At the moment, the future of nutrition services for OSU’s Wexner Medical Center (OSWMC) exists largely in the minds of Julie Jones, R.D. and other members of the department’s management team, but that won’t be for long. Now in the sixth year of a seven-year project cycle, the face and capabilities of Wexner’s food and patient services are on the cusp of dramatic change.
The physical signs are everywhere at the medical center’s Columbus, Ohio facilities, from the ongoing construction of its new hospital tower to the ongoing renovation of the OSUWMC’s existing central kitchen, servery and patient meal production systems.
Temporary wall structures are up or marked out on the floors of existing main hallways. New central production capabilities are coming on line along with a new, call center-less room service model.
The first of eight new satellite finishing kitchens is operating, with another coming online May 8 and the remainder to follow between now and the fall. A Seasons Express grab-and-go concept is about to open near the hospital’s main caféteria, which itself will soon undergo a total renovation and expansion.
By the beginning of 2015, nutrition services will oversee dining-on-demand patient services for 1400 beds, its food production, storage and distribution support areas will have been rebuilt, and retail operations will have reach and scope well beyond those that exist now.
OSUWMC’s nutrition services department is on the forefront of virtually all of the trends driving healthcare foodservice, and its long term plans for efficiency, flexibility and cost management position it well for the coming era of Accountable Care.
Looking across the market, Food Management found an abundance of evidence to support its selection of Ohio State University’s Wexner Medical Center as the magazine’s Healthcare Innovator of the Year.
A delivery model for the future
The standing desk in Julie Jones’ office seems to fit her management style well. Like most FSDs, she returns to her computer repeatedly throughout the day in fairly intense spurts between meetings, construction walk-abouts and other activities.
She’s only had the desk for a short time—“It’s part of research we’re doing to evaluate the health and metabolism implications it could have for office workers,” she explains.
“We’re taking a much broader view of employee wellness programs these days.”
In fact, Jones’ workdays are long ones right now, set to become longer in coming months.The immense construction project now underway on the OSUWMC campus began last September and will proceed until early 2015. In that time, Nutrition Services’ master plan moves it through dozens of phases as the inpatient cancer/critical care tower and foodservice renovations are completed.
An intense focus has been on a complete re-thinking of how patient meal service is provided across OSUWMC’s increasingly spread-out operations.
Listen to Kent Hess, Associate Executive Director of the medical center.
“Over the past ten years our thinking has evolved to see that foodservice can be a game changer, an influence both on satisfaction and length of stay.
“Yes—we’ve made a huge investment to move to a dining-on-demand system. And yes—when it’s not part of your core business, justification of such costs is more difficult than for an investment like an MRI machine. But our Nutrition Services team has provided great leadership in developing a service model that will carry us forward and marry up with our goal to provide a more personalized healthcare experience.”
A move to community care
Hess also points to Wexner’s efforts to extend its reach into the community, including partnerships with home-care and meal organizations.
“A broader part of our mission is to ensure the community has the lowest healthcare costs in the future,” Hess adds. “To better manage discharge care and reduce re-admissions, we’ll need to partner with other care organizations across the continuum.”
The consolidation of healthcare into larger service organizations has real implications for the food and nutrition services offered, says Mary Angela Miller, R.D., a Wexner administrative director. Miller, who began her career in clinical nutrition and once was FSD at Wexner, now oversees a variety of departments and clinics.
“When you look at our operations broadly—the various hospitals in our medical center, the schools, the physician practices, the ambulatory care centers—it represents a much different management challenge than many of us had when we started in this field,” says Miller.
“It means a different patient meal delivery strategy, a different retail strategy, a different production strategy, a different HR strategy. It means developing standards to be used across one’s operations, but which can be customized to meet the individual needs of a given site.”
At Wexner’s 200 bed University Hospital East (UHE), in east Columbus, UHE Administrative Director Diane Gordon says her facility and Care Point East, one of 20 Wexner outpatient locations, are examples of how that customization works.
“We were originally a community hospital closely associated with this area,” she says.
“Since we became part of OSUWMC, we’ve worked to retain our community hospital atmosphere. Foodservice is part of that, and so is our involvement with the community here in terms of wellness, outreach and education programs.”
One Team, Multiple Sites
Chris Basmagy, assistant director-retail, oversees retail operations at UHE and five Seasons Express locations not on the main Wexner campus. Sheila Reckner, assistant director-patient services, oversees patient meal service.
“Some of these locations would not necessarily fully support foodservice because they don’t have the necessary space or traffic,” Basmagy says. “But employee expectations don’t change. Wexner is considered a regional ‘Employer of Choice,’ and food services are a key amenity for employees and guests.
