I am taking notes at a small round table that's jammed into a corner of Dan Henroid's office at the University of California-San Francisco's Medical Center (UCSFMC).

Like everywhere else in this city, space here is at a premium. The room is densely packed with stacks of papers, books, filing cabinets, rolled blueprints and reports. Despite this, you do not get a sense of disorganization — just that a lot is going on and that Henroid has a lot of balls (and ideas) in the air at one time.

At the moment, he's focused intently on a small sketch he started as we talked about his approach to planning. Henroid (MS, RD, CP-FS) is big on process and a systems approach to just about everything, from project management to POS data and food production analysis.

The sketch is actually a flow chart showing how the hospital's foodservice and nutrition functions share information with each other. The little ovals show various data sources across its operations: a network of temperature-monitoring sensors, bar code readers in retail operations, special diet meal orders on the patient tray line and more. One project the department is working right now, he says, is to eliminate the paper-based diet orders from physicians, replacing them with a digital record approach.

His point is that there are many opportunities — and payoffs — to connecting ongoing processes and data streams.

A focus on retail

A few minutes later, our conversation veers to the recent renovation of the Moffitt Café, UCSFMC's main cafeteria, and the c-stores it uses to handle overflow and extended hours traffic. The rolls of blueprints behind him are from those projects, and they remind me of the quick visit I paid here last summer, when the main café space had just been gutted and was in the early stages of reconstruction.

Also, although this is a medical center, as a part of the UC system it's required to embrace the system's aggressive sustainability goals. Henroid's department is well along this path on everything from procurement policies to composting, as it is with several other initiatives.

“I inherited a very strong team here,” Henroid begins. “Our clinical services are very respected, so we focused on the retail side from the beginning.”

“I believe that what people perceive in the front of the house strongly affects the perception they have of what you are doing in the back for serving patient meals. For example, nurses are key influencers of perceptions that patients and others have of the facility and of meal and other services. The perceptions they have of our food and service are important in making sure patients are satisfied.”

When Henroid arrived at UCSFMC in late 2006, there was a $350,000 capital project in the works that would have fixed the worst problems of the existing café.

“But operationally, it would have taken us backwards,” he says. “Our existing servery was in poor shape, but it did have custom counters and other touches. The plan called for replacing these with modular components that were functional, but would not have provided the look and feel we needed to grow the business. And we clearly needed to do that to improve our financials.”

Retail sales in the existing cafeteria and c-store were $3.5 million in 2006, a healthy sales volume, but without enough margin to fully cover the region's high operating costs. Working with consultants from Robert Rippe & Associates and DM&A, the group projected that with the right improvements, enough retail business potential existed to take sales to $6.5 million. Along with other changes to enable efficiencies, that would let the operation cover its costs and help it achieve other stated hospital goals, such as improving employee satisfaction with the work environment.

Henroid says the hospital's COO at the time was committed to making the second floor (a main thoroughfare for many administration employees, visitors and staff) a much more welcoming and contemporary place.

“This is one of the premier acute care hospitals in the country and she wanted our dining facility to reflect that sense for the employees,” Henroid recalls.

He successfully worked at getting her approval to pursue an alternate design and capital improvement investment, illustrated with drawings from the project's assigned architect and project manager. The $6.5 million alternative proposal was funded in 2007.

Like most large medical centers, UCSFMC had long struggled with capacity challenges during peak lunch service periods. The project team knew an improved cafeteria experience would create an even greater demand, and so a major focus of it was on strategy to help speed up service and traffic throughput.

The plan had to address many other constraints: low ceilings that could not be raised; pillars and support walls that could not be moved; fire regulations that required the retention of an existing fire exit; limits on drain and electrical panel placement; environmental regulations that required particulate scrubbing on the new hood exhaust system; seismic regulations requiring every piece of equipment weighing more than 20 pounds to be bolted to the floor or the counter. Further, the existing cafeteria footprint could not be expanded.

