Consulting Report for Haven Hospital

Haven HospitalFood and Nutrition Services Department 555 N. 5th StreetBaltimore, Maryland

Nutrition Solutions, Inc.77 Spruce StreetSilver Spring, MarylandNatalie Frison, RDLuz Padua-Perez, RD

Submitted 14 October 2013

About NSI Located in Silver Spring, MD Team of 15 RDs 12 years of experience in Food Service

Management and Clinical Nutrition Services

Contracted by Haven Hospital to assist in improving efficiency, patient satisfaction, and sustainability

About Haven Hospital Located in downtown Baltimore General medical services:

medical/surgical, GI, cardiology, oncology, 10-bed ICU

250 beds 100% occupancy rate For the past 3 years:

Consistent 10-15% decrease in revenue 50-60% overall satisfaction rates

Outline A. Statement of ProblemB. Assessment and Findings C. RecommendationsD. Conclusion

Problems Patient Satisfaction with AYR Menu Content for Room Service Staffing and Outpatient Nutrition Program Equipment Purchasing Sustainability Initiatives

Goals: Increase revenue by 25%, reduce costs by 15%, and improve patient satisfaction by 25%

I. Patient Satisfaction with AYR Implemented AYR about 2 years ago Has not improved patient satisfaction as

was anticipated Assessment:

Conducted surveys Interviewed patients and food service

staff

I. Patient Satisfaction with AYR Found that:

Patients are confused about AYR Patients are not calling in orders Room Service Associates lack customer

service skills and knowledge of diets AYR menu is inappropriate

Recommendation 1 Laminated flyers in patient rooms

Step-by-step instructions on how to place order

Visually appealing Large font, graphics, bold colors

Simple explanation will increase number of patients calling in to order

Recommendation 2 RSAs should participate in monthly in-

services Improve customer service skills Learn about diets and restrictions

Recommendation 3 Design new menu for room service

Larger font, visuals Organized into sections Use symbols for diets

II. Revision of Room Service Menu Selections Current menu items not appropriate and

not cost-effective Surveys indicated that menu is too “fancy” Current cost is $7.50 Reduce to $5.36 28% reduction in cost HS snacks not cost-effective

Recommendation 1 Replace “fancy” items with popular, less

expensive items Reduce average meal cost per day from

$7.50 to $5.36 Savings of $195,275 per year 3-day standard menus

Table 1. One-Day Standard Menu Cost

Total Cost: $1.71

 BREAKFAST Portion Cost ($)

Banana 1 0.26

Corn Flakes 1 bowl 0.49

Scrambled Eggs 2 oz 0.19

Whole Wheat Toast 1 slice 0.11

Margarine 1 pat 0.02

Orange Juice 4 oz 0.16

1% Milk 8 oz 0.23

Coffee 6 oz 0.10

Jelly 1 pc 0.06

Half & Half 2 pc 0.06

Salt 1pkt 0.01

Pepper 1pkt 0.01

Sugar 2 pkt 0.02

LUNCH  Portion Cost

Garden Vegetable Soup (LS) 6 oz 0.12

Roasted Turkey Breast 3 oz 0.79

Mashed Potatoes 4 oz 0.29

Chicken Gravy 2 oz 0.04

Broccoli Florets 4 oz 0.15

Oatmeal Raisin Cookie 1 Cookie 0.15

Crackers 2 pkt 0.06

Iced Tea 8 oz 0.01

Salt 1pkt 0.01

Pepper 1pkt 0.01

Sugar 2 pkt 0.02

Total Cost: $1.65

 DINNER Portion Cost

Chicken Noodle Soup (LS) 6 oz 0.26

Rotini with Meat Sauce8oz pasta + 6oz sauce 0.76

Green Beans 4 oz 0.17

Vanilla Ice Cream 4 oz 0.30

Wheat Dinner Roll 1 0.12

Margarine 1 pat 0.02

Crackers 2 pkt 0.06

1% Milk 8 oz 0.23

Hot tea 6 oz 0.04

Salt 1pkt 0.01

Pepper 1pkt 0.01

Sugar 2 pkt 0.02

Total Cost: $2.00

Recommendation 2 Simple, cost-effective HS snack

available to all patients Appropriate for diabetic patients No other snacks needed Cost was $3.75 per patient per week Reduced to $2.37 per patient per week

Table 2. HS Snacks

Weekly cost per patient: $2.37

Snack Cost ($)

