It's no secret that there haven't been many new hospitals constructed in this country over the last decade. The national total of acute care facilities has been in decline since the 1980s, a victim of increased outpatient treatment, budget cutbacks and managed care pressures. So you tend to listen closely when you're told Seattle's Swedish Medical Center is putting the finishing touches on a new hospital and medical services building out in the fast-growing Issaquah-Sammamish region to the city's east.
The new facility offers a stunning departure from traditional operations, providing patients, visitors and staff with a shopping mall retail environment on its ground floor. Café 1910, opened there in July and named for the date Swedish was founded, marks another significant innovation for an institution already noted for being one of the earliest pioneers of patient room service.
Referring to that earlier initiative, Swedish Administrative Director of Support Services Kris Schroeder says, “For a long time, colleagues kept asking us, ‘What's next?’
“For foodservice at Swedish, this is what's next.”
Welcome to the Shops at Swedish
This is what Swedish says is “a new way to be well, get well and stay well,” a contemporary and very retail-oriented approach to acute and primary care services. The Issaquah facility rises up out of otherwise undeveloped fields at the end of a freshly-laid asphalt road, and as you walk into the main entrance, you wonder at first if you're in the right place.
A three-story, atrium-lit lobby leads directly to what appears to be a contemporary, T-shaped, suburban shopping mall. Along its walls are frontages for the ‘Shops at Swedish.’
You pass a Starbucks, glass-fronted showrooms for Perfect Fit (women's lingerie), Be Well (a wellness boutique), Flex Time (a yoga studio), Lily and Pearl (a high-end gift shop), Comfort and Joy (new mothers and babies needs) and Adventure Kids Playcare (short term day care). Around the corner is Café 1910, a healthy dining eatery that fits right in with the other retail shops.
In fact, Café 1910 is the main cafeteria for Swedish outpatients, visitors and employees. The hospital building connects to the mall on its far side and there you find frontages for ‘Oncology,’ ‘Pharmacy,’ and ‘Imaging,’ each also fitting right in to the mall environment. The four floors above house physician offices.
It turns out that this “adjacency” — placing some service departments in the mall (where building codes are less stringent than they would be in the hospital) — helped save on first construction costs. It also lets departments like Oncology and Nutrition Services offer friendly, convenient and lifestyle-friendly access to outpatients and others visiting the campus.
A closer look reveals that the retail shops carefully complement the medical center's other services. Perfect Fit, for example, offers not only sleepwear and intimate apparel, but also a large selection of post-operative breast surgery garments and private prosthesis and wig fitting services by specialized staff. Be Well is focused on dermatology products, fabrics and other aids for patients with untoward effects from chemotherapy, radiation and similar treatments.
In the same way, Café 1910 is designed to highlight healthful and nutritious food. There are no fryers or soda dispensers, only fresh-made items from high quality ingredients. It breaks with tradition in other ways as well, providing staff and diners with lots of natural daylighting, a spacious dining room, an outdoor dining patio and menu rotations that are on-trend as well as healthful.
“One of our real achievements here is having the café act as a focal point at the main entrance,” says Schroeder. “It underscores the idea that we are about improving the overall health and wellness of this community.”
Another achievement was the department's opportunity to design an innovative patient room service production line in the kitchen of the hospital next door and to apply new efficiency-driving technology throughout its operations.
There are automated temperature logging sensors in coolers across the campus, automated hand washing verification stations in food handling areas, television-based room service ordering in patient rooms and barcode scanning equipment that tracks tray movement while also accepting credit card payments from visitors wishing to order additional in-room meals. There is little here that is not state of the art.
Planning for Flexibility
Swedish Director of Nutrition Services Candace Johnson and Executive Chef Eric Eisenberg take me on a tour of the Café 1910 before lunch. They are the ones who largely oversaw its creation and are obviously proud of what it has to offer. “On July 7th we had 23,000 people tour the facility and did cooking demos all day long,” Eisenberg says.
The cafe's design is similar to what you'd find in many newer corporate dining settings, with a made to order grill, sandwich and salad stations, a rotating chef's table geared to small batch cooking, hearth oven station and taqueria.
Johnson has had plenty of experience in hospital nutrition services and within the Swedish culture. She began working as a tray passer for the hospital to help pay her way through college and has performed just about every other role in the department over the past 20 years. She was a key player on the original team that implemented room service at Swedish campuses and is intimately familiar with the production flows at each of them.