Adding convenience capacity

One strategy important to managing foodservice demand during interim construction was the creation of a micro c-store on the building's 9th floor in 2008 and the creation in 2009 of the Moffitt Café Express, located just outside of the cafeteria entrance (see sidebar).

“The Moffitt Café Express was a huge success and gave everyone a taste of what we were planning to accomplish,” says Henroid. “It helped communicate to our customers that the renovation's temporary inconveniences would be worth it later on.”

With the c-stores up and running, the renovation moved into Phase 2 and the existing seating area was partitioned off. It became a makeshift grab-and-go service area, retaining only 50 seats out of its original 400. Behind the partition, the main servery was gutted and construction got underway.

Splitting the incoming traffic

Meanwhile, the design continued to evolve with the project team keeping its focus on the core challenge: modifying the space and production model to scatter customers more quickly, offer them more choices and move them through the servery more efficiently. It called for an increased number of entree stations (to seven, from the former four) as one way of reducing lunchtime queues.

Another goal was common to most contemporary onsite café renovations: introducing enough out-front cooking and finishing work to give the sense of fresh food preparation. This would also reduce the need for constant in-service re-supply deliveries from the central kitchen down the hall, where most cooking had formerly been done.

As one enters the fairly narrow servery entry from the second floor hallway, customers now face a digital greeter board which splits traffic to the left and right. To the left are well merchandised deli sandwich and stone hearth oven-outfitted pizza stations. These emphasize selections that are for the most part ready-to-go. To the right are grill and entrée stations, supported by modest cooking facilities, and which appeal to customers seeking traditional comfort foods.

In the center, behind the kiosk, is a large oval island that offers (on its left bank) an attractive self-serve salad bar; and on its right, a made-to-order Mexican station that doubles as a tossed-to-order salad station. Servers inside the island can refresh both areas from under-counter refrigerated coolers and interface with customers without blocking traffic. Refrigerated storage is built in under many of the other station counters as well, keeping additional prepped ingredients close at hand during high volume periods.

Towards the rear, a Chef's Table offers daily specials during lunch and dinner and made to order breakfast offerings in the morning. It was designed so that different pieces of equipment (woks or a sauté station) can be changed in and out via a custom lockdown for different menus on different days.

Room for the new stations was eked out of the existing café layout by careful sizing of the new stations and the elimination of a secondary cashier station and fountain beverage area that had been located near the café entrance.

To help address the longstanding bottleneck at checkout, there are now six cashier stations, extending into the seating area. Moving them out in this way freed up room for the relocated fountain station and a large refrigerated air screen merchandiser for bottled beverages.

In the end, this required a modest reduction in seats (from 400 to 366) but these were reconfigured for greater flexibility. There is now a greater variety of seating options, ranging from two-seat tables to others for four, six or eight diners, as well as large tables for groups.

Checkout times were also sped up by eliminating the previous “by the ounce” salad bar model (and its cashier station weighings). Customers now fill portion-controlled salad takeout containers that are charged at a flat rate price for a quick checkout. The salad bar “is our second highest grossing station after the grill,” Henroid adds.

The grill station, always prone to long queues, had its menu simplified. And the deli station, rather than emphasizing made-to-order options, was designed to attractively merchandise a variety of pre-prepared sandwiches, appealing to customers the minute they walk in to the café.

Limited Room Service Options

All this emphasis on upgrading retail operations does not mean that the patient side of UCSFMC's food service has been overlooked. An aging kitchen and labor constraints have combined to mean a select patient menu system is still the best solution within its budget, but the department has changed from its former three week, restaurant-style lunch and dinner menu rotation to a uniformed host/hostess program with a seven day select menu. Tray presentation has been redesigned with a greater emphasis on garnishes, small ceramic casserole dishes and other features that make patient meals appear more customized.

Henroid says that while “on-demand” ordering isn't currently feasible, “We make sure every patient and family are treated in ways that make it clear the program is geared to their needs and that they have an experience in which service options are clearly provided.”

