Baptist Health Medical Center

Little Rock, Ark.

By Donna Boss -- Foodservice Equipment & Supplies, 10/1/2003

As one of the fastest growing medical institutions in the South, Baptist Health has been pressed to meet increasing demand for its services. At 840-bed Baptist Health Medical Center-Little Rock, the largest not-for-profit healthcare facility in Arkansas, which includes a 160-bed Rehabilitation Center and 500-seat conference center, on- and off-campus services have grown consistently during the past three decades. In addition, the number of staff has grown exponentially, which has resulted in a significant increase in cafeteria sales.

"Despite the enormous growth of the medical center and need to increase food production," explained Glenyce Feeney, system director, Nutrition and Foodservices, "the original kitchen hadn't been updated for 30 years. We replaced a few pieces of equipment and expanded storage, but hadn't made any significant changes. Oftentimes, though changes were requested - and even approved - they weren't made because our capital budgets were frozen."

In 1999, a new chapter in the evolution of the medical center's Nutrition and Foodservices department was begun. Soon after Feeney hired Charlotte Mosqueira as director of the department, the two recommended that simple "in-kind" equipment replacement was no longer sufficient in light of the need for more substantial changes. The two foodservice professionals pinpointed the dishwashing area as a renovation priority and hired The Hysen Group of Northville, Mich., to prepare a layout and design. With plan in hand, Mosqueira met with the medical center's top administrators and promised that by consolidating two antiquated dishwashing rooms with two dishmachines and a traywasher into one large room with one flight-type dishwasher, a water trough trash accumulator and waste pulper, soiled tray return conveyor and power-agitated pot sink, five FTEs could be eliminated from the department.

"We were given approval to move ahead," recalled Mosqueira. "We lived up to the promise to reduce labor, which we did by attrition. The project was done on time and within budget, reaching completion in November 1999. This established our credibility with administration."

As they began to consider another project - upgrading refrigeration and storage facilities - it became clear to Feeney and Mosqueira that a long-range master plan to renovate the entire antiquated 40,000-square-foot kitchen and, eventually, the cafeteria as a whole, was crucial to the future success of their department. "We had to increase production capacity significantly to meet the foodservice needs of the 840-bed hospital, our 160-bed Rehabilitation Center, catering for the medical center and conference center, outpatient services, satellite operations and the cafeteria," noted Feeney. "We wanted to increase efficiencies, both by improving the flow of work and reducing our dependency on labor." Equally important was the need to bring the operation in compliance with current sanitation and safety codes.

No doubt, the success of the dishwashing area upgrade had given Baptist's administrators reason to believe that a master plan for a comprehensive renovation would prove beneficial. But approval of the foodservice master plan was predicated on a multi-phase renovation of the kitchen and servery. "We had to spread capital costs over several years," explained Mosqueira. "If money became tight one year, we could postpone a phase until the money was available. Anyway, we also couldn't renovate everything at once and keep the foodservices functioning."

Renovation phases were divided by function and location within the kitchen. Phase One, undertaken in the latter half of 1999, was a consolidation of the sanitation area; Phase Two, done in the first half of 2001, involved the rearrangement and upgrade of refrigeration and storage; Phase Three, conducted from January 2002 to March 2003, focused on the tray assembly area and offices; Phase Four-A, undertaken from April 2003 to September 2003, targeted the production area; and Phase Four-B, which will commence in 2004, will involve advanced meal preparation. Phase Five will renovate the cafeteria serving area, while Phase Six will redesign the dining areas.

Though this multi-part renovation was welcomed by the Nutrition and Foodservices department staff, they also knew the process would be arduous. No new square footage was allocated to the department, so efficiencies had to be achieved within existing spaces. The plumbing and ventilation systems had to be replaced, as well. What's more, Feeney and Mosqueira insisted that the renovation be invisible to patients and staff, who weren't supposed to see any interruptions in quality or service.

During Phase Two, storage was rearranged and upgraded. Among the key features was the construction of a roll-in, custom-made blast chiller that accommodates up to four mobile carts. "The chiller allows staff to get ahead of themselves on production and meet high sanitation standards," noted Paul Hysen, principal, The Hysen Group.

