At a Glance
UCLA Health System: the Ronald Reagan UCLA Medical Center (includes Mattel Children’s Hospital UCLA and the Resnick Neuropsychiatric Hospital at UCLA) and Santa Monica UCLA Medical Center and Orthopaedic Hospital
Beds: Westwood: 520; Santa Monica: 315 (266 after renovation)
Retail outlets: 4
Annualized Retail Meals Served: 3.3 million
Annualized Retail Revenues: $13.4 million
Cost/Patient Meal: $5.30 (incl. $2.30 food cost)
Annual Operating Budget: $19.6 million
Budgeted FTEs: 252.4
Annual Catered Events: 6,000+
Key Personnel: Paul Watkins, JD, associate director of operations for UCLA Hospital System Real Estate/Support Services; Patti Oliver, MS, RD, MBA, director of nutrition services; Lawrence Harvey, assistant director of nutrition services; Gabriel Gomez, executive chef
Sometimes it takes an earthquake to shake things up.
Take the dining operations at UCLA Health System's main hospital facility in the Westwood section of Los Angeles. A year ago, it operated out of an antiquated kitchen that prevented any real deviation from a traditional trayline system. Meanwhile, retail operations centered around an equally dated café that had not seen significant upgrades in many years. It was well managed but limited by its infrastructure.
Today, a short 12 months later, the hospital boasts a model room service dining program, with to-order patient meals flowing from a modern kitchen custom designed just for that kind of production. And its retail operations are now augmented by a thoroughly modern dining commons with a series of fresh food stations serving a mix of ethnic and traditional dishes fitted expressly to meet the expectations of the local customer base.
The catalyst for this change: the Northridge earthquake, which hit the Los Angeles area in 1994 and prompted the state legislature to require California hospitals to move their acute and intensive care units to earthquake-resistant structures by 2008. After weighing the high cost of retrofit options for its existing structure to meet the mandate, UCLA decided to build a brand new facility instead.
As a result, UCLA Health System's nutrition services department — long starved of major capital funds — got itself cutting edge new facilities in the ultra-modern Ronald Reagan UCLA Medical Center complex, opened last June to “hospital of the future” raves (see sidebar).
It's both an enviable position and a challenging one for Nutrition Services Director Patti Oliver. After all, with the new facilities came raised expectations for both patient satisfaction and retail success.
Since taking over direction of the department in 2005, Oliver worked hard to ensure that the new construction would position her department for the challenges it would face in coming years.
Now it's time to begin putting that groundwork to the test.
A Chance at a Start-Over
Oliver took over as director knowing that the move to the new building would eventually be made (the original 2004 opening of the Reagan Center was pushed back several years, giving her an opportunity to add her input to the plans.)
Undoubtedly, the key opportunity presented by getting a new facility was the chance to implement room service, something that was not really feasible in the original building because of structural impediments.
In early 2006, UCLA Health System contracted with consulting firm Room Services Technologies LLC to work out the plans for designing a kitchen specifically adapted to the kind of room service dining program needed by the facility's critical-patient-heavy population (of the Reagan Center's 520 inpatient beds, 154 are in intensive care, a very high ratio).
“We have some of the sickest patients in the world here,” Oliver says. “Many are undergoing transplants or other very serious procedures. In addition, we also have a diverse range of patient populations requiring different kinds of meal delivery — pediatric, oncology, eating disorders, cardiac care, ketogenic. I'm really running about four different kinds of room service programs, not just one.”
Those different models include a hybrid day-ahead ordering system for ICU patients who are usually incapable of — or not inclined to — order meals themselves. In these units, department ambassadors come in once a day to take orders for the next day, rather than at each meal period.
“ICU patients are often hooked up to tubes with lots of people around them,” Oliver explains. “Our ambassadors often felt reluctant to interrupt a procedure.” By taking orders once a day, the interruptions are minimized. “The patients still get the meals they ordered at the times they want, but we stay out of the way as much as possible,” she says.
In the neuropsychology units, patients eat together in small groups as part of their treatment, so the meals have to be delivered together at specific times. This often means producing and delivering 75 patient trays right in the middle of a mealtime rush.
“The patients are very specific as to the group they are in, so the meal carts have to have a specific number of trays at a specific time because they are in group therapy the rest of the time,” Oliver explains.
Customizing Room Service
To overcome this logistic hurdle, Nutrition Services developed a protocol in which the meal tickets for the neuropsych patients (they get to choose what they eat from the room service menu) are printed in batches so they can be prepared without overwhelming the kitchen and delaying orders coming down from other units.
“You can't print 75 tickets at once and then tell people not to order while you're filling them,” Oliver says. “This way we can fulfill a batch, then assemble the other tickets that were printed over that time before printing another batch for neuropsych.”
Batching is also used to fulfill liquid diet orders. “We found that most people on liquid diets can't really call in their orders because they are really sick, and even if they did, what choices do they really have?” Oliver says. “So we started preprogramming the 30 to 40 clear liquid trays we need per meal period.”
A separate challenge was posed by the emergency room, where patients often have to spend considerable time waiting for beds, given the hospital's high occupancy rate. The solution: a system in which nurses fax in orders from patients.
It lets nurses control the amount of food flowing to ER from the kitchen but it adds another layer of complication to the ordering system.
Even in the “regular” room service program, there are challenges. While around two thirds of UCLA Health System's patients at a given time are on regular room service, many are on restricted diets of one sort or another, necessarily reducing the available choices. That makes a difference as time goes on and a patient is faced with the same limited options day after day.
To alleviate the monotony, Executive Chef Gabriel Gomez visits with extended stay patients once or twice a month to work out some custom meal choices. Oliver says this was especially gratifying recently with a pair of long-term pediatric patients, one of them a strict vegan teen. Gomez talks to the patients and then works with staff dietitians to develop meals that break the monotony without breaking diet restrictions.
