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Whiteville Medical Center

Meaghan Butler and Alexandra RaymondOctober 13, 2014

Problem # 1Food Service Systems

Whiteville Medical Center (WMC) is the largest hospital in the city of Whiteville, Maryland with 800 beds, an 80% occupancy rate, and a 4-day average length of stay. The hospital consists of three intensive care units, an oncology and cardiology unit, and an award winning gastrointestinal floor. The hospital also provides outpatient nutrition counseling services.

WMC is known for its advanced transplant services and also employs some of the top physicians and dietitians in the country. Unfortunately, WMC is also known for serving terrible food and a less-than-friendly food service staff. At their recent quality audit and safety check, the auditors were less than pleased with the old and broken equipment, below average patient services reviews, and poor sustainability practices. For these reasons, the hospital hired Bumond Consulting Firm (BCF) to assist them in modifying their current food service system. BCF is hopeful in improving the hospital's efficiency, patient satisfaction, cost effectiveness, and sustainability practices.

The firm has plenty of work ahead, considering the staff has been using a cook-chill method for the past 30 years and has not updated any of the equipment. The hospital currently has a traditional menu delivery system and a select menu. This means hostesses travel up to the patient’s room to obtain menu choices for the next day. Each meal on the menu consists of three different options each day and rotates throughout the week. The meal selection starts over again on Monday. The trays for each floor are delivered at specific times during meal hours. This system is easier for the staff because of the consistency. Because the hospital is so large, however, the hostesses feel as if their time with the patients is rushed. They have difficulties traveling to each room throughout the hospital in a timely manner. Patients have also complained that there are not enough food options for them on the menu. They report that they would like to choose what time they would like to eat their meals.

Due to the feedback from unsatisfied patients, the Food Service Department would like to move to an At Your Request Menu. At Your Request Menus are most tailored to patient needs. BCF believes that the customization of the At Your Request Menus would help to increase patient satisfaction scores. BCF will also determine which food service system is most efficient for providing food for about 640 patients daily as well as visitors and the hospital staff.

The current method utilized by the WMC kitchen is cook-chill, or ready-prepared. This system has helped the department save a lot of money on both food and labor costs. Making foods in advance takes a lot of stress out of meal production during patient meal times. However, patients perceive the quality of the food to be much lower. In addition, some foods do not freeze or chill well, so this limits menu options. Food safety is also a huge concern with this method. If one batch has been exposed to bacteria, all the patients who received food from that batch will be exposed as well. Management has always been fearful of a foodborne illness outbreak.

Since the department is experienced with cook-chill, they have also thought about purchasing food from a commissary. This would significantly lower food and labor costs. However, management has ruled this method out because there are no commissary kitchens nearby. Management has also considered the possibility of WMC becoming a commissary, itself, but budgeting issues will not allow for this at the time being.

Another option the hospital could consider in terms of food service systems is assembly serve. In the assembly serve foodservice system, all the foods would already be prepared and the staff would simply have to heat the meals. This would definitely decrease labor and equipment needs/costs. But, this system would increase food costs, and with 640 beds occupied on average, the department would spend too much on food. In addition, assembly serve would mean very little variety and menu options. This is also not the best method to ensure patient satisfaction.

Lastly, we consider the conventional foodservice system. In this foodservice system, meals will be prepared onsite, right before they are served to the patients. Ideally, the food items are made-to-order. This foodservice system would allow the department to have much more flexibility in menu items and ensure patient satisfaction and food quality. However, this would increase labor costs. The WMC staff would not only be doing more work during meal times, but they would also have to be trained on the new system. This could decrease some of their patient satisfaction outcomes for at least the first few weeks.

BCF looked closely at the options available and narrowed them down to two--updating the current cook-chill system or moving to a more conventional system. In order to decide which system would be more effective, the firm estimated how each system would affect efficiency, patient satisfaction, and sustainability.

Cook-ChillEfficiency:There is no doubt that the cook-chill method is extremely efficient. The staff is already familiar with this method an would not have to be trained. Since the food is already prepared, there is minimal preparation and the staff does not have to worry about meals being ready in time.Patient Satisfaction:Currently, patients are extremely dissatisfied with the food quality at WMC. Many of the comments they get back from patients are, “it just didn’t taste quite right.” Cost Effectiveness:The equipment is 30 years old and broken, so all of the equipment would need to be replaced. However, this method has lower labor and food costs compared to conventional.

