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Summer 2014

News and Views to Strengthen Your Healthcare Foodservice Operation™

Gordon Food Service®

Peerless in Lapeer: A Dining Room Transformation

The Thrill of the Grill

Cost, Care, and Customer Service

What Kind of Leader are You?

Welcome to the Summer edition of enrich! This issue offers a ray of sunshine as we tackle many topics challenging the healthcare industry today.

The Triple Aim of the Patient Protection and Affordable Care Act prioritizes improvements in cost, care, and customer service. Consultant and public policy expert Nick manetto offers his assessment of the progress made after the first four years of the healthcare law and the challenges that loom ahead. Don’t miss this article on page 18, filled with updates and thought-provoking insights to help you achieve your cost, care, and customer service goals.

Speaking of improving costs, take time to review the Cutting Costs Through Benchmarking article. Hear from operators who have been successful in managing their costs and improving their operation by benchmarking with the AHF Benchmarking express program. Your Gordon Food Service Customer Development Specialists are eager to help you enjoy similar success and get you started with your own benchmarking. Ask them how.

A great example of how food and nutrition services can help healthcare operations meet care and quality goals comes from Lapeer County medical Care Facility in michigan. Chef Allen Alvarado and his team share their approach to improving the dining experience and, ultimately, the entire organization. You’ll be both impressed and inspired by what this team has accomplished. read on for additional ideas such as the importance of good service from your waitstaff, and increasing meal and snack choices for your customers.

Our culinary focus spotlights the opportunity to use outdoor grilling to create excitement around your foodservice program. Check out the delicious and refreshing recipes, but be warned, your mouth may just start watering.

Welcome to

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8/6M

DANA FILLMORE, RD, CP-FS, Editorial Director. Dana Fillmore manages Healthcare Marketing for Gordon Food Service. Previously Dana was the Manager of Nutrition Services for Gordon Food Service, providing expertise in matters related to nutrition and food safety for all Gordon Food Service customers. Her professional membership in the Academy of Nutrition and Dietetics and her background as Adult Foster Care Consulting Dietitian and Clinical/Foodservice Dietitian supports her specialty in nutrition and foodservice. Her professional food safety certification is supported by the National Environmental Health Association.

News and Views to Strengthen Your Foodservice Operation™

A quarterly publication of Gordon Food Service®ISSuE 14 · SuMMEr 2014

Published for Nursing Home and Hospital Foodservice Directors as well as Senior Meal Program Operators, this publication provides timely information about food and service trends, industry information, regulatory and legislative updates, recipes, and new products. It is our goal that customers know Gordon Food Service understands their industry, their needs, and that we have the tools, resources, and solutions to help them be effective and efficient operators.

The opinions, beliefs, and viewpoints expressed by the contributors to Enrich™ magazine do not necessarily reflect the opinions, beliefs, viewpoints, or official policies of Enrich magazine or of Gordon Food Service Inc. Enrich magazine and Gordon Food Service Inc. do not guarantee the accuracy of all published works. All works submitted to Enrich magazine for publication become the express property of Gordon Food Service Inc. No reproduction of the contents of Enrich magazine, in whole or in part, may be made without the express written consent of Gordon Food Service Inc. Copyright 2014, Gordon Food Service Inc. All Rights Reserved. Enrich, GFS, and Gordon Food Service are trademarks of Gordon Food Service Inc. Other company, product, and service names may be the trademarks or service marks of others.

eNriCH™

eDiTOrAndy Maier

mANAGiNG eDiTOrDanielle Bloom

CONSuLTiNG eDiTOrRobin Watson

ADVerTiSiNGDanielle Bloom

eDiTOriAL DireCTOrDana Fillmore, RD, CP-FS

eDiTOriAL ADViSOrSDana Fillmore, RD, CP-FS

Sara Kwiatkowski, RDGerry Ludwig, CEC

reCiPe DeVeLOPmeNTEd Westerlund, CEC

reCiPe NuTriTiONJessie Waalkes, RD

reSeArCH ANALYSTAshley Moritz

PHOTOGrAPHYJulie Line, Big Event Studios

Robert Neumann, Big Event Studios

FOOD/PrOP STYLiSTMichelle Callaghan-Hale

ACCOuNT mANAGerMelissa Ayotte

DeSiGNerJulie Baldwin

PrODuCTiON mANAGerDeb Daniels

features columns in the kitchen

6 CuTTiNG COSTS THrOuGH BeNCHmArKiNG

Discover how data analysis and comparisons strengthen operations.

12 THe THriLL OF THe GriLLAdd variety to the menu and excitement to residents’ routines.

14 PeerLeSS iN LAPeerA dining program’s transformation makes a difference in Michigan.

18 COST, CAre, AND CuSTOmer SerViCe: THe TriPLe AimA look at the progress in administering the Affordable Care Act.

10 eNHANCe Increasing access to food offers

enhanced choices and can improve clinical outcomes.

22 mANAGer’S memO Train for superior service that

makes residents feel welcome and special at mealtime.

32 iNDuSTrY uPDATe

33 ASK THe DieTiTiAN Understanding gluten labels

and nutrition recommendations for pressure-ulcer management.

34 eNGAGe Assessing your leadership

style helps manage staff and situations.

24 GriLLeD rOmAiNe SALAD

25 GArDeN GriLLeD VeGeTABLeS

27 GriLLeD iSLAND SALmON

28 Tea-BrineD GrilleD Pork loin

30 iTALiAN PeSTO SLiDerS

31 HerB-GrilleD CHiCken

22 2418

2 WeLCOme TO eNriCH

34 ADVerTiSer iNDex

in every eNriCH™

On the Cover:initiating culture change, and enhancing the overall foodservice experience in Lapeer, michigan. Page 14

3ENRICH | Summer 2014 3

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At Heinz, making smart choices doesn’t have to mean losing flavor. We proudly offer a large portfolio of condiments, sauces, soups, entrees and tomato products. Additionally, we offer lower sodium ketchup and

soups, as well as fat free condiments and salad dressings. These options can help meet your patient feeding and cafeteria needs while offering the great taste your patients and customers have come to expect from Heinz.

To learn more about the full portfolio of Heinz products and brands, or to access downloadable rebates, visit www.heinzfoodservice.com.

Smart Ladle™ Tomato SoupReorder No. 599580 Sodium: 400mg/serving

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Smart Ladle™ Cream of Mushroom SoupReorder No. 599562 Sodium: 410mg/serving


r educing the cost of healthcare, improving health, and enhancing the patient experience are primary goals of the Patient Protection and

Affordable Care Act. To meet these goals, every facet of the healthcare industry is dealing with cost-containment pressures. Food and nutrition departments are no exception.

One of the most valuable tools for identifying cost-cutting strategies is benchmarking, a standard or reference by which existing procedures can be measured or judged.

Businesses began embracing benchmarking as standard operating procedure in the mid- to late 1980s, using it to identify their comparative strengths and weaknesses versus similar processes. This knowledge helps guide process improvements, including cost reduction and operational efficiencies, and aids in differentiation marketing.

The success of benchmarking in the commercial sector compelled many governmental and nonprofit organizations to adopt benchmarking as early as the 1990s. That’s when the seeds of AHF Benchmarking EXPRESS, a service of the Association for Healthcare Foodservice, were planted.

“One of our legacy organizations instituted a benchmarking program for healthcare operations way back then,” says Julie Jones, Director of Nutrition services for a large Midwestern academic medical center and a member of AHF’s benchmarking committee. Acute-care hospitals have blazed the trail in financial benchmarking over the years, and now with the cost pressures of the affordable-care era, more and more hospitals and post-acute-care facilities are joining the ranks of avid benchmarkers.

Benchmarkingby: Aaron Frazier

Cutting Costs Through

Benchmarking measurements let you see exactly where your costs are

out of line with the norm.

6 Gordon Food Service

Key PeRfoRmAnCe inDiCAToRsRelaunched in August 2013, the new AHF

Benchmarking EXPRESS provides access to 64 key performance indicators (KPIs) important to healthcare food and nutrition directors. That said, “I don’t know anybody who looks at all 64,” Jones says. “One of the advantages of the system is that it is really customizable and lets users work with the KPIs that matter to them.”

Most operators, Jones says, are interested in just a few KPIs, usually these:

•Food cost per patient day. Total food cost (including floor stock, supplements, catering, etc.) divided by patient days.

•Total cost per patient day. Total food costs plus supply costs, other direct costs, labor except clinical, and labor costs clinical only, divided by patient days.

•Net of cash per patient day. The sum of costs minus the sum of all cash divided by patient days.

•Net cost per patient day. The sum of costs minus the sum of retail cash, catering cash, other cash, transfers/credits, and foregone revenue, divided by patient days.

