SAGE GRADUATE SCHOOL: DIETETIC INTERNSHIP

Menu/Theme Meal Project

Overland Park Regional Medical Center
Dianna Sinni Spring 2014

I. FACILITY NEEDS & MENU CHANGES Overland Park Regional Medical Center (OPRMC), managed under Compass Groups food service entity, Morrison, will be executing a new patient menu this Spring 2014. This updated menu, entitled Great Living, will incorporate consistent carbohydrate, renal, and cardiac diets under the regular menu option; the regular diet order will now be a 4-in-1. The main goal of this menu update is to ensure patients do not feel restricted and to provide seamless production from both the culinary and service teams. The retail cafeterias demographics include approximately 75% employees and 25% visitors or guests. Through integration of the new patient menu in the cafeteria, employees and guests are able to taste the food. The hopes for this menu highlight is to create awareness of the menus flavor, aesthetics, and nutrition profile, allowing employees to successfully and positively speak personally to the patient food. Another purpose for serving the patient menu in the retail cafeteria is to provide a week for the culinary staff to produce it and work out the kinks as all of the recipes are entirely new. The theme meal of this weeks menu will be Wednesday, as this is typically a high traffic day for the retail cafeteria. In regards to sustainability, the theme menu and meal will adhere to portion controls through correct serving utensils. The retail space utilizes nutrition signage reflecting macronutrients per serving; thus a utensil will match the correlating signage for serving. However, since the cafeteria hot bar is a self-serve line, there is no ideal method to ensure waste will not occur, especially after food has been put on a customers plate. Additionally, in order to reduce waste, the food will be prepared according to typical sales projections of the cafeteria, so as to not produce too much more food than what is expected to be purchased. II. FACILITYS CURRENT MENU GUIDELINES OPRMC adheres to stringent nutrition guidelines for both retail and patient menus. These guidelines come from the Compass Group management group, Morrison, and are monitored through quarterly audits. The following guidelines are as follows: Patient Guidelines: The new nutrition guideline for the Great Living regular diet menu combines the 2 gram sodium, cardiac and consistent carbohydrate diet restrictions under one heading. This is a noadded sodium, low fat, low cholesterol diet with 60-75 grams of carbohydrates (4-5 exchanges) per day. It increases dietary fiber by 20%, decreases overall sodium content by 50%, and decreases total and saturated fat by 45-59% from the previous patient menu. Table 1.1 highlights the nutrient guidelines:

Retail Guidelines: Morrison has a detailed nutritional criterion, called FIT, for caf menus. At least 50% of the offerings in the retail cafeteria must adhere to these guidelines, including to-go items and main entrees. The guidelines focus on total calories, total fat, saturated fat, trans fat, and sodium for sides and entrees These dietary guidelines were developed to align with the current USDA recommendations. Table 1.2 outlines the criteria, otherwise known as FIT, for any Morrison hospital retail dining. Table 1.2: FIT Criteria For Retail Dining (BF = Breakfast)
Calories Total Fat (g) Saturated Fat and Trans Fat combined (g)
*criteria for artificial trans fat is 0g.

Full Meal 600 (400 BF) 25 (20 BF) 5

Entre Only 400 20 5

Side Dish 250 n/a 2

8 Fl. Oz Soup n/a n/a 2

12 Fl. Oz Soup n/a n/a 3

Sodium (mg)

600

600

250

500

750

III. ONE WEEK MENU & THEME MEAL Since the one week menu will highlight the new patient menu, the weeks menu was planned by handpicking specific dishes from the already created patient menu, correlating with the day of the week, to be served ala carte on the hot bar. There are two main entrees and four sides; so typically patrons serve themselves 1 entre and 2-3 full-size servings for each. Some also graze and take half or quarter portions of each item to taste them all. Since the entire weeks menu consisted of the same theme (patient menu highlight), I focused on Wednesday for this projects theme meal as it is generally the cafeterias busiest day of the week. The following page details Table 2, which provides a snapshot of the weeks menu.