Conventional

Efficiency: Conventional style foodservice systems are less efficient than cook-chill methods because food is prepared as close to service time as possible. This requires a great deal of labor, and the labor load is often unevenly distributed because of the presence of “peak” production times. Patient Satisfaction: Patient satisfaction is typically very high with conventional foodservice methods because the quality of the food is high. There is also no limit to the types of foods that can be produced using conventional cooking methods, thus, patients are often more satisfied with this food preparation method because their menus have more options.Cost Effectiveness: Much of the equipment that would be required for conventional foodservice systems would also be required for cook-chill production methods. Conventional foodservice systems would, however, require much more labor than cook-chill methods would. Conventional methods would also require a great deal of time, and foods prepared under this foodservice style often have a limited shelf life.

Equipment Cook-Chill Conventional

Twin Kettle Mixer $95,045.83 (includes cleaning kit)

$95,045.83 (includes cleaning kit)

Convection Oven $6,886.16 x 2 = $13,772.32 $6,886.16 x 2 = $13,772.32

Convection Steamer -- $13,150.87 x 2 = $26,300

Range, 72”, 12 Open Burners -- $4,995.15

Hot Food Serving Counter $5,170.71 x 2 = $10,341.42 $5,170.71 x 2 = $10,341.42

Countertop Griddle -- $2,011.58

Mixer, Planetary -- $4,687.30

Meat Slicer $3,674.53 $3,674.53

Mixer, Planetary $22,323.54 $22,323.54

Heated Holding/Transport Institutional Cabinet

$4,038.51 x 2= $8,077.02 $4,038.51 x 2= $8,077.02

Robot Coupe Food Processor $3,595.15 $3,595.15

Metering Filling Station $41,128.64 --

Air Operated Casing Clipper $9,560.32 --

Cook Chill Packaging Accessories

$2,512.16 --

Vacuum Clipper Machines $19,092.64 --

Ice Water Control Panel $4,037.60 --

Air Agitated Ice Builder $42,925.12 --

Compressed Air Systems & Refrigerated Air Dryers

$4,789.12 --

Totals: $280,875.41 $194,823.84

*The cost of equipment above is from an estimate from Performance Interiors.

Based on the cost-analysis, BCF has concluded that implementing a conventional-style kitchen is the best decision for Whiteville Medical Center for several reasons. First, the capital costs of implementing the conventional foodservice system are lower than that of the cook-chill system. In addition, patient satisfaction scores for meals derived from the conventional cooking methods are historically higher. Patient satisfaction is a priority for both BCF and WMC. Despite the fact that labor costs are about 8% higher for conventional foodservice, BCF believes that the increase in patient satisfaction scores will prove more useful to the hospital in the long run. Lastly, in order to successfully carry out the At-Your-Request Dining program, implementation of the conventional foodservice system would be ideal.

Problem # 2Menus and HS Snacks

Menus

Although WMC will implement an AYR menu system, they must still decide on a menu rotation for the non-select patients. They have decided to implement a 7-day rotation for a few reasons. The 7-day rotation makes it easier for the staff to remember what foods to cook, since each meal will be on a certain day of the week. In addition, the average length of stay at WMC is 4 days, so most patients will not have the same meal twice. With the AYR system, it is also very rare for a patient to have at non-select menu unless they are on a clear or full liquid. Most patients will be able to utilize the room service system to choose their foods from an extensive menu, so the non-select menu will only really be used as a back up.

To increase sustainability practices, the At Your Request Menu will change every 90 days to include seasonal fruits and vegetables. The cafeteria menu will also be on a 90-day rotation with each Monday as “Meatless Monday.” These concepts will be discussed further in “Problem 5.”

WMC plans decrease meal/day costs from $7.50 to $5.85. The “regular” menu is under $5.85, and each of the special diet order menus are very similar to the “regular” menu with some modifications. There are only minor variations for the specific diets to increase consistency in the men. This will hopefully aid in reducing food costs because the cooks will not be preparing multiple different types of meals.

