The foodand nutrition services department at The University Hospital, Newark, NJ, has faced all of the usual challenges of the healthcare segment, and then some, in the two decades since it opened as part of the University of Medicine and Dentistry of New Jersey (UMDNJ) in 1979.
Competition from local operators? Since the mid 1990s, foodservice has had to deal with an independently-owned Burger King franchise located in its own building, right next to the main servery.
Reductions in subsidies? UMDNJ foodservice was never subsidized. Originally a contract operation, a dozen years ago it made the transition to self-op and since then hasn’t looked back. And it doesn’t just break even. Last year, the department contributed over $300,000 in “rent” to UMDNJ for space and utility overhead charges. Over and above that, it contributed another $100,000 to UMDNJ’s bottom line, and is looking to do even better this year.
At a Glance
Total operating budget: $6.5 million
Annual food/supply purchases: $2.5 million
Meals per year: 1.3 million
Retail sales: $2.7 million
Number of beds/Occupied beds: 446/300
Foodservice FTEs: 104
Net cost per patient day: $21.41
Prime Vendor: Sysco
FTE cutbacks? Since 1993, full-time dietary positions have been reduced 27 percent even as services have expanded. Along the way, the department watched as the bulk of its meal activity migrated from in-patient feeding to over 60 percent non-patient dining. In response, it has developed a highly successful retail program that ranges from the multi-station concepts of its Garden Cafe to grab-and-go remote options to white tablecloth dining.
The advantage of tenure
The one constant in all of that change has been Director of Food and Nutrition Services Betty Perez, R.D., DHCFA, who from all reports has continued to bring vision, ideas and a seemingly endless source of energy to UMDNJ’s foodservice operations. “Betty sees our department as a force in the community and the industry,” says Janet Reid-Hector, M.S., R.D.,CNSD, assistant director of clinical services. “Her strength is her willingness to embrace new programs and stay on the cutting edge of what it takes to provide cost-effective patient care and continuing innovation on the retail side of our business.”
FM last visited University Hospital in 1994, shortly after it had transitioned to self-operation. It’s worth noting that four of the five members of the original transition team noted in that story—Retail Services Manager Bill Baglione, Assistant Retail Services Manager George Hariton, Operations Manager Rose Durning, and Betty herself—are still with the department. Similar tenures are held by many among foodservice’s hourly staff, and there is little doubt that this kind of continuity is a major contributor to the financial results the department has been able to generate.
Located in the central ward of Newark, UMDNJ offers a full range of health services ranging from newborn to geriatric care. It also has the distinction of having offered New Jersey’s first liver transplant program and of serving as a Level 1 trauma center for the northern part of the state. With a medical staff of 862, The University Hospital offers the largest medical teaching program in New Jersey. Last year it had over 19,000 admissions, over 175,000 ambulatory care visits, over 1,800 deliveries and 70,000 emergency room visits. With a patient base that is 75 percent Medicaid reimbursed or uninsured, the hospital provides over $80 million a year in charity care.
As a teaching hospital, UMDNJ has an immensely diverse customer base, including international faculty and students as well as a patient base drawn from the highly urbanized Newark population. Because of this, UMDNJ’s patient and retail food offerings must span a wide range in order to appeal to the broad spectrum of ethnic and cultural tastes that are represented daily.
A strategic emphasis on customer satisfaction
At a time when benchmarking comparisons drive hospital strategic and tactical plans, UMDNJ’s strategic emphasis in the foodservice department is increasingly on patient satisfaction while it maintains the excellent financial performance it has already achieved (see ‘High Five’ sidebar.) The challenge, says Winsome Myrie,M.S., CALA, patient services manager, “is to ensure that patient satisfaction and just plain courtesy remain at a very high level while the department adheres to strict financial guidelines.” Education, both of customers and staff, is critical to that effort, she adds.
“No matter how good your food is, your service levels are what make or break your customer satisfaction scores. We spend a lot of time training staff on how to handle people even if they are very ill and sometimes not so nice.
“Teaching customer service skills is not a one-time effort—it’s an ongoing task. It starts in the initial hiring process, when you look for people who have a genuine customer orientation. You need to help them develop that attitude and give them the tools so they can take extra steps when they are called for.”
Typical of how this philosophy is implemented in practice is the“Spirit Lifter” snack cart the department operates. It pays surprise visits to floors throughout the hospital on holidays and other special occasions, and helps brighten the spirits of patients who would otherwise be home, spending time with their families.
Let’s do lunch
While the High Five program focuses on patient satisfaction, the department has paid plenty of attention to ensuring the satisfaction of internal customers as well. Most employees dine at the Garden Cafe in the main building, where new food concepts and retail innovations are introduced regularly.