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project Table 2: One Week Menu and Theme Meal (Week of March 4th-March 8th)
*Theme Meal highlighted in yellow*

Category
Soups

Monday
Broccoli Cheddar Creamy Potato

Tuesday
Chicken Tortilla Cream of Mushroom

Wednesday
Chicken Noodle Fire-Roasted Corn

Thursday
Broccoli Cheddar Hearty Vegetable

Friday
Chicken & Rice Black Bean

Chef Breakfast Bar Cheese Omelette with Sauted Breakfast Potatoes Pizza Station PIZZA/PASTA BAKE Entre Station Entre 1 Entre Sides 2 Roasted Turkey Breast with au Jus Traditional Beef Lasagna Whipped Potatoes with Olive Oil Sauteed Zucchini, Yellow Squash, & Red Peppers Whole Baby Carrots Buttered Egg Noodles Outtakes Chef Salad Smokehouse Chicken Sandwich Turkey Garden Salad Dijon Roast Beef Sandwich Santa Fe Chicken Salad Tuscan Turkey Sandwich Chicken Caesar Salad Chicken Salad Sandwich Chicken Fajita Salad Garden Salad Chicken Soft Tacos Rotisserie Style Chicken Mexican Corn Rice Pilaf with Fresh Mushrooms Italian-Style Vegetable Medley New Potatoes Whole Wheat Pasta with Meat Sauce Herb Roasted Pork Loin Seasoned Green Beans Maple Mashed Sweet Potatoes Fresh Steamed Broccoli Herbed Rice Pilaf Tuna Noodle Casserole Meatloaf Turkey ala King with Fettuccine Zucchini and Tomatoes Rice Pilaf with Mushrooms Whipped Potatoes with Olive Oil Bowtie Pasta and Chicken Alfredo Dijon Crusted Tilapia Carrot and Cauliflower Blend Roasted Potatoes with Fresh Herbs Parslied Noodles Fresh Steamed Broccoli PIZZA/PASTA BAKE Whole Wheat Cinnamon French Toast Potato Vegetable Skillet with Scrambled Eggs Casserole Breakfast Egg Thin with Fresh Spinach & Hash Brown Patty Egg and Cheese Breakfast Burrito with Pico de Gallo

Items highlighted in green = Vegetarian options

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project IV. NUTRIENT ANALYSIS The nutrient data below was analyzed using Morrisons Webtrition nutrient analysis system and recipe database. In order to adequately compare the nutritional data of each meal listed above, it is important to first reiterate that the theme meal was created by handpicking options from both lunch and dinner off of the new patient menu. The patient menu is calorically dense, adheres to consistent carbohydrate, 2 gram sodium, and heart healthy guidelines for each meal; however the theme meal is more of a showcase of these items and does not necessarily reflect this in its entirety. It does not reflect a single patient lunch menu which would be more nutritionally consistent and in line with the aforementioned diet guidelines than the theme meal is. Table 3.1 Theme Meal Nutrient Analysis per Serving
Hot Bar Item Whole Wheat Pasta with Meat Sauce Herb Roasted Pork Loin Seasoned Green Beans Maple Mashed Sweet Potatoes Fresh Steamed Broccoli Herbed Rice Pilaf TOTALS: Energy (kcal) 340.042 226.221 31.67 90.346 23.519 158.526 1395.798 Total Fat (g) 11.17 13.311 1.534 1.695 0.256 1.79 29.756 Sat. Fat (g) 2.668 4.879 0.223 0.472 0.027 0.327 8.595 CHO (g) 44.591 0.284 4.403 17.877 4.593 31.507 103.25 Sugar (g) 5.768 0.004 0.84 6.08 0 0.511 13.203 Fiber (g) 5.449 0.112 2.054 2.155 1.798 0.841 12.40 Protein (g) 19.575 24.64 1.019 1.646 1.951 3.113 51.944 Sodium (mg) 351.134 274.748 30.228 49.109 22.827 165.208 893.254 Serving Size 1c pasta 3/4c sauce 3 oz 1/2 cup 1/2 cup 1/2 cup 1/2 cup

Table 3.2 Previous Weeks Meal Nutrient Analysis per Serving

Hot Bar Item Slow Roasted Pork Carnitas Grilled Skirt Steak with Chimichurri Roasted Tomatoes Mexican Corn Pinto Beans Spanish Rice TOTALS: Energy (kcal) 244.524 255.756 19 78 137 107 841.296 Total Fat (g) 15 15 1.434 0.687 0.591 2.57 35.282 Sat. Fat (g) 5.139 5.24 0.2 0.103 0.173 0.564 11.419 CHO (g) 2.717 0.348 1.627 18 22.24 19.34 64.272 Sugar (g) 0.557 0.143 0.857 3.249 1.734 2.121 8.661 Fiber (g) 0.824 0.074 0.454 2.489 7.495 1.258 12.594 Protein (g) 23.701 27.17 0.364 2.5 8 2 63.735 Sodium (mg) 437.38 362.586 119.79 1.733 196.77 90.53 1208.789 Serving Size 4oz 4oz 1 halve cup cup cup