Cost Breakdown of the Regular MenuBreakfast Cost Lunch Cost Dinner Cost

Spinach and Mushroom Omelet on flat bread 0.8 Chef salad wrap 0.95 Roast Turkey Breast 0.87

Orange Juice 0.36 LS Beef Veggie Soup 0.56 Steamed Broccoli 0.06

2% Milk 0.24 Oatmeal raisin cookie 0.29 Mashed Potatoes 0.09

Coffee or tea 0.12 Unsweetened Ice Tea 0.21 Iced Vanilla Cake 0.39

Non Dairy Creamer 0.03 Sugar packet 0Unsweetened Iced Tea 0.21

Salt and Pepper 0 Salt and pepper 0 2% Milk 0.24

Sugar 0 Salt and Pepper

Total Cost 1.55 2.01 1.865.42

Day 2

Breakfast Lunch Cost Dinner Cost

Buttermilk Pancakes 0.14Egg salad Sandwich on multigrain bread 0.74

Beef, broccoli, brown rice stir fry 1.68

Syrup 0.07 Garden Side Salad 0.26 2% Milk 0.24

Turkey Sausage Links 0.28 Dressing 0.19 Fountain Soda 0.21

Apple Juice 0.16 Fruit cup 0.25 Ice Cream 0.43

Coffee or tea 0.12 Unsweetened Ice Tea 0.21 Salt and Pepper

2% Milk 0.24 Fruit Ice 0.39

Non dairy creamer 0.03 Salt and Pepper

Sugar 0

Salt and Pepper 0

Total Cost 1.04 2.04 2.565.64

Day 3

Breakfast Cost Lunch Cost Dinner Cost

Oatmeal 0.12Vegetarian Black Bean Chili 0.56 Citrus Herb Pollock 0.8

Banana 0.26 Cornbread 0.2 Basil Rice 0.66

Bacon 0.32 Garden Side Salad 0.26French cut green beans 0.24

2% Milk 0.24 Dressing 0.19 2% Milk 0.24

Coffee 0.12 Unsweetened Ice Tea 0.21 Fountain Soda 0.21

Non dairy creamer 0.03 Chocolate chip cookie 0.29 Iced chocolate cake 0.38

Cranberry juice 0.19 Salt and Pepper Salt and Pepper

Butter

Total Cost 1.28 1.71 2.535.52

Regular Menu

Day 1 Day 2 Day 3

BreakfastSpinach and Mushroom

BreakfastButtermilk Pancakes with

BreakfastOatmeal

omelet on flat breadOrange juice

2%milkCoffee

Salt and PepperNon dairy creamer

Sugar PacketKetchupButter

Cost: 1.55

syrupTurkey sausage links

Apple Juice2% milk

CoffeeSalt and Pepper

Non dairy creamerSugar Packet

ButterCost: 1.04

BananaBacon

Cranberry Juice2% Milk



ButterCost: 1.28

LunchChef salad wrap

LS Beef vegetable soupOatmeal raisin cookieUnsweetened ice tea

Salt and PepperSugar PacketMayonnaise

MustardCost: 2.01

LunchEgg salad sandwichGarden side salad

DressingSeasonal Fruit cup

Fruit iceUnsweetened iced tea


MustardCost: 2.04

LunchVegetarian black bean chili

CornbreadGarden side salad

DressingChocolate chip cookieUnsweetened iced tea

Salt and PepperSugar Packet

Cost: 1.71

DinnerRoast turkey breast

Steamed broccoliMashed potatoesIced yellow cake

2% milkUnsweetened iced tea


KetchupButter

Cost: 1.86

DinnerBeef, broccoli stir fry with

brown rice2% milk

Unsweetened Iced TeaIce cream


Soy sauce packetsCost: 2.56

DinnerCitrus Herb Pollock

Basil riceFrench cut green beans

2% MilkUnsweetened iced tea

Iced Chocolate cakeSalt and Pepper

Sugar PacketButter

Cost: 2.53

Total Cost: 5.42 Total Cost: 5.64 Total Cost: 5.52

Cardiac Menu

Day 1 Day 2 Day 3Breakfast

Spinach and Mushroom egg Breakfast

Buttermilk Pancakes with Breakfast:

Oatmeal

white omelet on flat breadOrange juice

Skim milkCoffee

Herb seasoning and PepperNon dairy creamer

Sugar PacketKetchup

Margarine

syrupTurkey sausage links (LS)

Apple JuiceSkim milk

CoffeeHerb seasoning and Pepper


Margarine

BananaEgg whites

Cranberry JuiceCoffee

Skim milkHerb seasoning and Pepper


Margarine

LunchChef salad (LF, LS)

LS Beef vegetable soupSalt free crackers

Oatmeal raisin cookieUnsweetened ice tea

Herb seasoning and PepperSugar Packet

LunchTuna salad sandwich

Garden side saladOil + vinegar

Seasonal fruit cupFruit ice

Unsweetened iced teaHerb seasoning and Pepper

Sugar Packet



Oil + vinegarSugar cookie


Sugar PacketDinner

Roast turkey breastSteamed broccoliMashed potatoes

SherbetSkim Milk


Sugar PacketKetchup

Margarine


brown riceSkim milk

Unsweetened Iced TeaIce cream (lowfat)