•Labor hours per meal. Productive hours divided by total meals.

Each AHF Benchmark EXPRESS user inputs data from his or her own department once a month. The system aggregates the numbers to reveal a snapshot of the user’s individual performance and how it stacks up against other operations in the system (roughly 175 at press time).

The information is presented in terms of percentiles, so users can see how they rate compared to the 25th, 50th, and 75th percentile of operations in the system. Users also can sort results to compare themselves to operations of like bed count, service type, and location.

“Most numbers you want to be low—like net cost per patient day,” says Liz Boone, Executive Director of Nutrition Services at an 800-bed Midwest hospital and chairwoman of AHF’s benchmarking committee. “Others you want high, like average cost per transaction. A lot of directors will set departmental goals based on this information—say, ‘We want to be at or below the 25th percentile for this KPI.’”

Cutting Costs Through

FEATurE: CuTTING CoSTS THrouGH BENCHMArkING

7ENRICH | Summer 2014

iDenTifying “ouT-of-Line” CosTsSo exactly how does this help with cost cutting? Well,

you can’t manage what you don’t measure, maintains Gordon Food Service® Healthcare Marketing Manager Dana Fillmore, RD, CP-FS. Benchmarking measurements let you see exactly where your costs are out of line with the norm; the data you’ve collected about your operation provide the means to analyze and improve your operation and bottom line.

Consider net of cash per patient day, for example. “It’s my favorite metric because it’s the truest representation of departmental performance,” Boone says. “If your number is too high, you need to do something to address it. You can’t control patient days, so you have to look at costs and revenues.”

On the cost side, make sure you’re taking full advantage of group purchasing organization contracts and rebates. Talk to your suppliers about switching to less expensive product alternatives. Consider implementing systems that can cut down on food waste, spoilage, and excess inventory. Think about pushing reusable mugs in the employee cafeteria and charging for disposable containers. Perhaps it’s even time to look at cutting cafeteria hours or changing the way you do catering.

On the revenue side, work on bumping up your average retail transaction by offering more craveable foods, raising price points, decreasing portion sizes, bundling food

products, and promoting impulse purchases. Consider doing away with employee discounts and freebies. Would a coffee kiosk or sandwich cart bring in more money than you’d outlay to maintain it? How about an unstaffed micromart for employees?

Some of these changes will encounter resistance, but benchmarking gives you the numbers to justify your recommendations to administration—and to employees, if need be.

You can perform a similar analysis and exploration for any other KPIs that are out of whack. On the other hand, you also can use benchmarking to counter cost-cutting requests.

Let’s say patient days have declined and you’re asked to reduce your full-time employees. But you use KPI metrics to show that patient meals have stayed a steady 25 percent of your total meal mix, thanks to an increase in non-patient meals. And you can use the labor-hours-per-meal metric to prove that employee productivity has remained constant.

You can’t manage what you don’t measure.



TALKing To ADminisTRATionJones says the ability to talk to administrators in the

language they understand—numbers—is a key benefit of benchmarking.

“Without benchmarking, you’re just not prepared to deal with cost-cutting requests like these,” she emphasizes. “I’ve had directors tell me that their administration isn’t asking for this kind of information, so they don’t feel the need to benchmark.”

But Jones predicts that it’s only a matter of time before most of these directors are confronted with a mandate to cut departmental costs—and they won’t be equipped to respond.

“You can’t say, ‘Give me five months to gather my figures and I’ll get back to you,’” Boone says. “You need the information at your fingertips all the time.”

Besides, benchmarking allows you to “toot your own horn” with administration.

“You should be sharing your most important KPIs with administration on a regular basis,” Boone says. AHF Benchmarking EXPRESS presents a lot of information in an at-a-glance graphic format ideal for presentation.

This is particularly helpful when you are new to a facility and trying to understand the operation, and when you’re orienting new leadership to your department and services.

“And,” she adds, “it’s a great tool for justifying new program proposals, setting department goals, and budgeting.”

It’s clear that cost reduction will be a major thrust of healthcare for the foreseeable future. Benchmarking will help you contribute to your organization’s cost-cutting goals while demonstrating the continued viability of your department, especially if you wish to remain self-operated. e

for more informationContact your Gordon Food Service

Customer Development Specialist

for assistance with your

benchmarking needs.



enhance ...

r esident-centric foodservice is a critical part of culture change in long-term care.

It goes hand in hand with the paradigm shift that’s giving residents more control over their environment, according to Diane Hall, RD, LD, NHA, president of the Florida-based consulting firm, Balance Senior Nutrition. Letting people decide for themselves when and what they want to eat improves clinical outcomes and, Hall maintains, respects their dignity and independence.

“People who might not ordinarily eat a sit-down meal may opt for snacks throughout the day,” Hall says. Hall is in the process of helping a Florida-based senior-care provider implement 24/7 “snack cafés” at each of its locations.

“One of the first things we had to do was get the buy-in of medical staff,” Hall says. “They had to agree to ‘liberalized diets.’ As a result, we’ve eliminated all restrictive diets except for consistency diets.”

Maintaining a 24-hour operation does increase costs, she admits, but she stresses that the change may also mean a reduced need for costly medical intervention as residents better maintain weight and vitality.

“You have to look at the long-term,” Hall says. One way to minimize costs is to offer grab-and-go items in off-hours rather than (or in addition to) made-to-order items. The 24/7 route isn’t the only possible solution, either—offering baskets of fruit or snacks such as cookies or popcorn

throughout the day can be very effective. Place them in activity rooms or communal kitchens, and the aroma alone can uplift residents. Another affordable option is to install a mini-fridge stocked with fresh fruit, beverages, puddings and yogurts, sandwiches, and other snack items.

“Most facilities offer a version of snack carts,” Hall says. “These typically include graham crackers, cookies, and other foods that don’t work for consistency diets. A refrigerator allows you to offer food everyone can enjoy.”

Place refrigerators in neighborhood kitchens or dining areas, or in view of the nurse’s station. “You want residents to have free access, but you also want to maintain some supervision.”

Be sure to enforce normal food-safety and sanitation standards.

“Increasing food access requires a multidisciplinary approach to food safety,” Hall says.

Provide food-safety training beyond just the foodservice department. Educate residents’ families, too, because resident-centric foodservice also encourages visitors to bring in food for their loved ones.

Skilled-nursing centers aren’t the only providers seeking to increase food access. Nontraditional food outlets are springing up across the healthcare spectrum. These operations are satisfying customer demand while generating new revenues in ways such as:

Ancillary dining spaces. Traditional cafeterias and dining rooms are being supplemented with restaurant-like concepts that offer longer hours, especially in the evening, and may also be marketed to the outside public. Satellite cafés in hospitals—near the ER or ICU, for example—are enabling people to stay closer to family members, Hall says.

Kiosks and carts. Coffee kiosks and grab-and-go carts in strategic locations enable residents, employees, and visitors to satisfy cravings without trekking to central dining locations—an especially welcome benefit on large campuses.

Retail outlets. Mini convenience stores, stocked with a variety of packaged and ready-to-go-foods as well as household sundries, are on the increase. Unstaffed micromarts are also being used to give second- and third-shift hospital employees more food choices when cafeterias are closed.

Whatever you do, make sure it’s a good fit for your facility. The first step to increasing food access is to survey your customers. Their answers will guide your planning process.

“It’s not about whether they like cheese or spinach,” Hall explains. “It’s when and how and why they like to eat.” e

Enhance Satisfaction

By increasing Access to Foodby: William Collier

CoLuMN: ENHANCE

People who might not ordinarily eat a sit-down meal may opt for snacks

throughout the day.


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547850 547772 547871


S ummertime backyard barbecues are practically a national pastime for people in their prime. And you can make those occasions more than just fond

memories for long-term care and senior-living residents by adding grilling to your foodservice repertoire.

Grilling is a delicious way to whet residents’ appetites while creating a social occasion that engages them. Plus, grilling gives food and nutrition directors a chance to offer variety and show off their creativity.

There are many ways to configure your grilling service. For example, one Midwest nursing home instituted a monthly grilling day. A large outdoor grill was set up just outside the cafeteria. Windows were opened so the aroma of grilled summertime favorites, like burgers, hot dogs, and brats, could be smelled throughout the building.

“It created extra excitement for residents,” says Gordon Food Service® Nutrition Resources Manager Sara Kwiatkowski, RD. “There was so much anticipation. They could smell the food grilling. It was something different, a special-occasion day. It broke up the monotony, even though the regular menus there were extensive.”

geTTing sTARTeDA number of practical considerations come into play,

everything from determining what you can do to how you can do it.

Gear up. Purchase or lease any necessary equipment.