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project Table 3.3 Grill Entre & Sides Being Served Alongside Theme Meal
Grill Item Corner Diner Burger Onion Rings French Fries Bacon American Cheese Sweet Potato Fries TOTAL: burger/fries/cheese Energy (kcal) 509 225.55 197.23 37 53 151 759.23 Total Fat (g) 30 14 11.14 3 4 5 45.14 Sat. Fat (g) 11.07 1.12 1.4 0.95 2.13 0.391 14.60 CHO (g) 31 22.75 22.5 0 1.213 26 54.7 Sugar (g) 9.18 1.654 0.181 0 0.8 7.1 Fiber (g) 4.48 1.449 1.72 2.52 0 3 Protein (g) 30 2.978 2.032 3 2.39 1 Sodium (mg) 807.2 435.87 303.67 116.82 182 116.45 1295 Serving Size 1 sandwich cup cup 1 slice .5 oz 1/3 cup

For example, when comparing the theme meal (Table 3.) to the previous weeks meal (Table 3.2), it is clear that the theme meal offers significantly more calories and carbohydrates than the previous weeks menu. This is due to three reasons: the fact that the theme meal is actually two separate meals options on the hot bar (each 4 carbohydrate servings), and patient meals needing to be more calorically dense for inpatient purposes. Typically, retail patrons do not serve themselves an actual portion size of each option, but rather stick to 1 entre and 2-3 smaller sides, and therefore will consume much less carbohydrate and caloric content than what is recorded in the tables above. Total and saturated fat content of the theme meal is also lower than the previous weeks meal 8.5g vs. 11.4g saturated fat, and 29.7g vs. 38.2g total fat. This can be attributed to the ingredients in the theme meal vs. the ingredients in the previous weeks meal. For example, the patient menu uses olive oil rather than butter or margarine, and white meat poultry and loin (muscle) cuts of meat whereas the pork carnitas and skirt steak of the previous weeks meal are more fatty options. Lastly, the sodium content is lower by approximately 300mg for the theme meal vs. the previous weeks meal. This is because the theme meal adheres to the patient menu guidelines, which is noadded-sodium. However, one could also argue that the previous weeks meal is relatively lower in sodium too; it must adhere to the FIT guidelines of less than 600mg/meal (keeping in mind the hot bar offers two meals, not just one). When comparing the theme meal to the grill meal being served at the same time, it is clear that a grill meal is extremely high in fat, sodium, and carbohydrates. For the purposes of this analysis, I added totals for a burger, fries, and cheese which might be a typical grill order. The calories are 760kcal for this meal, which is actually half of the calories from the theme meal (or possibly one meal option from the hot bar). Although similar in calories, the grill special is much less nutrient dense due to its lack

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project of whole grains, fruits, and vegetables. The grill meal is also exceedingly high in sodium vs. the theme meal, with 1295mg of sodium for a cheeseburger and fries vs. 892mg for two meal options. V. WASTE REDUCTION In order to reduce waste, and since this was the first time the team had executed the new patient menu, I compiled general notes of what items were wasted after lunch time and which seemed to be customer favorites based off of refilling and customer observations. This information was useful for the Executive Chef and Patient Services Manager in understanding which items are most popular and more likely to be ordered by patients when the menu is fully installed. For example, the pasta dish was very popular and ran out early, while the steamed broccoli had leftovers after the lunch rush. Although unable to purchase and use for the theme meal, I priced out compostable containers and encouraged the Food Service Director and Executive Chef to use these for environmental sustainability. At this time, they are not able to budget for these products due to current hospital construction budget constraints, but they did express wanting to move that way in the future. VI. MARKETING MATERIALS/IMAGES The following images reveal what the plated theme meal looked like. We had these plates on display for customers and employees to view above the hot bar, so that they could understand what the new menu would look like when plated for patients.

The following page is a copy of the actual retail cafeteria menu that was posted on the hospitals intranet, by the entrance of the cafeteria, and emailed out to all staff.