"Due to the new blast chiller, we're seeing an improvement in all facets of our food production," stated Mosqueira. "Having this refrigeration capability also allows us to prepare food for catered meals in advance, plate the items and store them in the chiller on roll-in racks, move the racks into a combi oven [which was installed during Phase Four] and heat them for no more than seven minutes." Just before serving, staff garnish plates. The combi system is designed to heat meals and serve up to 450 guests at a catered event in 20 minutes.

In Phase Two, the majority of walk-in refrigerators and freezers were replaced, as well. "The insulation in the walk-in refrigerators had been damaged by water infiltration," recalled Hysen. "Because the insulation value was gone, the refrigeration couldn't maintain proper temperatures."

Old refrigerated units were replaced by four custom-built walk-ins (a fifth will be added in 2004) with a minimum of eight-foot ceiling heights, quarry tile floors, wide doors to admit full pallets of food products and a high level of interior illumination enhanced by a white fiberglass wall finish. Another feature designed into all pieces of refrigeration - standing, roll-ins and walk-ins - are clear, one-piece acrylic doors. Though they are slightly more expensive than solid doors, Hysen and Mosqueira maintain that supervision is easier, sanitation is improved and energy savings are realized because doors are no longer propped open when staff are inside.

During Phase Three, tray assembly was redesigned and offices were moved and reconfigured. Offices were moved to the perimeter of the department on one side, which allowed the tray line to be repositioned and aligned with a glass-doored walk-in refrigerator to assure cold foods were handy as needed. Positioned on the hot side of the tray line are 13 mobile temperature- and humidity-controlled food holding carts, which have been positioned in a newly designed cart parking area that became possible as a result of space consolidation in the dishroom and the repositioning of the offices and tray line. Efficiency on the tray line was also enhanced by a built-in water line with single valves for filling and draining. As a result, the tray line's productivity is stellar by industry standards: 6.5 trays are produced per minute and up to 700 trays per meal. Patient satisfaction scores remain consistently high, in the 95th percentile ranking in peer group for quality of food.

Phase Four-A focused on production areas. The cold food production area was enlarged thanks to consolidations of space in the dishwashing area and the movement of a partial bakery to the general food production area. "As with many facilities of this age, little consideration was given to cold food production," said Hysen. "As a result, as the medical center grew, catering and cold food prep and assembly were critically short of space."

Key Equipment List

Equipment that was installed included four combi ovens (four more will be installed in 2004), which are used to cook everything from vegetables and breads to casseroles. (The racks from the combis can be rolled directly into the blast chiller.) Also installed were fryer batteries with automatic oil filtering systems, grills, charbroilers and mixer-kettles to be used for advanced meal preparation. (This last type of equipment will be installed in Phase Four-B in 2004.)

Another contribution was made to productivity and efficiency by the addition of a centralized overhead utility distribution system that is controlled by a computer system. This system allows staff to program equipment such as dish warmers and cabinets holding hot food to turn on at a specified time in the morning and shut off at a pre-set time at night.

To enhance ventilation, two exhaust hoods were installed to accommodate equipment that is positioned face-to-face. According to Hysen, this configuration is preferable to a back-to-back alignment because employees have more efficient access to multiple pieces of equipment.

Another means of controlling quality and costs was introduced by the installation of the department's first ingredient room, where meal components are measured and weighed prior to production.

Phase Four-B will be the installation of the advanced food production equipment. Included in this lineup are additional combis, 150-gallon mixer-kettles, an in-line conveyor water-bath chiller, vertical pouch filling unit, utility distribution system, ice makers with pneumatic distribution to ice dispensers and a central high-pressure-hose cleaning system with six remote connection points.

With the renovation of the kitchen in place, the staff will begin to prepare for Phase Five, a cafeteria servery renovation. The following year, the dining area will be redesigned.

In the meantime, emphasized Mosqueira, "A staff celebration is in order. We've been renovating for five years. The results are phenomenal. But, we'll all be very happy not to have construction crews in the kitchen every day!"