One recent success story has been the New Delhi Deli, retail’s newest self-branded concept. It started out as a way to offer a vegetarian option at lunch in the form of authentic Indian food, and has since become a permanent station for both lunch and dinner periods. The concept proved so successful it has since been expanded to also include traditional N.Y.-type deli offerings.
Weekly rotations of Basmati rice side dishes and vegetarian entrees keep customers coming back, and include Indian favorites like Channa Masala and Samosa. “It has been very popular with our Indian customers and with vegetarians who now have a lot more variety than just eating from the salad bar every day,” Baglione says.
Nearby, the Kosher Corner makes it easy for those who wish to do so to keep their meals kosher, not only with traditional entreees but also with a variety of breads and Dunkin Donuts sourced from nearby kosher facilities.
Another fairly new concept at the Garden Cafe is the Chicken Coop, developed to bring together traditional grill options and lunchtime favorites like fried chicken, soup and chili under a single banner. “It is not a traditional concept, but the homestyle menu has a sense of soul that works very well for us,” says Baglione.
That same customer focus carries over to other foodservice locations in the hospital. The Bistro Cafe, a 36-seat white tablecloth dining room is a case in point (see sidebar). It also provides an opportunity for culinary staff to “strut their stuff” beyond the limitations of traditional cafeteria fare. Bistro Cafe entrees and check averages are mostly in the single digits, but you’d never know it from the menu. It also features high-end signature cheesecakes prepared by chef Gregory Dukes. (These are so popular, they are also offered to employees at special occasion “cheesecake bar” events.)
Head Chef Elijah Green supervises a staff of ten cooks to help ensure that this diverse food production meets department standards. Green manages production, writes recipes as needed, and coordinates with Operations Manager Rose Durning to make sure specialized ingredients are available as needed.
Green has worked in the department for over 20 years, and says he is amazed to look back at how extensive the menu is today in comparison to the standard cycle and patient menus used in the early 1980s.
“It has really been the customers who demanded the changes,” he says. “Even with a six week cycle, they will ask why a particular item is on the menu again. We are fighting a battle every day to provide variety and we treat this place like a family business where that is our goal in running it. We tell our staff that if we don’t, someone else can always come in to run it for us.”
Cruising for customers
Continuously growing retail revenue is never easy, and Perez has sought out new opportunities wherever they have been viable. Expanding the department’s on-campus catering business—known as “Rx Caterers”—was an early strategy, and under the direction of George Hariton, it now handles about 400 events a month.
To make snacking more convenient for the time-short hospital staff spread across UMDNJ’s multi-building campus, retail services has outfitted a variety of mobile carts to provide decentralized service with what the department informally refers to as its “Cruisin’ Cafe.”
Another opportunity to expand retail operations opened up a few years ago, when the administration gave foodservice the responsibility for operating a satellite cafeteria located in its separate Doctors Office Center, where many of its physicians’ offices are located. That operation had been run by a local contractor, but was brought in-house at Perez’ urging in order to take advantage of economies of scale her department could bring to bear.
Now known as the Balcony Cafe following a remodel, it is overseen by Assistant Retail Services Manager John Murray, who as an R.D. has been able to broaden and customize many of the cafe’s menu offerings for a previously untapped customer base that frequents a health club facility located on the floor. Murray developed a menu that includes health drinks, special entrees for a weight loss program, and other choices that make it a destination for this group as well as healthconscious UMDNJ employees.
While lunch drives most retail revenue, no daypart has gone untapped. A New Morning Menu rotates entrees like Country Fried Chicken & Waffles and Fried Whiting with Eggs, and Homemade Waffles with Toppings and Pork Roll. And when customer surveys showed a significant amount of after lunch traffic going off site for snacks because a nearby shopping area also offered lottery tickets, the department made arrangements to sell lottery tickets at the Garden Cafe. These are handled both by vending machines and by a half-door “window” that opens for this purpose in the afternoons.
“It increases afternoon traffic,without any increase in labor,” says Baglione. “It also keeps workers on campus, improving productivity. Our main concern was to make sure our customers understood that the food always comes first during peak periods.”
That’s just another example of why maintaining a successful retail environment requires more than just the right food and display techniques, he says.
“A big part of our training here has been to get staff away from thinking that they are just part of the dietary team. That means focusing on what it means to be cost-effective, on the financial impact of added sales, the importance of portion control, upselling and on doing whatever it takes to get each tray sale as high as possible.”
“Retail gets a lot of visibility, but the clinical side remains the core business given the hospital’s mission,” Perez says. Also, while it comprises a smaller percentage of overall revenue than it did at one time, the breadth and scope of its services have grown in recent years, as the hospital’s ambulatory care and outpatient service loads have increased.
The quality and delivery of those services are overseen by Janet Reid-Hector, assistant director of clinical nutritionservices. Reid- Hector joined UMDNJ in 1993 and has played an active role in helping the department evolve as demand for ambulatory care services has dramatically increased.
