When a cycling accident put Margherita Stewart Sagan in the hospital a few years ago, the food was inedible. Her plate of chicken, she said, “looked like it had been washed in the fast cycle of the laundry machine.”
Sagan wasn’t expecting a gourmet meal, but she was surprised how little hospital cuisine had changed since her previous overnight stay. Decades earlier, during her C-section recovery, the food was just as awful. “I basically starved,” she told me.
Her two experiences, more than 20 years apart, inspired her to open the restaurant Noon All Day, strategically located near two San Francisco hospitals. Since last year, Sagan and her partner, Sher Rogat, have been serving healthy food designed to travel well. It’s aimed at patients and their loved ones, as well as all the healthcare providers and hospital employees who’ve been choking down laundry-machine chicken. Offerings include salads with avocado and apple, chia puddings and Moroccan-spiced chickpea pancakes.
“We’ve made a pact with each other,” said Rogat. “If anything, god forbid, should happen, I will always bring her food because we all know now that the food at hospitals is not up to our standard.”
Meals served on hospital trays have historically amounted to unappetizing, nutritionally empty fuel. As culinary traditions go, this one doesn’t make a lot of sense: The benefits of a diet rich in plant-based foods and low in processed ones are supported by a vast body of scientific research. According to a recent study published in JAMA, almost half of deaths due to heart disease, stroke or type 2 diabetes are associated with poor diet. Yet at institutions devoted to fighting disease and improving health, candy and white bread are often easier to find than fresh fruits and vegetables.
A few hospitals, however, are starting to invest in healthier, tastier cuisine, forgoing flash-frozen dinners for local ingredients and hiring chefs to create the types of food that patients and hospital employees might look forward to eating — and visitors might even stick around for.
Nutritional blind spot
Most hospitals and healthcare facilities in the U.S. have contracts with behemoth industrial food corporations like Aramark, which also provides food service to prisons. Many hospitals also have on-site fast-food restaurants, like McDonald’s and Chick-fil-A, although some are letting these contracts expire in response to mounting pressure from groups like the nonprofit Physicians Committee for Responsible Medicine, which recently ranked the most hazardous hospital environments in the country.
“Without pointing fingers, this is the way it’s always been,” said Dr. David Eisenberg, director of culinary nutrition at the Harvard T. H. Chan School of Public Health. “People, after cardiac surgery, shouldn’t be getting Hoodsies and mystery meat. It’s preposterous. We don’t hand out cigarettes to people on the pulmonary ward. Why are we feeding them garbage after they have cardiac or gastrointestinal problems? It’s ridiculous. But because this is the way it’s always been, I think it will continue being that way, until people stand up and say, ‘That’s scandalous!’”
“There are a lot of great hospitals with great MRI machines and great surgeons, but there are very, very few that serve good food.”
This nutritional blind spot may be partially due to how physicians are trained in the first place. “Nutrition has never been front and center as part of the job of a doctor,” Eisenberg said. “To this day, doctors are not tested on their certification exams on their ability to advise patients on which foods they should eat more of or less of.”
For now, the task falls to a number of pioneers working to make changes at the grassroots level. Eisenberg, who happens to be the son and grandson of professional bakers, reached out to the Culinary Institute of America 20 years ago, proposing they collaborate with Harvard on a conference where health professionals could talk about advising patients on eating and cooking wholesome, nutritious foods. Two years ago, he helped launch the Teaching Kitchen Collaborative, a hub for organizations that have built on-site “teaching kitchens,” which are like laboratories for nutritional health. Of the TKC’s 41 members, 13 are healthcare organizations, including giants like Kaiser Permanente and Cleveland Clinic.
“How do you incentivize people to build teaching kitchens?” Eisenberg asked. “Well, right now we can’t.”
But he’s playing the long game. “The bigger issue is,” he said, “can we imagine hospitals becoming showcases of excellent food that teach people to cook it and communities to grow it?”
An executive chef touch
It might be hard to envision hospitals as centers of culinary innovation, but a growing number of chefs are trying to make that happen.
Chef Bruno Tison, who grew up and trained in France, at first seems like an incongruous presence in a hospital kitchen. Last year, Northwell Health, New York state’s largest healthcare system and a member of the Teaching Kitchen Collaborative, hired him as their vice president of food services and corporate executive chef.
