By Chelsea Pillsbury
Thousands of people are admitted to hospitals every day, with the average inpatient stay between four and five days, according to the Centers for Disease Control and Prevention, Atlanta. Any length of time in a hospital means stress, pain and general discomfort for the patient, but hospitals are looking to provide comfort through improved food offerings and hiring chefs eager to re-imagine cafeteria food. As patient satisfaction becomes increasingly important, healthy, made-to-order meals are becoming the norm in hospitals across the United States.
Hospital foodservice has dramatically improved in the past 10 years. The national push for healthier eating options in schools, restaurants and in the home has prompted hospitals to eliminate fried foods, cut down on such unnecessary fats as heavy cream and butter, and increase the use of whole grains, fresh herbs and locally sourced produce. Hospital foodservice is improving kitchen by kitchen in response to trends, regulations, patient demand and the determination of chefs like Ryan Conklin, CEC, executive chef, Rex Healthcare, Raleigh, North Carolina.
Conklin, a graduate of The Culinary Institute of America, Hyde Park, New York, has been managing health care foodservice for the past 10 years and is committed to modernizing health care cuisine to remove its label as just “hospital food.” He became an executive chef at age 24, and previously worked at the Four Seasons Hotel New York, and also spent time in Limerick, Ireland; Sarasota, Florida; and New York’s Hudson Valley region. Conklin not only manages Rex Healthcare foodservice, but also represents the hospital in culinary competitions including the ACF-sanctioned Cut to the Core competition, Johnson & Wales University, Charlotte, North Carolina, and the Association of Healthcare Foodservice Management competition, Miami and Phoenix.
He believes one reason hospitals are incorporating healthier and more personalized meals is because of awareness raised through TV and the Internet. “These mediums not only showcase the importance of health, but allow unique and obscure ingredients, such as quinoa or kale, to become mainstream, recognizable, and therefore useable in my kitchen,” Conklin explains.
Healthier food trends are expected to grow over the next few years, according to Lisa Falcone, CEC, RD, CP-FS, operations support director at Aramark, Sacramento, California.
Falcone has worked as a foodservice director and district manager at several hospitals, and currently serves as a director of quality assurance for all lines of business at Aramark. In addition to being an ACF-certified Executive Chef, she is a Registered Dietitian with the Academy of Nutrition and Dietetics and a Certified Professional in Food Safety with the National Environmental Health Association.
“Continued and increased farm-to-fork movements, using local produce, green initiatives and composting are becoming increasingly common,” Falcone says. “We’re also seeing a return to comfort foods and a focus on getting patients to eat while they are in the hospital in order to promote their healing and recovery.” Hospitals have been placing dietary restrictions on sodium and fat intake for decades. Now, with such trends as on-site and rooftop gardens they are increasing their fresh food options as well.
Several statewide programs are promoting these changes. In 2012, The New York City Department of Health and Mental Hygiene led a Healthy Hospital Food Initiative with the goal to create a healthier food environment in New York hospitals. Participating facilities were asked to adopt New York City Food Standards, an executive order signed by Mayor Michael Bloomberg in 2008. These healthier standards are for all foods purchased and served by city agencies, including schools, senior centers and homeless shelters. Participating hospitals are asked to comply with the orders regulations for healthier cafeteria, vending machine and meal offerings.
Michigan Health & Hospital Association in Okemos, Michigan, adopted a resolution encouraging community hospitals to implement a multifaceted healthy eating experience in 2010, and offered varying levels of involvement.
On an individual level, hospitals around the country are adopting standards and practices to increase the quality of their foodservice. Overlake Medical Center in Bellevue, Washington, approved a sustainable food purchasing policy in 2011, and included a pledge to purchase food free from pesticides, hormones and non-therapeutic antibiotics, as well as increase the proportion of locally sourced foods and the availability of fresh fruits and vegetables.
In Ann Arbor, Michigan, St. Joseph Mercy Ann Arbor & Livingston Hospitals and Health Centers turned 22 acres of its campus into a farm and have a full-time farmer on staff. Outside the U.S., hospitals in England were recently required to meet higher food standards and will be publicly ranked based on meals they prepare. In India and China, private hospitals are described as five-star deluxe hotels.
Operational Changes and Hotel-style Room Service
Healthcare foodservice has been focusing on healthy eating for years says Nicholas Mercogliano, CCC, sous chef, Robert Wood Johnson University Hospital, New Brunswick, New Jersey. “The public needs to continue the push for healthy eating in schools and at home.”