“When the administration was planning Issaquah, Chief Administrative Officer Kevin Brown saw foodservices as an important way to make this facility a destination for the community and at first believed the best way to do that would be by bringing in commercial mall restaurant concepts,” says Johnson. “Our argument was, ‘Nutrition Services can do it and there are clear advantages to letting us do it.’”
One of these was that Nutrition Services would have unrestricted access to the main hospital kitchen next door, access a third party would not have because of regulatory requirements. Although much prep and finishing work is done in the Café 1910 space, the main kitchen and storage space remains in the lower level of the hospital.
Another key point: “The kinds of commercial concepts that were considered had tightly defined areas of focus, both menu and service wise, and would not have given us the long term flexibility we would need to satisfy the same employee customers day after day,” she adds. “We had the expertise to rotate concepts and menus in a way that commercial concepts don't.”
Finally, the uncertainty that existed in terms of how much traffic the facility could expect to see after opening “injected an element of risk into contract negotiations with outside companies,” Johnson says. “We had the advantage of being able to create efficiencies by combining operations where it made sense.”
Behavioral style interviews
When it came time to staff the Issaquah operation, the new foodservice jobs were posted, but “the interview process was conducted in a behavioral style and was fairly rigorous,” says Johnson. “This was not the way we filled new positions traditionally, but we wanted to make sure we used a consistent and fair way to evaluate candidates in terms of the interpersonal skills we needed to provide the level of service the administration wanted.”
Interviews were largely conducted by Issaquah Nutrition Operations Manager Stephanie Mitchell and Sam Colombi, Issaquah's sous chef.
“We worked up interview scripts with the HR department to help us probe candidates' experiences in handling peer relationships, stress under pressure, and how they dealt with things that had gone well or not so well in the past,” says Mitchell.
“One of our goals is to improve relationships across departmental lines, so we were very focused on finding people with the interpersonal skills to help us do that.”
“There is a healthy competition among the staff here — they push each other in a positive way to do better each day. It is a place where there are no ‘ways we've always done it,’ and is a chance to create an atmosphere where sharing is the norm.”
Reading the labels
Because the medical office building at Swedish/Issaquah only opened in July, and with the hospital not accepting inpatients until November, it's too early to forecast numbers in terms of daily traffic and revenue, Mitchell says. “Still, Café 1910 has already had a lot of visitors from the community and has done very well so far.”
So well, in fact, that Administrative Director of Ambulatory Care Susan Gillespie notes that, in the first month, Nutrition Services was the only hospital group to beat its budget.
“The hospital hopes Cafe 1910 becomes a community icon that represents what healthful food can be like,” she adds.
“Swedish is widely known in this region for the quality of its patient care. Our Nutrition Services and our room service program are key components of that care.”
"That's why we put Café 1910 at the front door of the facility. It's the way we welcome our clients and customers.”
A Move to Community-Based Care
According to Susan Gillespie, Swedish/Issaquah's administrative director of ambulatory care, Swedish in 2006 shifted its emphasis from centralized downtown care to a "hub-an-d-spoke" community-care model. In it, the main downtown Swedish facilities focus primarily on tertiary (or specialized) care, with community-based hospitals and clinics like Swedish/Issaquah feeding that campus with referrals for their most complex patient cases.
Today Swedish has five campuses: First Hill and Cherry Hill are tertiary care centers in downtown Seattle. Smaller community hospitals are available to the north of the city at the Ballard and Edmonds campuses. To the east, Issaquah-Sammamish region became a major focus of Swedish's longer-term growth plans. There, a regional population of about 100,000 is home to many who work in nearby Redmond and until now was the largest community in the area that did not have its own hospital beds.
Swedish opened a freestanding emergency care department there five years ago and its growing use helped justify the decision to build the new hospital and medical office building. In doing so, Swedish worked closely with community advisory groups for input on topics ranging from wayfinding to complementary wellness and nutrition services.
"What the community wanted was a healthcare partner that could provide services and resources to help it become the healthiest community in the country," says Gillespie. "That became a theme for the facility's planning and an intimate part of the service package we want to deliver."
The medical offices (outpatient services), along with Cafe 1910, opened in July. The hospital will open with 40 of its planned 175 beds in early November.