Herb seasoning and PepperSugar Packet



Skim milkUnsweetened iced tea

Angel food cakeHerb seasoning and Pepper

Sugar PacketMargarine

Calorie Controlled (1500 calories)

Day 1 Day 2 Day 3

BreakfastSpinach and Mushroom

BreakfastButtermilk Pancakes (1/2

BreakfastOatmeal

omelet on flat breadOrange juice (4oz)

2% milkCoffee


Sugar SubstituteKetchup

Margarine425 calories

serving) with diet syrupTurkey sausage links

Apple Juice (4oz)2% MilkCoffee


Sugar SubstituteMargarine

388 calories

Banana (1/2)Egg whites

Cranberry Juice (4oz)Coffee

2% milkSalt and Pepper

Non dairy creamerSugar Substitute

Margarine449 calories

LunchChef salad (LF, LS)

LS Beef vegetable soupSalt free crackers

Oatmeal raisin cookieUnsweetened ice tea

Salt and PepperSugar Substitute

646 calories

LunchEgg salad sandwichGarden side salad

Oil + vinegarSeasonal fruit cup

Fruit iceUnsweetened iced tea


KetchupMayonnaise

512 calories



Oil + vinegarSugar cookie

Unsweetened iced teaSalt and PepperSugar Substitute

Ketchup616 calories


Steamed broccoliMashed potatoes

SherbetSkim Milk

Unsweetened iced teaSalt and PepperSugar Substitute

KetchupMargarine

467 calories


brown riceSkim milk

Unsweetened Iced TeaIce cream (lowfat)


Soy sauce packets

617 calories



Skim milkUnsweetened iced tea

Angel food cakeSalt and PepperSugar Substitute

Margarine

449 caloriesTotal Calories for the day:

1,538Total Calories for the day:

1,517Total Calories for the day:

1,514

Puree Menu

Day 1 Day 2 Day 3

BreakfastVegetable Quiche Puree

BreakfastButtermilk Pancakes with syrup

BreakfastOatmeal

Orange juice2%milkCoffee



(Puree)Turkey sausage links (Puree)

Apple Juice2% milk



Butter

YogurtCranberry Juice

2% MilkCoffee


Sugar PacketButter

LunchChicken Salad (Puree)LS Beef vegetable soup

(Puree)Ice Cream

Unsweetened ice teaSalt and Pepper

Sugar PacketMayonnaise

Mustard

LunchEgg salad (Puree)

Fruit iceYogurt

Unsweetened iced teaSalt and Pepper


Mustard


(Puree)Cornbread (Puree)

SmoothieUnsweetened iced tea


DinnerRoast turkey breast (Puree)

Steamed broccoli (Puree)Mashed potatoes

Ice cream2% milk




brown rice (Puree)2% milk

Unsweetened Iced TeaSmoothie


Sugar PacketSoy sauce packets

DinnerCitrus Herb Pollock (Puree)

Whipped Sweet PotatoesFrench cut green beans

(Puree)2% Milk

Unsweetened iced teaIce cream


Butter

Gluten Free Menu

Day 1 Day 2 Day 3

Breakfast Breakfast Breakfast

Spinach and Mushroom omelet on GF bread

Orange juice2%milkCoffee



GF Buttermilk Pancakes with syrup

Turkey sausage linksApple Juice

2% milkCoffee


Sugar PacketButter

Scrambled eggsBananaBacon




ButterLunch

Chef saladGF Roll

LS Beef vegetable soupIce cream

Unsweetened ice teaSalt and Pepper


LunchEgg salad sandwich on GF

BreadGarden side salad

DressingSeasonal fruit cup

Fruit IceUnsweetened iced tea


Mustard


RiceGarden side salad

DressingPudding




Steamed broccoliMashed potatoes

Gelatin2% milk




brown rice2% milk

Unsweetened Iced TeaIce cream


Soy sauce packets



2% MilkUnsweetened iced teaChocolate ice cream


Butter

Low Fiber Menu

Day 1 Day 2 Day 3

Breakfast Breakfast Breakfast

Cheese omelet on a flatbreadOrange juice

2%milkCoffee



Buttermilk Pancakes with syrup

Turkey sausage linksApple Juice

2% milkCoffee


Sugar PacketButter

Scrambled eggsWhite toast

BaconApple sauce




ButterLunch

Tuna salad on white breadLS Beef vegetable soupOatmeal raisin cookieUnsweetened ice tea


