Cheathem_D_Mgt.D.3.

3_Tray Line Communication & Productivity

Tray Line Communication & Productivity

Section 1. The patient tray line assembly process that is utilized and implemented by the

Gulf Coast Veterans Affairs in Biloxi, Mississippi (VA) involves seven food service

employees that operate various positions and stations of the tray line. As seen in Figure A.1,

Appendix A, the tray line consists of a starter, sides, diet, entrée, drink, tray check, and

loading position. The stations include empty trays, condiments/silverware, sides cooler, diet

cooler, entrée cooler, beverage cooler, and retherm carts. The VA utilizes a cook-chill food

production method and all meals are prepared the day before the meal service and stored in

the walk-in-ready-to-serve cooler. From here, the food for each specific meal is placed in the

various stations for ease of tray assembly. Lunch trays are assembled at 7:30AM, dinner

trays are assembled at 11:30AM, and breakfast trays for the next day are assembled at

1:30PM in the afternoon. The setup and design of patient tray line assembly does not differ

from breakfast, lunch, and dinner.

At the beginning of the tray assembly process, the starter position takes an empty tray

and tray ticket and assembles the basic components of the meal with silverware and

appropriate condiments. The tray is then placed on the conveyor belt and the sides, diet,

entrée, and beverage positions load the tray with the appropriate food items as indicated by

the meal tray ticket. The tray checking position is responsible for assessing each tray for

accuracy and ensuring that all food items reflect the tray ticket as assigned. The loading

position is then responsible for loading the prepared tray onto the retherm cart for further

transport to the various locations being served at the VA facility. At this point, all food items

are still frozen and the retherm carts will not start the reheating process until one and half

hours prior to the meal service as they are programmed to do so automatically.

Cheathem_D_Mgt.D.3.3_Tray Line Communication & Productivity

Section 2. The evaluated processes of patient tray line assembly were observed to meet the

set policies and procedures of the VA food service management system. Each tray line food

service employee stayed in their station and served their designated food items accordingly to

the tray ticket description. The tray checker and loader were observed to complete their

assigned tasks appropriately as well. The tray checker would also take a sample tray from

each type of diet and store it in the test tray cooler to be assessed for quality assurance by the

kitchen supervisors. Additionally, samples from each food item observed to be stored in the

walk-in-ready-to-serve cooler for a minimum of three days to ensure quality and safety of the

meals being served in the various facilities. This collection of samples is not a very common

procedure that is carried out in food service settings, however, the VA has ample storage

space and the means to do so. In the past, this type of record keeping, and quality analysis

has helped to narrow down any potential food borne illness issues or texture modification

inconsistencies that were served to patients struggling with dysphagia.

Upon further observation and discussion with the diet position employee, it was noted

that this position was responsible for more than just assigned diet items. Rather than solely

being responsible for ordered nutritional supplements or thickeners for the tray assembly

process, the diet position was seen to also load the tray with items such as salads, butter,

applesauce, etc. The food service employee working this station explained that the diet

position was originally designed to only provide the specific diet order needs, but it has

developed and grown into being more of a “wild card” station as other items are expected to

be provided here.

The tray line productivity was assessed to be completing about five trays accurately

per minute. This assessment also took into consideration various points of line stoppage
Cheathem_D_Mgt.D.3.3_Tray Line Communication & Productivity

related to missing tray line items or certain food items running low and needing to be

replenished. Specific problematic stations were not observed as each station experienced a

type of line stoppage at some point. The most notable obstacle that was observed was the

time it took for the food service staff to read the tray ticket in its entirety. The tray tickets are

not laid out in any specific format and someone who is loading side dishes must read the

entire tray ticket to ensure that nothing is missed as it is not grouped by type of items.

Section 3. Recommendations that would help to improve the overall functionality and

efficacy of the VA’s patient tray line assembly includes redefining the diet station and color

coordinating the tray ticket lines in accordance to each tray line position. Redefining the diet

station to provide nutrition supplement and also cold condiments would help to clarify to the

food service staff what is expected at this tray line position. Having it stated that this station

covers more than one group or class of tray items would improve the understanding and

perception towards working this area of the tray line assembly process.

Implementing a color coordinating design for tray tickets and assembly would help

reduce the risk of human error and increase patient tray line productivity as the line

employees would be able to spend less time reading the ticket. Rather than the employees

having to read the entire ticket as they do now, having each station color coordinated with the

tickets would help them to focus on what their specific station needs to provide. For

example, diet line items would be indicated with blue, side line items would be indicated by

yellow, entrée line items would be indicated by orange, and so on. Collectively implementing

these recommendations would be beneficial for both tray line employee understanding and

morale while also helping to improve and increase the patient tray line productivity.
Cheathem_D_Mgt.D.3.3_Tray Line Communication & Productivity

Appendix

Figure A.1 Drawing of Gulf Coast Veterans Affairs of Biloxi, Mississippi’s Tray Line Assembly and Associated Food Production

Service Areas