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project

TT

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project Additionally, nutrient analysis signage and copy of the patient menu were set out on top of the hot bar line. The following image shows what the entire hot bar line looked like on theme meal day:

VII. THEME MEAL COST ANALYSIS The hot bar is weighed at $0.44/ounce for customers. The following cost analysis was created by observing customer plates, confirmation from cashiers revealing average plate size to be 14 ounces in weight, and using Webtrition nutrition/cost analysis software. It was observed that most customers took small portions of each item to have a sampler platter, rather than just one entre option and two sides. Also, the following analysis for the hot bar is for 226 patrons, out of a total of 346 for the entire days lunch. Total revenue for lunch in the entire cafeteria was $1,454.84, with $809.11 of that specifically coming from the hot bar. In discussion with the Food Service Director, we decided that we could increase check averages by increasing the price per ounce from $0.44 to $0.49 to generate more overall revenue from lunch. However, this is something to be done later in the year, not immediately. Table 4.1: Theme Meal Recipe Cost taken from Webtrition software
Recipe Whole Wheat Pasta with Meat Sauce Herb Roasted Pork Loin Seasoned Green Beans Maple Mashed Sweet Potatoes Fresh Steamed Broccoli Herbed Rice Pilaf Recipe Yield Serving Size Recipe Cost/Serving

50 50 50 50 50 50

12oz 3oz 4oz 4oz 4oz 4oz

$0.58 $0.56 $0.24 $0.20 $0.24 $0.13

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project Table 4.2: Theme Meal Cost Analysis
Item Name Average Serving Size 3 ounces 3 ounces 2 ounces 2 ounces 2 ounces 2 ounces FCost/Ounce Fcost/Average Serving Size $0.33 $0.57 $0.12 $0.10 $0.12 $0.14 Total # Servings Recipe Costs

Whole Wheat Pasta with Meat Sauce Herb Roasted Pork Loin Seasoned Green Beans Maple Mashed Sweet Potatoes Fresh Steamed Broccoli Herbed Rice Pilaf

$0.11 $0.19 $0.06 $0.05 $0.06 $0.07

226 226 226 226 226 226

$74.58 $28.82 $27.12 $22.60 $27.12 $5.82

Food Cost/Plate (14oz):$1.31 Total Food Cost: $296.06 Food Cost %: 36.6% Profit/Loss: $513.05 profit without labor/production costs included Compared to the grill meal being served alongside the theme meal, the theme meal is definitely much more costly for the department because each recipe uses more ingredients. However, the revenue generated from the grill meal is higher than that of the theme meal because it is not weighed per ounce. The grill special is a flat $3.89 for customers, with additional sides such as onion rings, French fries, or sweet potato fries an additional $1.49. One grill meal could be $5.38 per customer, while the theme meal plate averaged only $1.31 per plate. IX. MENU/THEME MEAL PLANNING SCHEDULE + EQUIPMENT NEEDS Table 5: Theme Meal Production Schedule: TIME EMPLOYEE/AREA
6:00-7:30am Cook 1 Cook 2 BREAK 7:30-7:45 7:45-10:30am Cook 1 Cook 2 Lead Cook 10:30-11:00am Cook 1

PRODUCTION
Prep green beans, broccoli, and mushrooms. Peel sweet potatoes Chop herbs Thaw pork and turkey meat Cook pasta + rice pilaf Saut mushrooms Steam broccoli Steam and mash sweet potatoes Saut green beans Prepare turkey meat marinara sauce Roast pork loin

SERVICE

Bring up food +

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project

Cook 2 Executive Chef FSM Director DI Intern Retail Cooks 1-3 Retail Cooks 1-3 Retail Cooks 1-3 Dishwasher 1 Discard lunch, run dish machine, wipe counters, sweep mobile warmer from downstairs kitchen Discard breakfast Wipe counters clean, set lunch Refill hot bar Wipe clean

11:00-2:00pm 2:00-3:00pm

Equipment Needs: There were no additional equipment needs. The hospitals kitchen is a fully equipped food service operation with all of the necessary tools to produce and execute meals. Budgeting: There was no budget constraint for this menu or theme meal. X. CUSTOMER SATISFACTION/POST-EVALUATION In order to assess our customer understanding and enjoyment of the new patient menu, I created a quick survey. We did not opt to do this during the theme meal day, because we wanted to gather information regarding the entire weeks meal satisfaction, not just one day. The survey was accessible in two places: by the cashiers and set at a table by the exit of the cafeteria manned by myself. A collection box was set out in two places inside the eat-in cafeteria, on top of the garbage and on my table by the exit door. The survey was available for customers Thursday-Friday during lunch hours. Also, since the majority of employees eat each day in the cafeteria, we did not want to hassle them with five days of the same survey. I received a total of 45 completed customer satisfaction surveys. The following data was analyzed from the responses: Table 4.1: Example Customer Satisfaction Survey

Sunflower Caf

Customer Satisfaction Survey

Please circle and fill-in Did you know that the new Great Living patient menu was part of todays menu options? YES NO

What did you eat from the soup, salad, and hot bar options? Please fill-in and rate your meal enjoyment: ______________ 1 2 3 4 5

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project

not my preference

enjoyed moderately

enjoyed very much

Please provide additional comments:

Thank you for your feedback!