Assess staff needs. “It’s an extra effort to get out of the kitchen and cook the food, so ask yourself if you can do it even if you bring in extra help,” Kwiatkowski advises.

Run the numbers. Consider how grilling will affect your inventory needs and food budget.

Schedule it. Decide how often you’ll offer grilling. Monthly, weekly, or more often? Also decide whether to limit it to just summer or other seasons. One excellent option for keeping the scale manageable, Kwiatkowski says, is to serve small segments of the resident population at a time on a rotating basis, such as a certain wing on a designated day.

The Thrill of the Grillby: Robin Hill

Grilling is a delicious way to whet residents’ appetites while creating a social occasion that engages them.

12 Gordon Food Service12 Gordon Food Service

Plan and post menus. Planning ahead helps control food and labor costs. Posting the menu in advance builds anticipation among residents. Take care to vary the menu; don’t offer the same grilling specials every time.

Gather input. “Get opinions at a resident council meeting and gain their buy-in,” Kwiatkowski suggests. The residents will be vocal, so you’ll know right away if they like it.

Be accommodating. Residents with special dietary needs, such as low-sodium or low-cholesterol diets, need to follow medical orders, so always offer options, Kwiatkowski recommends. If you’re grilling burgers, offer a turkey burger or grilled chicken breast as an alternate selection. Be advised, she adds, that “a little extra planning may be needed depending on how many grills you have.”

Build excitement. Promote grilling day as you would any event. If possible, open windows so the aroma of grilled food can entice patients.

Do lunch. “The elderly eat better at the noon hour,” Kwiatkowski says. “Lunch is often their biggest meal of the day.”

WhAT To menuOnce you decide to offer grilling, there’s a world of

possibilities for what to serve, as long as you observe a few simple food-safety rules.

Burgers. “You don’t want to deal with raw ground meat,” says Gordon Food Service Corporate Consulting Chef Gerry Ludwig, CEC. “Use high-quality, frozen, raw ground beef or turkey patties that can go right on the grill and cook up beautifully. They thaw as they cook and turn out just as juicy as fresh.”

Boneless, skinless chicken breasts. “This is a desirable menu item even though it is a volatile choice from a food-safety perspective. Use herb and spice rubs—many are sodium-free—or simple marinades such as a little oil with soy sauce, fresh lemon, or lime juice to kick up flavor," Ludwig advises. Grilled chicken breast can serve as a salad topper, sandwich protein, or primary entrée.

Grilled vegetables. “With diverse choices and a high level of food safety, grilled vegetables are a natural choice,” Ludwig says. Cut cauliflower into “steaks”’ and marinate them in olive oil and lemon juice before grilling. Use larger cuts of zucchini or yellow squash. Include asparagus if your budget allows, and take the opportunity to highlight some in-season local vegetables.

Kebabs. Skewer chicken, beef, or pork with vegetables. If you’re using raw, whole-muscle meat, make sure it’s fully cooked before serving.

Pork ribs, back ribs, rib tips. “Ribs are highly appealing,” Ludwig notes. “You can get them nice and crispy, caramelized, and smoky with a high level of food safety.”

Hot Dogs and Sausage. Precooked hot dogs and sausage cook quickly, increase food safety, and are summertime staples.

Seafood. While seafood can be a pricey addition to your menu, the right portion purchased at the right price can elevate your menu without breaking the bank. Ludwig suggests salmon, noting, “Salmon steaks hold up well on the grill and can be seasoned many different ways.” See page 26 for a recipe.

Whole-muscle cuts of meat. “The one with the highest level of food safety would be some sort of beef steak,” Ludwig says, “though there are cost constraints, and you must make sure they’re tender enough to eat. The number-one cut for this scenario would be chuck tender cut across the grain; it’s very tender and easy to eat. For whole-muscle pork, opt for boneless pork tenderloin. Cut it into medallions that you can put between plastic and pound to create thin cutlets for grilling quickly on a hot grill or using in kebabs. Grilled pork chops are also nice.” e

Food-Safety Considerations

Outdoor grilling requires all the usual practices, plus extra vigilance to keep residents safe.

Prevent cross-contamination. Keep preparation surfaces clean. Change or clean cutting boards whenever you switch between proteins and/or vegetables. use separate utensils and platters for each item; never switch between raw and cooked foods.

Bring out uncooked food in increments. “make sure you have enough staff to keep bringing out refills of raw food to be cooked unless you have a number of grills going at the same time,” Kwiatkowski advises.

serve food immediately. “As always, do not leave food sitting out for a long time,” Kwiatkowski says, noting that it’s important to keep hot food hot and cold food cold.

maintain proper temperature control.

• Cold food must be held at 41ºF, or below.

• Poultry products must be cooked to 165ºF and held at 135ºF or higher.

• Beef patties must be cooked to 155ºF and held at 135ºF or higher.

• Fish must be cooked to 145ºF and held at 135ºF.

FEATurE: THE THrILL oF THE GrILL


H earing that one of your cooks made a resident burst into tears is not the way you want to greet the morning. But Allen Alvarado, Executive Chef of Lapeer County

Medical Care Facility, was pleasantly surprised when he rushed over to console the resident in question.

“She said to me, ‘I just want you to know that I’ve been here for many years, and this is the first time I’ve ordered an over-easy egg and gotten an over-easy egg, just the way I like it,’” Alvarado recalls. “She was crying tears of joy.”

That resident’s experience—and others like it—confirms for Alvarado, his staff, and facility administration that their overhaul of the food and nutrition programs these past few years has been well worth it.

Lapeer County Medical Care Facility is a 202-bed skilled-nursing center in eastern Michigan, on a site that was originally set up as “The County Poor Farm” in the late 1800s. A skilled-nursing facility was built on the grounds in 1971. In 2011, the facility embraced culture change and began making its environment more home-like for residents.

Dining was a key consideration in this transition, and administrators wanted a high-caliber chef to guide the process. Enter Alvarado, who had moved back to the area after an illustrious career with such foodservice titans as Orlando’s Church Street Station, Nashville’s Wild Horse Saloon at the Opryland Hotel, the Florida-based, upscale

Puff ’n Stuff Catering, and Emeritus Corporation, which operates nearly 500 senior-living communities in 47 states.

Upon returning to his hometown of Lapeer, Alvarado hung up his apron and was pursuing another line of work. But, when his daughter saw an ad that read, “Looking for a chef with heart,” she sent in her father’s resume.

Lapeer County Medical Care Facility called him the next day. And it wasn’t long before he was helping to oversee service of 900 to 1,200 meals a day while managing a complicated kitchen and dining transformation.

WeLCome To The neighBoRhooD“The facility was originally built with a commissary

kitchen, where food was prepared and plated for transport to the dining room, where it was served via tray line,” Alvarado explains.

As part of the culture-change initiative, Lapeer built a new addition and established six “neighborhood zones,” each with its own private dining rooms and kitchens.

“We were going to tackle them one a time, but we finally decided to do them all at once,” he says. “That was a bit of a challenge.”

Indeed it was, concurs Culinary Supervisor Kathleen Morris, who retired in April after more than two decades with Lapeer.

Peerlessin Lapeer

by: Patrick Bax


“We worked out of a school kitchen for five weeks or so—it was during the summer—and transported meals back to the facility via Cambro carriers,” she recalls.

During the transition, the staff also visited other nursing facilities to get a firsthand look at the restaurant-style service Lapeer would be implementing.

“Change is hard,” Morris acknowledges. “And we were changing almost everything—menus and recipes, the way we ordered, how we served meals, and our interactions with residents.”

More than once, Morris and Alvarado heard objections, such as, “But this is the way we’ve always done it.” They countered by positioning the changes as opportunities to grow and learn new, more marketable skills. They instituted ongoing training programs covering everything from ServSafe skills to proper service manners. But what really made the difference was the way residents reacted to the changes.

“When you get compliments on the food and the way you’re handling yourself, you feel good about what you’re doing,” Alvarado says. “And the neighborhood concept enables us to build much closer relationships with residents, which has been very rewarding for all of us.”

The PeRsonAL APPRoAChWhen residents enter the light and airy dining rooms,

they’re greeted by a black-aproned CNA (Certified Nurse Associate) who asks where they’d like to sit, then escorts them to a white-linen-clad table, and takes their drink orders. Each resident receives a personalized menu printed out from the facility’s SureQuest foodservice-management software system.

“Our menu software maintains a detailed database for each resident, including such information as food allergies and dietary restrictions,” Alvarado explains. “If there’s something on the day’s menu that doesn’t suit a resident’s diet, that item won’t appear on his or her individual menu.”

