At A Glance: Sacred Heart Medical Center

•455-bed hospital (with a current census of about 350) serves apprximately 25-30 room service tray daily.

•Cost per patient day (with or without room service) is appoximately $13.75.

•Patient satisfaction scored based on inhouse surveys are consistently 93% to 94%.

•When the new 359-bed facility opens in 2008, the room service component will continue as is. 

But Traver has succeeded, with a small-scale program that involves the delivery of 25 to 30 room service trays daily. He has achieved his cost-neutral goal by keeping things simple.

“When I observed room service processes elsewhere, I saw that several things drove the extra cost,” Traver recalls. “They offered service 24 hours a day so they were offering it at [some] very low volume times. There was a need for tray passers and call takers—typically four of them—plus they had to buy software. So, I fretted something fierce about how to handle those costs. I figured if you could avoid those things, costs would probably stay stable.”

Just call FOOD: After surveying the room service software available at the time, Traver decided to dispense with those expensive programs. Instead he opted for a simpler approach. He put room service menus in all the patient rooms and added a dedicated telephone in the diet office for room service orders. Every patient has easy access to the room service menu since it’s included in the Guide to Patient Services book that is provided in every room. And when patients dial 3663 (i.e., FOOD), they are hooked up to the diet office. Personnel, alerted by the distinctive ring tone, answer the phone with, “Room Service.”

Another way Traver reduced costs was the decision to restrict delivery times to 12 hours rather than run room service 24 hours a day. “We deliver from 7 a.m. to 7 p.m.—then it’s over,” says Traver. That keeps room service to the same schedule as the medical center’s regular foodservice.

Room service trays are made up and delivered at the same time the staff assembles the regular tray line. He dispensed with the need for adding extra delivery personnel by multi-tasking the people he already had. “Our ‘floaters’, who were delivering special request trays, now deliver room service trays as well,” explains Traver.

The menu: In addition to investigating the room service procedures of several other hospitals, Traver obtained copies of their menus and incorporated many of those ideas into his own room service menu.

Currently, the Sacred Heart room service menu lists four soups, four sandwiches (peanut butter and jelly, tuna fish, turkey and roast beef), hamburgers, chicken breast sandwich, Shrimp Louis salad, milk shakes, four types of dry cereal, fruit and low-fat yogurt. There is a full line of beverages and miscellaneous items such as macaroni and cheese, potato chips, popcorn and toast. The Kid’s Corner section features chocolate milk, Nutra-Grain bars, waffles, Spaghetti-O’s and fish strips. The menu also boasts a section called Sweet Treats that includes Danish pastries, packaged cookies, custards, puddings, Popsicles and ice cream.

To make things easier operationally, all of the items on the room service menu were taken from the medical center’s existing menus.

“The core of it all is the menu—the quality of product lines,” says Traver. Today, at Sacred Heart, costs per patient day (all costs divided by the number of patients) run approximately $13.75. And there is no extra cost in doing room service. In fact, the only “cost” the department incurred was the addition of the dedicated room service telephone in the diet office.

Benefits?: So, it can be done, but Traver still is skeptical in regard to the benefits of the concept in general.

After more than four years, Traver still finds it very interesting that room service has not proven to be a very big part of his patient service. Patients who choose to take advantage of room service are primarily new moms, orthopedic surgery patients and those in oncology. (It’s not available to intensive care unit, mental health and rehab patients.)

“There’s no doubt about it—room service is good foodservice, but I’m not sold that it’s good healthcare foodservice,” he contends. “My question in regard to [room service in] healthcare foodservice is cost. We’ve been able to pull it off, but when you go totally to room service without conventional service you will have added initial costs, plus operational costs.”

Traver further argues that much of the room service in other facilities across the country has been implemented out of a desire to improve the department’s Press Ganey patient satisfaction scores. As an example, he offers St. Bernards Medical in Jonesboro, Ark. “Carolyn Hackworth, its longtime food service director (who retired last year) had a great menu and was passing trays and didn’t offer room service,” he notes. “She was in the 98th to 99th percentile with Press Ganey patient satisfaction—so it’s possible to get up into the 99th percentile without room service.”

Measuring satisfaction: At Sacred Heart, however, Press Ganey scores are not part of the picture since Traver measures patient satisfaction with his own methods several times a year. The same system has been in place for the past 20 years and department scores are typically 93% to 94%, he reports.

The institution of room service has had no impact on those scores, either up or down, according to Traver.

“We’ve always done well by focusing on patient satisfiers. When we simplified our menu about 10 years ago, there was also no measurable change in satisfaction, although I really expected there would be a negative impact.” To simplify purchasing, the hospital went from a four-entrée select, seven-day rotating menu to a two-entrée select, four-day rotation.

Patient satisfaction comes from quality and attention to detail. “We have very good food—much of it made from scratch. Our temps are good—we have the Aladdin Heat-On-Demand system; and we listen to our patients,” he says. Patient surveys are taken three or four times year. Every other year, a focus group of former patients is held by the hospital’s business development and marketing department.

Blueprint for change: Traver also oversees the facility’s retail operation that serves approximately 1,600 customers daily in the cafeteria and in two coffee shops. This enterprise accounts for more than $5,500 in daily sales. He oversees the housekeeping department in addition to his foodservice responsibilities. Another big responsibility is planning for the move next August to a new 359-bed facility across town. For the new facility, Traver plans to stay with the same conventional meal delivery system and a room service component that he has now, since it’s working so well.

For the new cafeteria, he’s planning to offer exhibition cooking, a style of service he couldn’t provide in the older facility because of fire regulations. His regular foodservice staff will provide the training and cooking for this exhibition station, he says, noting that “Cooking fresh to order is really important to people these days.”

Keeping pace: Traver keeps up with current trends, such as healthy dining, sustainable foods and sourcing locally.

“We sell a good deal of fruit, vegetarian items and a lot of other heart healthy things such as whole wheat pasta and whole wheat buns for burgers,” he notes. “It’s exciting to be part of the preventive medicine movement. We [non-commercial operators] play a big role in it. I love the manufacturer end. They have a grasp on trans fat—it’s a big commitment and now it’s getting down to us.”

In an effort to bring more sustainably raised products to the table, Traver has been aiming to buy as much regionally as possible. Currently, about 36% of his $1.7-million food purchasing budget is spent locally. Items such as milk, bread, cookies, tofu paste, yogurt and raw ground beef—a relatively expensive product—are bought locally.

Just as he continually surveys patients to make sure their wants and needs are best served, so, too, he aims to keep his finger on the pulse of the cafeteria crowd with other surveys and focus groups. “We have a lot of customers in their 20s and 30s eating in the cafeteria; many work in patient care. This way, we know what to offer to satisfy them.”