30.04.2009 – The Clinic of the Future in Greifswald

 

Text: Gerd Hartmann
Photo: University Clinic Greifswald

Turn left and left again, then straight on through the long corridor, a short halt to wait for the automatic door to open. It seems to know the way. It stops in front of the lift, then rolls in and descends to the cellar. The small figure which trundles so purposefully through the university clinic Greifswald is a robot. Its name: Transcar 2.

The nimble helper and its nine identical colleagues play a leading role, not in a computer simulation but in reality. On the new campus of the university clinic Greifswald, the things that nurses and nursing assistants used to have to wheel along the corridors are fetched and delivered by an automatic transport system. Carrying meals, laundry, medication, sterile instruments or waste, the driverless transport vehicles, which look like large trays on wheels, are in use 19 hours a day. They travel between the individual wards and the central service center up to 300 times without any human support. They can even call the elevator themselves. 

Only Frank Schneidenbach knows exactly where the laser-steered helpers are located and what they are doing at any given moment. On his screen in the logistics center, he monitors their progress through the kilometers of hospital corridors and the tunnel system which links the individual buildings with the service center. The system has been in operation since the opening of the newly constructed wing in 2003 and it runs without a hitch, as Schneidenbach can testify.  

In 2010, twenty-one robots will be deployed throughout the clinic. This is when the construction of Germany’s most modern university clinic, in which over 260 million Euros are being invested, will be concluded. The new campus will unite the 21 clinics and 19 institutes spread across the city. Part of the futuristic clinic is already in operation. Several wards with over 350 beds are accommodated on the spacious complex with gardens and water features.  

Construction is not the only issue at the university clinic Greifswald; there are many other considerations. Firstly, there is the need to provide optimum medical care to the region including, increasingly, primary health care. In the federal state of Mecklenburg-Vorpommern the population is decreasing as are the number of general practitioners. Secondly, cutting edge medicine and medical research need to be promoted. Cooperation between the various medical disciplines and investment in medical high-technology are part of the strategy as is the wide scope of research. This is termed community medicine for which there is an institute at the university clinic – the only one in Germany. Long-term collation of data from 4,000 subjects facilitates analysis of typical regional illnesses and the risk factors attached to specific sections of the population. The results will benefit everyone including the clinic which can use them to target and develop its services.  

The scientific activities, which are as innovative as they are wide-ranging, and the medical opportunities make Greifswald an attractive location for student doctors. 1,300 future human and dental medics are presently registered at the Ernst-Moritz-Arndt university. On average there are fifteen applicants for every place.

Ingenious Logistics  

A truck docks onto the »station«, as the loading ramp in the service center is generally known internally. The freight: insulated metal containers with patients’ lunch. The silver containers are quickly wheeled into the distribution station but don’t remain there very long. A flashing robotic member of staff soon arrives to take the first containers to the wards to which they are allocated. A coin-sized transponder on each container communicates the necessary data.  

The transport system is as ingenious as it is fascinating – and the contents of each of the food containers are also the result of complex logistics. With a smile and a friendly good morning, Dussmann Service’s Anita Liebenow arrives at the patient’s bed. She is a Menüdame as the nine hostesses are called here. Every morning, she takes patients’ orders for the meals on the following day. She notes whether a white or brown bread roll is preferred for breakfast, the choice of lunch menu and the selection from the eight different side dishes for the evening meal. Anita Liebenow’s handheld mini-computer contains the weekly meal plan and information about the dietary needs of each individual patient. The software automatically excludes inappropriate components from the selection.  

This is not an issue for Mr. Busse, a patient on the orthopedics ward following a hip operation. His diet is not limited but he decides against cheese and ham for breakfast anyway. »I like the classical bread and jam breakfast,« he says but orders savory curd cheese and sausage for the evening meal. He has already selected his lunch menu from the meal plan which is available in each room. Then he jokes with Anita Liebenow. They know each other already because it’s Mr. Busse’s third stay. With luck, the last time, he hopes, now that he has a second successful replacement hip operation behind him. 

Early in the afternoon, Mr. Busse’s meal requests reach the central kitchen together with those of the other 700 patients in the various clinic locations. Situated in a logistically advantageous location, in an industrial park, the Dussmann Service team prepares the meals for all of the clinic sites. In addition, lunch is prepared for two staff restaurants and a cafeteria. Each day, 2,400 portions, including breakfast and evening meal, leave the modern kitchen on Koppelberg, which recently achieved organic certification. 

