S6 EP8: Carmel Lazarus on the Future of Health

 Carmel's resrearch helps identify how food services can help reduce waste, save the hospital money and promote patient satisfaction. 

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Transcript

[00:00:00] David Cummins: Good day and welcome to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:00:23] I'm your host, David Cumins, and today we are speaking to Carmel Lazarus, who after completing her Bachelor of Science, continue her studies to finish her masters of nutrition and dietetics. 

[00:00:33] Following this achievement, Carmel commenced a fruitful career in the world of healthcare. Beginning in the early 1990s, Carmel has traveled the world assisting hospitals, patients, and staff with their nutrition needs.

[00:00:45] After 15 years at St Vincent's Private Hospital in Sydney, peppered with lecturing and extra study in her downtime, Carmel evolved her career to work at CBORD, a global technology and software company to assist people with their nutritional needs. 

[00:00:59] We look forward to speaking to Carmel today and finding out more about how technology can assist patients now and into the future.

[00:01:05] Welcome Carmel, thank you for your time to be here. 

[00:01:08] Carmel Lazarus: Thank you. It's nice to be here. 

[00:01:10] David Cummins: I must admit a lot of people in the world of health infrastructure don't necessarily think about the support services catering cleaning but it's an integral part of healthcare, especially when it comes to design and patient caring for patient needs.

[00:01:25] What drove you to work in the healthcare nutritional space? 

[00:01:30] Carmel Lazarus: I guess I grew up in a family that was looking after people, both my parents were pharmacists or worked in pharmacy. So I knew I wanted to do something that was health related and I was always interested in food and nutrition, I mean, who isn't interested in food and nutrition. 

[00:01:47] So I guess that's really why I started working in nutrition. I enjoyed the food side of things doing food technology at school. I wanted to do something that was working with people. 

[00:01:59] David Cummins: That's fantastic because I think there is always a calling for people to work in the world of health because you are always have this need for or desire to help patients and community and other staff.

[00:02:08] But over your career, especially over the last few decades, the demand and evolution of nutritional needs for patient has changed dramatically to the point of today. 

[00:02:19] Do you mind just taking us through that journey of, from the nineties to now and how it's changed so dramatically?

[00:02:23] Carmel Lazarus: Yeah, absolutely. And I think that's a really important point. 

[00:02:26] Nutrition is ever evolving and it's very much based on the balance between art and science so there's always new developments. When I started as a clinical dietician in the nineties, I'm probably giving away my age now, but nutrition in hospitals was very much focused around providing nutrition, particularly from a food service point of view for managing chronic disease like heart disease and diabetes. 

[00:02:53] Very much focused around education of patients while they're in hospital. And really that started to change through the nineties and early two thousands.

[00:03:03] We actually did a study at St Vincent's where we looked at the prevalence of malnutrition in the hospital setting. And what we found was that about 30% of our patients were mildly or severely mostly moderately malnourished. 

[00:03:20] And that changed the way we provided our service because it was very much about providing that adequate nutrition while patients were in hospital.

[00:03:28] So food service then became a really integral part of it. And I guess that's why I made the transition into food service, because I thought that could affect a lot more people than providing that clinical support. 

[00:03:41] And when we first did that study we were really really surprised at the finding, particularly because it was a private hospital.

[00:03:49] But there's lots of studies internationally and in Australia that indicate, that up to one in three patients in a hospital setting are poorly nourished and that impacts their recovery and the way they cope after surgery and also their wound healing and how long they're in hospital for.

[00:04:07] David Cummins: Yeah, it's really interesting, especially when you talk about healthcare and nutritional needs today versus the eighties, nineties and two thousands. 

[00:04:16] In reference to infrastructure and kitchens and support services, I've built a lot of larger kitchens and they're huge beasts that suck up a lot of demand and you produce this phenomenal food, which can create wastage when patients don't eat it. 

[00:04:35] Not only that, I'm sure most people listening have heard about complaints from patients whether the food's not hot enough or of poor quality, which I find phenomenal because I've seen them work so hard. 

