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Institutional Dining: How Hennepin Healthcare Geared Up

William Marks, fourth from the right, with his management staff in the main dining room of Hennepin Healthcare before the pandemic hit.

When the pandemic was first on the horizon, William Marks, director of food, nutrition and environmental services at Hennepin Healthcare, says his team began to reconfigure everything from patient meals to how they’d feed the doctors and nurses on the frontline once they had to close all their dining rooms. 

Some of the issues they were faced with immediately were: What do you do if half your staff comes down with the virus? How do you extend the life of your limited supply of masks? How do you feed COVID-19 patients while keeping other patients and staff safe?

There were a lot of what-ifs that had to be dealt with, he says, but Hennepin Healthcare has “an incredible command structure” that deals with crisis management with military precision. 

“Every day brings on a new challenge,” he says. “It’s an amazing time in healthcare; I’m glad I’m experiencing it—and another side is that I wish I had retired and was watching this on the sidelines.”

Patient foodservice has had some changes, but not many considering everything going on. “We have different levels of isolation, and we don’t want any cross-contamination,” he says.  “We decided that anyone on any sort of isolation is served on disposable trays and containers—fine for a picnic, but not a good way to eat.”

Another consideration was to decrease the number of times staff goes into patients’ rooms, so nurses now deliver and remove trays to isolated patients. This is also a way to conserve the PPE, such as masks. 

“We used to go around with iPads to get your order for lunch, dinner and breakfast, but we stopped doing it. (Instead) we give them a paper menu on their tray for breakfast. That’s a big change, its hard to figure out what you want at breakfast for lunch and dinner.”

William Marks oversees both the foodservice and the cleanliness of HHC.

An irony is that the hospital started receiving an outpouring of support from the community they couldn’t use. “We are getting incredible amounts of donations,” he says. “People are showing up with food, a lot we can’t accept, like a hot dish” or large orders of sandwiches that don’t go through the proper channels.

“We appreciate the big heart,” he says, “but we don’t know how (or when) it was prepared. We have to know the chain of control to be sure food is safe.”

Having to turn down food doesn’t make him popular with either the staff or the donors. “I’ve been the Grinch,” he admits. 

In the beginning it was all about planning for the surge. “What if we ended up like New York” was the fear. The first four weeks were spent finding and utilizing space for additional hospital beds and tracking down needed equipment and supplies. 

Ironically, those makeshift hospital wards directly impact food delivery. “A new area doesn’t have room numbers,” he says, “so we have to figure out how to get food to them.” 

In addition, there was a constant flow of directives from the Centers for Disease Control (CDC). “That was tough, dealing with the changes,” Marks says. “We knew if you made a change, it would be changed—you’d make changes to the changes. The CDC was learning, too.”

Departments with employees who could work from home, such as finance, stayed home. “I allow my managers to work from home one day a week, but I run a kitchen, and you can’t cook from home,” Marks says.

The next step was when non-frontline workers started wearing masks and practicing social distancing. The actions aren’t second nature yet. “Seven weeks later, I still see people too close,” he grouses. “It took weeks to beat into people’s heads, make sure it (your mask) is over your nose.”

One of foodservice’s first assignments was to close the retail operation. Since guests were no longer allowed inside the building to visit patients, the main dining room was streamlined to a rotating schedule of pre-made salads and sandwiches. They may be pre-packaged, Marks contends, but they’re not ordinary. “We’re making spectacular salads, four different salads, and charging reasonable prices,” he says, adding, “This is not a time to make money off of anyone, especially staff.” They’ve since added two kinds of pre-portioned soups and chili. 

Staff is having to adjust as well. “Though we sure miss the innovation station—the tikka masala and pot stickers—it really is great that the cafeteria is doing what they’re doing to stay open for the staff,” said Erica Monroe, a physician assistant. While she may miss the tikka masala and the toasted cheese sandwiches hot off the grill, she sees the new version of the cafeteria as a bright spot in the day. “Even though we can’t sit and eat/socialize, the routine of walking to the cafeteria to pick up lunch is still there, and it’s nice to have that piece of normalcy amidst a changed hospital and quieter hallways,” she said. “I’ve seen and heard staff talking about the cafe/market, and walking away with a bag of take-home staples.”

The market was another one of Marks innovations. At home he was the designated food shopper and when he went to the store, “I was PPE’d up pretty good. My wife gave me this list, which had paper towels and toilet paper on it and there was nothing there. Cleaning supplies were wiped out.” The next day at work he asked their suppliers if they could order extra items to stock an employee store with. 

At the beginning of the pandemic, when stores' supplies were running low,  healthcare workers didn’t  have to worry about not being able to find essential items, “plus it keeps staff out of stores,” Marks adds.

“When I first spotted the rolls of toilet paper, I thought it was a funny joke,” Monroe says. “But then I noticed the milk, eggs, butter, sliced cheese, and boxes of vegetables and fruit.” While the fresh-out-of-the-oven chocolate chip cookies are still sadly missing, she did buy a prepackaged one and instead of a single-size milk, she bought a gallon of milk to bring home. “I also bought a $26 box of produce,” she said.

The surge hasn’t hit yet, but that doesn’t mean that every day Hennepin isn’t preparing for it, as well as for the day they reopen their retail operation. 

“What we’re going through is what every hospital is going through,” Marks says. Everyone is struggling with what foodservice will look like post-COVID-19. There are big decisions and smaller ones like: Pump-style condiments versus individual packages, and are they in a basket or handed out by the cashier? And can they go back to the way it was, or does food still need to be packaged in some way when it’s placed on a tray?

“Let’s see what the fast-food folks do, they’re smart,” he says, adding, “It’s a crazy time.” 

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