It’s the food, stupid.

You can brag on and on about your meals per man hour, your production efficiencies, your computerized back of the house, your balance sheet, your purchasing systems, your smart-looking servery. But if the customers don’t like your food, forget about it. You’re dead, doomed, out of luck.

Sometimes the food really is crummy. You may have inherited the situation, or have been brought in to turn it around. Bad food can be a one-time, accidental occurrence. Or it can be reliably, consistently bad. Just as often, the food is fine, and only its reputation is crummy. In either case, you’ve got your work cut out for you.

If food really is the issue, the cause may be a personnel or a presentation problem, or both. Perhaps the standards simply haven't been high enough and more intensive training and stronger quality assurance may be necessary.

Perception issues are more problematic. Even if the food improves, perceptions—and participation—may not. And while food quality issues are often readily identified, it can be a lot harder to pinpoint the source of an image problem. However negative opinions are formed, the danger is that they can have immediate and irreversible results.

Just ask any management company that has seen a contract suddenly put out for bid, or been brought in to turn an operation around. Or any self-op that found out its administration wanted the food upgraded only after a  contractor has been hired to make that happen. Or a liaison who’s been taken to task because of complaints that the quality of cafeteria food is negatively affecting employee productivity.

Think it’s a problem that “can't happen here?” It can.

Consultants say the best strategy for maintaining a top food quality reputation combines a proactive perception measurement and management program with quality improvement and quality assurance standards.

But theory is one thing, and reality is another. Here are four real-life strategies employed by onsite operators when they had to turn around a food quality perception problem.

The Case of the Nightmare Review

(Continued from page 1)

Barry Schlossberg remembers how that workday in the last week of June 1997 began: with the exhilarating announcement that he had been named corporate foodservice director for the new partnership of Beth Israel and St. Luke’s-Roosevelt hospitals. He also remembers how it ended: with a cover story on New York’s Best Hospitals in an issue of New York magazine he picked up at a Pennsylvania Station newstand to read on the train ride home.

Schlossberg, who had been running Beth Israel Health Care System’s foodservice for 11 years, read a positive review of his own program in the article before his eyes found the sentence, “But the food at St. Luke’s-Roosevelt is absolutely horrible.”

“Well, it was pretty obvious right then that we had a serious public relations problem and that things were going to have to change,” Schlossberg recalled recently. “New York magazine was well-read and this issue would be circulated to all the doctors and hospitals in the city.”

When the St. Luke’s-Roosevelt vice-president overseeing foodservice walked into Schlossberg’s office the next day, “I asked him to give me six months to turn it around and, if he did, I promised he’d never see that kind of review again.”

Having worked in the New York metropolitan area healthcare environment for so long, Schlossberg already was familiar with the background of St. Luke’s-Roosevelt’s foodservice department.

“The hospital had gone through some difficult economic times, there had been major layoffs in the medical center, and somewhere along the way, the push to reduce labor had led the administration to a decision to go to a nonselect menu heavily reliant on convenience foods,” he says.

Under the gun to send an immediate, loud message that the foodservice would improve, Schlossberg moved quickly to introduce choices in the menu.

“We couldn’t add any labor, of course, so we reworked the existing staff. Two hot entrées and a cold alternate appeared on the lunch and dinner patient menus within the first month. Within several months, to-order room service and menu choices were implemented for breakfast. Within the first six months, scores on Press-Ganey, a popular healthcare customer survey system that is relied on industry-wide to measure customer satisfaction, had improved by seven percentage points.”

The turnaround in food and service quality from the devastating 1997 review is still underway, according to Schlossberg. The biggest decision aimed at improving quality and control was the move to centralize all patient food production for the entire Continuum Health Care System (which includes Beth Isarel, St. Luke’s-Roosevelt, and three other New York-area hospitals) in the huge cook-chill facility that had been standing unused at St. Luke’s-Roosevelt. Directors from all affected units were brought together last summer to construct the new menu. Production equipment was moved from Beth Israel to St. Luke’s-Roosevelt, cooks were transferred, tray lines redesigned, rethermalization systems improved and training sessions scheduled.

The new restaurant-style patient menu offering 10 choices at lunch and dinner was introduced in February.

In a total reversal from the former reliance on convenience foods, all items except pizza and lasagna are produced from scratch. “In the old system, even the meatloaf was a convenience food,” says Schlossberg. “Now, when we have mashed potatoes on the menu, we start with raw, unpeeled potatoes.”

“It was a slow night at the city desk...”