With a seven-week menu cycle that includes roughly 15 always-available choices and a daily chef’s special, it’s a safe bet that no resident ever feels deprived. “They don’t feel hesitant to ask for what they want, either,” Alvarado says. “Every item is made to order in each private kitchen, and residents are encouraged to let cooks know how they like things prepared, what ingredients they do and don’t like, and so on.”

That’s how a cook learns to prepare an over-easy egg “the way my mom used to do it” or leave the greens off a chicken sandwich “because I don’t like lettuce.” Similarly, servers come to anticipate residents’ preferences, such as whether they like coffee before or after their morning toast.

“I tell everybody to approach their job like they’re cooking for and serving family,” Alvarado says.

foCus on ReAL fooDOf course, sometimes family members need a little

extra help.

“Malnutrition and dehydration are the biggest challenges for dietary staff,” Alvarado says. “I meet with our registered dietitian regularly, and with our nutritionist almost daily, to monitor resident nutrition needs. We’ve made a real effort to address these challenges with ‘real food,’ not supplements—and, in fact, we’ve greatly reduced our use of supplements.”

Alvarado’s strategy is to pique appetites, then satisfy with flavor.

“You have to find something that the resident actually likes to eat,” he says. “Then you layer in taste and nutrients.”

In the case of protein deficiencies and to promote healing, Alvarado turns to familiar favorite recipes made with natural protein sources, such as eggs, milk, poultry, and meat. Chicken salad and roast beef sandwiches with fresh spinach happen to be two of the favorites.

Fresh is a key concept here, as virtually everything is made from scratch, including soups and sauces—“tomato, Alfredo, velouté, béchamel, you name it.”

In addition to lowering costs and facilitating meal personalization, scratch-cooking enables better control of nutritional content.

“We can control exactly how much sodium and sugar we use, for example,” Alvarado notes. “In all areas, we tend to go well beyond the minimum nutrition standards set by the state.”

“i tell everybody to approach their job like they’re cooking for and

serving family.”

FEATurE: PEErLESS IN LAPEEr


There are also practical considerations that are more easily met by a from-scratch approach. For instance, Alvarado notes, pizza is a popular item on Lapeer’s menu, but the crust was a challenge for denture-wearing residents. The solution? Morris found a soft, pliable naan bread that they now use for handmade pizzas.

In addition to pizza, Sloppy Joes, enchiladas, and tacos are also resident favorites, reflecting overall societal trends toward casualization and ethnic dining. But, Alvarado adds, residents still like their meatloaf, turkey, and roast chicken.

BeyonD The Dining RoomsThe meals residents enjoy also are offered in an

employee cafeteria.

“If they’re eating it, we’re eating it,” Alvarado says.

This cafeteria also serves as an overflow dining space for residents’ families when neighborhood dining rooms are full, and it’s equipped with six vending machines for third-shift employees.

The dietary staff also provides lunches and occasional breakfasts to a day care center for children that’s located on the same grounds. It seems as if elementary-school lunch programs could learn a thing or two from Lapeer.

“We’re making them the same kinds of foods we’re making for our residents—even broccoli and Brussels sprouts sautéed in butter and seared on the grill,” Alvarado

says. “Don’t tell me kids won’t eat vegetables.”

The children visit the nursing community on a regular basis, part of a jam-packed schedule of activities that includes warm-weather outdoor events, such as an annual barbecue contest judged by residents.

How does Alvarado maintain such a sophisticated program in an era of ever-tightening budgets?

“We track and monitor everything,” he says. “I go through detailed weigh sheets every three weeks, looking for what’s not being used and what’s being wasted. I adjust allocations accordingly. It’s a constant balancing act.”

It helps that the Lapeer administration has invested in state-of-the-art software systems that support recipe management, online ordering, purchasing-contract analysis, and more.

“The leadership here, including administrator Gary Easton and Director of Nursing Doug Campbell, embraces whatever it takes to make life better for residents,” Alvarado says. “They opened their arms to me and the ideas I had for making an already impressive program even better. They really care.”

That attitude trickles down to every level of the organization.

“I am really proud of the way my staff has gotten closer to residents and how they take residents’ well-being to heart. It brings tears to your eyes to see it.”

After cooking for presidents and their families, serving celebrities and dignitaries, and catering events for up to 20,000 people, Alvarado says he has found his true niche at Lapeer.

“I’ve never done anything else in my career that has made such a difference.” e

“We track and monitor everything. it’s a constant balancing act.”

FEATurE: PEErLESS IN LAPEEr



New GFS® Trans Fat Free Margarine offers the smooth texture and rich flavor you expect from margarine, with zero grams of trans fat. Its special formulation of palm and soybean oils yields a healthier margarine alternative—ideal for cooking, baking, sauces, and gravies, and, of course, as your favorite spread. Contact your Gordon Food Service Customer Development Specialist.

SMARTCHOICE.

Spread —it—

Around.


Cost, Care, and Customer Service:

The Triple Aim by: Patrick Bax

T riple Aim, a concept developed by the Institute for Healthcare Improvement, was seen as a set of guiding principles that drove development and, ultimately,

enactment of the Patient Protection and Affordable Care Act of 2010. This strategy calls for new healthcare designs toward three goals:

•Reduce per-capita spending on healthcare (cost).

•Improve the health of populations (care).

•Improve the patient experience (customer service).

While the development of the Triple Aim and the healthcare law have been controversial, the goals themselves are near-universally embraced—and healthcare organizations of all types have been transforming their operations to support them. Now, four years after the law’s passage, here’s a look at the progress being made, especially as it relates to ancillary services such as Food and Nutrition and Environmental Services departments.

First, some context, in the form of a brief legislative review.

Nick Manetto, a Director on the Health and BioSciences Team for Washington, D.C.-based FaegreBD Consulting, a national advisory and advocacy firm, says the healthcare law is “bruised and battered—but it remains the law of the land.” While it remains vulnerable—“particularly if enrollment figures lag, costs increase, and discontent increases”—the healthcare law did meet the stated goal of

enrolling 7 million people in new health plans by March 31, 2014, and recently topped 8 million.

At this time, 26 states plus Washington, D.C., have used the healthcare law to expand Medicaid coverage, or are considering expansion. Another 19 states have declined or are leaning that way on Medicaid expansion, and six are still debating the issue (at press time).

The bottom line, according to preliminary government figures is this: more than 10 million previously uninsured Americans are now covered by health insurance. That’s 10 million more people who can pay for healthcare. Presumably, some portion of them will access the services of your organization—and some portion of this group may need your services.

While the healthcare law grabs the lion’s share of attention, Manetto believes other laws and policies could potentially have even more of an impact on healthcare providers. Across-the-board reductions in Medicare payments under “sequestration” have been extended to 2023. And despite a recent change by Congress to delay implementation by one year, providers still face a looming transition from ICD-9 to ICD-10 that’s proving more expensive than anticipated. There is also a continued push toward “value” by rewarding high quality and penalizing high costs, preventable readmissions, and poor performance.


FEATurE: CoST, CArE , AND CuSToMEr SErvICE : THE TrIPLE AIM

The healthcare law formalized this push by establishing the Hospital Value-Based Purchasing (VBP) program. Under the VBP, Medicare rewards or penalizes hospitals based on how well they perform on specific measures, or how much they improve their performance on each measure compared to their performance during a baseline period.

Currently, the hospital program measures include patient experience and outcomes and clinical process of care. In October 2014, efficiency will be added to the mix. In the most recent round of scores, announced in November 2013, roughly 45 percent of hospitals received bonus payments while 53 percent were penalized.

Manetto reports that VBP programs are in planning or pilot stages for other healthcare settings, including, rehabilitation hospitals, and long-term-care sites. “So VBP should be on the radar of these operators,” Manetto says. Most recently, the same law that delayed ICD-10 by one year also included a value-based purchasing program for skilled-nursing facilities.

In light of these legislative directives, how are healthcare providers doing in their pursuit of the Triple Aim?

The Obama administration reported in April 2014 that healthcare spending since the 2010 passage of the healthcare law has risen by 1.3 percent a year—the lowest rate ever recorded. What’s more, healthcare inflation is the lowest it’s been in 50 years.

How much of this is a direct result of the healthcare law is a matter of debate, according to Manetto. “But it’s undeniable that we’ve seen a shift in the provider community,” he says. “Cost reduction and value over volume have become a real movement.”

That movement extends to food and nutrition services, where directors and dietitians are increasingly challenged to do more with less. Gordon Food Service Healthcare Marketing Manager Dana Fillmore, RD, CP-FS recommends capturing savings through:

•Group Purchasing Organizations (GPOs). Work with your GPO and foodservice distributor to obtain the best pricing possible for your circumstances. Ask your foodservice distributor to recommend product substitutions that will save money while maintaining quality.