Mustard

LunchEgg salad sandwich

Fruit iceApplesauce



Mustard

LunchPasta with marinara sauce

Dinner rollChocolate chip cookieUnsweetened iced tea



Mashed potatoesIced yellow cake

2% milkUnsweetened iced tea


KetchupButter

DinnerCheeseburger

2% milkUnsweetened Iced Tea

Ice creamSalt and Pepper

Sugar PacketSoy sauce packets


Basil rice2% Milk

Unsweetened iced teaIced Chocolate cake


Butter

Clear Liquid Menu

Breakfast

Apple JuiceVegetable broth

Hot teaGelatinFruit ice

LunchCranberry JuiceVegetable broth

Hot teaGelatinFruit Ice

Gingerale

DinnerApple Juice

Chicken brothHot teaGelatinFruit Ice

Gingerale

Full Liquid Menu

BreakfastCream of wheat

2% MilkOrange Juice

Fruit IceCoffee

Non-dairy creamerButter

LunchVegetable Broth

V8 Juice2% MilkYogurtGelatin

PopsicleApple JuiceGingerale

DinnerVegetable broth

V8 Juice2% MilkYogurt

PuddingPopsicle

Cranberry JuiceGingerale

HS Snack Rotation

Whiteville Medical Center has also asked the Bumond Consulting Firm to develop a HS Snack schedule. The schedule is on a 7-day rotation to provide consistency for the nourishment staff,

but variety for the patients. The average length of stay is 4-days, so most patients will not have the same snack twice.

Patients will not be provided with extra snacks throughout the day by the food service staff. The hospital floor nurses are required to place a snack order at 9am each day for the following day. The nurses are allowed to request juice, sodas, graham crackers, assorted chips, peanut butter packets, an assortment of seasonal fruit, and yogurt, as well as a few other food items. The Food and Nutrition Department found it is much easier if nurses take responsibility for feeding patients if they are hungry throughout the day. This is because the nurses will be able to administer medications, like insulin, to the patients if necessary when they eat their snack. It is also the responsibility of the nurses to record how much food a patient eats during a meal or snack, so the RDs can properly assess their patients. The food service department will also charge each individual unit for the food items they purchase, so this money does not come out of the budget.

Day Snack CostDay 1 1/2 Ham sandwich with 2% milk 0.45+0.24=0.69Day 2 Fruit and cottage cheese bowl 0.67Day 3 1/2 turkey sandwich with 2% milk 0.47+0.24=0.71Day 4 2oz pretzels, 1oz cheese cubes, fruit cup 0.22+0.20+0.25=0.67Day 5 #16 scoop of tuna salad, crackers 0.70+0.17+0.87=1.74Day 6 Yogurt parfait 0.53Day 7 1/2 peanut butter and jelly sandwich, 2% milk 0.25+0.24+0.49=0.98

Total: 6.66/week*All milks are 8oz**If a patient is allergic or dislikes the option available, they can request a different snack. Their options include:

Fruit and cottage cheese plate Yogurt parfait ½ turkey sandwich or peanut butter and jelly with 2% milk

Problem # 3RD Staffing

Staffing

As requested, Bumond Consulting Firm has also developed recommendations for new RD Staffing and Scheduling at Whiteville Medical Center. Using the Sodexho Clinical Dietitian Staffing Assessment algorithm for moderate acuity, we determined that Whiteville Medical Center would need the equivalent of 11 Full Time Equivalents (FTEs) for clinical dietitians. The algorithm we used took into consideration the size of the unit, the percent occupancy of the unit, the acuity of the patients within the unit, and the nature of care necessary (ie. mostly diet education, etc.) to estimate the number of full time dietitians required.

Below is the spreadsheet of our Clinical Dietitian Staffing Assessment. As previously mentioned, we devised this spreadsheet based on the Sodexho Clinical Dietitian Staffing Assessment Moderate Acuity Model. We included each of Whiteville Medical Center’s nursing units, the number of beds in each, and the figures for percent occupancy, which are measured on a monthly basis. We also included the staffing factors utilized in Sodexho’s model. We multiplied the number of beds, the percent occupancy, and the staffing factor to reach our product, the number of FTEs in each unit. We modified some of the staffing factors based on the nature of the work required by dietitians. We increased the staffing factors for three units we felt demanded more labor, from 0.014 to 0.015. These units include the step-down intensive care unit, the gastrointestinal unit with a large tube-feeding population, and the medical services unit with a great need for diet education.