At first, Tison was hesitant to say yes — after all, his resume includes time at the Plaza Hotel and a few Michelin stars. But then he saw the healthcare industry as a new frontier for the culinary arts.
“Let’s be honest with each other,” he told me. “The healthcare industry has neglected food and nutrition. There are a lot of great hospitals with great MRI machines and great surgeons, but there are very, very few that serve good food.”
He was impressed that Northwell wanted to serve healthy, locally sourced meals with an executive chef touch. But there are challenges, Tison says: “The equipment is antique, sometimes 20, 30 years old. We can no longer find the parts to repair it. In healthcare, we think about buying a new MRI machine before a stove.”
Tison’s job entails training new chefs at Northwell’s 23 hospitals and revamping menus. It also requires advocating for larger cultural reform. “You have to change the culture, because in a hospital a lot of people do not believe food is important,” he said. “They believe that people come to a hospital to be treated and that’s all. But it’s much, much deeper than that.”
In addition, some Northwell hospitals now have what they call a “food pharmacy,” where they offer free, wholesome food, left over from vendors, to low-income patients. They also teach food-prep and nutrition classes.
In addition to changing hospitals’ food culture, Tison has found ways to save money, negotiating new deals with local vendors. “We were buying processed, packaged bread from I-won’t-tell-you-who,” he laughed. “And we have renegotiated a contract with three Manhattan artisanal bakeries, the same the finest restaurants in New York City are using. We’re going to be serving artisanal breads to our patients as well as our employees. And we saved $100,000.”
Other changes include a move from premade liquid coffee to the fresh-ground variety, and from frozen precooked chicken to fresh, antibiotic-free — all while saving Northwell hundreds of thousands of dollars.
Farm to operating table
Austin Buhler, the executive chef at Central Valley Medical Center in Utah, has been doing something similar on a smaller scale since the hospital hired him to improve the quality of patient meals. Before he came on, the hospital — a 25-bed acute-care facility — offered only “heat and serve” industrial fare. Now Buhler is bringing in fresh clams to make clam chowder, and local acorn squash that he stuffs with wild rice and cranberries.
“Our lettuce comes from a farm 20 minutes from here,” he said. “Our tomatoes and produce come from another farm.” He makes a point to share this information with patients when he visits them, which he does regularly. Sometimes a patient will know the farmer personally, he’s found: “It brings them into it.”
In addition to designing the room-service menu patients order from, Buhler oversees the cafeteria where employees and families eat. “I started getting to know the patients, the hospital staff, the doctors, and I fell in love with it,” he said. “I love being the one person that walks into the hospital room that lights up their faces. I’m not there to prod them, I’m there to bring them their food.”
Chefs I spoke with pointed out that better food also encourages families to stick around and eat on site, a welcome revenue boost for the hospital.
The hospital clientele is an added bonus. Serving royalty and 1,000-guest celebrity weddings, Tison explained, “you very, very rarely get a thank you.” At hospitals, people are grateful.
Healthcare is a new world for him: “When I see the eyes of a patient who received a beautifully prepared meal, something special for a patient who has had a hard time recovering, you should see people with tears in their eyes, being so thankful. The first time that happened, I had to turn around, because I was starting to cry myself.”
“It just takes courage to do it,” Eisenberg said, of changing the way hospitals serve food. “These are the kinds of things the Teaching Kitchen Collaborative, this small band of crazy thought leaders, are attempting to demonstrate. If the medical community and the culinary community partner, we might have a way forward. And if we don’t, shame on us.”
In response to your article, quotes from Austin Buhler, I applaud the skills you have brought to CVMC but part of what you have stated is not totally true, which offends me. I was the Certified Food Service Manager from 2011-2015, and revamped the department which included to have 95% of the food prepared and served was made from scratch and I improved and revamped the menus and the patient satisfaction scores improved 56 %. I may not be a trained chef but I have a degree in culinary management , and 25 years of experience in health care food services and a Certified Dietary Manager since 1993 which is required to manage a food service department in most hospitals and health care facilities. I also am a member of Association of Nutrition & Foodservice Professionals and have proudly served as President of ANFP Utah.
Contracting with chains we love would be better. Chik Fil A, Chipotle, Domino’s, Noodles and Company , Elevation Burger, Arby’s, and Cracker Barrel would do it. They all offer healthy choices for everyone.