[00:04:46] So there seems to be this recurring thing in a lot of hospitals about patient satisfaction with food not being hot enough, but also a wastage.

[00:04:54] So, I believe CBORD helps resolve a lot of those pain points. Do you mind just talking a little bit more about CBORD, the technology you use and how it can improve hospital infrastructure and patient needs?

[00:05:05] Carmel Lazarus: Sure. And I agree. I think hospital food gets a really bad rap, maybe rightly so in some facilities. 

[00:05:13] But I guess I've been really lucky to have had my career, being able to work in making change within food services and certainly at St Vincent's. That was part of my role in looking at the way we ran our room service operations and how we could be more efficient.

[00:05:30] And that was really why I transitioned to CBORD. CBORD was a company which very reputable company which provides the software to enable us to provide a really efficient and effective food service. 

[00:05:45] So it provides a back of house support technology with recipes and purchasing and procurement, but also that front of house patient ordering piece. We also have patient ordering app and we also can track individual patient waste as well as intake. 

[00:06:03] And so my skills and background in working in food services in hospital kitchens and my dietetic background seem to work well with working with CBORD to really work with customers to help them look at the current models that they're providing and help them to redesign their models being supported by the technology that we provide.

[00:06:27] David Cummins: So you're talking about two different things there. 

[00:06:29] You are talking about a model of care change, enhanced patient satisfaction and on demand service, but also the infrastructure. So I just want to dissect all those three. 

[00:06:37] Just focusing on the infrastructure, their physical infrastructure that's required.

[00:06:43] Does that mean if it's more on demand service, the kitchen itself does not need to be as big and the staff needs not as big. 

[00:06:51] What does that mean from an infrastructure point of view? 

[00:06:54] Carmel Lazarus: Yeah, that's a really good question. 

[00:06:55] And really the movement over the last 10 years or so towards a more flexible meal service has caused us to really look at the way our our kitchen is set up and think about the design and the footprint. 

[00:07:10] And I guess that's why it's really good to talk to you because often when I'm asked to come in and talk to sites, they've already designed their kitchen. It might be a Greenfield site or a Brownfield site, so we actually come in late and sort of have to change things.

[00:07:26] So you're right, there's a lot of things that impact on that infrastructure and in room service we tend to not need as much space. The menu is quite different. 

[00:07:36] So from a procurement and stock inventory, you're not needing to keep as many items, but you still do have that menu variety.

[00:07:45] And I guess the type of menu you can buy in some items and then finish it off, or you can actually cook to order. 

[00:07:53] So you're not necessarily having to have as bigger back of house footprint. It all depends on your menu and your philosophy and I guess that's something that we do is there's no one size fits all. We go in work with the site and look at what their needs are. 

[00:08:08] There's a whole lot of things that are really important in terms of where the location of the kitchen is, and you are probably very well aware, but when we work with sites, they're very focused on the clinical stores and how it's really important that the clinical stores are very close to the doc and the wards and are very central, but they never think about the food service and how important that is to be centralised because there's a lot of, there's a lot of walking backwards and forwards. 

[00:08:34] Patients generally consume at least three meals a day so you are delivering, and you're collecting six times a day. So if your kitchen is not close to your clinical areas that's a huge operating cost for your site. And that's often not considered, but the clinical operations are considered.

[00:08:53] So it's great to sort of be looking at it holistically. 

[00:08:56] David Cummins: So keeping that in mind as well, then with the models of care, it would purely depend on the service offerings of a hospital, would it not as well? 

[00:09:03] So it would be very different food offering for a pediatric hospital versus a mental health hospital, teenage mental health gerontology, even cardiac, neuro every one of those disciplines has extremely different and unique health needs and dietetic needs, would it not? 

[00:09:22] Carmel Lazarus: Yeah, they do. And that's where the skill of the dieticians as well as the skill of the food production and chef team come in because it's about building your food service operations, but also building your menu. 

