Dining By Design Puts Patients At The Head Of The Table

By Nancy K. Crevier

Dining By Design is Danbury Hospital’s response to the industry trend of providing a made-to-order, restaurant-style meal service to patients. Created by Danbury Hospital manager of food and nutrition services Richard Zettegren, and set up by Room Service Technologies, the new dining program is under the direction of a Newtown man, Chef Patrick Wilson.

Formerly the general manager and executive chef for St Andrews Golf Club at Hastings-On-Hudson for ten years, Chef Wilson heard about the hospital’s search for an executive chef through a friend. “I was curious,” admitted Chef Wilson, and that curiosity has led to what he called “a revolutionary move for me” to implement the meal program at the hospital.

“It was a new challenge to me, and the right time — the time for new accomplishments,” said Chef Wilson, who is a 1991 graduate of the Culinary Institute of America in Hyde Park, N.Y., and has received the highest level of accreditation, that of Master Chef. He has also served on the Culinary Institute of America’s (CIA) ProChef Advisory Committee, and has traveled extensively to expand his knowledge and skills.

Dining By Design is the wave of the future, said Chef Wilson, for institutions like hospitals and nursing homes. “You have baby boomers coming up and it’s an upgrade for the food industry,” he said.

The process of introducing the program into the hospital began in August with a complete redesign and buildout of a new restaurant-style kitchen to facilitate the new way of making and delivering food to patients. “We went live with the program on November 16,” said Chef Wilson, and in just one month he feels that a lot of the initial bumps have been smoothed out. “Now we’re working on perfecting the system,” he said.

From the kitchen staff of ten cooks, five cold food preparers, and numerous support staff, to the “ambassadors” that take meal orders from patients on the floor, Chef Wilson retrained the staff of 100-plus people. “It has been 100-hour weeks plus, getting this program into place, but I believe in this program and the challenge,” he said.

Increasing Patient Satisfaction

“I began considering this kind of program when I started three years ago,” said Mr Zettegren. “I knew we needed to increase our patient satisfaction score. The old menu system just wasn’t working.” His own father had praised a similar program in place at Yale-New Haven Hospital when he was there for surgery, so after a lot of research and several site visits to other hospitals, Mr Zettegren decided it was time to embark on a room service-style of menu for Danbury Hospital. Leadership at the hospital was very supportive, said Mr Zettegren, realizing the far-reaching benefits of a good food program.

“First is patient satisfaction with meal service and the ‘halo effect’ on the overall stay, and resulting employee satisfaction, too,” he said. Cost savings over time, due to less waste, is the second benefit, offsetting the enormous cost of the changeover. “Patients eat what they order, so we could see the potential for better nutrition,” Mr Zettegren said.

Dining By Design also goes hand in hand with the hospital’s designation as a Planetree Facility. “This is a concept of health care that puts the patient at the center,” said Mr Zettegren. “This includes not only the room service model of dining, but things like bringing in complementary medicine, pet therapy, more music, and an ease of patient access to their medical records and care,” he explained.

Finding an executive chef with the qualifications necessary was an eight-month process, he added. “We needed somebody who was an educator, had superb culinary skills, is people oriented, both toward employees and our patrons, and somebody who had a flair and an interest in fresher, sustainable choices. Patrick fit the bill,” Mr Zettegren said.

He believes his hotel background also contributed to his suitability for the position, said Chef Wilson, who has opened hotel kitchens in St Louis, Denver, and Manhattan.

With Dining By Design, from 6:30 am to 7 pm patients can call in and order anything off of their own, diet-based menu, which can be anything from a completely unrestricted diet to one of strictly purees and broths. Specialty diets can be accommodated, whether for religious or personal reasons, and the kitchen tries to include ethnic choices, as well, on the menus. There is no set “mealtime,” and the process gives patients a little bit of control over their care, said both Mr Zettegren and Chef Wilson. Visitors can also order meals, for a nominal fee.

Patients who are unable to make the call utilize an “ambassador” to take their daily order. The orders are sent by computer to the kitchen. The kitchen staff receives each order approximately 45 minutes before it is due to the client, the maximum time that it is supposed to take for an order to be processed and sent to the patient.

Set up galley style, the room service section of the hospital kitchen utilizes stoves, ovens, toasters, and grills to prepare the hot portion of the meal. Any cold preparations are handled by staff filling the trays. The plated hot meal is set onto a specially warmed thermal plate, covered, added to the tray, and set onto one of 20 carts designated for various areas of the hospital.

On top of each cart is a large timer. “When the first tray goes on, it is set for 10 minutes,” explained Chef Wilson. When the timer goes off, the cart and any trays on it are set in motion to arrive promptly at the patients’ rooms.