Dussmann Service is responsible for catering in the entire university clinic – a challenging task. There is not only the meal range of standard nutrition, light standard nutrition and ovo-lacto vegetarian nutrition. The kitchen also prepares ten different meal variations for the children’s ward and meals to cater for up to 20 different special diets each day, according to dietary and nutritional needs, for example allergies. For private patients there is also a »gourmet menu« which offers a comprehensive premium range of à la carte menus especially created for the purpose. When small snacks and finger foods are needed, Dussmann Service is the right address. The kitchen supplies events and receptions in the university with bespoke buffets and snacks. 

Meal Requests for Cancer Patients 

As many transplantation and cancer patients are treated, the kitchen offers individual »special requests«. »These patients often have a completely different sense of taste«, explains head dietician Birgit Giese. »This is why they can select what appeals to them most.« Every day Birgit Giese and her five colleagues cook between 20 and 30 of these special requests – individually. Many small saucepans steam on the stoves. »We do everything possible for these patients,« confirms Ms. Giese. So if someone really wants to eat smoked eel, that’s what they get. 

The clinic kitchen produces food using the Cook&Chill procedure. Hot meals are prepared the day before and go straight from the kitchen into one of the three large chillers. These heavy-duty chillers lower the temperature of the foods to 3° C within 90 minutes. The foods are not reheated to service temperature until they reach the wards which means that both taste and vitamin content are better preserved than if the meals were portioned hot and kept hot for hours in transport. 

This is where high-tech comes into play: In the food containers, there are two contact heating plates under each tray slide – one for the soup and one for the main course – so that the food can be regenerated to an individually predetermined temperature. And if salad replaces the soup, it is not a problem; the heating plates only connect when the cover over the plates has a metal core. If not, the food remains chilled.  

In order to keep the cold chain unbroken, the temperatures where meals are portioned are maintained at 7°C. Mr. Busse’s order has been printed in the meantime and lands on the empty food tray on the portioning conveyor belt. Bit by bit, the Dussmann employees assemble the meal. At the end of the conveyor belt, a dietician checks that everything is as it should be. If a piece of cutlery is missing or the wrong side dish has been served, her  trained eye spots it. The finished meal trays are immediately put into the pre-cooled containers and sealed for delivery. Less than a quarter of an hour later, the first truck arrives and the food starts its journey. The truck has transported the breakfast dishes to the adjacent dishwashing kitchen on the way back. This is the cycle of logistics.

Successful Quality Management 

The university clinic Greifswald is a success story. It is the biggest employer in the region with more than 3,400 employees and growing – because the future will bring additional expansion and the corresponding increase in jobs. This is an important sign for the weak infrastructure of Mecklenburg-Vorpommern. The clinic has achieved its budget for several years now – an exception as opposed to the rule in the health care sector. The university also has an impressive Basisfallwert value. This term describes the statistical value which reflects the performance and the management of a hospital. The lower the figure, the more cost-effective the organization. Greifswald boasts a value of € 2,662.50, the second best among all of the German university clinics. More than anything else, this is thanks to consistent quality management. In each clinic there is a quality assurance officer who is responsible for the analysis of work procedures and service provision quality to patients. As the first German University Clinic, Greifswald has been awarded the certificate »Committed to Excellence« by the European Foundation for Quality Management (EFQM). 

Communication is also a very important issue in the context of catering services. Every four weeks there is a meeting of the kitchen committee. At these quality assurance meetings, representatives of the different sections, such as the wards and the heads of nursing, come together with Dussmann Service employees. This guarantees regular feedback concerning daily procedures and requirements.

»Achtung, automatic transport« warns the robotic colleague with a tinny voice. »Achtung, change of direction.« It carefully parks in the corridor in front of the orthopedic ward, puts down the container and sets off again in a hurry to the next job. In the ward office the telephone rings signalling that the meal container has arrived. Sister Kathrin only needs to plug the container in. 45 minutes later, the soup and the main courses have reached serving temperature: exactly 85° C. Distribution of meals begins and the logistics management of the central kitchen has prepared for this too: the patients’ meals are ordered in the container from top to bottom according to room and according to the individual layout of each ward. 

Mr. Busse knows nothing of the complex routes his order has taken between his making it yesterday and its service today but he enjoys the braised chicken breast in herbs. And that’s the most important thing.

 

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