•Efficient operational systems. Implementing good food production and meal delivery processes is key. While it involves an initial outlay of cash, investing in

equipment and software that increase your efficiency can pay off in short order. Look for any level of automation—from cook-chill systems and cycle menu programs to vending machines and unstaffed micromarts—that can help you maximize operations and control costs.

•Manage labor. Operational efficiencies can help reduce your labor force, which is likely your biggest expense. Fillmore advocates benchmarking your labor hours against other operations to determine if you’re above the norm. If so, it’s time to take a good, hard look at how you’re utilizing your workforce. (See “Cutting Costs Through Benchmarking” on page 6.)

•Reduced waste. Food waste is a huge issue in healthcare environments. Companies like LeanPath, a food-waste-tracking consultancy headquartered in Portland, Oregon, use technology to help operations reduce pre-consumer waste. LeanPath says its users average savings of 2 percent to 4 percent on food costs. As more and more food and nutrition directors add other ancillary services to their responsibilities, the opportunity to achieve significant departmental waste reductions increases exponentially.

•Employee training. Proper employee training is key to effective customer satisfaction and cost management, in the kitchen and throughout a facility.

revenue enhancement goes hand in hand with cost reduction.



Fillmore also advises that revenue enhancement goes hand in hand with cost reduction, and suggests:

•Expanding cafeteria reach. Promote your operation more aggressively to employees, visitors, and the surrounding community. You may have to upgrade your food offerings—and you definitely want to consider retail-style branding.

•Adding retail outlets. Consider coffee kiosks, sandwich carts, C-stores, and anything else that can bring in additional revenue. Just be sure you can bring in more money than you spend.

•Boosting catering. If you’re not already catering in-house activities and events, research what doing so would mean for your operation. If you are already catering, think about ramping up your marketing and/or catering off-site events.

imPRoving CAReIt’s too early, Manetto maintains, to determine whether

the healthcare law is improving our overall health. But at least one early indication is positive: The Medicare Payment Advisory Commission (MedPAC) reported in March 2014 that hospital readmissions dropped for the first time last year and discharges to community settings were up by 2 percent.

Under the healthcare law, hospitals with higher-than-average readmission rates for certain conditions are now being penalized financially. The federal government reports

that the readmission of Medicare patients alone costs $26 billion a year, so the stakes are huge. When you combine readmissions, value-based purchasing, and programs to drive use of healthcare information technology, payers, particularly hospitals, are seeing a sizeable portion of their revenue being exposed to some level of risk or, conversely, exposed to some level of bonus payments.

There is increasing recognition of the role malnutrition plays in readmissions. Many hospitals and post-acute-care facilities are enlisting dietitians to provide early and ongoing nutrition screenings, assessments, and education. Some dietitians even make home visits to ensure that patients have the proper nutritional support, whether it’s a working refrigerator or enrollment in Meals on Wheels. This can open up another revenue stream for food and nutrition departments.

Reducing readmissions also requires closer collaboration between hospitals and post-acute-care providers, including their dietary staffs. Savvy skilled-nursing and rehabilitation facilities are boosting their own bottom lines by demonstrating their competence to referring hospitals to capture a larger market share.

imPRoving CusTomeR seRviCeThe patient experience is a cornerstone of both the Triple

Aim and Value-Based Purchasing (VBP). Patient satisfaction is measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).



“We can extrapolate a bit from the most recent VBP scores and say that roughly half of hospitals are doing better and half are doing worse when it comes to customer service," Manetto says. 'How was your food?’ is not a question asked by HCAHPS, but, as every survey ever conducted has shown, foodservice plays a big role in overall patient satisfaction with healthcare providers.”

Thus, food and nutrition services undoubtedly contributes to the “overall rating” score. Consider also how Environmental Services can also affect the “cleanliness and quietness of the hospital environment” score. It’s incumbent upon directors to make team members understand how important their work is to the overall financial health of the organization.

Staff happiness and satisfaction are also critical to patient and resident satisfaction.

“How well you treat your staff affects how well your staff treats your patients and residents,” Fillmore says.

oTheR PRessing issuesManetto believes there will be changes to the healthcare

law going forward, but we’re unlikely to see a wholesale repeal—at least as long as President Obama remains in office and the Senate remains closely divided between Democrats and Republicans.

Whatever happens, it’s imperative that food and nutrition directors pay close attention to legislative changes and make a case for their departments.

“Be sure your administration understands how your department can help the organization achieve the highest patient-satisfaction scores possible to earn high VBP scores and corresponding incentive payments,” Manetto says. “Get in front of your Government Affairs office, if you have one, and get them to advocate for continued inclusion of patient-satisfaction data. And urge your lawmakers to oppose future cuts by demonstrating the value of in-house foodservice and how it leads to better quality and better health outcomes.” e

A Catalyst for the Triple AimAsk your gordon food service Customer Development specialist about the broad range of Catalyst® tools that can help you address cost control and sales-building in pursuit of the Triple Aim.


T hink about the times you’ve enjoyed dining and how much great service made you feel welcome and special.

It’s the same for residents of healthcare communities. Mealtime is often the highlight of their day. “Mealtime is show time,” says Gordon Food Service® Noncommercial Segment Leader Lee Wolf-James, RD, LD. This means dining provides another opportunity to enhance a resident’s overall satisfaction with where they live and to improve your overall satisfaction scores.

That’s where good waitstaff training comes in.

“Training is very important because, even more than the taste of the food, people have to like where they are,” Wolf-James says. “And people like being treated with dignity and respect.”

Here’s what to focus on in training:

Exceed expectations. “Foodservice is now a marketing tool of the healthcare community,” says Gordon Food Service Customer Effectiveness Manager Ken Wasco. Many residents are more educated and sophisticated than in the past, he notes, which creates a new level of service expectations.

“They’re looking for more of a restaurant experience,” Wasco explains. “The better the experience is for the resident, the better their feelings toward the healthcare community.”

“Giving somebody great service means you care about them and their welfare,” adds Holly Becker-Baratta, Dining-Room Manager at Beacon Hill at Eastgate in Grand Rapids, Michigan, which operates independent-living and continuing-care residences. “You don’t want people to feel like they’re just in a cafeteria line. You want them to feel like they’re a member of a community.”

Attend to the basics. Waitstaff must be well-groomed and in clean uniforms. Make eye contact with residents. Greet them as they enter, and check on them during the meal to see if they need anything. And don’t forget the most obvious nonverbal cue, a smile. It also means no unnecessary sidebar conversations with other staffers.

“If people are trained to treat others correctly, that will help diners enjoy the food,” Wolf-James says.

Know your customers. Listen to their concerns and respond to their questions. “Treat them like you would treat your own grandmother or grandfather,” Wasco says. “If your staff is good, they’ll know Mr. and Mrs. Smith, what their background is and where their grandchildren live, as well as what foods they like and don’t like, and what they might be allergic to.”

Watch your language. There’s a big difference in communication styles between the older residents’ generation and those of the often-younger waitstaff. “Saying ‘It’s my pleasure to serve you’ is much more appropriate than saying ‘No problem,’ or ‘Back at ya,’” Wolf-James says. “And be specific: Not just ‘How is everything’ but ‘How is your pork chop?’”

Train, train, train. Invest in your team. Train them thoroughly before they start working the floor. Pair new hires with your best servers to help them learn the ropes. Being introduced to a new server by one they already know and like will give residents an extra level of comfort. Make training continuous with ongoing refreshers about key service points.

Reward outstanding effort. “If your people are doing a great job, reward them. It’s how you develop your staff,” Wasco says. “They’ll feel better and go the extra mile. If your servers enjoy their jobs, they’ll feel fulfilled and are more apt to stay.”

Set the example. Managers should personify the behavior they expect.

“The strongest tool for teaching staff how to do it correctly is to model that behavior yourself,” Wasco advises. “Show them what you want by doing it the right way.” e

Giving somebody great service means you care about

them and their welfare.

CoLuMN: MANAGEr'S MEMo

The Elements of Good Waitstaff Service

by: Rob Walters


You didn’t invent fire, but it’s not hard to improve upon it with recipes that capture the fun and flair of grilling. everything cooked over heated coals

takes on a one-of-a-kind mouthwatering flavor. From salads and vegetables to burgers, chicken, pork, and fish, grilled food loves a crowd, so you can make a meal that is as much a social occasion as it is a nourishing delight.

