Room service dining for patients is all the rage in hospital foodservice. Figures from the National Society for Healthcare Foodservice Management (HFM) show that 37 percent of respondents to an HFM survey earlier this year indicated they have implemented room service dining in some way, a quarter of them within the past year. Many more say they plan to do so in the near future.

But those broad numbers obscure a very important caveat, which is that there is little uniformity to how room service is deployed in different hospitals. Some provide it almost universally, while others limit it to select units. Some use staffers as order takers while others leave it to patients to call in menu requests by phone. Some deploy a single common menu, while others let patients see only their diet-specific selections. Some adapt basic, traditional dishes to the new ordering model, while others design elaborate menus, sometimes in multiple languages.

One thing is certain, though. Room service is a sea change for healthcare patient dining, putting the customer in charge.

That can be disconcerting for dining services departments used to controlling meal delivery schedules, but it also has major impact on other departments. Nursing, for example, can no longer depend on regular mealtimes to administer medicines that must be taken with food, and labs have to account for meals taken at odd times when scheduling procedures that require a period of fasting.

Sizing Up the Cost

Operationally, converting a hospital kitchen to room service means going from mass production to customization, from steam kettles and convection ovens to charbroilers and griddles, and from traylines to hotel style cook stations and tray assembly areas.

“Real estate is a key factor,” says Ellyn Luros-Elson, president of Computrition, Inc., a major vendor of nutrition software for healthcare applications. “How is the kitchen is laid out and how far do you have to take the food? Traditional hospital kitchens often don't have space where you can do grilling, for example.”

That was the situation facing Patricia Ours, director of food & nutrition services at Reid Hospital in Richmond, IN, when room service debuted there in 2005. “The cooks prepared the hot items and then we had to cart it to the other side of the kitchen for assembly,” she says.

However, that is no longer an issue, since Reid opened a brand new hospital in September with a kitchen designed for room service. Now, the hot and cold areas face each other so trays can be prepared quickly.

Other key issues: orders have to be double-checked to make sure the guy with the triple-bypass isn't trying to sneak a cheeseburger, and then transmitted quickly to production so that components can be prepared and the tray assembled.

“You have a window of about seven minutes to plate an item,” says Gary Conley, president of the Room Service Technologies consulting firm. “Much above that and you won't get it to the patient in the promised 45 minutes.”

Consequently, many departments use automation that quickly cross-checks orders with dietary restrictions and kicks order tickets to hot and cold prep areas simultaneously, helping to meet the short time window.

Implementing room service also means a significant labor commitment, as it almost always requires not just adding FTEs but a different kind of labor — more customer-friendly, flexible and multi-skilled — from what the closed-environment, clockwork routine of traditional hospital traylines demanded. In union shops, job descriptions have to be rewritten and posted (for an expert take on how room service changes the employee culture and how to deal with that, see the column at right).

Increased labor, new equipment and infrastructure changes are costly but, unlike hotels, where guests pay for room service up front, hospital room service doesn't charge, at least not directly. Furthermore, with no menu prices, each meal is in effect reimbursed at the same rate, despite varying food costs.

Fortunately, most hospitals have found that patients don't regularly order the most expensive selections. Still, the issue underlines the importance of designing a room service menu balanced between premium selections and attractive options that have lower food costs.

Given all these challenges, the natural question is, why do it?