We did not include any information in the “Outpatient” category of this spreadsheet, because none of the inpatient dietitians will be completing any outpatient work. We have hired a strictly outpatient dietitian to cover all of these responsibilities. Additionally, we included the categories of Management Responsibilities, Community Programs, and Non-Productive staff time into our staffing model. We estimated that our inpatient dietitians would be completing a total of 13 hours/year of hospital-wide presentations. We also estimated the number of hours per week each dietitian would be participating in managerial responsibilities such as completing test trays or meal rounds; conducting surveys; attending meetings; or hosting employee in-services. We divided these hourly estimations by 40 to reach our FTEs. We then added up the entire FTE column to determine our Total Productive FTEs for the dietitians, which was 9.8.

Finally, we multiplied our Total Productive FTEs (9.8) by the percent of productive hours that are dedicated to vacation, holiday, and sick time (12%). This brought us to our Total Non-Productive FTEs, or 1.2. Adding up both of these totals, we reached a final number of 11 FTEs required for clinical dietitians in Whiteville Medical Center.

Spreadsheet:

Based on a budget of $1,180,000 from Whiteville Medical Center, we then determined the breakdown of experienced dietitians, entry-level dietitians, and dietetic technicians-registered (DTRs) that would be most suitable for the hospital. To do so, we compared the information

from the algorithm with the designated medical specialties of each unit to determine the proportion of experienced dietitians necessary. Upon this assessment, we estimated that a total of six full-time experienced inpatient dietitians would be sufficient within our budgetary constraints. These dietitians would cover the specialized units including oncology, pediatrics, and intensive care units, and GI floors. The outpatient dietitian and weekend coverage dietitian would also be experienced dietitians, totaling eight experienced dietitians, altogether.

In addition to these eight experienced dietitians, we also included three entry-level dietitians in our staffing model. These inexperienced dietitians would cover the general medical service units and medical/surgical service units. These dietitians would also delegate some of their low-risk patients to three Dietetic Technicians (DTRs). The purpose of staffing three DTRs in addition to 11 RDs is that DTRs are entirely qualified to complete consults and dietary educations for low-risk patients. BCF feels that utilizing DTRs to see low-risk patients is an effective means for the hospital to save money and a resourceful way to give the dietitians more time to dedicate to the high-risk patients.

Altogether, this brings us to 12.4 FTEs for the inpatient dietetic staff at Whiteville Medical Center, and 1FTE for the outpatient dietetic staff. This value is slightly higher than the number derived from the Sodexho Clinical Dietitian Staffing Assessment. Whiteville Medical Center is fortunate enough to have it in their budget to afford additional FTEs, as indicated below.

Below you will find the official Nine Week Rotating Schedule, and the Whiteville Medical Center RD/DTR Salary Table.

The Rotating Nine Week RD Schedule indicates the hours each dietitian/DTR would work per week, and the days that each would cover the Saturday shift. Because of the size of the hospital, BCF decided to staff three dietetic employees on Saturdays and one experienced dietitian on Sunday. The inpatient dietitians cycle rotate through a nine-week rotation, beginning

with dietitian A and rotating all the way through to dietitian I, for Saturday coverage. Dietitian K, the experienced weekend dietitian, would cover both the Saturday and Sunday shifts. The DTRs would cycle through a three-week rotation within this nine-week rotation. Each Saturday, one DTR would be scheduled to see all of the lower-risk patients, beginning with DTR 1, followed by DTRs 2 and then 3. This schedule ensures that there is consistent coverage of the patients within Whiteville Medical Center.

As evidenced in the Whiteville Medical Center RD/DTR Salary Table, some of the experienced dietitians have additional certifications. Both of the Intensive Care Unit dietitians have Nutrition Support Certifications, and both the Neonatal Intensive Care Unit and Pediatric dietitians have Certifications as Specialists in Pediatric Nutrition. These certifications are reflected in their pay increases of $3,000 and $2,000, respectively. The remaining two full-time, experienced dietitians are paid the standard rate for experienced dietitians, which is $55,000. The final experienced dietitian is the weekend dietitian. She is paid a slightly higher rate of $28 per hour because she is an experienced dietitian, but also because she is working strictly on the weekends.