Reintroducing an old flame—grilling

Recipes

enRiCh | Summer 2014 23

Grilled Romaine Saladgri l led Romaine saladYield: 24 8-oz. servings recipe Manager code: salad238ReoRdeR No. descRiptioN AmouNt

182570 Markon® romaine Hearts, halved 6 lb.

247685 GFS® Hickory-Smoked Bacon, sliced 1½ lb.

432050 Primo Gusto® Extra virgin olive oil 1½ c.

129631 Markon Sweet Grape Tomatoes, halved 3 lb.

198757 Markon Green Peppers, sliced 1⁄8" thick 1½ lb.

439746 Yellow Peppers, Sliced 1⁄8" thick 1½ lb.

108308 GFS Iodized Salt to taste

225037 Trade East® Ground Black Pepper to taste

recipe oregano Chive olive oil 1 c.

574771 Pepper Mill® White Balsamic Dressing 12 oz.

460095 Primo Gusto Fancy Shredded Parmesan Cheese 12 oz.

PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Slice the romaine in half lengthwise. Each half should weigh approximately 4 oz. Cover, label, date, and refrigerate for future service. Slice bacon widthwise into ¼" pieces. Place in a heated, nonstick sauté pan and cook until crunchy. Allow to drain. Cover, label, date, and refrigerate for future service.

TO PrePAre à LA CArTe:Add 1 Tbsp. of olive oil to a heated nonstick sauté pan. As soon as the oil begins to smoke, add 2 oz. of grape tomatoes and sauté 15 to 20 seconds. Remove from pan. While pan is still hot, add 1 oz. each of green and yellow peppers and sauté until lightly browned but still firm to the bite. Remove from the pan. Season the vegetable mixture with salt and pepper to taste. Brush the sliced side of one romaine half with 2 tsp. of oregano chive olive oil. Season with salt and pepper. Place on a heated char-grill or broiler, sliced-side down. Grill until leaves begin to char and the center has just begun to wilt. Place the charred romaine half in the center of a warmed serving place charred-side up. Sprinkle the sautéed vegetables over the top of the romaine. Drizzle ½ oz. of white balsamic dressing over the top of the vegetables. Sprinkle 1 oz. of warmed bacon and ½ oz. of Parmesan over the top of the vegetables.

oregano Chive olive oil

Yield: 1½ qt. recipe Manager code: rcomp376ReoRdeR No. descRiptioN AmouNt

562718 Markon oregano, finely chopped 1 c.

562696 Markon Chives, finely chopped 1 c.

565148 Trade East Garden Seasoning 2 Tbsp.

432050 Primo Gusto Extra virgin olive oil 1 qt.

PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Combine all ingredients in a nonreactive storage container. Whisk thoroughly. Cover, label, date, and refrigerate for future service.

nuTRiTionAL info (per serving)

Calories: ................................................................340Fat: .........................................................................30 g.Sodium: ......................................................... 518 mg.Carbohydrates: ................................................ 10 g.Protein: .................................................................12 g.

typical cost per portion: ................. $2.00


in the kitchen: recipeS

garden gri l led vegetablesYield: 24 8-oz. servings recipe Manager code: vegetarian018ReoRdeR No. descRiptioN AmouNt

198595 Eggplant, peeled and cut into to ¼" slices 1½ lb.

198927 Markon® Medium Zucchini, ¼" slices cut on the bias 1½ lb.

198935 Markon Medium Yellow Squash ¼" slices cut on the bias 1½ lb.

272515 Asparagus, trimmed 1½ lb.

588381 Markon roma Tomatoes, halved lengthwise 3 lb.

565148 Trade East® No Salt Garden Seasoning 1 c.

108308 GFS® Iodized Salt to taste

225037 Trade East Ground Black Pepper to taste

432050 Primo Gusto® Extra virgin olive oil ½ c.

602251 Cooked Couscous 3 lb.

562696 Markon Chives, finely chopped ¼ c.

recipe Basil Pesto vinaigrette 1½ c.

PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Place 1 oz. each of eggplant, zucchini, yellow squash, asparagus, and 2 oz. of Roma tomatoes in a stainless-steel mixing bowl. Add 2 tsp. of garden seasoning and season with salt and pepper. Mix with a rubber spatula. Place the vegetable mixture on a heated char-grill or broiler. Remove each vegetable from the grill, as needed (vegetables will have varied cooking times). Place 1 tsp. of olive oil in a heated, nonstick sauté pan. Add 2 oz. of couscous and ½ tsp. of chopped chives to the pan. Toss pan until mixed. Cook until just warmed through. Place the couscous in the center of a warmed serving plate. Stack the vegetables on top of the couscous. Drizzle 1 Tbsp. of basil pesto vinaigrette over the top of the vegetables.

Basi l Pesto vinaigrette

Yield: 56 oz. recipe Manager code: dressing059ReoRdeR No. descRiptioN AmouNt

743879 GFS Canola/Extra virgin olive oil Blend 1 qt.

868830 rice Wine vinegar 2 c.

844761 Primo Gusto Basil Pesto Sauce 1 c.

138300 Trade East Granulated onion 1½ Tbsp.

513881 Trade East Granulated Garlic 1½ Tbsp.

424307 kosher Salt 2 tsp.

225037 Trade East Ground Black Pepper ½ tsp.

PrePArATiON iNSTruCTiONSWash hands. Combine all ingredients in a stainless-steel mixing bowl. Whisk together until blended. Transfer to a nonreactive storage container. Cover, label, date, and refrigerate for future service.


Calories: ................................................................320Fat: ..........................................................................17 g.Sodium: .......................................................... 49 mg.Carbohydrates: ................................................36 g.Protein: .................................................................. 5 g.

typical cost per portion: ..................$1.00

Garden Grilled Vegetables


Grilled Island Salmon


gri l led is land salmonYield: 24 8-oz. portions recipe Manager code: seafood130ReoRdeR No. descRiptioN AmouNt

745341 Alaskan keta Salmon Fillets, 4 oz. 24 ct.

recipe oregano Chive olive oil 24 tsp.

424307 kosher Salt to taste


recipe Island rice, warmed 6 lb.

557781 Markon® Lemons, quartered 6 ct.

TO PrePAre à LA CArTe:Wash hands. Wash all fresh, unpackaged produce under running water. Drain well. Brush both sides of salmon with 1 tsp. of herb oil. Season with salt and pepper. Hatch mark with the skinned side up on a heated char-grill or broiler. Turn salmon. Cook to desired doneness. Place 4 oz. of rice in the center of a warmed serving plate. Place the salmon on top of the rice. Garnish with a lemon wedge.






432050 Primo Gusto® Extra virgin olive oil 1 qt.


is land Rice

Yield: 7 lb. recipe Manager code: side208ReoRdeR No. descRiptioN AmouNt

432050 Primo Gusto Extra virgin olive oil 1 oz.

198307 Markon Diced onions, ¼" 8 oz.

198331 Diced Green Peppers, ¼" 8 oz.

321141 red Pepper, small dice 8 oz.

557714 Gran Sazón® Black Beans, drained 12 oz.

189979 GFS® Pineapple Tidbits, drained 12 oz.

556662 GFS Long Grain rice Pilaf With orzo 7 lb.

655244 Trade East Jamaican Jerk Seasoning 1 Tbsp.

PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Add the oil to a heated nonstick sauté pan. Add the onions and green and red peppers and sauté until tender but still firm to the bite. Season to taste with salt and pepper. Place in a large, stainless-steel mixing bowl and allow to cool. Add the black beans and pineapple. Mix together with a rubber spatula. Cover with film wrap until needed. Place 2¾ qt. of water in a nonreactive rondeau. Bring to a boil. Add the rice pilaf seasoning packet and Jamaican seasoning, stirring until dissolved. Add rice and cover tightly. Place in a heated 350°F convection oven and cook 25 to 30 minutes or until all liquid has been absorbed. Stir with a rubber spatula to distribute seasonings. Place rice in 2" stainless-steel hotel pans and allow to cool slightly, uncovered. Add the rice to the vegetable mixture, mixing with a rubber spatula. Season to taste with salt and pepper. Transfer to 2" stainless-steel full-size hotel pans. Cover, label, date, and refrigerate for future service.


Calories: ................................................................289Fat: ...........................................................................8 g.Sodium: ........................................................ 559 mg.Carbohydrates: ................................................27 g.Protein: ................................................................25 g.



Tea-Brined gri l led Pork LoinYield: 24 8-oz. servings recipe Manager code: pork060ReoRdeR No. descRiptioN AmouNt

recipe Sweet Tea Brine 3 gal.

120980 Davis Creek Meats® Center Cut Pork Loin 6 lb.

768801 russian Fingerling Potatoes 3 lb.

592293 Markon® Jumbo Carrots, ¼" slices cut on bias 1½ lb.

551325 Leeks 1½ lb.

recipe oregano Chive olive oil ½ c.

108308 GFS® Iodized Salt to taste


432050 Primo Gusto® Extra virgin olive oil 1½ c.

recipe Mustard Thyme Sauce, warmed 36 oz.

PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Trim any excess fat and silver skin from the pork loin. Slice into 4-oz. portions. Place pork portions in 4" stainless-steel full-size hotel pans in a single layer. Pour the cold brine over the pork until completely covered. Cover and refrigerate for 24 hours, turning pieces every 30 minutes for the first 2 to 3 hours. Cook the potatoes and carrots in separate pots of boiling, salted water. Shock vegetables under cold running tap water, then allow to drain. Slice potatoes into ¼" slices on the bias, widthwise. Transfer to separate covered storage containers, label, date, and refrigerate until needed. Trim the dark green leaves from the leeks. Slice in half lengthwise and cut into ¼" slices on the bias. Rinse under cold tap water to remove sand. Drain and pat dry with paper towel. Transfer to a covered storage container, label, date, and refrigerate for future service. Remove the pork loin from the brine and allow to drain. Pat dry with paper towel. Cover, label, date, and refrigerate for future service.

TO PrePAre à LA CArTe:Brush the pork with 1 tsp. of oregano chive oil. Season the pork with salt and pepper. Place on a heated char-grill or broiler. Cook to desired doneness. Slice pork on the bias. Add 1 Tbsp. of olive oil to a heated nonstick sauté pan. Add 2 oz. of fingerling potatoes and 1 oz. each of carrots and leeks. Season with salt and pepper. Sauté until lightly browned, tender, and warmed through. Ladle 1½ oz. of sauce in the center of a warm serving plate. Place the sautéed vegetable mixture in the center of the plate on top of the sauce. Shingle the pork on top of the vegetable mixture.

sweet Tea Br ine

Yield: 3 gal. recipe Manager code: rcomp346ReoRdeR No. descRiptioN AmouNt

562726 Markon Fresh Thyme, cut into 1" pieces ½ oz.

562785 Markon Fresh rosemary, cut into 1" pieces ½ oz.

225053 Trade East Black Peppercorns 4 Tbsp.

273937 Trade East Bay Leaves 5 ct.

Water 3 gal.

314641 GFS Light Brown Sugar 3 c.

557781 Markon Lemons, sliced ¼" thick 12 ct.

138300 Trade East Granulated onion 4 Tbsp.

513881 Trade East Granulated Garlic 4 Tbsp.

424307 kosher Salt 3 Tbsp.

695742 GFS Iced Tea Bags 6 ct.

PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Place thyme, rosemary, black peppercorns, and bay leaves in a piece of cheesecloth so they are loosely packed. Tie the top of the cloth closed with butcher’s twine to make a sachet. Place the water, brown sugar, lemon slices, granulated onion and garlic, salt, and sachet in a large nonreactive pot. Bring to a boil. Simmer 10 minutes. Remove from heat. Immediately add the tea bags and cover the pot. Allow to steep 15 minutes. Strain the tea brine mixture through a fine mesh strainer into a nonreactive storage container and allow to cool. Cover, label, date, and refrigerate for future service.

Tea-Brined Grilled Pork Loin




Calories: .................................................................553Fat: .........................................................................28 g.Sodium: ........................................................658 mg.Carbohydrates: ................................................ 52 g.Protein: ................................................................28 g.







432050 Primo Gusto Extra virgin olive oil 1 qt.


mustard Thyme sauce

Yield: 1½ qt. recipe Manager code: sauce504ReoRdeR No. descRiptioN AmouNt


109620 Jumbo Spanish onions, diced 1 c.

322164 Chopped Garlic 1 Tbsp.

673609 Hearthstone® roasted Pork Gravy 50 oz.

793485 Dijon Mustard 1 oz.

562726 Markon Fresh Thyme, finely chopped 2 Tbsp.



PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Add the oil to a heated, nonstick sauté pan. Add the onions and garlic to the pan. Cook until tender. Add the pork gravy to a nonstick sauté pan. Add the onion and garlic mixture, mustard, and thyme, and bring to a boil. Adjust to desired consistency with water or stock. Simmer 2 to 3 minutes. Season with salt and pepper. Allow to cool. Cover, label, date, and refrigerate for future service.


italian Pesto Sliders

i tal ian Pesto sl idersYield: 1 8-oz. servings recipe Manager code: slider038ReoRdeR No. descRiptioN AmouNt

525212 GFS® Ground Beef, 80/20 4 oz.



555801 Mini Brioche Bun, sliced in half 2 ct.

190969 Primo Gusto® Deluxe Marinara Sauce, warmed 2 Tbsp.

206059 Markon® Medium Green Peppers, sliced 1⁄8" thick 1 oz.

109620 Jumbo Spanish onions, sliced 1⁄8" thick 1 oz.

726567 GFS Mozzarella Cheese, quartered 1 ct.

844761 Primo Gusto Basil Pesto Sauce 2 tsp.

PrePArATiON iNSTruCTiONSWash hands. Divide ground beef into 2 oz. portions. Hand patty into 2" circles. Place in a storage container between parchment-paper layers. Cover, label, date, and refrigerate for future service.

TO PrePAre à LA CArTe:Wash hands. Wash all fresh, unpackaged produce under running water. Drain well. Season slider patties with salt and pepper. Place on a heated char-grill or broiler. Cook to desired doneness. Toast the insides of two buns under a heated salamander or broiler until golden-brown. Spread 1 Tbsp. of marinara on the bottom half of each bun. Place on a warmed serving plate. Place the burgers on top of the marinara. Spray a heated, nonstick sauté pan with pan spray. Add peppers and onions. Sauté until just cooked through. Season with salt and pepper. Divide the peppers and onions between the two burgers. Place a quarter piece of cheese on top of the peppers and onions. Place under a heated salamander or broiler to melt the cheese. Spread 1 tsp. of pesto on the inside of the top half of each bun. Place the top on the slider.


Calories: ................................................................ 597Fat: .........................................................................38 g.Sodium: ........................................................646 mg.Carbohydrates: ................................................ 32 g.Protein: ................................................................ 33 g.




herb-gri l led ChickenYield: 20 8-oz. servings recipe Manager code: chicken074ReoRdeR No. descRiptioN AmouNt

532312 Seedless Cucumbers, julienned on mandoline 1¼ lb.

198935 Markon® Medium Yellow Squash, julienned on a mandoline 1¼ lb.

268127 GFS® Boneless Skinless Chicken Breast Fillets 20 ct.



recipe oregano Chive olive oil 7 Tbsp.

recipe Quinoa vegetable Salad 2½ lb.

321141 red Pepper, finely diced 5 oz.

570722 Pepper Mill® Greek vinaigrette Dressing 1¼ c.

877500 Green onions, thinly sliced on the bias 1 oz.

PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Slice the cucumber and yellow squash into 3" pieces. Julienne each piece on four sides down to the seeded core. Discard core. Keep in separate covered storage containers and refrigerate until needed. Brush both sides of the chicken with 1 tsp. of oregano chive olive oil. Season with salt and pepper. Place on a heated char-grill or broiler. Turn chicken 45 degrees to create hash marks. Grill until cooked through. Remove from grill and slice on the bias. Place 2 oz. of quinoa in a stainless-steel mixing bowl. Add 1 oz. each of cucumber and yellow squash and ¼ oz. of red peppers to the quinoa. Season with salt and pepper. Place the salad mixture on a serving plate. Drizzle 1 Tbsp. of Greek dressing over the top of the salad. Shingle the sliced chicken over the top of the quinoa salad. Place 6 to 7 slices of green onion on top of the chicken.


Yield: 1 ½ qt. recipe Manager code: rcomp376ReoRdeR No. descRiptioN AmouNt




432050 Primo Gusto® Extra virgin olive oil 1 qt.


Quinoa vegetable salad

Yield: 2½ lb. recipe Manager code: side207ReoRdeR No. descRiptioN AmouNt


198536 Markon Jumbo Celery, finely diced 1 lb.

109620 Jumbo Spanish onion, finely diced 8 oz.

322164 Chopped Garlic 2 Tbsp.



602242 Quinoa, Cooked 4 lb.

PrePArATiON iNSTruCTiONSWash hands. Wash all fresh, unpackaged produce under running water. Drain well. Place the olive oil in a heated, nonstick sauté pan. Add the celery, onions, and garlic and sauté until tender. Season with salt and pepper. Spread vegetables out in a full 2" stainless-steel hotel pan. Refrigerate and allow to cool, uncovered. Place the quinoa in a stainless-steel mixing bowl. Add the sautéed vegetable mixture. Mix together using a rubber spatula and season with salt and pepper. Cover, label, date, and refrigerate until needed.


Calories: ................................................................ 243Fat: ..........................................................................17 g.Sodium: .........................................................201 mg.Carbohydrates: .................................................. 7 g.Protein: .................................................................17 g.


