A Kitchenless Kitchen?

on September 30, 2011 at 4:33 pm

In the late 1980s, following discussions with clients, legislative bodies and healthcare experts across Canada, Burlodge Canada Ltd. identified the primary challenges healthcare managers were facing in the delivery of dietary services.

• Equipment in many hospital kitchens is outdated and food cannot be stored, prepared, or served in an efficient and sanitary manner. This leads to compromised storage space and temperatures, sub-standard production yields, inefficient staff, and inflexible meal service formats

• High maintenance and repair costs result from the use of older equipment. Many hospital kitchens require renovation and equipment replacement to ensure that equipment malfunction does not impede meal service

• Inappropriate food-serving temperatures due to centralized hot-plating techniques are omnipresent in many institutional dietary services. Moreover, the tray systems often cannot maintain adequate food temperatures from the central plating location to the point of service.

• Inconsistent skill levels of staff has always been an issue. For example, the Shepherd’s Pie made by Chef A on Monday may not taste the same as the Shepherd’s Pie made by Chef B next Monday

• Patient dissatisfaction with services is becoming more prevalent. In addition, old methods of meal delivery and menu design are not keeping up with the expectations of today’s clientele

• Kitchen facilities are underutilized because the original architectural designs called for considerable space allocation and because of shrinking in-patient loads. In today’s kitchens less space is required and in some cases (depending on the amount of food production done on-site) a “kitchen” is not needed at all, thus enabling a hospital to reclaim space for other uses

• The need for self-sustaining cafeterias is becoming more of an issue. Hospitals simply cannot afford to subsidize these operations any longer. In order to be profitable, cafeterias must win back the “brown bag” customer and entice visitors to the hospital.

• Future regionalization and consolidation must be at the forefront when developing new approaches to meal preparation and service. The challenge is to reengineer today while reducing potential redundancy for tomorrow.

• Reduced allocation of public funds brings with it caution about capital projects. Often there is a need to forgo kitchen renovation projects for other “front of the house” needs or medical equipment. Solutions that push the envelope and consider a “kitchenless” orientation are becoming more prevalent today.

Is Food Outsourcing the Answer?

Many believe that food outsourcing (or purchasing prepared entrees, starches, desserts etc. from reputable food manufacturers) can generate considerable savings. This is true up to a point. My experience with “kitchenless” or outsourced food projects indicates that operators, who adopt food outsourcing to augment their department reengineering initiatives, have realized up to 6% budget reductions while also enhancing food quality. Moreover, the ability to avoid the capital investment required to replace outdated production equipment is often a precursor to adopting food outsourcing.

However, Burlodge has learned from the projects it has implemented that it is the introduction of cold-meal-assembly principles, and the departure from hot-belt lines and insulated trays that offer the most sustainable savings (up to 12-16%). This is because cold-meal assembly allows a team to prepare meal trays in advance using one shift of employees around a belt line rather than the shift-and-a-half required for a hot-belt line. The chilled meals are then reheated (rethermalized) later in the day, close to service, in specialized state-of-the art meal carts.

This raises the question, “What should come first – food outsourcing or new tray assembly and delivery systems?” The answer is that each can exist separately, however, coupling these approaches leads to improved flexibility, and considerable savings (some clients are realizing up to 18-22% in savings and in some cases higher). Moreover, by combining these solutions, there is an increase in menu item consistency and more control of food cost. Less money is spent on repairs and maintenance of kitchen equipment. The appearance of food trays improves and food temperature is more consistent. Finally, there is more flexibility in meal service times.

A Burlodge Client – A Progressive Case Study

Burlodge Canada has been in business since 1994 and now has over 420 clients across Canada. Over 77% of Burlodge equipment sold to health care clients has been in Acute Care settings while over 20% has been in Long Term Care locations (the balance is production equipment and pot washers). In Canadian Healthcare, over 45 Million Meals a year are served using Burlodge Equipment. The experience this company has in advanced meal system implementation and operational design is unprecedented. The health care locations that find the greatest operational savings when implementing Burlodge systems fall into the range of 100 beds and higher. The common scenario for these locations can be explained by reviewing a generic case study of a 220 bed acute care facility who purchased the Burlodge equipment.

This 220 bed acute care hospital first embraced a food outsourcing and hot plating approach that has resulted in a small operational savings in its food service budget. They had been operating like this for about 5 years when the hospital was faced with a kitchen fast-approaching obsolescence. Cooking equipment was malfunctioning, and health and safety challenges in the kitchen were becoming more of an issue. The kitchen needed to be renovated to meet modern standards. The hot-belt line was not ergonomically sound, and hot trays prepared-centrally in the kitchen were not keeping food temperatures at high enough levels to withstand the distribution time to the bedside. The hospital and Burlodge investigated many options to reengineer the food services department and presented a business case to the hospital for review.

The solution? Eliminate the kitchen entirely. The hospital introduced a whole new technology: cold plating using outsourced foods. The hospital uses retherm carts from Burlodge that hold pre-plated cold foods on patient trays. The trays had been prepared in advance using a cold beltline process. The Burlodge Cart holds the trays cold and when programmed to begin heating a portion of the food tray, the cart begins its retherm cycle while keeping the food that is to be served cold at a cold serving temperature ready to present to the patient. The hospital implemented a cold beltline approach and saved 24% with the new process. In this new system, individual food trays are assembled using outsourced foods from reputable food suppliers. The trays are prepared as close to delivery time as possible in a 10C environment. Once each tray cart is full, it keeps the trays cold at 4 C. While being held inside the cart, one side of each tray is rethermalized while the other side remains cold. Since the new system has been in place the hospital has seen patient satisfaction surveys related to Nutrition Services increase and worker injury decline. While the reengineering initially required a capital investment, the planned annual savings provides a payback in less than two years. The investment included asbestos removal and kitchen renovations to install new flooring and a cold room for tray assembly. A review of the original business case shows that the total number of full-time employees (FTEs) related to patient services (excluding Clinical Nutrition) was once 27.56. With the new system in place analysis of the operation confirms the business case as the FTE compliment is now 18.71.

Lessons Learned

While this particular solution is common place in today’s Canadian Health Care marketplace, each hospital uses their own unique method and approach to using the equipment. However, each facility experiences similar outcomes when adopting the Burlodge equipment such as improved patient care and annual savings that financed the investment. Individual hospitals have unique challenges, and solutions are required that meet the needs of each specific location or grouping of locations. For example, Burlodge recently installed a new meal delivery system using outsourced foods at one hospital so that it can provide meals to another hospital. In the same month, a Burlodge trayed meal delivery system was installed at a hospital that uses cook chill technology to produce foods for itself and other hospitals in the region. In both cases the system was customized to meet the challenges of regionalization. Another Burlodge project has cold foods being used by a combination of cook chill and food outsourcing but the delivery of meals is being done in a bulk service format. This bulk system actually has the Burlodge Bulk Retherm Cart brought to the acute care floor where patients meal trays are prepared at the point of service. Patients make a choice and feel more in control of their dining experience. They even have a choice of portion control, juice, vegetable, coffee, tea etc. The room service concept called Client Focused Dining by Burlodge, is being regarded as best practice.

The merits of food outsourcing, cook chill, and new meal plating and delivery systems are proven; it is the manner in which these new resources are used to reinvent the food service department that is the crucial step and Burlodge Canada is there to help.