Initial Bumps

“Initially, it was a little rocky,” admitted Chef Wilson. “We had comments that the program was moving a little slow. Some treatments had to be dovetailed with mealtimes in rehab, and that was challenging. It was a hospitalwide change, involving not only the kitchen staff and patients, but the caregivers and nursing staff, as well. I think we are moving to the point of perfecting the system now, though,” he said. “The staff has been wonderfully cooperative.”

Chef Wilson is quick to compliment the kitchen staff that he oversees. Formerly a “can to pan” operation, the cooks were not used to doing a lot of a la carte cooking, he said. “They’ve done a tremendous job. I’m amazed at how smoothly the transition has gone, and there’s a sense of excitement now,” said Chef Wilson.

He is also grateful for the assistance of the purchasing agent, as the hospital switched over from once weekly deliveries, to deliveries of fresh produce and other restaurant supplies six days of the week. “We try to use local vendors, too, whenever we can, to make the meals,” said the chef.

In the kitchen, Chef Wilson is hands-on, staffing the line, the prep area, preparing sauces, and creating new dishes to tempt the patients’ palates. “I like the craft. I’m not the kind of executive chef who just walks around and watches over everyone.”

The dinner meals turned out by the Danbury Hospital kitchen staff include choices such as salmon steak served with a garlic, olive oil, and tomato sauce, or with lemon butter. One of the favorites this past month has been the pan-fried chicken, said Chef Wilson, a sautéed, cornflake crusted breast of chicken with a side of corn relish.

Streamlining Recipes

The overhaul of the meal system meant reviewing and modifying, improving, and streamlining recipes, he said, as well as putting his personal touch into some. The past winner of the Brookfield Chili Cookoff, Chef Wilson lobbied to use his own chili recipe, with special ingredients approved by the dietitian. There are some limitations to his creativity, but all of the items are prepared to order, from the freshest ingredients, stressed Chef Wilson, and what goes out of the kitchen must adhere to his personal high standards.

Marrying those high standards, cooking hundreds of meals to order, and staying within dietary guidelines has been a monumental feat, he said. He relies on the input of the hospital chief clinical dietitian, Janet Hiser. “She has worked closely with me so that portion guidelines, temperature control, and dietary considerations are met,” he said.

“Patrick brings to Danbury Hospital lots of expertise from the restaurant world,” said Ms Hiser. “Our biggest challenge with Dining By Design was that there is a different population of patients in the hospital than you would find in a restaurant. We are looking to offer five-star dining, but have a great number of therapeutic diets we have to work around,” said Ms Hiser.

Not only did they have to tweak the recipes to make them flavorful and still stay within dietary restrictions, whether a broth, a puree, or a solid steak, but they had to take space constraints into consideration, she said. “For instance, we couldn’t make both a low-sodium beef and barley soup and one that was not low-sodium, so we worked together to create a product that could be served across the board for many patients,” said Ms Hiser.

She is very pleased that the hospital now uses fresh vegetables and herbs in place of canned or frozen. From a dietitian’s standpoint, meals created from fresh products are more easily controlled, so far as the addition of salt or sugar, for example. “We even grew our own herbs this summer,” said Ms Hiser, “and you can’t get anymore local than that.”

She feels that she and the staff have leaped the hurdle of adapting to new job descriptions, and have settled into the revamped positions nicely. “This is very exciting, fun, and challenging. We’ve taken the perception that hospital food is bland and boring and turned it around. We’ll only continue to get better and better,” she said.

More Changes Coming

Once Chef Wilson and staff feel that the room service side of Dining By Design is under control, he plans to reorganize the cafeteria at the hospital. It may be another year of long hours and exciting changes, though, before the chef who has won gold in the 2008 International Hotel/Motel Show in Manhattan, gold in the Boston Culinary Classic with Best in Show for Pastry, and received silver in Cleveland and New York City competitions in 2010 is ready to take a break and tackle national cooking competitions again, but it is an aspect of his career to which he looks forward.

“It was sometimes painful and challenging during the learning curve,” said Mr Zettegren, “and we are still working on the timing. But patients tell us the food is very, very good.” One patient’s comment that he particularly liked, said Mr Zettegren, was, “The food was very good. I can’t make jokes anymore about hospital food.” Dining By Design could easily change how people think about hospital food, he said.

Chef Wilson anticipates a “trickle down” effect from Dining By Design. “If Danbury Hospital does a great job in all areas — including food service — people who are having elective surgery might choose our hospital because of that little oomph of better food. It’s a stretch,” he said, “but Danbury Hospital is committed to doing it right.”