Mercogliano graduated from The Culinary Institute of America in 2011 and from Le Cordon Bleu College of Culinary Arts, Scottsdale, Arizona, in 2013. At age 23, he was named in the 2014 Foodservice Director’s “30 under 30” list, and received the 2014 Association for Healthcare Foodservice Future Horizons Award.
Mercogliano and the other foodservice staff at Robert Wood Johnson University Hospital work with dietitians and nutrition experts to track patient dietary requirements and consciously work to reduce sodium and fat in the hospital kitchen.
Operational changes can also make a big difference in providing patients with higher satisfaction and comfort. One of the more popular practices is hotel-style room service. In the past few years, there has been a significant increase in the use of this system that enables patients to choose when and what they would like to eat from a menu, just as if they were in a restaurant or hotel.
“Robert Wood Johnson University Hospital has been offering room service dining since 2003,” says Mercogliano. “The patients love it, and I think it should be offered in every hospital.” Robert Wood Johnson University Hospital isn’t only doing foodservice right; the hospital is consistently ranked among the best hospitals in America by U.S. News & World Report, and its campuses have earned national recognition for clinical quality and patient safety. Recently, the hospital was given the “Most Wired” designation by Hospitals and Health Networks magazine.
For Mercogliano, being a hospital foodservice professional is about making a difference, changing the perception of hospital food and knowing that patients will look forward to getting their meals.
“Patients want restaurant-quality food in the hospital,” says Mercogliano. “Our staff is committed to exceeding patient, employee and visitor expectations, and we are proud of what we accomplish.”
Other operational changes include offering various menus such as vegetarian, Asian, kosher and children’s to cater to the diversity of the patient population. Offering familiar and comforting meals is a way to ensure patients eat and gain back their strength so they can be allowed to go back to the comfort of their homes. So why aren’t all hospitals switching to hotel-style room service dining?
“While hospitals will see a reduction in food cost with the use of a room service menu, these operations tend to be more labor-intensive than traditional service,” says Aramark’s Falcone. “It is difficult to maintain responsible and reliable hourly workers.”
Conklin points out that implementing this type of operation usually calls for an initial investment from the hospital to fund kitchen renovations able to support a cook-to-order, restaurant-style line. However, he still thinks this trend will continue to grow and that someday hospital food will no longer have a negative connotation.
“Health care has become more competitive than ever, and organizations are looking at all possible ways to provide excellence through service,” says Conklin. “It is only a matter of time before excellent food starts to become a marketing tool for health care facilities, if it isn’t already.”
In response to the issue of maintaining a trained culinary staff, Rex Healthcare implemented a Black Hat Chefs Culinary Training Program and a Black Hat Chefs Discovery Program. The first is a multi-week intensive training program that is available for all Rex Healthcare cooks to take, and the second is a continuing-education program where cooks learn new culinary techniques and methods.
The Hospital Food ‘Label’
Pecan-encrusted chicken with citrus maple sauce, pork carnitas, mango salmon, chicken enchiladas and herb-crusted cod are just a few examples of items on the menus at Rex Healthcare and Robert Wood Johnson University Hospital.
With the meal options above, it doesn’t seem like many would be complaining about their food. The public perception of bad hospital food is something many hospital foodservice chefs are actively fighting.
“I’m working to receive my ACF-certified executive chef certification by 2016,” says Mercogliano. “I want to become executive chef of a large-volume health care operation and then director of food nutrition by the time I’m 30.”
These goals spell good things for hospital foodservice, as spreading awareness of change is one of the most important aspects in the process of leaving behind hospital food stigma.
As patients tweet pictures of their meals from hospital beds, social media becomes an important way to share bad or good hospital food with the world. Conklin advises patients to use social media as a way to garner attention and vocalize their message of satisfaction or unhappiness with their hospital stay.
“If you see an area for improvement, let them know via social media,” says Conklin. “Your message will be heard by the key decision makers who can ignite change.”
Conklin is advocating for change through social media and a blog dubbed www.newschoolhospitalfood.com. His goal is to remove the entire label of “hospital food,” and he encourages chefs entering the field to stay committed to cooking the best-quality food at their locations, even if they encounter obstacles.
“Most importantly, as a chef, you must visit patients regularly to not only get feedback, but to let them see that you are passionate about providing them the best meal possible,” says Conklin.
There are almost 6,000 hospitals in the U.S., making hospital foodservice an interesting and viable career where cooks and chefs might have the chance to implement new operations while making a difference in hundreds of people’s lives.
While no one ever wishes to spend time in the hospital, chefs all around the country are doing their best to ensure that patients have the best stay possible.
Chelsea Pillsbury is communications coordinator at the American Culinary Federation.