TONYA BURNETT has rejuvenated the foodservice department at ST. RITA'S MEDICAL CENTER by:
• BUILDING a strong team environment by mentoring employees and putting others first
• IMPLEMENTING a room service program for patient dining, which has increased patient satisfaction, allowed the addition of local and seasonal menu favorites and reduced the amount of trays per patient day
• STARTING a productivity initiative that resulted in the elimination of 10 FTEs, and reducing in-house catering services to cut costs to the hospital
• BUILDING a new kitchen and café and increasing revenue and meal transactions
Tonya Burnett, director of nutrition services for 434-bed St. Rita’s Medical Center in Lima, Ohio, is described as “very people focused,” by Chris Provaznik, vice president of operations. “She is very caring about her staff and our patients.” It’s that caring attitude that has enabled Burnett to expand services while decreasing costs and employee hours, Provaznik says.
“Tonya is focused on doing the right thing for her employees,” Provaznik says. “She is a strong advocate for them. She has given her time to mentor employees who have then been promoted and gotten higher paying jobs. Her employee group, for the most part in the hospital system, is the lowest-paid group, and Tonya works with HR to provide financial counseling for them.
“It’s a team that pitches in. Last week we had 40 more patients than we did beds, and everyone was in the kitchen helping,” Provaznik adds. “Two of the supervisors were plating food.”
This team attitude is on display during the hospital’s annual United Way campaign. Nutrition Services has consistently been one of the highest contributing departments. The department was honored last year for its efforts with the 2009 Campaign Chairman’s Award. Always the team player, Burnett is quick to deflect personal praise. “All the things we have accomplished and worked on at St. Rita’s Medical Center are because of great teamwork and effort on everyone’s part,” she says. “It is not just me. My team is outstanding.”
Patient service: One of the things the team was able to accomplish was switching to room service for patient dining in February 2010. “We were doing retherm,” Burnett says. “Our primary reason [to switch] was to increase patient satisfaction. We also needed to move away from [the old] system because it limited the types of foods we could serve.”
Patients can order meals between 6:30 a.m. and 6:30 p.m. by dialing a call center to place their orders. The ticket is printed on the production line where the food is prepared to order. Finished trays are put in carts, which are designated by zone to break up delivery. A timer is started when the first tray is put in the cart. After 15 minutes a porter takes the cart to an ambassador on the patient floor. The ambassador delivers trays to the patients. Burnett says the average delivery time for a tray is less than 30 minutes.
Since the switch to room service, patient satisfaction has increased. Press Ganey scores for the department’s overall meals are now in the 70th percentile for all of Press Ganey. Before the switch to room service, the department’s overall Press Ganey scores were in the 39th percentile. For facilities the same size as St. Rita’s, the department is in the 91st percentile. The department is in the 95th percentile for facilities its size for quality of food.
“We changed the menus pretty extensively when we went to room service,” Burnett says. Burnett’s team worked with a room service consultant, Room Service Technologies, to create new menus. “We put together what we thought might be menu options from our old menus and what was popular,” she says. “They shared with us things that other facilities had used.”
Menu changes: The menus also were changed organizationally. Previously all items were offered à la carte. Now the items are bundled to create meals. For example pork roast is offered with sweet potatoes and green beans. Burnett says most patients order the meal as it is combined on the menu, but she said patients could make substitutions.
After the menu was created, Burnett says a personal experience led her to revamp the menu further. “We have a lot of repeat patients, and they get familiar with the menu and wanted more variety,” she says. “We have some units that have a longer length of stay, so we found that patients were getting a little bit tired of the menu. I had a personal experience when my father-in-law was in the hospital. As I was trying to help him order, it was a big eye-opener. This was very early on in our room service process, and I realized that there weren’t really a lot of local area comfort foods. Lima is a large city, but our surrounding area is very rural and there are a lot of farming communities. Things like chicken and noodles over mashed potatoes and beef and noodles are very popular around here, especially with older people.” To incorporate some of these local favorites, a weekly specials menu was added to the base menu. The specials menu runs on a four-week cycle. Each week’s specials menu has three entrée selections and an entrée salad.
Seasonal items also are added to the specials menu. During the winter months, pumpkin pie and heartier soups were menued. Lighter items are being offered for spring.
Another result of room service is reducing the number of trays per patient day. Before room service, the department was serving 3.85 patient trays per day. With room service, that number is 3.02 because late, duplicate and extra trays have all but been eliminated.
Efficiency: During the last quarter of 2010, Burnett and her team embarked on a productivity initiative. “There are very high expectations to operate very efficiently in all of our areas,” Provaznik says. “We got some information that said we were a little bit on the high side [of labor hours to meals]. Tonya and her team went through all the processes and, during eight to 10 weeks’ time, evaluated every process to figure out how we could become more efficient. I know it wasn’t easy.”
Burnett was able to cut 10.225 FTEs by rearranging workers’ hours. Only one person was let go because that position was eliminated. “We had increased our FTEs when we went to room service,” Burnett says. “We took out as many, if not more, FTEs than we added in with room service. We did it by shaving hours here and there. We have employees who want to pick up as many hours as possible, so even if their position was shaved they will pick up hours someplace else so they don’t really notice a change in hours. Now, we are exceeding our productivity target.”
Part of being efficient meant taking a look at in-house catering. “We take a little different philosophy [than other directors],” Burnett says. “A lot of organizations view catering as an opportunity for revenue or an increase in meals. The majority of the revenue that you are generating for in-house catering is internal and it’s just a paper transfer within one department to another. There is really no cash involved with it. We have taken the approach that we want to decrease in-house catering as much as possible. If we’re going to get real money, we’ll do whatever. Catering is very labor intensive, so with our productivity initiative we’ve tried to cut back. We don’t do any special catering to departments for meetings. The employees have learned that if they are having a meeting during lunch they go down to the café, get lunch and take it with them. Sometimes we give meal tickets to come to the café. Yes, there is a cost with that, but then you don’t have the labor cost and the waste because they are only taking what they want.”
Another efficiency, and employee benefit, has been expanding the department’s payroll deduction program to operations outside of foodservice. Employees can use the payment system at a freestanding Starbucks location, Walgreens and a gift shop, which are in the lobby. The department has no connection with these operations, but it has offered the payroll deduction program to benefit employees.
Fresh start: In 2007, the foodservice department moved into a new kitchen and café in a newly built nine-story patient tower. Burnett was at the helm of the design project, which included the new High Street Café. “Tonya had the opportunity to design from scratch
a brand new kitchen and café,” Provaznik says. “That took a tremendous amount of work, creativity and research. The café is a great place to escape. Some of the members of the chamber of commerce and the mayor use our café conference rooms when they have meetings here.”
The High Street Café has a made-to-order grill area, a pizza and deli area, display cooking, comfort foods, a salad bar, soup, grab and go, desserts and a self-serve bar that changes daily.
The department is implementing a wellness initiative in the café as well. Nutritional information will be posted for menu items, with a stoplight feature designating which items are better for you. Green denotes healthy, while red means not so good for you. In addition, the department is adjusting recipes and portion sizes for unhealthy, but popular, items such as pizza. Instead of cutting a pizza into six slices, the pie is now being sliced into eight.
Since moving into the new café, revenue and meal transactions have increased. In 2010, the café did more than 610,000 transactions, up from 513,000 prior to the move. The café also does more than $2.2 million in revenue each year, up from $1.5 million before the move.