“We’re experimenting with ‘micro-markets’ and augmenting some of our location services with food trucks. We’re striving to achieve all the efficiencies we can while still maintaining the standards of the main campus.”
Basmagy’s role illustrates how Wexner’s nutrition and foodservice management team is structured to provide this “one team—multiple site” approach. As a group, it is well-balanced across ages, skill sets, education and tenure.
Six of the staff are registered dietitians, with tenures ranging from two months to 27 years. Two others earned degrees in nutrition, sans internships. Two more have culinary degrees that complement the nutritional focus of the department.
Together, this combined expertise has paid dividends as the department’s production and delivery systems have been re-engineered. The department services six different hospital entities. Each has its own financial statement, with the nutrition department’s services billed backed to them individually.
Closing the call center
Jones’ team has been exploring alternative approaches to meal service for years. She will quickly tick off the various approaches it has employed for patient service, moving from paper menu selections to Palm-based spoken menu to laptop order entry to iPad-assisted bedside ordering last year.
“As we planned for the future, we talked to other segments with high volume on the scale we were looking at—casinos, large hotels and cruise ships,” she says. “We wanted to see how their practices differed from those common in healthcare.
“At the end of the day, we developed a hybrid model based on cook--chill and satellite finishing kitchens (hospitality centers), using technology to help with dietetic management and meal tracking. We tried to incorporate the best from both worlds.
“Once the program is fully in place we believe we’ll be delivering high quality patient meals at a significantly lower cost than many cook-serve room service programs. We’ll also have the long term operational flexibility we need to manage costs, quality and patient satisfaction.”
Instead of having a call center, Wexner’s nutrition aides use iPads to take and schedule patient orders at bedside. The system is web-based and device-independent; it also features multiple user interfaces. Nurses, for example, can access a streamlined, color-coded view of the system that scrolls through the beds in a unit.
“The nutrition aide’s view is different and more of a tray production process management tool,” says Laura Meadows, the department’s systems analyst. “It’s geared to daily workflow and also appears on a monitor in each local hospitality center.” Yet another version will eventually be offered for some patients to use directly.
Meals are assembled in the centers, each one located close to a patient care community (oncology, cardiac, etc.) Nutrition aides help patients select meals, place orders and also deliver them. (For more details on the room service model, go to http://bit.ly/ZxMyEs.)
Culinary Director Drew Patterson works closely with Mike Folino, R.D., assistant director of retail at the main campus, to develop menu offerings that meet goals for efficient production and culinary and nutrition quality.
For example, he’s developed an arrangement with Wexner’s distributors to source pre-portioned raw meat, packaged with low sodium sauces or mirepoix specified by the department and delivered in refrigerated, sealed pouches. These are ready for tank cooking “at a price only slightly above what we would pay for raw product,” he says.
“One of the advantages is that we can cook the product as needed, but do not have to deal with the food safety issues associated with handling raw meat. The bags are never unsealed until they are fully cooked and ready to be finished and plated at one of the satellite kitchens.”
Contrast that, he says, with the traditional process. “We had someone opening the meat, draining the juice, cutting it into three-ounce portions, dealing with the yield issues ourselves. Now it’s much easier to manage inventory and yields.”
Purchasing for these and other food supplies is managed by Erica Hamilton, assistant director-business services, who also oversees the department’s budgets, cash reconciliation, and operational P&Ls.
A dramatic retail transition
As Wexner’s main retail facilities undergo a complete remodel in coming months, “it will be a matter of moving one domino piece after another as construction proceeds,” Jones says. The new patient service model will be phased in as each hospitality center is completed. And Folino is planning now for the new retail capabilities the renovations will bring in 2014.
The main cafeteria will remain operational throughout the construction period, with renovations taking place piece by piece over 12 months. When construction is complete, the new entrance will open to a community “avenue” stretching from the existing facilities to the new tower, giving it better access to Wexner’s large campus population.
“The new Seasons Café will have digital menu boards, kiosk ordering and a much more dynamic menu served from seven stations,” Folino says. “It will occupy prime real estate in the middle of the avenue, with much higher visibility than it has now.”
The Seasons Express will be retained and will also be located in that corridor, as will sub-contracted branded concepts including the Wendy’s that has been a fixture at OSUWMC since the 1990s. Other options such as mobile cart service and sub-contracted food truck options round out the mix.
“There is much uncertainty in healthcare reform, but some things are clear,” says Jones.
“There will be significant pressures to personalize the patient experience and to maximize the use of technology to improve service delivery. On the retail side, we have to provide high quality, convenience and nutrition at a variety of price points, locations and hours of service.
“We have tried to look at these needs wholistically, and find ways to deliver food and nutrition in this larger context. That’s what will be required in an era of Accountable Care.”