While room service at the main hospital only started when the Reagan Center opened last summer, Oliver had been testing the concept for several years before that at the other facility where she oversees dining, UCLA Health System's Santa Monica branch, about 10 miles from the main campus.
A traditional community hospital, Santa Monica was also structurally more capable of converting to room service without a major renovation. Unlike at the main facility, where a massive fixed trayline dominated the kitchen space, Santa Monica's kitchen was modular and could be disassembled in sections.
Not everything translated. Serving hours are different at Santa Monica as opposed to Reagan. At Santa Monica, room service is offered from seven in the morning to seven at night to accommodate a geriatric population used to earlier dinners. At Reagan, “seven is too early to shut down and we ended up extending the call center to 7:45 to take orders,” Oliver reports. “In the morning, we backed it to 6:45 because everybody calls by seven to get their breakfast orders in.”
Santa Monica will be getting new facilities in the next couple of years as an ongoing construction project proceeds. Unlike the Reagan Center, which is one building, Santa Monica will encompass four separate towers, which are being built successively. One is already open. The next two, one with the new cafeteria on its first level and the other with the new central kitchen in its basement, are both scheduled to open in the latter half of 2010.
When completed, the new kitchen will contain production both for the room service program and for the retail operation. The café will feature eight serving stations, including the facility's first-ever espresso cart, as well as deli, hot entrée, grill, pizza, display cooking and made-to-order sushi stations and a branded El Pollo Loco outlet.
The patient menu at Santa Monica is the same as at Reagan, though the diet orders are not as complex, with nine different specialty room service menus in addition to the regular menu.
A Surge in Retail
The new Reagan Center has also strengthened retail food sales, despite a price increase in the new dining commons made necessary by rising costs. Oliver tried to mitigate the increase with different and higher-end choices in the new venue.
Selections include charbroiled chicken selections from the café's branded El Pollo Loco station, fresh sushi, traditional grill and deli favorites, prepared and build-your-own salads, soups, several daily entrees, a daily healthy choice special, a daily international selection and a variety of grab-and-go items.
Sales have remained strong despite the recent economic downturn, a development Oliver attributes to the prices that, despite the increase, remain very attractive compared with the street. “Where else,” she asks, “can you get a salmon dish with two sides and a drink for $7?”
Despite the new dining commons directly across Westwood Plaza, the previous cafeteria, Café Med, continues to operate in the old building, which now houses medical offices. Oliver says she plans to keep Café Med open to serve the building population, who seem to prefer their own dining venue.
Overall sales have been boosted by a new POS system installed in all retail locations that enables transactions made with Bruin Cards, the debit facility available to all UCLA students and staff at both the medical center and the adjacent university.
With some 10,000 onsite staff — doctors, nurses, administrators, support personnel as well as students from the affiliated medical and dental schools — plus thousands of visitors, UCLA offers plenty of growth potential for retail sales. With the new facilities, Nutrition Services is well poised to take advantage.
Dining After Dark
Unlike the other major onsite segments, hospitals commonly support 24-hour foodservice to accommodate night shift staff. Vending is traditionally the default choice for overnight meals, but many hospitals prefer to offer something more substantial, if only to communicate to overnight staff that they are valued.
That was traditionally the solution at UCLA Health System until the January 20 opening of an overnight café inside the new Ronald Reagan UCLA Medical Center. Located not far from the main dining commons, which operates from 6:30 am to 10 pm weekdays (7:30 am - 8 pm on weekends/ holidays), it is designed to bridge the graveyard shift gap by offering a more comprehensive onsite dining option than vending only can provide.
The café serves a selection of prepared salads and sandwiches, hot soup, snacks, baked goods and even sushi and prepared kosher meals. Gourmet coffee drinks, juices and other beverages round out the offerings.
It serves not only the hospital’s overnight staff, but also patients and families waiting for beds in the emergency department. “We usually have about 20 people waiting for beds in ED, where there aren’t any convenient ways to get something to eat,” notes Nutrition Services Director Patti Oliver. “Also, there are families who can be here for 24 hours or more, waiting along with patients. The overnight café gives them a convenient way to get something.”
She says the café has been meeting its nancial goals in the early going. “We didn’t expect to make money but we’re more than covering the labor cost and even increasing sales with each coming week.”
The café staff generally consists of two people, with one handling checkout and the other making drinks at the espresso machine. Oliver says she has built traf c by merchandising the new overnight service through internal e-mail notices as well as through physical signage in areas like the emergency department.
It was worth the wait, most would agree. When UCLA Health System decided to build a new main hospital facility following the 1994 Northridge earthquake that damaged its original building, plans called for completion by 2004. Cost overruns, construction delays and design changes pushed the opening back four years, but when the facility nally became operational on June 29, 2008, the oohs and aahs drowned out any grumbles.
Designed by C.C. Pei in collaboration with his father, renowned architect I.M. Pei, the 10-story, 1,050,000-sq.ft. structure features all the latest in hospital layout and technology. The 520 large patient rooms (there are also an additional 61 short-term beds) have large windows to let in natural light and provide terri c views, as well as daybeds for visitors and wireless internet access. The beds in ICU are accessible to nurses and doctors in a 360-degree radius, while oor plans in the surgical units are modular to allow easy accommodation to changes in medical technology.
One of the rst total hospital replacement projects to be built in accordance with the latest California seismic safety requirements, the Reagan Center is designed to remain functional even after a 8+ magnitude earthquake.
Occupying four acres off Westwood Plaza on the UCLA campus, the Reagan Center also houses the Stewart and Linda Resnick Neuropsychiatric Hospital at UCLA and Mattel Children’s Hospital UCLA.