After analyzing the survey data, represented below in Table 4.2 and 4.3, it is evident that customers were split between being aware and unaware that the patient menu was highlighted in the cafeteria options. In reflection, I asked a Director to complete a survey and was surprised to find out that she hadnt known about the patient menu feature, as all Directors had been informed at a Directors meeting of what would be happening. Also, it seems that 26% of people, the majority, moderately enjoyed the lunches, while 24% enjoyed their options very much. Only 11% categorized their meal as not my preference. The comments in the feedback sectioned varied greatly, but here is a snapshot of the majority of comments that were relevant to the patient menu: Appropriate portion size, but tasted bland. Needs more salt. Tasted and looked good, but could use more spice. Everything on the menu looked appetizing

The remainder of comments highlighted customers dissatisfaction with lack of available options (ie. pizza line only open 2 days, grill line not having available specials, besides burgers, this week). Table 4.2 : Customer Awareness

Customer Awareness of Patient Menu Options in Cafeteria

Aware (YES) Unaware (NO)

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project Table 4.3 : Customer Satisfaction

Customer Satisfaction of Patient Menu in Retail Cafeteria

1-not my preference 2 3-moderately enjoyed 4 5-enjoyed very much

XI. SUMMARY/REFLECTION This menu and theme meal project focused on integrating the new Great Living patient menu into the hospitals retail cafeteria, offering employees and guests an opportunity to taste the new menu and for food service staff to ease into production before patient service begins. The menu reflected the patient nutrition guidelines encompassing no-added sodium, consistent carbohydrate, and low fat criteria. The ingredients focused on whole foods, creating flavor with fresh herbs, cooking with heart healthy fats like olive oil, and lean protein choices. The recipe selection was easy, as the patient menu is on a one-week cycle menu, which we decided to stick to in retail integration. In retrospect, this project was a very big undertaking for both myself and the food service team. It was the first time the culinary team had ever prepared or seen the new patient menu and there were many questions and concerns regarding new methods and recipes. The recipes for the entire week, theme meal included, were challenging for production because some of them were written in poor culinary terminology. I observed some of the culinary staff, especially those whose second language is English, struggle with understanding the new menus. This is much of the reasoning behind choosing to prepare this menu for the retail space to work out the kinks and to get everyone acquainted with the recipes, methods, aesthetics, and flavor. Although it was challenging for many, the food service team did a great job pulling together and executing it flawlessly without major problems. I was amazed to see how they picked up the new recipes very fast and were excited to cook in new ways!

Dianna Sinni Sage Graduate School: DI FSM Menu/Theme Meal Project For myself, I had a hard time analyzing the nutrient information and the costs because my theme meal was technically two meals under the hot bar. It was very tedious to extract the necessary information out of the Webtrition nutrient analysis software, as it is poorly organized and not user friendly. I worked closely with the Food Service Director on the cost analysis part, as he was able to print out summaries of the retail cafeterias revenue and sales for the theme meal lunch. It was helpful to learn how his processes work, and what pieces of information he finds to be most important. On the retail front, most customers seemed to enjoy the meal! In particular, the patient services catering associates greatly benefited from the weeks menu, as they were able to see what it should look like and taste it for themselves. Many of them told me that the weeks menu made them feel more comfortable speaking the menu to patients in the future. However, besides the food service team, I dont think many other OPRMC employees cared about tasting the patient menu first. As a customer of the retail cafeteria myself, I was disappointed in the weeks menu for its limited vegetarian entrees. However, in order to stay in sync with the patient menu cycle, we did not offer any entrees other than the patient options. Also, most people seemed to be unaware of the patient menu offerings in the cafeteria, even with our marketing efforts. I have recommended, in the future, more marketing efforts to be used such as utilizing the TV screen in the cafeteria and creating table tents. All in all, I learned that there are many things to think about when updating a menu. Flavor, nutrition, and cost all must be taken into account to make a menu successful. It was a great learning experience to work closely with the Executive Chef and Food Service Director to execute this weeks menu and theme meal.