This is Hospital Food?

By Leslie Cole, The Oregonian
Tuesday, March 7, 2006

Picture hospital food.

Now picture this:

A hungry new mom orders wild salmon with a side of roasted organic sweet potatoes from a hospital kitchen that cooks it on the spot and hustles it to her room.

Doctors sip organic, fair-trade coffee from biodegradable bamboo cups. Cafeteria chefs walk to a weekly farmers market steps away from the hospital's doors, filling baskets with pesticide-free fruit and vegetables for the next day's meals.

Quite a contrast from a bowl of canned fruit cocktail.

Hospitals nationwide are starting to follow their own advice: In order to be healthy, your food and environment should be that way, too. It's happening right here in Oregon; in some cases, we're leading the charge.

Food-service managers are tweaking cafeterias to look more like restaurants, pushing recyclables and trimming kitchen waste. They're serving patient meals in the style of hotel room service, and looking for ways to get locally grown foods and hormone- and antibiotic-free milk and meat on their menus. Some are even rethinking the contents of the hallowed hospital vending machine.

"What I'm hearing is, they are increasingly seeing food as a treatment issue and not necessarily as a cost center," says Scott Exo, executive director of Food Alliance, a nonprofit organization that's working with hospitals to get more local, sustainably grown food into their supply chains.

It's still early in this revolution in Portland --most of the folks in charge are crafting mission statements and food policies, not plating local, organic salad greens for a daily lunch special --but hospitals are stepping away from business as usual in the kitchen.

Purchasing plans call for buying more local products, steering clear of pesticides and antibiotics, and reducing or eliminating waste. Some food service-directors are thinking more like restaurateurs, asking how good the food can be, to draw more people in and push profits higher.

Kaiser Permanente --with billboards brimming with blueberries, and a two-year-old food policy that calls for, among other things, modeling healthful eating habits and buying locally grown, chemical-free food --is out in front of the pack, at least on paper.

"That's very much a long-term vision," says Sandra Kelly, Kaiser's regional food-service coordinator. "But I think the train's really going down the track."

A small hospital

makes big changes

Despite big plans and wish lists, little has changed so far at Portland's major medical centers. But 230 miles to the east, a 49-bed rural hospital is showing what's possible.

At Hermiston's Good Shepherd Medical Center, patients order meals room-service-style, and all the cooking is done from scratch, with fresh, organic and sustainably grown meats and produce.

Nancy Gummer, the hospital's nutrition services director for 11 years, introduced scratch cooking and made-to-order meals last year, and recently overhauled her menu with more healthful choices, because it was the right thing to do, she says, and because the old way wasn't working.

"It was an exercise in futility," she says. "You'd send up trays, bring them back down, and throw it away. People didn't especially like the food."

Now, instead of dishing up meals from a steam table at the stroke of noon, Gummer's staff stays busy from 7 a.m. to midnight, trimming organic broccoli for stir-fries, dicing tomatoes for fresh salsa, mashing avocados for guacamole. They're grilling fajitas when orders come in, toasting and grinding flax seed for the salad bar, making pots of chili from scratch.

Out went the old gravy mixes and high-sodium canned soups, laced with additives that "have no benefit for the person eating it," says Gummer, who also teaches nutrition classes for diabetics.

If you want salmon, you can have it, and it's wild-caught. Your burger, as of January, is made with ground bison meat; Gummer pulled ground beef off the menu, a risky move here in cattle country, but burger sales bumped up 25 percent with the meat that's 75 percent leaner. You can still order roast beef or a steak, but it comes from cattle fattened up without hormones or antibiotics.

And in this meat-and-potatoes town of 15,000, roasted sweet potatoes and brown rice, two new side dishes, get ordered just as much as regular spuds and fries.

The 52-year-old registered dietitian says she makes her decisions by asking a few simple questions: "What's the healthiest food I can feed these patients? How can the food we buy contribute to the health of the environment we're living in?"

And, Gummer asks, does it taste good?

The answer is in the numbers. She's serving more meals now, around 15 percent more. Patients ask for recipes, and nonpatients can, and do, eat here as well, calling in orders and swinging by the hospital to pick them up. Her 26 employees are busier, but happier, she says. Some of the items are more expensive, but she is more accurately able to estimate the amount of food she'll use. A few things are cheaper, such as new take-out containers made of corn and sugar cane, from Biodegradable Food Service in Bend. Folks now have to request disposable dishware if they want it, so they're using less of it.

"What we're discovering is, it's a perception that doing the right thing is more expensive," Gummer says. "It's not a reality. . . . I haven't been a month over budget, on food or anything else."

Even if it were, a hospital comes out ahead, Gummer says. "When you're looking at food costs and health costs, you can't look at, 'How much per pound am I paying?' You have to look at the whole picture. Healthier people use less health-care resources."

