2004 Ivy Awards

Swedish Medical Center
Seattle

By Margaret Sheridan, Senior Editor

In 1994, Allen Caudle accepted the position of director of nutrition services at Swedish Medical Center in Seattle. Soon after, he asked the staff a question that he pondered for years: Why can’t hospital food match the quality and availability of that served by hotels with room service?

“They didn’t know. But they were curious, and wanted to find out,” says Caudle. This response reaffirmed why he left his previous position at a hospital in Portland, Ore. “The expectations at Swedish are higher,” says Caudle, now vice president of supply-chain management at the medical center.

Room service at Seattle's Swedish Medical Center was introduced at the hospital's First Hill location in February 1997.

Reworking the traditional hospital tray line system wouldn’t be enough. He and a core group of 25 colleagues knew they would have to scrap it all. With support from hospital administration, the team—headed by Kris Schroeder, dietitian and project manager—undertook what became an 18-month challenge to create and execute 24-hour hotel-style room service. In healthcare, there were no role models.

Robert Neroni, hired by Caudle and Schroeder as chef-consultant in 1995, introduced operational changes and skills-improvement programs for cooking staff. Now operator of a cooking school in Oregon, he brought 20 years’ experience as executive chef in hotels to Swedish. Neroni and a staff of 10 foodservice and dietary professionals rewrote recipes, the jobs manual and operations plan. “How to sweep a floor got four pages,” he says.

Swedish introduced room service in February 1997 at its hospital in Seattle’s First Hill neighborhood (one of Swedish’s three facilities). It remains a model for healthcare foodservice, allowing patients to eat what they want, when they want it. Within one year, the hospital was saving 40% on food costs due to reduced waste. The Swedish tradition of sending a full meal to any patient who did not make a selection had been shelved.

“When you talk [healthcare] room service, Swedish is the granddaddy,” says Michael Giuffrida, executive director of the Washington, D.C.-based National Society for Healthcare Food Service Management.

Number of beds served: 697 (First Hill Location); 163 (Ballard location) Annual foodservice budget: $10.5 million Retail outlets: 5 plus 2 espresso bars and 1 physician dining room Staff: 272 (42% part-time) Total daily room-service meals: 2,000

In 1998, Director of Food and Nutrition Services Sharon Cox visited the Seattle hospital to determine if its foodservice program could be adapted for Memorial Sloan-Kettering Cancer Center in New York City. The plan’s flexibility—allowing patients to eat when they want—was appropriate for oncology patients, whose unpredictable appetites are linked to levels of treatment.

“Kris Schroeder is a strong clinician who understands the culinary side,” says Cox. “Swedish’s meals look like they come from a restaurant, not a healthcare facility.”

The hospital’s foodservice flair is evident in imaginative plate presentations and distinctive china with patterned rims. Placemats, napkin rings and menus repeat the hospital’s cobalt-blue logo. Photos of finished plates in the kitchen show details of presentation. Nothing is left to chance.

“The biggest challenge at Swedish—which is spread out over acres in two locations—is food delivery,” Cox observes. “At Sloan, we’re a vertical operation with elevators and 10 floors.”

No Role Model
The transition from traditional tray line to room service was done at no added expense and no loss of jobs, says Caudle. “It required everyone to enhance their skills.”

Within 18 months of rollout, Caudle was promoted and Schroeder stepped into his position. She continues to refine room service and added a second location at Swedish Medical Center in the city’s Ballard neighborhood.

Restaurant-style presentation includes use of patterned china, cobalt-blue logos on menus, placemats and napkin rings. Employee schedules are staggered to handle demand for room service and retail.

Today, Swedish Medical Center produces 1,600 meals daily at First Hill and 400 at its Ballard location. Shift times are staggered. First shift requires the greatest number of employees to expedite room service and run retail outlets. A staff of 14 delivers and assembles trays.

Four employees handle the call center and two backhaulers bring soiled trays to the kitchen. The third shift dwindles to two delivery staff and two clerks on phones.

The pressures to decrease supply expenses are ongoing, says Schroeder. Staff input often helps. But a suggestion to save $11,000 a year by eliminating bottled water from patient menus backfired. “People are so invested in bottled water, especially patients with suppressed immune systems,” she says. So the hospital created its own brand of bottled water last year.

Culture Change
More hospitals are adopting variations of the Swedish program, and Schroeder is not surprised. “It shows the new consumer mindset. People are smarter. If they demand better food and service in restaurants, why not hospitals?”

Her nickname, “Queen of Room Service,” still catches her by surprise. “Room service isn’t rocket science. Hotels have been doing it for years,” she says. “But it has taken hospitals more time to recognize the importance of customer service. We were so focused on the clinical.”

Kris Schroeder

The director of nutrition services at Swedish Medical Center in Seattle is a foodie first, dietitian second.

“She’s fun to eat with,” says Bob Neroni, a consulting chef. “She never lets the clinical side get in the way. Sure, she analyzes, but later.’’

An avid cook and rock climber, she has a penchant for chiles and Southwest cuisine, part of her New Mexico upbringing. Teaching is a passion and fueled an interest in motivational speaking—on topics from food allergies to team building.

“Executing changes at Swedish required a culture change followed by behavior change. Switching [to room service] was hard [for some employees] because it takes people out of a comfort zone. You can lose control.’’

Success came from getting staff to work together and validate different points of view. She uses a rubber-band analogy. “Unless you pull it, the rubber band just sits there—you don’t know its capability. With room service, we stretched that rubber band. We kept the tension on and showed that everyone is capable of stretching.’’