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HEALTHY FOOD IN THE HOSPITAL KITCHEN · 7/7/2015 · Background • Columbus Community Hospital...
Transcript of HEALTHY FOOD IN THE HOSPITAL KITCHEN · 7/7/2015 · Background • Columbus Community Hospital...
HEALTHY FOOD IN THE HOSPITAL KITCHEN
The Essential Players, the Challenges and Making it To The Other Side
Emily Briggs, MS, RD, CD, CSOManager of Food, Nutrition & Diabetes Services
Columbus Community Hospital
Background
• Columbus Community Hospital (CCH) is a 25 bed critical access hospital
• Food and Nutrition Department underwent management change and took a new direction 2 ½ years ago
• It’s been a journey!– Players– Challenges– Outcomes
“Don’t mess with people’s food - and not
expect to hear about it.”
Administration’s Vision & Direction
• Manager of Food, Nutrition & DM Svs. Job Description at CCH:– “Provides menu evaluations/modifications with a focus on healthy options”.
– “Establish and maintain a ‘fine dining’ restaurant‐style mindset, providing a positive and memorable dining experience for all customers served”.
Administrative Support
• This is essentially a culture change, which can be difficult
• Imperative to provide the vision and direction, and support it in the face of challenges.– Financial support– Marketing and community support– Strategic plan (ie. NO fryers or soda fountain in our new café/kitchen)
Executive Chef: Melissa Osterhoff
• Essential in my opinion – we did a lot of research!– Menu writing – patient and retail
• Food cuttings/tastings, evaluations, sample procurement– Standardized recipes– Recipe development– In‐house trainer for food service staff– Ordering, food prep techniques– Sounding board for RDs– Friend maker – community– Enhanced ability to cater events ‐ bonus
Executive Chef‐Within Reach
• The average hourly wage for graduates with an Associate’s Degree in Culinary Arts was $11.64 in 2011 and $13.69 in 2010. – The Madison College 2011 Graduate Employment Report
• Median pay for Exec. Chef in 2012 was $20.42/hr ($42,480/year) Great schedule and benefits compared with retail food industry
• More freedom/creativity
Chef Interview Process• Evaluate their ego• Key phrases “I don’t know” & “I’d like to learn…”• What is their definition of healthy food?• What about following/writing recipes? • Portion sizes and standardization• Food Safety knowledge/practice?• Team player? – education of staff, working closely with RDs, community events?
• Management style – even if they won’t be “the manager”, it will likely be their kitchen to run.
• Have them cook!
Registered Dietitian (RD)
• Hospitals were moving away from RDs in food service management roles‐ Trending towards bringing them back in…
• RD support is essential in healthcare. – Years of specialized training– Direct link between patients and kitchen– Keep up with trends/fads vs. research– Provide training on “the medical stuff”– Generally “foodies” – different perspective– Chef’s resource and sounding board
Food Service Team‐ Driving The Culture Change
• Administration/Manager have the vision but the team makes it happen
• They feel the growing pains the most, are on the front lines
Food Service Team – Earn Their Support
• Set expectations and share the vision, but get their input
• Teach, teach, teach! • Enthusiasm is contagious – not everyone will “catch it”• Believe in their ability and good intentions• Be willing to “just try it” r/t workflows• Teamwork is essential• Empower them to deal with unhappy customers
– Versatile menu – suggest the soup or grab‐and‐go– Freedom to give out samples– A couple of good come backs
Customer Support ‐ Internal
• This felt like the most challenging! • Ask for feedback and use it
– Informal– Formal – Survey Monkey is great– Sincerely thank folks for their feedback, whether it is good or bad
Survey Monkey
• About 10 months after Executive Chef Start Date
• We found we may have gone too far in one direction
• Remember where you are (and therefore, who your customers tend to be)!
What are you MOST favorite food items offered in the cafeteria?