Monday Blueberry Nutri-Grain Bar

0.47

Tuesday Fruit-Flavored Low-Fat Yogurt

0.66

Wednesday Mozzarella String Cheese and Crackers

0.23

Thursday Granola Bar 0.29

Friday Fresh Fruit 0.18

Saturday Graham Crackers and

1% Milk

0.30

Sunday Soft Pretzel 0.24

III. Staffing and Outpatient Nutrition Program Haven Hospital needs to:

Improve nutrition services at the hospital Establish an Outpatient Nutrition Program to

increase revenues Assessment:

Clinical Nutrition Manager 2 Registered Dietitians:

20 hrs direct pt care; 13 hrs indirect pt care; 7 hrs non-pt care

Average number of pts/medical unit Conclusion: understaffed

Current budget for nutrition staff: $320,000

Recommendation 1: Nutrition Staffing

Position Salary

Clinical Nutrition Manager $93,750

RD1 $60,000

RD2 $60,000

RD3 $60,000

DTR $40,000

Annual Cost: $313,750

Hire 1 RD, 1 DTR Will work at the

hospital and the Outpatient Nutrition Program

Recommendation 1:Nutrition Staffing Assignment of RDs to medical units

based on % of patients per unit & RDs experience RD1: Surgery, ICU, GI RD2: Surgery, Cardiac, Oncology RD3 (new): Oncology, GI DTR will assist RDs

Reduce time spent in indirect pt care & non-pt care

Recommendation 2:Scheduling For the hospital:

Weekdays 2 full-time RDs 1 RD and 1 DTR

in the morning Weekends

Full-time RDs will alternate Saturday on-site Sunday on-call

For the ONP Weekdays

1 RD and 1 DTR in the afternoon

Weekends Off

Recommendation 3:Outpatient Nutrition Program Initially operate Monday-Friday, 1:00

PM-5:00 PM 1 RD & 1 DTR Services: consults and education classes Expand program as revenues increase

Nutrition Staff Schedule

Week 1

Monday

Tuesday

Wednesday

Thursday

FridaySaturda

ySunda

y

CNM x x x x x OFF OFF

RD1 x x x OFF x x On call

RD2 x x x x x OFF OFF

RD3 x/ONP x/ONP x/ONP x/ONP x/ONP OFF OFF

DTR x/ONP x/ONP x/ONP x/ONP x/ONP OFF OFF

Week 2Monda

yTuesda

yWednesd

ayThursda

yFrida

ySaturda

ySunday

CNM x x x x x OFF OFF

RD1 x x x x x OFF OFF

RD2 x x x OFF x x On call

RD3 x/ONP x/ONP x/ONP x/ONP x/ONP OFF OFF

DTR x/ONP x/ONP x/ONP x/ONP x/ONP OFF OFF

ONP= Outpatient Nutrition Program

IV. Equipment Purchases Assessment:

Outdated equipment Affects production Increases energy costs

More equipment to meet demands Equipment for retail to increase revenue

IV. Equipment Purchases General considerations:

Essential for Menu/ Production needs Budget: $20,000 Increasing revenues for retail Energy conservation Reliable brands Client’s preference

3 major & 4 minor pieces of equipment

Vulcan-Hart (VC4GD) – 40” Gas Convection Oven Price: $3,215 Full size interior: 29”x 22 1/8” x

20” 5 full size pans 2 speed fan 44,000 BTU/hr burner 1 year warranty Life: 12 years

Why gas?- Cost of gas vs electricity- Client preference

Vulcan-Hart (VC4GD) – 40” Gas Convection Oven Oven Performance

(FSTC/ASTM) Energy

consumption: Input: 44,000 Btu/hr Idle: 11,850 Btu/hr

High cooking energy efficiency

Fast cooking times Heavy load cooking

uniformity

Southbend (EZ24-5)-Electric Counter Steamer Price: $4,317 Size: 29.5" x 24" x 25" 5-12" x 20" Pan Capacity Convection (pressureless) Connectionless 15 kW 1 year warranty Life: 10 years

