Regina Toomey Bueno, senior director of food and nutrition services at NYU Langone Medical Center in New York City, isn’t afraid of change. When she interviewed at NYU in 2007, Toomey Bueno’s plan for the foodservice department was to change patient service from a traditional tray line to a pod system. The switch would require full support and buy-in from the hospital’s administration and foodservice staff. Toomey Bueno was hired in January 2007, and immediately started working to set up the pod system, which went live in January 2009. When she talks about the change, Toomey Bueno is quick to point out that the switch was a collaborative effort and was only possible because of her team’s dedication and open-mindedness. For her employees, however, the change to pods, and many other changes since Toomey Bueno came onboard, are because of the team mentality she has fostered.
“I think I have a really great group of people who work here and they put up with my nonsense,” Toomey Bueno says. “The pod thing was really big, and they really got excited about it and they did a great job. They had to believe me when I first got here and they did and it’s been great.”
Jonathan Murray, director of patient food and nutrition, says, “Regina involves everyone in the process of change. Her confidence radiates throughout the department and gives everyone a great sense of pride. It’s very unifying because we are all on this journey together. It’s one vision, but it’s a shared vision.”
A big component of that vision was the pod system. In the system, the tray line is broken up into several smaller, self-contained serving units. Each pod has a dedicated team that prepares meals for a set number of beds in the hospital. In June 2008, Toomey Bueno piloted one pod, and in January she switched the entire hospital to the pod system. The department now operates four pods. In addition, the department has switched from cook-chill to cook-serve. Now, only bulk items such as soups and sauces are prepared cook-chill. [To read more on pods, see FSD’s January 2009 issue, p. 42.] Even in the short time since the entire hospital has changed to pod service, Toomey Bueno says patient satisfaction has increased.
Building a team: NYU Langone Medical Center consists of the 850-bed Tisch Hospital and Rusk Institute for Medicine and the 125-bed NYU Hospital for Joint Diseases (HJD). All patient food is made at the main hospital—Tisch—and the food for patients at HJD, which is 15 blocks south of Tisch, is delivered twice a week. Patient food for HJD is still prepared using the cook-chill method. In total, Toomey Bueno oversees 280 FTEs and the production of 5,750 meals each day. With such a large operation spread out over two locations in New York City, it was essential for Toomey Bueno to build a strong management team.
“I’d say the biggest change besides pods has been changing the department’s structure,” Toomey Bueno says. “We eliminated some positions and created some new ones, particularly in the management team. We essentially had a director of operations and 85% of the department was reporting directly to him, which didn’t seem like a very doable job to me. So I created a director of patient service and a director of operations, which gave us a more reasonable split and allowed for better focus.”
In addition, Toomey Bueno increased communication. A daily managers’ meeting allows everyone to get on the same page and to address any concerns. “I think it’s important to foster the synergy of the team,” Toomey Bueno says. “You’ve got all these people and I think it’s important to have them interacting with each other. With our system before, it’s not that people weren’t team-oriented, but they were off doing their own things and we needed to bring them together.”
Another team-building exercise was rewriting the mission statement. “I think it’s really important to state what you’re about, and maybe I don’t look at it every day, but the exercise of making this philosophy is what’s important,” she says. “People want to feel they are appreciated, that they know what’s going on and that they are included in decisions, so we really try to do that. And I think that’s part of our mission. The flip side is you have to hold people accountable. I think it’s incumbent on us to provide people with all the direction that we can.”
Angela Anderson, assistant director of patient services, was at NYU before Toomey Bueno’s arrival. She says that since then the staff morale has increased. “We are more compatible now,” Anderson says.
Chris Lord, director of operations, says Toomey Bueno’s humility has greatly aided in the team atmosphere. “Regina expects you to get results, but she doesn’t constantly interfere,” Lord says. “She has a tendency to humble herself. Any kudos or recognition she gets she puts it back on the team.”
The management team isn’t the only group that Toomey Bueno has focused on. Under her guidance, several mentoring and training programs have been implemented for people looking to gain on-the-job work experience. Several employees work in the department through an organization called Contemporary Guidance Services (CGS), which places people in locations to provide them with training. CGS pays the employees for their time working at the hospital.
Toomey Bueno recently signed on to a program through the city’s Department of Education that will place at-risk students in the department to enable them to gain work experience.
In addition, volunteer college students do all patient nutritional screening, and the department hosts several other students to help them gain work experience and training.
“Sometimes you get people who just need a chance to develop their skills. It’s a benefit to us, too. We’ve hired quite a few of them,” Toomey Bueno says.
Retail upgrades: Toomey Bueno is the first to admit that the cafeterias at the two hospitals are in need of renovation. “In New York City, space is the final frontier. When some space becomes available, the competition for it is fierce.” In addition to the space challenge, Toomey Bueno says plans for a new hospital wing, which will most likely house the foodservice department, are in the works. So Toomey Bueno knows spending the money that is needed to update the cafeterias is not a smart, or likely, move.
Instead, the department has worked within its parameters. “Our main cafeteria is very busy; we are doing close to $3 million in revenue a year, but it’s very tight and we have to get a lot of people through in a short time,” Toomey Bueno says. “So we try to really emphasize grab and go.” Since Toomey Bueno joined the hospital in September 2007, retail sales have increased 20%.
Toomey Bueno attributes that increase to the emphasis on grab and go and upgrades made to the menu. “We’ve tried to jazz things up,” she says. “I think our menu is a little more adventurous; maybe that’s because it’s New York. We have brown rice, pigeon peas and rice, tabbouleh, a hummus and pita platter and a portobello mushroom burger. We have a lot of interesting things, but we also have the basic roast chicken and meatloaf. The other thing that is significant here is that we have a pretty large Jewish population. We don’t have a kosher kitchen; we use pre-packaged items.”
Other upgrades to the retail operations include changing to Green Mountain Coffee, marketing the department’s in-house bakery, with a branded concept named Patisserie Pujol, after the department’s baker, and increasing theme meals and special events. One such event was a six-course gourmet lunch for Administrative Professionals’ Day. “The idea is you can take your administrative professional to lunch and have a nice French meal,” Toomey Bueno says. The lunch was held in the faculty dining room with wait service and cost $24.99. “We are doing it primarily in part to show what we can do and that we have a talented culinary staff. We’re not doing it to make a whole lot of money, but we are also offering that opportunity for people so that they don’t have to go out to a restaurant.
“The secret to this job is it’s a journey, not a destination,” Toomey Bueno says. “You’ve got to learn to enjoy the journey. You have to go in and work every day to make it better because you can get overwhelmed very easily.”