The decision to offer newly formulated burgers in the Denver Public Schools was totally justifiable and the switch had been extensively student-tested and student-approved, but the media fall-out was potentially devastating.

In blind taste tests, students at all grade levels in all areas of the city had said they preferred the burgers which, unknown to them, contained small amounts of prune puree.

“We had been working with the California Prune Board on other product testings and we had been using prune puree very successfully in the baked goods we serve in the schools. The addition of the puree reduced the fat content and kept the product more moist,” says Donna Wittrock, foodservice director for Denver Schools. “When the Prune Board wanted us to sample meat products containing puree, we saw no problem with it.”

The burgers hadn’t made it onto the school menus last September when the California Prune Board released news of the successful student taste tests on a national news wire service. The story was picked up by Denver’s Rocky Mountain News and a reporter phoned Wittrock for more details about the new formulation of the burgers. That interview resulted in a local newspaper article with a very positive spin, according to Wittrock.

But then local talk radio hosts picked up the story and all chances of maintaining positive coverage flew off the airwaves. Wittrock says, “there were jokes about kids needing more bathroom breaks because of all the prunes in the burgers and there was talk about the mystery meat being served in the schools. I got calls from my managers all across the district that kids weren’t buying the hamburgers. At certain schools the numbers dropped from 200 hamburgers a day to 20. The word was getting around and we saw the impact on sales.”

Wittrock had legitimate reasons to taste test the new burgers. “We get prune puree through the government commodity program, so there are cost advantages to using it,” she says.

“You’ve got to keep in mind that the puree constitutes only three to five percent of the burger ingredients. But that small amount lowers the fat content by 38.4% to 9.3 grams. And the taste is really superior. My staff tested them first against the burgers we were currently serving and the new burgers were juicier and tastier and held up better on the line.

As the publicity continued unabated and burger sales continued to plummet, Wittrock sent out a letter to all foodservice managers informing them that the burgers currently being sold in the schools contained no prune puree and that the burgers containing the puree had been served only in the taste tests.

Delivery of the reformulated burgers was still months off. In the midst of the coverage, Wittrock served platters of “prune burgers” and current burgers to the seven school board members in a blind test. Six of the seven preferred the taste of the burgers containing puree.

The media deluge escalated. Television stations wanted to send crews into the cafeterias to follow up on the story. Print media wanted to interview students. And the radio hosts wanted on-air interviews. Wittrock called her school district public information office and asked for help.

“I was really concerned about the integrity of the program at this point,” says Wittrock. “My boss was concerned—naturally—about the damage that this publicity could cause the program. He suggested we call the California Prune Board for assistance handling the media. After all, they had issued the first release. That’s what we ended up doing. All calls that came into our offices were referred to them.

“As I look back I am not certain what I should have done differently. I know I’m serving a product that is lower in fat. I know kids like the taste. If kids wouldn’t have liked the burgers, we wouldn’t have chosen them. I suppose thinking about it now I should have thought through the subject and idea of prunes a little longer.

“I keep hoping it will go away, but as late as December there was a conversation on talk radio where one of the hosts was complaining about a visit he had made to a local restaurant where he said he had ‘the worst meal he had ever eaten.’ The other host said ‘it couldn’t be any worse than prune burgers in the schools.’ So it is still out there as a topic.”

The Revenge of the Vocal Vegetarians

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New College of the University of South Florida, a small, prestigious state honors college in Sarasota, Florida, had some things to smile about when The Princeton Review published its 1997 Student Advantage Guide to the Best 310 Colleges. New College made the lists for “most politically active” and “best dorms.” But the same guidebook also gave New College the top spot for “worst food.”

Even The Princeton Review’s own publishers have admitted that the guide’s rankings are based on an “unscientific survey” of current students at the colleges, but a bad review in the popular guidebook still has national exposure. Dave Glaser, coordinator of public affairs for New College, says the general consensus at the time of the ranking was that “the large number of very vocal vegetarians on campus” had a lot to do with the low food rating because they had been complaining that foodservice didn’t cater to their dietary requirements.

The bad publicity didn’t stop with the annual guide. The Sarasota Herald-Tribune ran a follow-up story on the “worst-grub honor” headlined “Dieting No Sweat at New College.” Glaser says a local television station crew filmed a blind taste test on campus in which a plate of food from the local hospital’s cafeteria and a plate of food from the New College dining room were subjected to student taste tests. The hospital plate won.

“In all honesty, we had a lot of fun with it when it happened,” says Glaser. “There were posters and jokes and a lot of talk among the students in the dining room. The only one who definitely wasn’t laughing was the representative from Marriott.”