Southbend (EZ24-5)-Electric Counter Steamer Pressure vs Convection Countertop

Saves Space Unit mobile

(connectionless) Capacity is sufficient to

meet needs

Southbend (KECT-20) – Electric Steam Kettle Price: $7,055 Capacity: 20 gal 2/3 jacketed Tilting Countertop Cook up to 290°F at

a maximum pressure of 50 psi

1 year warranty Life: 15 years

Southbend (KECT-20) – Electric Steam Kettle Essential: soups,

pasta Based on production

needs (250 pts): 2-20 gal kettles Existing 20 gal

kettle at facility Increased

productivity patient services & retail

Eagle (SHT4-NG) – 4-Well Gas Hot Food Table Price: $1,244 Size: 34.5" x 63.5" x 30.5" Total: 14,000 Btu 22 gauge type 430 stainless

steel Eight inch wide polypropylene

cutting board Warranty: 1 year from

installation Life: 10 years

Eagle (SHT4-NG) – 4-Well Gas Hot Food Table Essential for hot holding

- food safety for patients Gas – saves money Low energy

requirements (3,500 BTU/burner)

Individual gas valve for each well - better temperature control

Bunn (LCA-2 LP) – Coffee Dispenser

Price: $1,513 Size: 23.2" x 15.78" x

20.9" 1 gallon capacity 120 cups/hour Warranty: 2 years parts, 1

year labor Life: 8 years

Carlisle (6611) – 6 ft Six Star Portable Food Bar with Legs

Price: $1,971 Increase sales for all

meals Features:

Acrylic shield to protect buffet

Polyethylene-resistant material

Mobile Unit Adequate size for

cafeteria

14 Gauge Advance Tabco Premium Series SS-306

Price: $574 Size: 30” x 72” Stainless Steel 14 Gauge- Heavy Duty Compensates for space

lost with countertop equipment

Adequate size for space

Total Cost of Equipment Major equipment(> $2,000)

Convection oven: $3,215 Pressureless steamer: $4,317 Steam jacketed tilting kettle: $7,055 Total: $14,587

Minor equipment(< $2,000) Steam table: $1,244 Coffee dispenser: $1,513 Food bar: $1,941 Work table: $574 Total: $5,272

Equipment Total: $19,859

V. Sustainability Practices Want to initiate sustainability practices Assessment:

Looked at current practices Talked with staff Considered cost and ease of implementation

Focus on: Water intensity Organic and non-organic waste Carbon intensity

Recommendation 1:Water Intensity Detect and repair leaks Cost: Repairing leaks Advantages:

Prevent water damage Expand life of equipment

Disadvantages: Requires time and effort

Recommendation 1:Water Intensity Increase water efficiency of equipment

Replace old equipment with energy-efficient models

Run only full loads of dishes and load equipment to capacity before using

Cost: Purchase of new equipment Advantage: Decrease in monthly bills Disadvantage: Initial cost of equipment

Recommendation 1:Water Intensity Educate employee, patients, and visitors

Training for employees Flyers with how to save water and why it

is important Post monthly water use

Cost: Production of flyers Advantages: Improve water efficiency in

hospital and in community Disadvantage: Motivation of participants

Recommendation 2: Organic and Non-organic Waste Reduce waste

Optimize production and minimize leftovers Use reusable dishes Reusable glasses rather than bottled

beverages Green cleaning products

Cost: Purchase of dishes Advantage: Decrease monthly costs Disadvantages:

Initial cost Increase in labor to clean dishes

Recommendation 2: Organic and Non-organic Waste Reuse leftovers

“Chef’s Specials” on weekend for entrées and soups

Leftover breakfast meats used for meat pizza Cost: None Advantages: Reduced prep and cooking time Disadvantages:

Space to store leftovers Customers’ focus on freshly made food

Recommendation 2: Organic and Non-organic Waste Recycle

Recycling bins in cafeteria, hallways, offices

Flyers to promote recycling Cost: Monthly fee for recycling Advantages:

Ease of implementation Image of hospital

Disadvantages: Motivation of participants

Recommendation 3: Carbon intensity Reuse organic waste for composting

Coordinate with local farmer Cost: None Advantage:

Helping local farmers Image of hospital

Disadvantage: Need space to store compost

Recommendation 3: Carbon intensity Increase energy efficiency

Replace old appliances with energy-efficient models

Properly maintain equipment Replace standard bulbs with LED bulbs

Cost: Purchasing new equipment Advantage: Lower energy bills Disadvantage: High cost to replace

equipment

Summary By implementing our recommendations,

Haven Hospital will see an increase in revenues, a reduction in costs, and an improvement in patient satisfaction.

Questions