[00:09:36] And really your menu is your central. Thing. And you can integrate your menu as much as you can so that you're not having a different menu for every single patient cohort. And you try to streamline your food service operations to meet the needs of each of those patient cohorts within your group. 

[00:09:54] But it might be slightly different so your mental health group, for example, might have the same menu as other patients, but perhaps instead of having an on demand, for example, meal delivery, they might have set meals because they need to have their medications at set times. 

[00:10:10] That's part of again, what we do. We work with the site, we build the menu, we build the processes and the workforce structure. And we take all of those things into consideration. 

[00:10:20] David Cummins: So when you're talking about operations, models of care infrastructure, that pretty much means that the food services team should really be consulted really early days in the design phase, then as you just talked about the operations, the size, the mechanical exhaust, if anyone's been there, the surface of the flooring. It's all a very integral part of the design.

[00:10:41] How early should we be consulting with the food services team? 

[00:10:45] Carmel Lazarus: As early as possible.

[00:10:47] I've worked with lots of different sites and I'm just thinking about one particular customer who I won't name, but basically they said, " Here's the footprint that you have for your kitchen. We want an on demand room service model because we know that ticks all the boxes in terms of patient satisfaction, sustainability and improved nutrition and reduced costs. So we want room service. But this is your only footprint". 

[00:11:13] And so there was a lot of negotiation backwards and forwards to make sure that we did have enough space. Because there's always a trade off. There's never enough space. But often food services are the last that gets allocated and you do need a minimum space because obviously there's a whole lot of Work Health Safety issues, there's food safety and there can be a trade off.

[00:11:33] If there's not much space, then it may be that you need to buy in some product. But then again, it depends on where that food service operation is. If it's in, for example, far north Queensland, they mightn't have the same opportunities in terms of procurement as those in city-based areas. 

[00:11:50] David Cummins: Most hospitals do refurbs and retrofits. So what happens in that environment then? 

[00:11:55] How do we find that balance of, and I'm thinking of a few hospitals at the moment where we have to shut down the kitchen to do a refurb. Not only do you have lack of service for that X period of time, but also you have to retrofit in a existing footprint. How does that work for you guys?

[00:12:09] Carmel Lazarus: Well, it is a balancing act and look, we have kitchen designers that are part of our team. Or we are happy to work with the kitchen designers from the hospital and then we work in with the architects. So it's a whole lot of staging that needs to be planned for. And I'm gonna guess I'm thinking just of a few sites.

[00:12:27] When we are retrofitting, so where there's already exhaust and that sort of thing, we try and utilise what there is so that there's less disruption but there always is going to be disruption. I mean, you and I, David worked together, so we know about the disruption at St Vincent's with all the redevelopment.

[00:12:45] So you've just gotta try and find spaces. I've worked with teams including at St Vincent's over many years with redevelopments of kitchens that sometimes you have a mobile kitchen on the back loading dock for a period of time, or you buy in for a period of time. So I think the important thing is, is being prepared for that.

[00:13:04] And that's part of those project planning meetings and keeping the patients and all the staff informed so that they know what's happening so that if they are getting a different sort of meal they're aware of why they are. 

[00:13:18] David Cummins: Communication's always the key to any redevelopment.

[00:13:20] You briefly mentioned the benefit of using the stronger technology such as staff satisfaction and sustainability. Do you mind just talking a little bit in more detail about those benefits and any research you guys have to support that?

[00:13:33] Carmel Lazarus: Yeah, so we've worked with a number of sites and plus at St Vincent's implementing a room service on demand food service model. And there's a lot of research now emerging to support. So not only is it anecdotal findings in the site, but published research. So a number of sites in Australia have have done some published research.

[00:13:56] There's the Marter in Brisbane, there's Prince Charles. So there are customers that we've worked with and they've published research and they've found significant reduction in waste. 

[00:14:07] On average, some hospitals can have up to 50% of the waste related to food. So that's very significant. Generally it's 20 to 30%. There's a study that was done in 2020 that showed it ranged from 17 to 74% of the hospital waste was related to food. So that is significant for our traditional models. So we need to be looking at a different way, at a different model.