The entry-level dietitians are all paid the standard rate of $48,000. The DTRs are also paid the standard rate of $32,000. Altogether, the salaries of the experienced, inexperienced, and DTRs add up to $817,046.00. This accounts for 70% of the total RD Budget. With the remaining $362,954, Whiteville Medical Center will invest in continuing education for the dietitians and DTRs. Whiteville Medical Center will send their dietetic employees to conferences, pay for their academy memberships, and provide them with any updated tools/resources they need to most effectively do their job and keep up to date with current research. The leftover RD budget finances can also be allocated to provide the dietetic staff with bonuses or yearly raises based on performance or the acquisition of additional certifications.

Problem # 4Budget

Budget

The Food and Nutrition Department has a $250,000 budget for purchasing new, large equipment for the newly established conventional method. BCF plans to purchase higher-end, quality equipment because it has a longer lifespan.

The wish list includes: 1. Twin Kettle Mixers2. Convection Oven x 23. Convection Steamer x 2 4. Range, 72”, 12 open burners5. Hot Food Serving Counter x 26. Countertop Griddle7. Countertop Mixer, Planetary8. Meat Slicer9. Floor Mixer, Planetary 10. Heated Holding/Transport Institutional Cabinet x 211. Robot Coupe Food Processor

Some of the equipment the department does not need to update. For example, the microwave, the toaster, the tilt skillet, the refrigerators, and freezers are all still functioning. In addition, the hospital has sufficient patient delivery carts, silverware, lowerator plate dispensers, and trays.

Category AmountEquipmentLarge Equipment from Sodexho $194,823.84Trays - -Alladin (Domes and Bases) $116,229.00 Tray and Plate Dispenser - -

ITPrinter, port $1,625.00 Training $3,300.00

MenusNew AYR Menus $4,000.00

Total Allocated Dollars $319,977.84 Budget Variance $(69,977.84)

Problem # 5Sustainability

Sustainability

Hospitals and other mass-producing kitchens can be extremely energy and resource-intensive enterprises. The healthcare industry, as a whole, can play a pivotal role in mitigating the effects of climate change. Here at BCS, we firmly believe that it is our responsibility to ensure that our clients are doing everything in their power to minimize their carbon footprint, reduce waste, and improve the quality of lives of their patients, staff and visitors.

While evaluating Whiteville Medical Center’s sustainability practices, we came across three overarching areas for improvement. These areas include: reducing organic and non-organic waste; sourcing local, seasonal, or sustainably grown and raised products including produce, proteins (meat, seafood, fish), dairy and baked goods; and reducing WMC’s carbon intensity.

Reducing organic and non-organic waste

First, we propose several ways to reduce the amount of organic and non-organic waste produced by Whiteville Medical Center. Before making any particular adjustments, WMC’s Food and Nutrition Department will elect 5 employees to comprise a Sustainability Committee. This committee will work alongside BCF in the initiation of the following sustainability programs.

Upon the development of the Sustainability Committee, one or two members of the committee would be held responsible for conducting a food-waste audit. A food-waste audit would provide data on the types of food waste being generated by WMC. The audit, itself, requires added labor and time, but would provide WMC with great insight into their waste practices. Conducting a food-waste audit before implementing any sustainability initiatives, specifically, would be advantageous because it would give WMC the opportunity to evaluate their production and forecasting practices. After evaluating their production and forecasting practices, WMC could ensure that they are purchasing and producing only what they need, and nothing more. This would save WMC both time and money, in addition to reducing waste.

WMC should also consider composting as a viable option to reducing their organic and non-organic waste. An establishment as large as WMC produces tons of waste per week. On average, WMC serves 2,920 meals per day. This includes meals for patients, staff, visitors, and cafeteria customers. Using the RecyclingWorks Food Waste Estimation Guide, we estimate that WMC generates about 4.4 tons of waste per week. This equates to 228.8 tons of pre- and post-consumer waste per year. By purchasing an on-site composter, WMC could drastically reduce the number of tons of waste they send to landfills each year. Composting could also save WMC tens of thousand of dollars that would otherwise have been spent on trash collection.

Selecting an appropriate composter for WMC is difficult considering the hospital is located in the heart of a city. This limits WMC to in-vessel composters, which can get pretty pricey. Smaller in-vessel composters, such as the Hot Rot 1206, can cost about $119,880 including capital costs, installation costs, service charges, and staffing. The vessel can hold about 0.6 tons per day. The vessel is a continuous system, allowing waste to be added to the system periodically throughout the day. The vessel discharges compost at a steady rate throughout the day, as well. A composter such as this would be able to divert about 150 tons per year of food waste from going into landfills, drastically decreasing the amount of waste produced by WMC each day.

