Monday, October 15, 2012

Progress on Mission Nutrician????? Shouldn't nutrician have always been the mission?

I was asked to take down this post.  I was told I should not have it.  I posted it because I thought it was a bit of insight into the way they think at the hospital.  It was written by an award winning Chef.  If you Google "Chef Walter Bronowitz" you will see lots and lots of things and many are awards. He has taught people how to cook. He is a "leader in his field."  He has been at Seattle Children's for more than 7 years.  He was promised a new kitchen and he has been pouting about not getting it for low these many years. So after much screaming, much pleading, this is the best they can do.  They can bake a fake cheese sandwich on high fructose wheat bread and want to be patted on the back.   

I took this down because I wanted to help someone.  I am putting this back up because I was at the hospital today and this is what was for lunch.   

So here is the missive from Chef Walter


Pop quiz: When is a grilled cheese sandwich more than cheese melted between two pieces of bread?

Answer: When the person eating it is a child in the hospital.

At Seattle Children’s, the food we deliver is part of the care we deliver.

That’s why the Dietary Department is focused on getting more nutritious meals to patients. This spring, the cooks at Children’s introduced a dozen fresher, more nutritious items to patient menus (including a new, improved grilled cheese sandwich).

By next month, they’ll debut eight more.

Although the changes were in the works before the hospital’s Mission: Nutrition initiative launched last month, they have been swept into that widespread effort to bring healthier food choices to patients, staff, families and visitors, says Walter Bronowitz, Dietary manager and executive chef.

But building a better grilled cheese sandwich for patients isn’t as easy as it sounds. It means finding new products and, in some cases, new vendors. And, preparing nutritious entrees onsite (instead heating frozen foods) takes more space, time and thought.

While the hospital has grown around it, the kitchen – which prepares food for inpatient units, the café and catering – has been the same size since Children’s built its current campus in 1958.

When Building Hope opens in April, Walter’s crew will be challenged to do even more with the space it has. As they roll out their new menu items, the cooks and kitchen staff are very aware that they need solid processes to sustain the quality of their food as their workload grows.

That’s why the kitchen team is using Continuous Performance Improvement (CPI) principles to create and test drive the best systems for preparing and serving their new, more nutritious menu items.

Recipe for success
Here’s how CPI helped Walter, cook Heather Anderson and the Dietary team build a better grilled cheese sandwich.

Step one: more than bread and cheese
Since food is part of clinical care, there’s no improvising when it comes to feeding our patients. The cooks created a recipe for a more nutritious grilled cheese sandwich (baked, on whole wheat bread and two slices of tomato), along with standard processes to ensure every sandwich that leaves the kitchen is the same.
Step two: a place for everything and everything in its place
Walter’s team assigned space in their work area for ingredients they need on-hand for all their new recipes. Then they ran the numbers to determine just how much they needed. Now, they stock once a day instead of running to the storeroom or walk-in fridge to grab items whenever they run out. The result is a steadier work flow with much less waste – of food and of time.
Step three: batch it, time it, test it
Rather than making 90 grilled cheese sandwiches at once – and letting them sit while 90 meal trays are prepared – the cooks are making small batches so the grilled cheese sandwiches reach patients hotter and fresher. They used controlled trial-and-error – timing tray production and measuring sandwich temperature with each variation – to answer important questions about how small to make the batches.
Step four: check it and change it
After the new grilled cheese sandwiches hit the patient menu, the kitchen team kept close tabs for four or five weeks, re-testing, re-timing and adjusting their batch quantity until they found the right balance for maximum “yum.” They’ll revisit the process and tweak it regularly going forward.
Looking to the future
It doesn’t end with grilled cheese; the cooks and kitchen staff use the same process for every new item on the patient menu. Next up: French toast and Spanish rice.

“The thing about CPI work is that it requires some experimentation to learn what will work best,” notes Walter (pictured left). “We’re working through our new menu items one by one and letting each change settle into place to make sure it works before we go on to the next one.”