[00:14:35] And what sites implementing room service have found is that their food waste has reduced by more than half. So that is significant.

[00:14:42] Less going into landfill preventing that waste. And there's also significant cost benefits. So obviously not just the environment and financial, but also human health, if we think about planetary health.

[00:14:56] So from a sustainability point of view, a more flexible room service model. Even though the setup costs have to be factored in the long term, it's really the better way to go. And if you think about it, it makes sense because if you are sitting in hospital and you are not well, you have to order at least 24 hours in advance.

[00:15:19] And you and I are well, and I dunno what I'm gonna feel like eating tomorrow and we're expecting a sick person that's nauseous... so what do they do... they tick everything on the menu, all that food is delivered and then they may eat just one or two pieces of that. So huge amount of waste.

[00:15:36] In a on-demand model, patients order to appetite when they're hungry, and the research shows that their intakes actually improves both their protein and their energy, and as a percentage of their requirements actually improves. So, It kind of speaks for themselves. 

[00:15:55] David Cummins: Yeah, that's great. I mean.. Not to give too much away, but I quite often would have a bowl of cereal at four o'clock in the afternoon, because that's just what I want at that point in time. Cereal and fruit. And I'd absolutely love it. 

[00:16:05] So to actually have that ability to choose what I want, when I want, for the needs that I have now not only would it make me feel better, but I imagine the clinical outcomes would be more positive work because people are actually getting what they want when they want. So I totally see the benefits of it. 

[00:16:22] Just before we go, is there any take home message for people in the design phase now, or thinking about changing their food services or nutritional needs for a hospital.. 

[00:16:30] What's something that they can take home now within the constraints that they've currently got? 

[00:16:35] Carmel Lazarus: I guess, understand what the current challenges are and know what your waste is. So I think that's a really important thing to at least understand. And I think the other thing is it needs to be not a food service approach.

[00:16:49] It needs to be it needs to be some leadership and it needs to be hospital-driven I tell customers that I work with right from the beginning," this is not a food service project, it's a hospital project". And I think to get that buy-in, and just starting to talk about different models that are out there that we've been doing the same thing for so long and it's just contributing to lots of waste, not necessarily great nutrition.

[00:17:14] We still have malnutrition in our hospitals so there's gotta be a better way and the results, as I said, speak for themselves. The other benefit is that it's patient-driven. So Prince Charles (Hospital) who implemented room service in 2019, their food service team were awarded the CEO Award that year, and that was because they implemented a project that was patient-driven and patient-centred. 

[00:17:43] And we talk a lot about patient centricity, but this was about the patient getting to eat what they want and the rest of the department sort of working their processes around that.

[00:17:54] And that was an example to the rest of the organisation to look at how we do things and actually think about the patient at that centre and driving that change. 

[00:18:04] David Cummins: That's all fantastic. The thing I love about everything you've talked about today is it's got evidence to support it.

[00:18:10] And from a clinical background myself, I always say, what does the evidence say, "what does the research say". 

[00:18:14] I'm never smart enough to know exactly what will happen, but I'm smart enough to know what the research should say and happy to implement that. So I think to have an evidence-based program supporting your theories is phenomenal and I strongly encourage other people to do exactly what you said, explore challenge tests and always make sure patients are at the forefront.

[00:18:34] So thank you so much for the chat today. Thank you so much for your time. 

[00:18:37] I think the combination of your background has culminated into this amazing role that you now have, and I just wish you all the best in the future as well. 

[00:18:45] Carmel Lazarus: Thanks David. And thanks for the opportunity to spread the word because I'm very passionate about it and it's great to see the benefits at hospitals that we've worked with.

[00:18:53] Thanks for the opportunity. 

[00:18:55] David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. If you'd like to learn more about the AHDC, please connect with us on LinkedIn or our website. 

[00:19:04] Thank you.