Published on : June 22, 2010
Room Service, Food Service – A Quality Solution toward Lean Design
As manufacturers, construction managers, even software companies move toward “cutting the fat” and overall streamlining their respective processes; the food service industry, particularly in healthcare, continues the labor policing, bottom line movement which started in most major metropolitan facilities even before the automotive industries, bottling companies and other industry segments honed their operations into the models we look to as examples of “lean design”. Lean design is a practice which is often known simply as "Lean".
This practice considers the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination. Working from the perspective of the consumer who uses a product or service, "value" is defined as any action or process that a consumer would be willing to pay for. Basically, lean is centered on preserving value in a lean environment.
While we can glean some direction from other industry examples, food production and safety at a facility level has unique challenges that manufacturers, working exclusively with shelf stable parts and raw product, do not. Even commercial food manufacturers and processors have the advantage of working in state-of-the-art controlled environments, moving products toward final stage aseptic, shelf stable packaging for distribution, and sale.
Within the past six years there has been a building interest, particularly by premier healthcare facilities, in developing room service programs, involving both renovations in place as well as new construction. We feel this idea offers a lean direction relative to capital equipment, labor stability, and food cost while holding the greatest hope for providing the highest level of service and value to the patient.
There are a variety of options for the daily production and serving of meals in healthcare which could be labeled as “lean”. For example, substantial use of convenience product, outsourcing production, or advanced production systems all still use conventional meal delivery system and program. From one perspective, lean direction may not be a lean solution departmentally, for instance, the extensive use of convenience product to reduce labor also increases food cost, adds substantially to solid waste, and restricts control over food quality. Not every option is an acceptable fit for any given facility. We can start with the balancing of food service departmental goals vs. identifiable options, realizing every healthcare facility has its unique mission and personality which should not be overwhelmed by the options but used to determine which specific program is the perfect fit. Lean design and process is about maintaining and/or improving value and not necessarily about cutting labor or costs. It is a tool to understand how to efficiently, effectively, and safely deliver value consistently and enhance the patient experience.
There are a number of variations labeled “room service” in healthcare. What we consider the classic definition, is an operating program offering a restaurant-style menu of freshly prepared items designed for a specific facility and patient demographic. Patients are provided with multiple menu options for each mealtime and they are permitted to define when they wish to dine. Tray service is upgraded to be less institutional and more appealing on a par with hotel-style room service delivery.
Room Service, or a variation thereof, may not be for everyone; however, lean design and a lean operation can provide real economic benefit from this type of program. To determine the feasibility of a Room Service program, an assessment should be made to determine the current baseline regarding function and flow, infrastructure, equipment (type, life, efficiency, etc) and operational capabilities. Once a baseline of the existing operation has been studied and identified then various lean options and their cost vs. benefit (value) can be realized and presented for discussion and consideration as a means to assist the client in attaining his/her goals and objectives.
A number of years ago, healthcare facilities experimented with a precursor of today’s room service programs. There were several approaches to this, one of the most popular being a “spoken menu” program. In this approach, the customer was visited, personally, by a service representative, who presented today’s selections. This was based upon the airline model of service, where there were limited choices and the meals were pre-assembled in carts that were in the control of the service reps. Since the cart was in the area, when the selections were presented, the service was virtually immediate. However, the service rep often found that they had to “sell” the remaining selections at the end of a meal period. Although there was a value (improved customer satisfaction) to the personalized service, the customer expressed a strong interest in being able to control the time of the meal, as much as the content.
In the quest to improve value and efficiency to operations, other hospitals tried variations on the service models, all focused on offering more value while reducing cost and/or effort. Some of these involved programs that offered breakfast from a service cart that was transported by a service rep. Selections were presented to the patient and immediately served. Emphasis was on the continental breakfast style service, as well as on the fast food models (breakfast sandwiches, etc). An emphasis was often placed on the beverage service since it was thought that a good cup of coffee or tea was the centerpiece of the service. Although this was true, the life of these models was short-lived.
The lean essence of our Room Service program definition can be broken down by the following:
EQUIPMENT: The cooking equipment package dedicated to room service production is more of a short order line than a conventional battery of ovens, steamers, kettles, etc. customarily found for the bulk production for a conventional tray assembly process. The equipment is scaled down as the production timeframe is extended by nature of the program. Additionally, there is no need for the compliment of hot holding vessels, as menu items are prepared to order to complete the tray and expedited within 30 to 45 minutes to the patient(s). Although the delivery cart quantity requirement is greater for room service than with conventional delivery methods, the typical room service cart is smaller and much less costly.
REDUCTION OF FOOD WASTE AND QUALITY CONTROL: Since meals are ordered prior to service there are no trays delivered to empty rooms. There will be no rejected trays because the patient no longer desires yesterday’s selections, no conflicts with patient’s medical treatments, an extended dining window, and no necessity for late trays.
SOFTWARE: Over the last several years, there has been a consolidation in the number of software companies that support the healthcare foodservice marketplace. There have been a number of acquisitions and mergers that have resulted in a smaller number of choices but there are more advanced selections and sophisticated applications. Since our room service model is essentially “on-demand” service, this software needs to be able to support this function while handling the complexities of multiple diet-types, based upon patient restrictions (imagine operating a restaurant with 15 variations of the menu, every day!). The software companies have responded to this challenge, as well as adding functionality like advance order queuing and real-time meal tracking.
LABOR: Depending on the staffing situation before the consideration of going to a room service program, labor can be a wash, to modest increase. Depending on the involvement of other departmental staff, such as nurses passing trays, the adaptation of a room service program has a far reaching impact on the hospital as a whole. The entire tray line staff is reassigned to appropriate positions. Ambassadors are usually a new job description for most facilities and may consist of retrained tray passers or new hires. Cart transfers are not only reduced overall but spread over a longer period, easing the load on the vertical transportation systems. This factor alone relieves multi-departmental issues, particularly in older facilities with dated systems.
The feasibility of converting an existing facility or producing a new design should be led by a thorough assessment of facility plans and the relationship of food service to other departmental space, hospital staff, patient demographic and bed distribution, planned expansion of meal volume, and equipment package and building infrastructure. A complete assessment will result in the following bullet list of indicators:
- Establish an efficient, safe, logical flow for the meal production and assembly process.
- Meal assembly and distribution process must be smooth and timely to minimize “wait-time’” between order and service.
- Vertical transportation must be efficient and timely.
- Meal delivery must be timely and professionally executed.
With positive results from the above criteria a lean program and design can be developed providing the highest quality and level of service while providing value in a lean environment.
About the authors
Gary Conley is the President and co-founder of the Room Service Technologies, LLC. Gary has over 34 years of experience in the design, development and implementation of healthcare Food Service Systems. His experience has been in hospitals throughout North America and Asia. He is a member of the Association for Healthcare Foodservice. He graduated from Cornell University with a B.S. degree in Hotel, Restaurant and Institutional Management. He also completed specialized graduate level studies at Rutgers University and the University of Pittsburgh in the areas of business logistics and statistical analysis.
With a background in engineering/industrial design, Mike Kell began his 30+ year career in Food Service as a designer for a prominent manufacturer of food service equipment. Joining a major New York consulting firm in 1982, he was appointed Vice President of Design, managing projects in every food service venue with a particular focus in healthcare, corporate dining, and education. He has now joined SSA, an international consulting organization offering a complete scope of food service consulting services.