced in large part by an approved products list keyed to Aurora's membership in the Premier GPO. To further consolidate orders into as few items as possible, Riegler encourages cooperation on buying as few line items within distinct product categories as possible.
He says a particularly effective tool for encouraging this is having the same sales rep from prime distributor US Foodservice call on all the Aurora units across the state. “If the units in the south are buying 80-count potatoes, they should be buying 80-count potatoes in the north too,” he remarks.
As for the Food…
On menus, Aurora has deployed multiple dining concepts that incorporate cutting-edge food trends ranging from customized sandwich and salad selections to authentic ethnic dishes. With success in drawing more incremental retail dollars tied to its success in identifying and exploiting evolving consumer preferences, Aurora has to be willing to invest in changes, but they have to be the right changes.
“Our approach in the retail area is to keep fads in front of people but throw capital at the trends,” Riegler explains. “Healthy food is a great example. For years we looked at it as a fad. Well, it's not a fad anymore, it's a trend, and to meet it, we invested in making nutritional information available to our customers.”
Healthful dining is an institutional commitment sealed by Aurora's being a signatory to the Healthy Food in Health Care pledge (for more on this initiative, see the April issue at food-management.com/segments/healthcare/taking-pledge-0310/index.html ).
In addition to regular healthful choices and the nutritional information available in the cafeterias, healthy choices are also encouraged by initiatives such as “Wellness Wednesdays” (when healthier dining options are highlighted in the cafeterias), “No Fry Zone” days when healthy alternatives to French fries are served, “First Fruit of the Month” promotions that offer seasonal selections at a discount to encourage consumption, and an innovative punch card loyalty initiative that incents the purchase of healthier items.
Local sourcing is a component of the Healthy Food in Health Care pledge, and Aurora highlights its commitment with an annual Earth Day menu that uses only ingredients grown, produced or manufactured within a 150-mile radius. The food management department also sponsors farmers markets at the different hospital campuses during the growing season and even uses a the localest of sources — its own rooftop gardens — for fresh herbs at the West Allis facility.
The local angle is also highlighted by the prominent use of high-profile local brands in the retail operations. They include noted local roaster Stone Creek Coffee, which specializes in organic and “socially responsible” coffee products, as well as Klements Sausage, Papa's Bakery and Outpost Natural Foods, among others.
The healthful and appealing menu choices appear not only in retail outlets on Aurora campuses, but in patient dining, where a near-universal commitment to room service dining has significantly raised patient satisfaction. In addition, a “healthy catering” menu was recently developed to give catering customers standardized healthy options for their meetings and events.
Emphasis on Convenience
The menu and checkout automation system that is now installed across the Aurora food management network is the fruit of a five-year plan that launched in 2002. It automated diet office programs for patient trays in successive hospitals, adapting to the room service program as that initiative was implemented, also in multi-year stages. Now, all hospitals are automated, with the software managing all patient diet protocols and monitoring all retail sales.
The newest automation component is a dining debit program that piloted at a number of sites late last year, offering payroll deduction and a five-percent discount on sales as an incentive. In the first few months of the program, more than 4,000 Aurora staffers have enrolled, out of a potential onsite population of around 12,000. The option, along with the earlier introduction of credit card payment, promises to help boost sales in a difficult environment, says Riegler.
“Price is a big issue for employees,” he notes. “When it comes to onsite cafeterias in healthcare, there's still a kind of entitlement mentality.” It's a mindset that automation apparently helps overcome, he adds. “When we added credit card payment, we saw our guest checks jump a little, and now that we're adding the dining debit we see the guest checks jumping a lot.”
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Aurora is also trying to boost sales by making purchases convenient with additional cashiers at peak times, plenty of grab and go and more behind-the-counter staff. For example, the deli station sells more made-to-order sandwiches after adding a third line while keeping sales of pre-made alternatives as high as ever.
The willingness to make an investment also helped boost night time sales, as well as customer satisfaction among third-shift employees. The new third shift chef — an added position — who makes breakfasts to order at the St. Luke's facility during the overnight hours prompted in a 35-percent jump in overnight sales.
The same philosophy also affects the composition of the culinary team. When Riegler began his tenure, Aurora had one chef in the system. It now has eight, with four or five more close to completing certification.
“It was a slow build,” Riegler says. “Step by step, we upgraded the positions at the different facilities from cooks to chefs and made the wage competitive enough so that chefs would leave the country clubs and restaurants to come work for us. Chefs are now a requirement in hospital foodservice. Five years ago, hospital directors would routinely ask each other, ‘Do you have a chef?’ Now, you don't ever hear that.”
Riegler says he sees chefs as not only a necessity for keeping up with customer demands for quality dining choices, but as a net bottom line booster. Their contributions not only enhance food quality, leading to more sales, but they also help control costs.
“A good chef will keep your garbage cans empty,” he says. “If you don't have the kitchen control you get from a good chef, it's costing you product dollars. But once you get that garbage control, it pays for itself. And that's what happened for us in every one of our facilities.”