In response, the staff at the contracted foodservice, now Sodexho Marriott, went to work with an aggressive effort to open lines of communication with the students and to make a major menu commitment to vegetarian items. They were rewarded when the next year’s edition of the annual Princeton Review guide noted that “the foodservice is rapidly improving (at New College) but still has a way to go.”

Jerry Dixon, Sodexho Marriott’s foodservice director at New College for the past 18 months, has immersed himself in the restrictions, recipes, and variations of the vegetarian movement. Key to his success in turning the program around is a student vegan consultant. The first to fill the position was “the student who asked me the most detailed questions,” he says. The student consultant is paid “slightly more than minimum wage” for several hours each week spent consulting with the cooks and Dixon on the vegetarian menu.

“We needed to communicate with the students,” says Dixon, “because the requirements on the different vegetarian diets can be very complicated. We make a real effort to let them know everything that is in our food.”

The student consultant has access to all the recipes, access to the cooks, and access to the production area and ingredient room. He/she is in charge of writing the ingredient cards that are placed at each serving line station. The cards list the major ingredients as well as the ingredients within the ingredients. Some of the cards are 40 items long.

“I know more about vegetarians than ever before but even I don’t know as much as the students,” admits Dixon. “They know more about the vegetarian food supply than any corporate procurement person. They can tell me when there is going to be a shortage of soy milk because of a strike someplace in the world. Statistically 50% or more of our students consider themselves vegetarians but there are many varieties. We’ve got the ovo-lacto who eat eggs but no dairy, the traditional vegetarian who eats no meat but is fine with dairy, some who eat no sugar because it is refined and some who won’t eat honey because of the enslavement of the honey bee.”

Of the five entrées on the menu at lunch and dinner, two are regular meat items and three are vegetarian. Of the three, one contains cheese and one a protein source.

“The recipes are more labor intensive because it takes time to chop and dice fresh vegetables and they often require more ingredients to get the taste the kids want,” says Dixon. “We solicited recipes from students—including a curried sweet potato and lentil stew—and some from Sodexho Marriott files, like a curried bulgur wheat entrée. The student consultant is there when we are developing recipes to let us know that if we include a particular ingredient, more people won’t be able to eat it.”

Shifting Emphasis from the Budget to Quality

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A new administrative team at Burlington Medical Center, Burlington, Iowa, decided it was time for a shift in the center’s operating philosophy and community reputation. From their predecessors, the administrators had inherited a center with a robust balance sheet and sufficient cash to pay for a significant amount of new construction that was on the drawing boards.

“Within our geographic area, we have market dominance but our image was not what it should be,” admits Mark Richardson, the new chief executive officer.“We wanted to shift our reputation within the community from one of budget conservatives to one of service and quality.”

The new emphasis was developed after extensive surveys and focus groups with community members, physicians, employees and patients. The research was designed to measure the current status, identify areas for improvement and serve as a benchmark for the coming changes.

When the medical center’s foodservice scored a basement level rating of 3% on the Press-Ganey patient satisfaction index, Paul Deignan, the center’s foodservice director, also new to the job, was not surprised.

“The entire philosophy of the organization had been budget driven,” he recalls today. “The financial priorities of the organization took precedence. There was minimal training and everything was done as economically as possible. The attention to quality just wasn’t there.”

This budget-driven philosophy translated into minimum menu variety, minimum choices and minimum equipment investment.

“Moving to an emphasis on quality has been difficult for employees,” admits Deignan. “It is difficult for people who have lived in a constrained economic environment to subscribe to the philosophy that quality saves money. But that is the message the new administration wants to get out.”

In foodservice, the quality changes included the addition of two FTEs and the introduction of restaurant-style patient menus. Refrigeration and beverage bars were installed on patient floors. A dietitian who had spent one day a month with foodservice now consults two days a week.

In the nursing home, big print menus were introduced and family members are encouraged to help the patients make selections. An attendant was hired for the communal dining room, food is served on china and placemats.

Food tastings were introduced and holiday parties to which family members are invited. Labor costs in foodservice have risen by 13% and 11% in each of the last two years, primarily because of the extension of benefits to employees who were moved from part-time to full-time status, but overall foodservice costs have increased by only three-tenths of one percent per patient day.

In the most recent Press-Ganey survey, the nursing home foodservice satisfaction score was 84%, among the highest in the hospital complex. Both Richardson and Deignan expect the hospital foodservice’s numbers to show comparable improvements with the changes introduced by a chef newly arrived on staff who is reworking the patient menu and will be training employees.