While it can be tough to get certain foods in Hermiston, far from urban truck routes, Gummer's been able to find almost everything she needs from her regular distributor, Food Services of America in Spokane. The only new piece of equipment required for scratch cooking: two stainless-steel pizza prep tables, with extra work space, refrigerated compartments and bins to hold fresh, chopped vegetables.

Changing her approach was easy, she says, because the hospital is small. "We don't have as many layers. When we want to make change, we just do it."

Distributors supply lots

of food, but not

always what's wanted

Hermiston's model is harder to duplicate in Portland, where hospitals serve thousands, not hundreds, of meals a day. Their suppliers are, so far, unable to offer the local connection many food service managers want.

Hospitals typically buy food from large national food distributors, under contracts approved by a Group Purchasing Organization, which pools transactions to keep costs down. The distributor (Portland's big three are US Foodservice, SYSCO Corp. and Food Services of America) carries liability insurance and provides assurances about food safety.

In exchange for getting lots of food delivered on schedule at a low price, hospital kitchens sacrifice flexibility and control: They can ask for Oregon-grown berries and broccoli, or biodegradable coffee cups, but if the distributor doesn't carry them, they can't get them without going outside the contract.

"Most of the hospitals would like to feel that we're actually the customer again," says Steven Hiatt, food and nutrition services director at Oregon Health & Science University. "When our clients say, 'This is (the food) we want,' it's our job to go out and find that."

Some are leaning on distributors to pull in different products, others talk of pooling their buying power and finding vendors willing and able to get them local, sustainably grown foods.

"We're hoping it keeps them awake," says Lin Rush, Providence's regional hospitality services director, about pressing suppliers for new products. "If we feel that they're not working hard enough to try to find things for us, we'll go elsewhere."

However attractive buying from a local farmer might seem, it's not always realistic for big institutions.

"We're very much at the beginning of this conversation," says Suzanne Briggs, a Portland consultant hired by Kaiser to help with local-food purchasing. "Part of it is, how do we buy from local farmers? How do we get the distributors to support local farmers? How do they design their menus to take advantage of the local produce?"

Even if they could get fresh broccoli and spinach from the farmer down the road, many hospital kitchens --designed for reheating, not cooking --aren't set up to handle it. They need refrigerated space to store it, sinks to clean it, counters to chop it and staff to do the work.

Kitchen scraps now go

to composting company

But in other areas, hospital kitchens already look different.

* Portland's big four hospital systems all serve only rBST-free milk, from cows that are not given synthetic growth hormones.

* OHSU and two of Legacy's hospitals replaced disposals with waste pulpers, which grind up leftover food and compostable garbage, suck out moisture and drop it into biodegradable bags. Trucks pick up 2 tons of the stuff each week from OHSU's loading dock and haul it to Cedar Grove Composting in Everett, Wash. (the company is looking to open a new facility in Portland), where it's piled into windrows and eventually breaks down into a garden mix that's bagged and sold at home improvement stores.

Nancy Oberschmidt, assistant director of food and nutrition services and the kitchen's recycling guru, also has found biodegradable replacements for nearly all Styrofoam and plastic dishware and utensils the kitchen once used.

* Also at OHSU, where 80 percent of the meals are served to visitors and staff, Hiatt wants cafeterias to act more like restaurants, pushing flavor and the pedigree of products. Early signs: Coffee pots campuswide brew organic, fair-trade and shade-grown coffee; vegetarian sushi and grilled vegetable wraps aren't just a sop for nonmeat-eaters; they actually taste good.

* At Kaiser Sunnyside Medical Center, vending machines offer a handful of " smart picks," such as baked chips, along with a predictable array of cookies and candy bars. Plans call for labeling fat and calorie counts in salad dressings, doubling the size of the salad bar when a new cafeteria is completed next year, and sourcing more foods locally. "We take an educational approach. We do not take a parental approach," Kelly says. "It doesn't mean that doughnuts and cookies will go away, but they will be pushed to the back."

The Wednesday farmers market across from Kaiser's North Interstate Medical Offices will be back for a second season in May, bringing farm trucks to the neighborhood, and fresh berry smoothies and local salad greens to the building's cafe.

* Providence Milwaukie started serving room service-style meals to patients last year, following a national trend, and other hospitals in the group will switch from the old tray-line system this year and next. Rush, the hospital services director, is working with the Food Alliance, an advocacy group for sustainable farming, to get more locally grown foods on menus, starting with a trial run of Country Natural Beef burgers at Providence St. Vincent Hospital .

* Providence and Legacy hospitals' staff cafeterias carve out room for at least one low-fat main dish on their lunch and dinner menus. Watch the lightning hands of the cook at Legacy Good Samaritan's stir-fry station as she sizzles your shrimp with broccoli and black bean sauce while you wait; at Providence, you can have tangy baked cod with spinach barley for lunch, take away the recipe, and buy a bag of Bob's Red Mill whole-grain hot cereal on your way out the door.