Nearing completion of her doctorate at Columbia University, Reid-Hector says she has always “tried to blend teaching with dietetics.” Among other special services, she oversees an annual UMDNJ clinical nutrition symposium marketed to clinical dietitians, physicians, nurses and pharmacists in the region, with the goal of encouraging a multi-disciplinary approach to disease and injury treatment. This year, the symposium focuses on the relationship between nutritional pharmacology and cancer treatments; other topics have included autism and team approaches to wound management.
“You have to tell your story well”
Perez has long been active in her professional associations. A past president of the New Jersey chapter of the American Society for Healthcare Food Service Administrators, she continues to serve on the ASHFSA New Jersey chapter’s board. She is also active in the National Society for Healthcare Foodservice Management (HFM) as an elected board member and is chair of that organization’s 2003 national conference.
Speaking to the challenges faced in the pressurized hospital acute care environment, Perez says it is not enough to meet your goals, or even to have a good story to tell.
“We are very aggressive in defending our operating budget, and to do that, you have to tell your story well,” she says. “You have to make sure that your administration is always fully aware of what is going on in your department and of the full range of services that you provide. Our goal is to keep the administration dazzled! If you are not proactive, your administration will not know what you are doing for the hospital’s patients, employees and students. Education is key to effectively marketing your department.”
That also means making sure past accomplishments are visibly documented. For example, the organization chart Perez provides for her department lists its FTE history in a box on the first page, ensuring that anyone reviewing its staffing levels is aware of the efficiencies it has achieved over the years.
Staff development is another priority, and Perez points to the long tenures of many employees as evidence that it pays off. To provide further career development opportunities for staff, she has introduced six “lead” positions in the department to give hourly employees an additional step up in terms of pay and responsibility.
“Our leads accent the management team,” she says,” helping to provide oversight seven days a week. It’s also our way of recognizing the extra contributions staff have made as we have downsized the workforce on both the management and hourly side.”
One thing Perez does not seem to be interested in is sitting on her laurels. At any given time, she has new projects in the works. On the front burner right now is a plan to take on responsibility for operating the hospital’s convenience store and gift shop. The department is also working on a new outlet called the “OR Express” that will turn a small hallway area outside the operating rooms into a remote, quickservice location.
“Over the years the scope of our services has changed, as have the size and number of buildings on our campus,” she says.
“We like to think that one way of looking at change is to say it will always mean additional business we can go after.”
Although the biggest impact of managed care on hospital foodservice has been on budgets and FTE counts, experts believe an increased emphasis on customer satisfaction is becoming the next big priority. At UH, Perez has worked with Steven Mosser, UMDNJ’s executive director of hospital support services, to introduce a new program they hope will raise Press Ganey scores while demonstrating the hospital’s commitment to customer service.
“Patients today are more educated and more demanding. Competition for them is keen,” says Mosser. “We want any patient who comes to UMDNJ to be a positive ambassador to the community on our behalf.
"That is the essence of survival in healthcare today. Most hospitals can compete clinically; the remaining key driver is customer service. "Our goal is to improve not just our scores, but satisfaction itself,” he adds. “And we want our patients to know that from the moment they first enter the hospital.”
The new High Five program, implemented in May, was developed by Perez and her management team and modeled after the service programs promoted by car dealerships seeking to do well on customer satisfaction surveys . “We want each patient to know from the beginning what Press Ganey evaluates, how scoring is measured and what we are trying to achieve,” Perez says.“We also want them to know how they can bring any shortcomings to our attention so we can address them with immediate remedial action.”
When a UMDNJ food server sees a new patient for the first time, he or she summarizes how the Press Ganey survey works and gives the patient a High Five bookmark with that server’s name and a hotline phone extension to use if there are any foodservice requests or problems to report.The patient is also told the department’s goal—to receive a “High Five” score on the meals section section of the Press Ganey survey.
“Shortly after, a member of our management team makes a follow-up ‘ambassador’ visit, and explains why the scores are so important to us,” says Perez.“The ambassador leaves a matching ‘High Five’ business card and emphasizes that both management and staff are committed to this program.We want patients to know that while they’re here, we want to do everything possible to make sure their foodservice experience is as good as we can make it.”
The Bistro Cafe, a quiet, 36-seat white tablecloth restaurant, sits comfortably with its own entrance right next door to UMDNJ’s main servery. Baglione created the cafe “on the cheap” from what was previously a meeting room two years ago, to provide an onsite option to physicians and others who sometimes need a place to entertain business guests or visitors. Menu options range from salmon, veal and steak entrees to specialty wraps to daily Chef’s Specials, all offered with full table service.
Open to all from 11.a.m. to 3.p.m., the Bistro Cafe generates about $75,000 a year in additional sales. Because production comes directly from the main kitchen, the only extra staff is for wait service, provided by a part time employee, who is assisted by dietary staff during peak periods.