Last year it put a room service program in place for the UCSF Benioff Children's Hospital that now does about 150 meals a day from an upgraded room service work area created in the kitchen as part of the café renovation. Though an increase in labor was requested to offer room service for the entire hospital, only a nominal increase was approved. Still, this will enable them to extend room service offerings to a 42-bed oncology/bone marrow transplant unit next year.

The hospital's catering activities remain robust, although at $2.2 million/yr, are somewhat behind pre-recession levels. According to catering manager Steve Shorette, a majority of this business is done for the university and is for small drop-off events, with about 5-8 larger receptions a week. (Because the school is largely a graduate institution, without an on-campus residential dining operation, it has no foodservice department of its own).

“Our catering is basically a break-even service proposition,” says Shorette. “The school has a totally open policy in terms of using outside caterers, but we emphasize that when our clients give us the business, the money cycles back to the institution. That image has helped us,” he adds.

Exploring internship options

Henroid has also taken a major interest in advancing UCSFMC's dietetic internship program. It is one of the oldest accredited programs of its type in the western half of the country, and he has sought to introduce increased emphasis on management and entrepreneurship skills in its program.

His own career in healthcare foodservice had an auspicious kickstart as a result of undergraduate and graduate internships he had at Penn State and at Southern Illinois University at Carbondale (SIUC).

“They were some of the most important points in my career and on influencing my decision to embark on a career in foodservice management,” Henroid says. “I received a NACUFS paid summer internship between junior and senior years when I was an undergraduate at Bradley University. Spending time in Penn State's dining services department then was a real eye opener for me. Going from a school with 6,000 students to a big one like Penn showed me the breadth of career opportunities that existed on the management side.”

Later, Henroid had similar experiences during the SIUC dietetic internship he did at St. John's Mercy Medical Center in St. Louis and his first management job as a foodservice supervisor at Rush University Medical Center in Chicago.

“It was at a time when Rush was preparing to install a new central kitchen and when Linda Lafferty, Mary Gregoire and Rebecca Dowling were all publishing research there,” Henroid recalls. “It was a great opportunity for someone just out of school to learn best practices about running a large department.”

Henroid says he would like to see the Association for Healthcare Foodservice (AHF) develop an internship program similar to the one NACUFS has in the college segment. He is developing such an internship at UCSFMC in the next year, “something that could be seen as a ‘proof of concept,’” he adds.

“We need to look at the demographics of this profession and do things to engage the next generation and encourage them to see it as a viable and challenging career option,” he says.

A Champion of Sustainability

As part of the University of California system, UCSFMC is expected to follow its ambitious sustainability policy, which affects everything from compliance with certain LEED standards in major renovations to sustainable procurement sourcing, energy management and the implementation of recycling and composting programs.

UCSFMC has not reached all the policy’s goals but has made significant progress towards many of them. For example, it calls for medical centers to have 20 percent of food purchases meeting sustainability criteria by 2020. “We are approaching 10 percent this year and hope to hit 15 percent by the end of 2011,” says Henroid. The policy defines sustainable food as having been produced within a 500 mile radius, and Luis Vargas, UCSFMC’s procurement manager, has worked closely with Bay Cities Produce, a local distributor, to identify and use sources meeting that criteria. As part of that arrangement, farm, packer, country and state origin information is provided to them at the invoice level.

The department’s recycling and composting program is likely one of the most mature in the segment, with between 84-87 percent of all its waste being recycled or composted. It eliminated foam disposables a year before the city itself mandated that change, and has developed a program to internally sort the waste streams from both its retail and patient foodservices operations, working directly from the café tray return belt and the kitchen scrape line. Clean compostable waste goes directly to a composting facility. “If you do consumer side sorting you never know how reliable it is,” Henroid observes. “We were afraid that doing it internally would slow us down, but our employees really got behind the idea and have found ways to efficiently integrate it into our operations. The value of sustainability does not have to be sold here.”

(You can read or download a pdf of the UC sustainability policy here: http://www.universityofcalifornia. edu/sustainability/documents/policy_sustain_prac.pdf)