JOHN MILLER has rejuvenated foodservice at the HENRY FORD HEALTH SYSTEM by:
• Consolidating menus and processes across the system to use labor and money more efficiently
• Switching three of the hospitals from contract managed to self-operated
• Implementing a healthy dining environment for patients and retail customers and participating in the Partnership For A Healthier America initiative
• Offering community education classes at the West Bloomfield Hospital greenhouse, which also provides produce for the system’s meals
Great leaders aren’t afraid of change. They understand that complacency is the first step to mediocrity. John Miller, systems director of culinary wellness for the Henry Ford Health System, based in Detroit, hasn’t shied away from changing the way the whole system operates. From creating consolidated systemwide processes, including room service, to transitioning hospitals to self-op and implementing far-reaching health and sustainability initiatives, Miller’s leadership philosophy is anything but laid-back.
Miller was hired 10 years ago as the foodservice director at Henry Ford Wyandotte Hospital. Within eight months, he was promoted to system director. The system is made up of six hospitals, 150 ambulatory care sites and two nursing homes. Miller is in charge of foodservice across the system. Not all sites, however, directly report to Miller, including the nursing homes and two of the hospitals. These sites have a foodservice director, who reports to Miller.
With such a large network under his control, Miller knew getting everyone on the same page would not only make his job easier but also create efficiencies by implementing similar processes and leveraging the system’s buying power.
One of the main steps to this systemwide cohesiveness was bringing everyone under the same management structure. Until three years ago, three of the hospitals were contract managed. “We have taken a 200-bed facility, our 802-bed flagship hospital and another 401-bed facility and converted them from contract foodservice to self-op,” Miller says. “That was a huge undertaking, but it’s been very successful.”
One of the biggest initiatives has been implementing room service in all of the hospitals. The process started at Wyandotte in a few patient units in 2006. “We knew that when we transitioned to room service, the initial start-up would be a little bit of a higher cost,” Miller says. “But we were able to prove that we’ve actually been budget neutral or better. When you look at net cost per patient day, it’s actually been reduced because we were able to look at efficiencies and ways to run the operations.”
One of those efficiencies was creating a template for a room service kitchen. The template was designed at Henry Ford Wyandotte and has since been implemented in two other hospitals. In this kitchen, there are three assembly lines. Workers on each line prepare meals for specific floors. For example, patient meals on floors one through three might be assembled exclusively on the first line. Patient trays are built in an assembly line, starting with cold food and condiments and ending with hot foods. All equipment is positioned so that staff have everything they need at their fingertips. As more hospitals are renovated, they will also use the same kitchen template.
Patient satisfaction has increased since room service began. Henry Ford Wyandotte improved 50 percentage points—to the 85th percentile—in Press Ganey scores for food quality. Henry Ford West Bloomfield Hospital, which opened with room service, has been in the 99th percentile since opening.
Strategic planning: To ensure the system operates as efficiently as possible, Miller holds monthly Value Analysis Team (VAT) meetings. The VAT meets to discuss ways to create a more cohesive network. The team reviews contracts, products, policies and procedures for all foodservice operations.
One of the areas the VAT felt would benefit from taking a bigger picture view was menus. “What we wanted to do was create some alignment across the system with the types of menus that we’re providing to patients and cafés,” Miller says. “We’ve developed a menu and recipe database that everyone has access to. We felt that we would be able to create efficiencies and achieve cost reduction by aligning patient menus.”
About 85% of the system’s patient menus are now the same. “When we have our VAT meeting and we’re talking about items that we are purchasing it’s easier because everybody is talking about the same thing,” Miller adds. Menus are also the same across the system in cafés located in both the hospitals and a corporate office building that houses hospital employees.
This alignment and efficiency creation has impressed fellow FSD of the Month (March 2012) Cheryl Shimmin, R.D., network director of nutrition services at Kettering Medical Center in Ohio. “John has been a mentor when it comes to being a system director,” Shimmin says. “Being new to my network nutrition services director role, I took a four-hour trip to Detroit just to participate in his VAT meeting. John is always willing to help his peers through his willingness to brainstorm with you and share ideas and through his passion for his profession. He is one of those very soft-spoken individuals who presents on-trend ideas and thoughtful high-impact answers when he speaks.”
Healthy changes: One thing that irked Miller when he joined healthcare foodservice some 20 years ago—after stints in hotels and restaurants—was that “when it came to food, we didn’t do the greatest job. Being in healthcare, we needed to walk the talk when it came to what we were providing for our guests and patients.” So Miller and his team set out to revamp menus to be healthier.
To help achieve this goal, Miller signed up his hospitals for a initiative developed by the Partnership For A Healthier America, a public health program launched in conjunction with Let’s Move!. By signing on to the initiative, Miller attests that menus will meet certain nutritional requirements, including an increase in the use of fruits and vegetables to 10% of total food purchases—the health system is at 20%—and labeling all food and beverages with calorie counts in the cafeterias and on patient menus. He has also pledged to remove all deep-fat fryers.
Unlike other healthy dining programs, this one comes with third-party verification. “You know anybody who is doing this is going to be getting some checks and balances,” Miller says.
Miller knows that in order to make his menu items healthier and taste great, he needs the culinary staff to pull it off. “We have chefs working in all of our operations, and when we bring in production staff we pay close attention to ensure they have that culinary background that you would see in any fine-dining restaurant or hotel,” he says.
Miller has also worked to change the perception of patient meals. “I don’t want to think of it as hospital food anymore,” he says about creating healthier options through culinary techniques. “We can do so much with the foods by enhancing them with herbs and spices rather than salt or fat,” he adds. “You have to have comfort foods, but they have to be healthier. We have meatloaf made with turkey and very lean beef.
“We asked patients what they wanted to see on the menu,” he says. “Most said that the menus are as good as any great restaurant that they’ve been in. When we get that kind of feedback, we know we’ve done our job.”
In addition to healthier menu changes, Miller’s team has started farmers’ markets during Michigan’s growing season. Eastern Market Corp., a food “district” and public market, assists with setting up the farmers’ markets. The company also provides local produce to be sold at the markets. This not only offers another way to get fresh produce in front of customers, but it’s also a way to support the local economy.
Community outreach: Another way Miller incorporates local produce is by growing it on site. When Henry Ford West Bloomfield Hospital opened in 2009, a donation was received to build a 1,500-square foot greenhouse and 1,500-square foot education center. This hydroponic, organic garden grows a variety of crops, including tomatoes, eggplant, beans and herbs. According to the hospital’s website, more than $20,000 will be saved by using the greenhouse’s produce in hospital meals.
Foodservice manages the greenhouse. Michelle Lutz, the resident farmer, manages day-to-day operations.
Classes for local students are also offered at the greenhouse, on topics ranging from agriculture to healthy eating.
Community education is also done in West Bloomfield’s 90-seat demonstration kitchen. Senior Healthy Living, Quick Meals for Families on the Go and Vegan Cooking are three of the classes offered. There’s also a program for kids, where children ages eight through 16 learn how to read nutrition labels and create a shopping list of healthy foods, among other topics.