It’s a heavy investment of time and energy up-front for a long-term payoff: more nutritious meals for patients and a more efficient kitchen for staff.

Walter is already gearing up for the future patient kitchen – which is currently just a shell in the basement of Building Hope. Some day, that kitchen will be capable of preparing individual meals for patients – room service style.

“Once we open the new building and we’re serving the extra patients well from our existing kitchen, we’ll turn our attention to the CPI projects we’ll need to make the next kitchen work,” he says.

Comments: I have removed all the names.  It is pretty clear I am not the only one that is upset. 

Comment by:
I'll give you that there is some improvement happening in very small baby steps and I'll even give you that there are principles being applied to try and streamline the efficiency of the cafeteria. HOWEVER, the picture alone at the top is BEYOND shameful. It is appalling to me that we serve grilled cheese (which isn't even cheese, but rather a piece of trans-fat filled oil) on a piece of 'whole wheat bread' that is filled with high fructose corn syrup and say that we're making a better sandwich.
We should be embarrassed by the fact that we even 'brag' about this as an improvement and we should be ashamed that our cafeteria has consistently fallen to the bottom of the pile and has not been updated since 1958. Nutrition should be at the core of a message of health and clearly it is at the bottom for our cafeteria and management.
There are hospitals around the country and even in this city that are doing a hundred times better with the food they supply, supporting local farms and making their own food.
This article is embarrassing, shameful and sad. Hippocrates said, “Let food be thy medicine and medicine be thy food” - I'm not sure that we can even say we serve real food in our cafeteria.

 I too agree wAt least use real cheese. Also, adding tomatoes to the sandwich is not real practical. Vegetables are very important however I don't know many children who would eat tomatoes on a grilled cheese. Even children who would eat a variety of veggies probably would not go for that one. The fake cheese is quite ridiculous.

You just expressed the exact sentiments that we discuss on a daily basis as nurses. Especially on the SCCA unit, maintaining adequate nutrition in nauseated/anorexic patients is a CONSTANT battle. If the hospital provided food options that were actually edible, Children's would save money on tray fulls of wasted meals. More importantly, financially strapped and emotionally stressed families would not be forced to leave their child's side to then spend extra money to grocery shop. We are lucky enough to live in a city where there is access to an abundance of local and organic goods, yet Sound Cafe offers heated canned soup and salad fixings from a bag. If we truly "are what we eat", then what does that say to the youth who we offer scrambled eggs from a carton? I find it offensive that the processed, low nutrient food we serve is compared to the care we deliver. Healthcare is ever evolving and ethically challenging on many levels. What would be most ethical and socially responsible for our patients from a nutritional standpoint would be to think bigger than a "new" grilled cheese sandwich.

The food we serve the kids here is appaling. I am embarrassed to serve trays to families. And the food offered in the cafeteria is beyond gross. Horrednous that, with all the information in this day and age about whole foods, you are bragging about making a grilled cheese "healthier" by adding some tomatoes?
And I like what's next on your list of things to improve: french toast and Spanish rice! Can't we start with things like LOCAL, ORGANIC vegetables? A salad bar that is appealing with fresh lettuce (iceburg??? NO!) and tomoatoes that look like they have been sitting on the back of some truck for two years.
Let's give our families who are paying THOUSANDS a day some good food that is nurishing, healthy and delicious. Let's stock our Nurishment Rooms with good options- this "juice" we offer, the peanut butter, bread- ALL CONTAIN HIGH FRUCOSE CORN SYRUP!!
When I was hired 5 years ago, all the talk was about food improvement. Here we are and I have seen no positive changes. This picture of the "healthier grilled cheese" is gross and offensive. You all should be ashamed!!

Oh by the way, I am so pleased someone at Children's is reading my blog. Hey Mark, it was great to see you today.

1 comment:

Maggie said...

Amen to the comments. The article about improving the "food" is horrifying. Having seen the mounds of inedible gunk plopped on the trays of the children I would say improvement needs to start at the top. A person who believes better grilled cheese is any kind of step forward has no vision.