At A Glance: Ronald Reagan UCLA Medical Center
•New 525-bed hospital designed to be room servic-friendly
•The new hospital, which opened June 29, 2008, was designed by I.M. Pei, the architect who designed the Louvre Pyramids in Paris
•7,000 meals are served each day in the Dining Commons, Cafe Med, patient dining and catering
In hospitals across the nation, operators are making the switch to room service to provide restaurant-style service for their patients. For many operators, that switch is often a slow and painful one. One of the biggest challenges is the design and capability of the hospital’s layout and kitchen. As a result, many hospitals offer room service only to select patients in certain wings, and some spend significant dollars to renovate existing kitchens to enable room service.
Patti Oliver, director of nutrition services at UCLA Medical Center in Los Angeles, is one of the fortunate few. When her department made the switch, it did so in a hospital that was specifically designed to cater to room service. After an earthquake damaged the original hospital in 1994, hospital administrators decided that a new hospital would be built to comply with strict regulations requiring buildings to be constructed to withstand an 8.0-magnitude earthquake. The new hospital, renamed Ronald Reagan UCLA Medical Center, opened early last summer, across the street from the old site.
Room service: “We knew a lot of hospitals were going to room service to increase patient satisfaction,” Oliver says. “We were not able to start room service in the old hospital, which obviously would have been the better thing to do to work out all the kinks before moving to the new hospital. But our kitchen was not designed to be room service-friendly, and we would have had to do a lot of renovations. Obviously when you are spending all this money to build a new hospital, that wasn’t possible. So we waited.”
Called Signature Dining, the Medical Center’s room service is “upscale, like you’d have in a five-star hotel,” according to Oliver.
The system is “ambassador based,” with each floor having two ambassadors—foodservice workers who function much like servers or waiters. The ambassadors are the face of the foodservice department and have one-on-one interaction with each patient three times a day. Ambassadors work three, 13 ½-hour shifts per week for consistency with patients. When room service first began, ambassadors worked eight-hour shifts, meaning the same ambassador visited patients for breakfast and lunch and a different ambassador visited patients for dinner. This created high customer satisfaction scores for breakfast and lunch, but dinner’s scores were lagging. Ambassadors explain the system and bring menus that comply with each patient’s specific diet. There are 13 different patient menus—pediatric, vegetarian, carbohydrate controlled, etc. Oliver says the difference in patient menus from the tray line at the old hospital and room service at the new hospital is extensive. Before, menu items had to be able to withstand the time spent waiting on a tray line to be sent up, which was nearly 90 minutes due to the large number of patients. “So whatever it was you were serving, it had to hold up that entire time,” she says. “You had to keep it hot and you couldn’t have it wilting and melting. Now, it’s line cooking to order, like in a restaurant.”
In addition to developing menus to meet patients’ specific dietary requirements, Oliver and her staff, including Gabriel Gomez, the new executive chef, have created menu items that appeal to the hospital’s diverse patient population. Such items include Moroccan chicken, island calypso chicken, General Tso’s chicken and authentic soft tacos.
Patients place orders with the call center any time between 7 a.m. and 8 p.m. Originally, the cut-off time to order dinner was 7 p.m., but Oliver found many patients wanted to eat later, so the order time was extended. After the order is placed, three tickets print out in the kitchen for hot prep, cold prep and an expediter. While the cold and hot food preparation is occurring, the expediter readies the tray with condiments, dishes and silverware. Once the food is ready, the expediter arranges all food and drink items onto the tray and places it on a cart. There is one cart for each of the hospital’s eight floors. When the first tray is placed in a cart, a timer is started. When the timer hits 10 minutes, the cart is sent up to the ambassadors through a dumbwaiter system. When a cart is on the way up, the ambassadors receive a phone call letting them know to go to the pantry area to receive the cart. The ambassadors then deliver the trays to the patients.
After a designated time for the meal period, each ambassador receives a list of the patients on his/her floor who have not yet placed an order. For example, the designated time for lunch is 1:30 p.m. The ambassadors then visit those patients to see if they wish to order. If a patient misses two meals, a dietitian visits the patient to assess any problems the patient might have.
Working out the kinks: As if starting room service was not challenging enough, Oliver and her staff also had to learn to navigate a new hospital. “We moved into a brand new facility—a huge complex one—and started room service on the same day,” she says. “It was just complete chaos. The ambassadors had maps to find all the rooms. Somebody walked by me on the second day asking where the bananas were and, ‘I was like I don’t even know.’ Nobody knew where anything was.”
And just when Oliver and the staff started to become accustomed to the new service and hospital, the service workers’ union for UCLA’s campuses went on a five-day strike. “Fortunately, a lot of my employees did come to work, which I was very grateful for,” Oliver says. “But a lot of them did not. So it was like we were just getting the hang of this new room service and all of the employees went out for a week. So I was wondering, were they going to forget everything they know and are we going to be starting back at square one? But once they came back, things came together and we rounded the curve.”
One advantage Oliver and her staff did have before they implemented room service was that their sister hospital, Santa Monica UCLA Medical Center, started room service earlier in the year, which provided a testing ground for Oliver’s team.
Other changes: Additional changes have occurred in the foodservice department aside from room service. I. M. Pei, the architect known for his work on the Pyramids at the Louvre in Paris, among others, designed the building. The Dining Commons, and hospital as a whole, is designed to let light into the space with high ceilings and large windows. The Dining Common’s menu offers the same items as before—made-to-order sushi, pizza and pasta, a grill, a salad bar and a deli. There is also a station for El Pollo Loco, a Mexican chain restaurant. The hospital’s station offers most of the restaurant’s menu items. A new component to the cafeteria is a display station, where a chef creates a stir-fry, pasta or salad to order every day.
There also is now a café open in the basement for the night shift. Originally, Oliver scheduled to have the downstairs café open during the day, but staff feedback pinpointed a need for late-night dining. The café has no cooking equipment, so most of the options are cold or frozen items that can be heated in microwaves. One FTE had to be added to staff the café.
Oliver also took the opportunity to upgrade the department’s technological capabilities when they moved into the new hospital. “We were really in the dinosaur ages three or four years ago,” she says. “We had an antiquated cash register system. We only took cash—no credit cards or anything. Everything was tabulated manually. The dietitians charted by writing in a paper medical record book. We didn’t have any type of hospitality suite or system. We had a back-of-the-house system for our menus and recipes, but we didn’t have it throughout the whole house.”
Now, everything is computerized. There is a POS system in the café, and all payment types are accepted, including the Bruin Card, the university system’s debit card. Dietitians have an electronic clinical documentation system. “We have a system for back of the house and the hospitality suite for room service so when the patients order it’s all connected,” Oliver says. “If they order something not on their diet, it doesn’t allow them to have it.”
In addition, Café Med, the cafeteria in the old hospital, is still open due to the large number of staff and medical students who are still housed there.