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From birth to death and every broken arm and gall bladder surgery in between, we go to the hospital. We don’t go for the food.
But hospital food is getting better. The blue Jell-O and stewed peas that brought bare sustenance to generations of patients have given way to designer menus and regional, sustainable cuisine in medical centers across the Sacramento region.
It’s not Chez Panisse in the cardiac ward. But amid the blood pressure cuffs and IV drips, the vegetables are organic and the chicken strips have more flavor than printer paper. With a wink from the doctor, local hospitals will provide beer and wine with meals. Soon, patients may not want to leave because the food’s so good—or at least not so bad.
“We know that food heals,” says Jack Breezee, regional director of food and nutritional services for 10 medical centers under the Sutter Health Valley Area hospital network. “By having the patient eat real food and enjoy what they’re eating, the outcome is better.”
Breezee has been dishing up hospital food for 31 years. His 10 hospitals serve about 4,000 meals per day. He has witnessed an evolutionary process and can boast how food and nutrition have grown in stature alongside technical breakthroughs in medical treatment.
Other Sacramento nutritional professionals have helped guide major improvements in dietary options for patients. Dina Simcock, a registered dietitian and nutrition manager at Kaiser Permanente’s South Sacramento hospital, convenes an advisory committee of Kaiser members to sample food options and provide input straight from the customer’s mouth.
“We have an obligation to provide healthy food to our patients,” she says. “We offer organic vegetables and cage-free-egg omelets. The goal is low-fat, healthy food that our patients will enjoy.”
At Mercy General, director of food and nutrition Jack McElvein insists some customers voluntarily walk into the hospital’s J Street Bistro for the food—even when they don’t need a doctor.
“Our new bistro offers really healthy, affordable food for the neighborhood,” he says. “It’s not just people who have come to see Dad in the hospital that are dropping by. People who live near the hospital are coming in for a really good Chinese rice bowl.”
UC Davis Medical Center has three cafes on its campus. While the dining halls primarily cater to staff and medical students, the hospital uses its cafes to test and enhance patient food. UC Davis also partners with other UC hospitals to scale up its menus and food purchasing power.
“We’re constantly trying new things,” says UC Davis Medical Center chef Jet Aguirre. “We’re much more geared to customer service than hospitals used to be.”
For patients, physicians are still the ultimate executive chefs in the hospital food chain. Doctors can behave like indulgent or strict parents when it comes to in-patient dining options. They establish the boundaries and set the choices. Physicians determine whether a patient can impulsively gorge or must be restricted to limited dining options, which typically means low fat, low salt or easy to chew. But doctors’ orders are changing, thanks to cultural evolutions and progress in the laboratory.
Consider cholesterol. For decades, hospital meals were prepared with the assumption that cholesterol was a mortal enemy. The goal was to manipulate cholesterol counts by removing lipoproteins from patient diets. Today, hospital experts are reconsidering their relationship with cholesterol. Modern research suggests the body will likely sniff out any dietary tricks and produce cholesterol no matter what turns up on a hospital dinner tray. Acknowledging our natural-born resistance to temporary manipulation, hospital meal programs have become less obsessively healthy.
“We have a role to educate, but we also have a role to satisfy,” Mercy General’s McElvein says.
In past decades, hospital food was bland and cheaply produced. Patients were expected to chew and swallow (assuming they could) or go hungry. And there were always feeding tubes. From the medical staff’s standpoint, whether a patient enjoyed lunch or not hardly mattered.
But indifference to the patient’s eating preferences is no longer acceptable. These days, the customers’ dining experience is taken seriously, measured and recorded.
“People are much more interested in their diet than they used to be,” McElvein says. “That’s good for us.”
Three basic menu models dominate the modern medical center eating experience. At one end of the spectrum is something called the “nonselect menu,” which means patients have no significant say in what arrives on their tray. They get what the hospital serves, based on doctor’s orders.
Another model is the “restaurant style,” where patients select from a menu and customize their dining experiences. Patients can ask for a hamburger or half a turkey sandwich. The order will be honored.
At the top is the “room service” model, which means what the name implies: Patients can order almost whatever they please. The kitchen will deliver, provided the guest’s physician doesn’t object.