Another proposition BCF has for reducing the amount of organic and non-organic waste is to donate any pre-consumer food waste to local area food banks, such as DC Central Kitchen. WMC can help contribute to local hunger initiatives by donating surplus prepared food, raw produce that would go bad before use, or raw produce that would otherwise be thrown out. Because only 0.6 tons of food per day can fit into the in-vessel composter, WMC is likely to have remaining food waste. Pre-consumer food waste that meets the requirements for donation set forth by local area food banks can be stored at the required temperatures and conditions, and often picked up free of charge by the food bank, itself. This would save WMC from depositing the solid waste to landfills, and from paying the trash collection charges they would have had to pay to have the waste picked up. Ideally, WMC would have a waste diversion rate of 50% or higher by the year 2016, meaning that at least 114 tons of food waste would be going to the composter or food banks each year to prevent waste from being deposited in landfills.

Sourcing Locally Grown and Sustainable Foods

Next, we propose that the patient and cafeteria menu cycles are changed every 90 days to incorporate seasonal produce. The drawbacks of making such adjustments would be that they would require more labor to train the production staff and more time invested in creating and costing out hospital menus. Sourcing seasonal food from local farmers, however, would minimize carbon emissions from produce transportation, minimize food-packaging waste, and increase patient and customer satisfaction. Seasonal, local produce may also lead to less food waste if the menu items are properly advertised as “local” or “seasonal” and if the food is fresher. By the year 2016, WMC should be sourcing at least 15% of its produce from local vendors or food hubs, such as Edward G. Rahll & Sons INC. in Jessup, Maryland.

Reduce Carbon Intensity

Lastly, we will detail several methods for WMC to reduce their carbon intensity. One way WMC can reduce their carbon intensity is to offer financial incentives for customers to bring in their own reusable plates, utensils, or storage containers. By providing customers with incentives such as a 5% discount on their meal for bringing in their own reusable containers, WMC can decrease their carbon footprint by purchasing less paper products and having less solid waste. Some drawbacks of this method are that it would require more training and procedures for the cashiers. In order to effectively implement this for the salad bar and deli areas, WMC would have to sell their own containers to their visitors. This is because the deli and salad bar areas are priced based on weight, and there would have to be a standardized container to assure that everyone pays the same rate. Another way to decrease WMC’s carbon footprint is to implement a hospital-wide recycling program. WMC currently has two types of bins in their cafeteria/eating areas. One bin is for recycling, and one bin is for trash. Though WMC claims to recycle, many employees have frequently reported incidences of recycling being disposed of in the trash dumpsters. BCF feels that it is time for WMC to implement a more efficient recycling program. Recycling, in general, prevents pollution, decreases emissions of greenhouse gases, reduces the need for landfills and incineration, preserves natural resources, and even helps the economy by protecting and

increasing the number of manufacturing jobs. The department will keep the two bins, but also post recycling signage above the bins to facilitate recycling and help keep people informed of the benefits of recycling. The Sustainability Committee will enforce recycling practices at WMC. Increasing recycling awareness in the hospital is an inexpensive solution. BCF believes it will prove effective because of the oversight by the Sustainability Committee.

Finally, BCF recommends that WMC incorporate more meatless items into their menus. Research from the Environmental Working Group’s Meat Eater’s Guide and the EPA’s Guide to Passenger Vehicle Emissions shows that meat, cheese and eggs have the largest carbon footprint. Ranging from 6.9 to 39.2 CO2 Kilos Equivalent, meat has a very large carbon footprint. The distance a car would have to travel to match the carbon emissions from the production of lamb is 91 miles. Coming up at a close second to meat is eggs. The average carbon emission for eggs is 4.8 CO2 Kilos Equivalent. This compares to the carbon emission from about 11 miles driven. Producing nuts, beans, tofu, and vegetables yields carbon emissions of about 2.0-2.3 CO2 Kilos equivalent, or 4.5 car miles driven. By replacing meat-, egg- and cheese-laden menu items with alternative recipes containing fruits, vegetables, grains, beans and nuts, WMC can decrease its carbon footprint substantially. BCF has developed a “Meatless Monday” plan for WMC to implement in the hospital cafeteria. The dietary staff on the phone will also promote meatless Mondays when patients call down to order their meals.

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