• “Italian chicken dippers and steak on a stick”• “Comfort foods”• “Mashed potatoes and stuffing entrees”• “American, common foods”• “The vending machine with soda and snacks”• “Regular foods without so many spices”• “Biscuits and bacon gravy, turkey and roast beef dinner”• “Mac and cheese”• “Desserts”• “Burgers, taco salad, roast beef”• “Bacon”• “Cheddar Munchers”• “Normal food”
What are your LEAST favorite food items offered in the cafeteria?
• “The creative items”• “Unknown foods”• “Most all of them these days”• “Most of it. Not impressed with the New Chef’s choices”.• “I’m very picky so my list would be very long”• “Too much kale”• “Many of the spices on various foods”• “Food that I can’t pronounce”• “The new ‘exotic’ food”• “Some of the foods with complex flavors or trendy food”• “Goat cheese and feta”• “Greasy and processed foods”• “High carb entrees”• “Gravies and sauces should be an option to have on the side”
What changes could be made to improve the items we offer in the
cafeteria? • “Taste better”.• “I think we need to go back to the basics. We don’t want or
need fancy stuff.”• “Go back to the homestyle cooking, can the fancy stuff.
Good portions, make it yummy again!!”• “Some options that may that may not be healthy – pizza,
chicken tenders, spaghetti.”• “Don’t make the dishes complicated with spices. Make
them normally.”• “Serve more normal food”• “Go back to the food we like.”• “More fresh salads and fruit”
Survey Action PlanThe Park Avenue Café will focus on providing fresh, seasonal menus with attention to choosing healthier ingredients (low fat/fat free dairy, healthy fats, whole grains, and reduced sodium) and promoting health and wellness through food.
• Provide one Chef’s Special Entrée (complex and unique flavor combinations, follows food trends, creative) and one Home‐Style Entrée (comfort food, simple flavors, traditional).
• Allow ½ portions of easily halved items• Be sure to incorporate “favorite” items nearly monthly (roast beef, taco salad,
Mexican, Italian, burgers {beef + one alternative burger}, pizza, Panini, etc. • Have fish 1‐2 times per week• Homemade soups• Specialty salad program • Healthier snacks/more small salads available • More fresh fruit• Provide description of less common menu items, staff awareness of ingredients• Post signage encouraging people to ask for samples/set samples out • Provide friendly, prompt, courteous service
Customer Support‐ Internal
• Provide Choices• Be sneaky (substitutions, hidden veggies)• Market and promote healthy options• Know your customers• Offer samples• Stick to your overall vision but be flexible• Have thick skin
Café Menu from “BC”, or “Before Chef” – June 2013
Monday Tuesday Wednesday Thursday Friday
Creamy Chicken Wild Rice Cream of Broccoli Chicken Florentine Artichoke Chicken Noodle Cream of Potato
Meatloaf BBQ Beef on A Bun Salmon Stuffed Pepper Grilled Cheese
Reuben Chicken Cordon Bleu Hot Ham Sandwich Pot Roast Baked Fish
Potato Wedges Triple Layer Bake Scalloped Potatoes Red Potato Sweet Potato Fries
Green Beans Asparagus Brussels Sprouts Baby Carrots Squash
Chicken Salad Seafood Salad Club House Wrap Egg Salad Ham Salad
Café Menu Now – June 2015
Monday Tuesday Wednesday Thursday Friday
Mushroom Brie Soup Zucchini Noodle Soup Wisconsin Cheese Soup Roasted Vegetable Soup Chicken Dumpling Soup
Shepherd's Pie Veggie Melt Sandwich Turkey Burger Shredded Chicken Salad Mediterranean Cod
Tex‐Mex Chicken Pasta Mediterranean Chicken w/ White Bean Puree
Orange Chicken, Asparagus & Quinoa Bowl Pork Tenderloin Marsala Sloppy Joes
Pasta Panzanella Salad (tomato‐crouton) Quinoa Roasted Baby Reds Breadstick
Broccoli & Cauliflower Roasted Asparagus Steamed Green Beans Sautéed Spinach & Mushrooms
Egg Salad Chicken Salad Seafood Salad Ham Salad Tuna Salad
Logistics of Introducing Healthy Food
• Time• Oh my gosh, the dishes!• Refrigerator and Freezer space are at a premium
• Re‐distribution of work• Prioritize/Balance• Vendors/Products
Getting Started
• This was a gradual process– Started by introducing one from‐scratch item per day
– Consider individual team member’s strengths and weaknesses
• Trial and error
Rearranging Work Flows
• Think outside the box and prioritize– What is important for you to make from scratch and what could be just as good brought in?
