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18 Industrial Management the most nutritionally sound foods possible to patients and customers. Forward-thinking managers in the hospital culinary industry are taking good nutrition to the next level for their departments. Some kitchens have disposed of fryers altogether and only serve grilled or oven-baked options. Some hospitals have taken to posting calorie counts in public places for all meals at the risk of decreased sales on high calorie items. Others have eliminated full-sized cola products in their cafeterias and only offer smaller portions. Finally, the most health-conscious managers have even introduced farm co-op programs and take-home rotis- serie chicken and meal options for staff members to share with their families at home, allowing the health trend to extend outside of the hospital. While this example touches only on food services, the managerial decision to pursue current demand patterns versus future trends is a controversial one. The consistency and dependability of current retail patterns provides a steady income stream for any department, but the manager must decide when ethical decisions and possible trend shifts are prevalent enough to risk a change in product offerings. Changing to a different product or service may cause a temporary decline in sales, but the long-term benefit has the potential to outweigh the short-term cost. Centralized hub versus decentralized spokes The third and final operational conflict in food services is centralization versus decentralization of production services. Most hospital designs include one main kitchen to cook meals for everyone in the facility, and this approach has many operationally and financially positive attributes. Creating one main hub of production eliminates the duplication of capital equipment, food inventory and labor throughout the hospital, contributing The most health- conscious managers have even introduced farm co-op programs and take-home rotisserie chicken and meal options. to a less expensive budget and better chance for profits at the end of the day. It also creates the opportunity for economy of scale within the facility – lean hospitals will create a "chef special" item each day that will be offered to the retail public for a discounted price and marketed to patients as the healthy, comfort option. This allows them to mass produce one meal and serve it to many different populations on the same day. The drawback to a centralized production plan is extended delivery distance to patient units and increased wait time for meals, which contributes to a great deal of dissatisfaction for hungry patients and family members. This issue lends to a second option for production: Decentralized "spokes" in each main hospital area. While this approach duplicates equipment and personnel, it brings the action closer to the customer, reduces delivery time and allows management to scale operations up or down based on population requirements. Hospitals that abide by this approach create smaller, boutique-style kitchens that only produce to a specific demand – higher-end retail food or mass-produced patient meals for the campus. It also allows hospitals to hire staff who may specialize in one type of food production for these areas. Choose your model Managing any type of food service department in healthcare or in outside industries creates a constant balancing act for quality products and services versus efficiency of production. While batch processing may be more efficient and cost-effective, creating just-in-time meals and intro- ducing choices to customers increase customer satisfaction exponentially. Maintaining current sales offerings is a great way to ensure a constant and steady income stream, but future trends in nutrition and healthcare may disrupt sales and create moral issues in the long term if contro- versial changes are not made to the department culture. Finally, while a centralized kitchen is less costly and has economy-of- scale benefits, decentralized mini- production areas are more effective in getting fresh meals to the customer in a timelier manner. Lean operation and effective financial decisions may not always lead to the best production model in a hospital, and managers are faced with decisions every day that place customer satisfaction and forward thinking against the operationally best production models. As a manager, you must decide what is the most important and beneficial model for your situation. If it is based on solid reasoning, it will lead to a successful business model for your department both in the short term and in the future. v