Kaiser Permanente offers a variation of the “nonselect” model. Patient food for Sacramento Kaiser hospitals is prepared nightly in a South San Francisco commissary operated by a vendor called Food Service Partners. Refrigerated trucks hit the road early each morning, bound for local Kaiser hospitals. The food is distributed to pantries strategically located within each medical center. The pantries feature freezers, refrigerators and microwave ovens.
“We have Kaiser personnel working at the FSP facility to make sure everything is done according to our standards,” Simcock says. “We have complete control over the food, and we create the menus based on input from our patients.”
Sutter adopted the “restaurant style” model two years ago. It’s been popular. Patients like it because they get choices. Doctors and nurses like it because patients are happier and eating better. Management likes it because it cuts down on food waste and saves money.
“We’ve liberalized the diet somewhat, and it’s been a good thing,” Breezee says. “The patient has a voice in what they are eating. If they want chicken strips or a hamburger, we make that available. It helps us control staffing and control costs.”
Mercy General may come closest to the room-service model. The hospital boasts meal options displayed in a trifold menu. Says nutrition director McElvein, “We make everything from scratch, or at least as close as we can come to that.”
UC Davis Medical Center chef Aguirre takes professional pride in fine-tuning his recipes to produce food that not only tastes good but looks good. He makes many items from scratch and once spent hours perfecting a stir-fry that was too salty, then not salty enough. Finally, he hit the bull’s-eye for finicky patients, as demonstrated by empty plates and requests for more stir-fry.
“We eat with our eyes,” says UC Davis patient services manager Sky Baucom-Pro. “We haven’t only improved the ingredients and quality of our food, but we’ve improved the plating so that the food looks attractive.”
The Sutter, Mercy and UCD models sound simple enough, but the hospital environment heightens the drama. Hospital patients are often fragile. Many have histories of malnourishment. Some have medical problems exacerbated or created by poor diets. Medical care requires a gastronomic level of attention and complexity that would stress Anthony Bourdain.
At every hospital, meals are customized for medical reasons or religious or cultural preferences. Sutter physicians work from a list of 84 dietary options when they admit a patient. Restrictions range from religious (no pork in Room 224) to preference (Ms. Schneider is gluten-free and vegan) to life and death (stroke patients may have trouble swallowing and can choke on certain foods).
At Sutter hospitals, a doctor’s orders are translated into code. Algorithms crunch data and determine what kind of food will appear on tomorrow’s restaurant-style menu. The program creates efficiencies. Hospitals pay close attention to how much food doesn’t get eaten—“You bet we do,” says Breezee, who notes Sutter’s food waste declined 12 percent after the restaurant style was deployed.
Uneaten food gets almost as much attention as dietary preferences at Sacramento-area medical centers. Standard operating procedure involves charting how much food a patient leaves untouched.
Leftovers are reported to dietary teams. Menus are adjusted based on what gets eaten and ignored. Financial pressures partially motivate the interest—no hospital likes to buy food and throw it away. But hospitals understand that food can be a noninvasive path to a patient’s heart.
“We make rounds with the nursing staff each day to get input from patients on their food,” says Simcock, the Kaiser dietitian. “Our population is incredibly diverse, and our food reflects that. We have Asian options, Hispanic options, Indian options, kosher options and vegan options. But people still love comfort food like meatloaf.”
Mercy mandates each patient receive a visit from nutrition department staff within 24 hours after being admitted. And Mercy administrators make daily tours—“leadership rounds”—to see how patients like their food and service.
Maternity departments and hospitals that specialize in pediatric care have unique considerations, but they can be surprisingly intuitive. Sutter ran focus groups for its new women’s and children’s facility in Sacramento. Fifty-seven kids and their moms were recruited to help build a pediatric menu. The results: Kids and mothers wanted the same things— foods they could hold. At Mercy General, Vietnamese women want simple rice porridge after giving birth.
Every hospital has food favorites— meals whose popularity transcends generations. At Sutter, it’s chicken and broccoli. UC Davis Medical Center patients love Taco Tuesday and the classic “chili mac,” ground beef and macaroni. Mercy General patients request food from the grill, especially hamburgers. Kaiser burns through omelets, meatloaf and mashed potatoes.
“It’s not like the old cafeteria days when we just slopped food on the tray and said, ‘Here you go,’” UC Davis chef Aguirre says. “For a chef, these are exciting times.”
And vastly more satisfying for a patient.