• Jell‐O, pre‐prepped fruit and veggies
– Positions that never scrubbed potatoes or chopped carrots before now took on some of those prep tasks
– We completely changed our café supper concept to make time for prep and making soups
Work With Your Vendors
• We brought in new vendors to get the best produce, increased deliveries from 2 to 4 per week on average
• Speak up about what you want and what your standards are– We always need to see the nutrition facts– Keep and eye on sodium, sugar, trans fats, etc.
Find Balance
• With the resources we have, we can prepare 3 made from scratch items per meal
• Balance intricate, high complexity items with simple items
• Reserve the right to simplify the menu on high patient census days
Find Balance
• Not everything has to be the gold standard of healthy. Education and choice are important;– Whole wheat pasta doesn’t hold up well in the steam table – “make half your grains whole”
– We still offer soda but have brought in Naked Juices, sparkling waters, unsweetened teas, etc. and stock them at eye‐level
– We promote healthy items (larger servings of veggies, MyPlate specials, salad bar, etc.) and provide customers with resources and education to make choices (nutrition facts, exercise required to burn off this dessert, etc.)
Community Support
• Community diner base is growing• E‐mail menu each month • Senior Center, health fair and school district cooking demos, etc.
• Patients end up coming back to eat in the cafeteria because they trust us
• Testimonial: One customer started eating with us for lunch every day and lowered her cholesterol 20 pts.
Two and a Half Years In…
• We have doubled the amount of food sold in the cafeteria at lunch time
• Customers are trying food they never would have and eating more vegetables
• Word of mouth in the community is changing people’s opinion about “hospital food”
• Press Ganey Scores for patient food have improved
• You will never make everyone happy!
Cafeteria Sales in Dollars 3/16
‐3/29/14
4/13
‐4/26
5/11
‐5/24
6/8‐6/21
7/6‐7/19
8/3‐8/16
8/31
‐9/13
9/28
‐10/11
10/26‐11
/8
11/23‐12
/6
12/21‐1/3/20
15
1/4‐1/17
2/1‐2/14
3/1‐3/14
3/29
‐4/11
4/26
‐5/9
CafeteriaCoffee ShopCateringLinear (Cafeteria)Linear (Catering)
Meal Equivalents By Pay Period
05001000150020002500300035004000
3/16
‐3/29
3/30
‐4/12
4/13
‐4/26
4/27
‐5/10
5/11
‐5/24
5/25
‐6/7/201
46/8‐6/21
6/22
‐7/5
7/6‐7/19
7/20
‐8/2
8/3‐8/16
8/17
‐8/30
8/31
‐9/13
9/14
‐9/27
9/28
‐10/11
10/12‐10
/25
10/26‐11
/811
/9‐11/22
12/21‐1/3/20
151/4‐1/17
1/18
‐1/31
2/1‐2/14
Meal Equivalents
“Quality of the Food”‐ The Patient Perspective
82.683.2 80.9 83.2 85.8 88.3 86.5
6569
52
76
84
9185
0
10
20
30
40
50
60
70
80
90
100
Oct‐14 Nov‐14 Dec‐14 Jan‐15 Feb‐15 Mar‐15 Apr‐15
CCH Mean CCH %ileGoal Mean Linear (CCH %ile)
Takeaways
• It’s OK to compromise and heed feedback – if it’s healthy but no one will eat it, who cares?
• You will have to think outside the box and work harder to make healthy changes with the same staff resources
• Sticking to your vision will pay off • As a health care facility, you set the standard of health and wellness in the community. What standard have you set?