Herb-Grilled Chicken


CoLuMN: INDuSTrY uPDATE

T he overall healthcare industry continues to face familiar challenges with new twists as it moves deeper into the payment reforms and quality initiatives of the

2010 Affordable Care Act. With the White House's recent statement that insurance enrollment on federal and state insurance exchanges reached 8 million, it is not surprising that many healthcare providers are seeing the first signs of newly insured patients seeking medical care. Data showing higher consumer spending on health services is proving that out. Most agree this is a good thing for overall population health and is an encouraging sign for healthcare providers.

However, as more consumers are using their health insurance, it is trending toward using those dollars in lower cost settings. Through programs such as Accountable Care Organizations and Managed Care, healthcare providers are working to offer quality care in the most cost-effective way. Put simply, they are trying to keep people out of the hospital and in less-expensive, lower-level care settings. This is evident based on a recent report from the IMS Institute for Healthcare Informatics that showed Hospital outpatient visits (versus inpatient) increased by almost 3.3 percent in 2013. And although skilled nursing occupancy rates are growing, they were outpaced by the growth in assisted living and independent living. Further down in the continuum of care, the home-care industry is undergoing significant growth, showing an annual average growth rate of over 7 percent, the steepest growth among all long-term care sectors. And, possibly proving to be a huge money saver, telehealth is being tagged as a top health trend for 2014. It is marked to grow over 50 percent, with an 18.5 percent annual growth rate worldwide through 2018. The growth in telehealth is partly attributed to payment reforms providing enough incentive to not only cover the costs of running the programs, but also to offset revenue losses when the programs keep people out of the hospital. Providers are finding creative ways to provide better care as well as increase the acuity level in lower-cost settings, potentially saving billions of dollars every year.

But can they accomplish this and still meet quality-of-care outcomes? That is the true test as federal and state reimbursement are increasingly tied to performance. There is good evidence, however, that acute and post-acute care are on the road to improved performance. A recent report from The Leapfrog Group shows nearly a third of hospitals

improving their performance at least 10 percent since 2012. The Hospital Readmissions Reduction Program saw positive marks with a recent MMRR (Medicare & Medicaid Research Review) report stating a dramatic improvement. The rate of Hospital Acquired Conditions also improved by 9 percent. In addition, the number of skilled nursing centers receiving five stars from the CMS (Centers for Medicare & Medicaid Services) continues to rise.

fooD AnD nuTRiTion seRviCes CAn imPACT QuALiTy AnD CosT

So your “customer” mix is adjusting: inpatient visits are decreasing in hospitals, acuity of care is increasing in post-acute settings, and we are more and more providing care through non-traditional settings. Think about how you can play a role in providing cost-effective, high-quality services to your evolving target population. Here are some ideas:

•Offer tasty and appealing menus that help with overall health, nourishment, and satisfaction of your patients and residents.

•Get creative in implementing operational efficiencies to improve quality of food and reduce labor expenses.

•Reduce food costs by implementing smart purchasing practices, scrutinizing inventory management, and limiting food waste.

•Enhance the dining experience through improved atmosphere and customer service.

•Highlight nutrition services in your discharge planning, including solutions where patients can find the products they need to stay healthy at home.

•Work with other departments, such as environmental services and nursing, to implement infection- control policies.

•Focus on employee training to assure competent and confident staff, which translates into increased employee and resident satisfaction and better care.

•Get a handle on operational budgets by using reliable benchmarks.

Ask your Gordon Food Service® Customer Development Specialist for help. e

The Pulse of the

industryby: Dana Fillmore, RD, CP-FS

Academy of Nutrition and Dietetics Practice Alert

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule enabling registered dietitian nutritionists (RDNs) in the hospital setting to become privileged to independently order therapeutic diets. The Academy supports this new rule that will provide patients with better healthcare and help hospitals function more efficiently. It will become effective July 11.


CoLuMN: ASk THE DIETITIAN

Q: Why aren’t food labels required to list gluten in the ingredient statement or allergen information?

A: Gluten can be difficult to identify on most food labels. Since gluten is the protein found in wheat, rye, and barley—plus certain cross-breeds of these grains and their derivatives—as well as in many products, simply looking for wheat in the allergen statement alone does not guarantee the item is gluten-free.

Until recently, there was no official definition of “gluten-free.” However, the Food and Drug Administration (FDA) has recently decreed that, in order to be listed on food labels as “gluten-free,” a product must contain fewer than 20 ppm (parts per million) of gluten per 1 kilogram of food. The rule goes into effect in August this year. It’s voluntary for manufacturers, but also holds foods that are labeled as being “without gluten” and “free of gluten,” or as having “no gluten,” to the same standard. Foods that are inherently gluten-free, such as bottled water and fresh produce, can make the claim as well if the manufacturer decides to label them accordingly. If a product carrying one of these claims fails to meet the requirements of the rule, it would be considered misbranded and subject to FDA regulatory action.

To help you better serve customers concerned about gluten, Gordon Food Service® will begin adding a new gluten-free symbol to private-labeled products this summer, identifying items that contain 20 ppm or less of gluten.

Q: What are the current nutrition recommendations for pressure-ulcer management?

A: In spite of all our efforts at prevention and all the improvements in treatment over the years, pressure ulcers affect as many as 3 million adults in the United States. Nutrition therapy plays a critical role in both the prevention and treatment of pressure ulcers in older adults. Controversy and limitations in research make it extremely difficult to have set nutrition guidelines in place for the treatment of wounds. A comprehensive, individualized nutrition assessment is therefore essential when implementing a nutrition plan of care.

In your nutritional assessment, take into consideration the patient’s medical history, weight history, nutrition and hydration status, wound status, and biochemical profile. While studies suggest that calorie intake should be 30 to 35 kcal/kg/day and protein intake should be increased to 1.2-1.5 g/kg/day for healing pressure ulcers, you should base your recommendation on this individualized assessment and size/severity of the wound.

In the absence of a true deficiency, supplementing with vitamin C and zinc for pressure-ulcer healing is controversial. Most studies suggest that older adults who are nutritionally compromised may need a multivitamin supplement, but the individual’s needs should determine any additional recommendations for supplementation. Scientific evidence does not support routine supplementation with vitamin C and zinc to promote wound-healing. If the individual shows a deficiency in these nutrients, you might recommend supplements until the individual no longer has the deficiency, or until the wound is healed.

To provide an adequate nutrition plan of care, you must closely monitor wound progress. If the current interventions aren’t working, it’s important to dig deeper to find the root issue. This sort of investigation often requires a multidisciplinary approach, as you must consider multiple aspects of wound care. As with many other medical diagnoses and conditions, the key to providing adequate medical nutrition therapy will be a comprehensive, individualized assessment. e

Gluten Labeling/Nutrition

Pressure-Wound management

and

ENRICH | Summer 2014 33

What kind of a leader are you? Commanders know what they want and expect it to be done a certain way, no questions asked. Entrusters give everybody a chance to weigh in, trusting that participation will lead to the right decision. Free thinkers believe people know what they need to do and leave their employees alone to take care of it.

eACh sTyLe hAs An uPsiDe …If you have a small group of untrained workers, you’d best

be a commander to get the job done on time and on budget.

A team that “gets it”—knows the who, what, when, and where of the group and why it does what it does—responds well to an entruster who invites opinions and feedback.

If team members are experienced, knowledgeable, and are being groomed for more responsibility, they’ll appreciate a free thinker who gives them the latitude to make their own decisions in pursuit of the goal.

… AnD A DoWnsiDeThere’s a fine line between “commanding” and

“dictating.” Cross it, and mutinies may result.

Entrusters know things will work out eventually—however, eventually may not be soon enough in today’s just-in-time world.

The “hands-off” approach of free thinkers often masks poor communication skills and can leave insecure workers

feeling rudderless and adrift.

ADAPT AnD ThRiveSo what’s the answer to being a truly effective leader?

I maintain that the most successful approach involves adapting your style to the needs of each individual.

Establish one-to-one relationships with every team member to align the experience, maturity, and personality of the individual with the overall goals and strategies of the group. In the process, you’ll provide each person with exactly the leadership style needed from one moment to the next. e

Ken Wasco, Gordon Food Service® Customer Effectiveness Manager

As a member of the Gordon Food Service marketing team, Ken Wasco conducts hundreds of seminars and workshops on ways to achieve higher levels of personal effectiveness through an emphasis on communication skills across the service industry.

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engage …

Assessing Your Leadership Style

by: Ken Wasco

CoLuMN: ENGAGE


GFS® Cattleman’s Reserve Burgers are made with a special au jus seasoning that delivers a

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