The era of value-based reimbursement is making patient satisfaction a costly thing to ignore, and that goes for the operating room right down to the hospital cafeteria.
It's with that in mind that many hospital leaders are putting extra attention not only into the food served at hospitals, but the look and feel of the cafeterias as well.
According to Toni Watkins, food and nutrition services director for Riverside Health System in Newport News, Virginia, cafeterias that look more like restaurants are en vogue, and the system two years ago invested in transforming theirs to follow the trend.
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At the brand new cafeteria at their largest hospital, Riverside Regional Medical Center, customers can look out over new landscaping, enjoy bar-style seating or sit at elegant tables. The hospital also improved the food options, which include a made-to-order sandwich station and pasta bar.
"There is a destination pizza area where we make our pizzas. We do our crust everyday. We really have great pizzas. It's really popular."
Taking one step further, hospitals are also trying to acquire staff with a much higher caliber of cooking expertise by looking to the restaurant industry to recruit professional chefs.
Thom Pastor, Nutrition Services Manager at St. Charles Healthcare in Central Oregon, said that's a key element in their operations.
"In our four hospitals, I can probably think of 10 highly qualified restaurant alum that are bringing those skills into the hospitals." In fact, Pastor said that's how he ended up where he is. Having spent eight years in the restaurant industry, he saw his current role as a new and better opportunity to nourish the community.
A former chef himself, his experience is what landed Pastor at St. Charles.
"The lifestyle in the restaurant industry has the reputation of being tough and the pay is notoriously low. And in this setting I get to use all those same skills but I work reasonable hours, have excellent benefits. I get paid as much or more as people with equivalent positions in the restaurant industry."
He also said having those types of professionals, with a restaurant industry mindset, working in a hospital's kitchen means everything improves, not just the food. And both visitors and patients notice.
"We care a lot about the presentation. We buy real, nicer utensils, we buy nicer plates and replace them when they get scratched. We care a lot about how the food shows up in the room, even the staff uniforms. Even though it's become passe in restaurants, we have our cooking staff in chef coats because even in our industry that's sending a signal that we care a lot about the food," said Pastor.
The new cafeteria at the Riverside Regional Medical Center features a pizza and pasta bar.
What you want, when you want it
Hospital stays previous generations endured likely came with set meals, or at least set meal times. The patient had very little choice in what they ate or when it came. But that kind of format no longer fits with today's on-demand society. In order to create a more patient-centered experience, hospitals are adopting a patient food services format that more closely resembles hotel room service.
Pastor said this is the biggest shift he sees going on in the industry right now, and his system is no exception. Patients can order what they want, however much they want, as long as it fits within whatever restrictions they may have in place.
"Even those with dietary restrictions can and should enjoy delicious food," Pastor said.
Watkins said one of their seven acute-care facilities has adopted a room-service concept for patient food services and they are looking at rolling it out system wide. In the meantime, they found a means to innovate, and get away from the assembly line format that pervaded hospital systems for decades, starting a spoken menu concept for patients that feels more personal.
"That has allowed patients to get away from a traditional hard copy menu and allowed patients to have a host or hostess go and visit the patient and be able to tell them about the menu selections, and enter that information in real time. So it still gives the opportunity for patients to be able to voice any concerns or anything else that they may want with a person directly in front of them."
Overlook Medical Center has eight beehives that produce honey for the hospital's food service department.
Michael Atanasio, food and nutrition director for Overlook Medical Center in Summiti, New Jersey, said the booming interest in sustainability is driving a growing demand that food servers of all kinds buy locally sourced produce and other products. That demand has trickled down to hospitals as well.
"We have our own gardens," Atanasio said. "We have eight beehives. I was the first hospital I believe to have beehives here. With the beehives we use the honey and we sell the honey. We cook with it. We also make products out of the wax like lotions and lip balms and stuff. Then we have gardens that I've expanded through a partnership where we use some of the proceeds here at work and then we donate some of it to the indigent and organizations that take care of the indigent."
Atanasio said all their gardens are organic, and even though they don't produce enough yet to significantly lower costs, it has certainly boosted revenue. He estimated that with all of their hives, they grossed about 400 pounds of honey, all of which they sold or used. That revenue, he said, more than covered the costs of the hives. Best of all, since they sell the honey and wax products in the gift shop, all of the money goes to the hospital.
Pastor said his hospitals also participate in a buy local initiative that has them partnering with a local farm.They get a weekly delivery of whatever the farmer has to offer, and they work those fresh items into their daily specials. It's doesn't cost them much, about $60 a week when they are in full swing. The farmer they partner with only charges them about $1 per pound, whcih Pastor called a good deal for some items like cauliflower, and expensive for others like potatoes. He said with thier region's very short growing season (about 100 days) they cannot rely on local farms for consistent supply, but they use this produce for daily specials and added variety.
Watkins says there is still a steady demand for comfort foods like pot roast and fried chicken, which they are unable to remove from their menu, but she too is seeing a notable spike in the demand for fresh foods.
The health and wellness industry is also driving interest in "superfoods" like Kale, one of several trendy items that have made their way to hospital eateries and patient services menus.
Atanasio said chai and pumpkin seeds are two relative newcomers that have also grabbed the spotlight, like others before them.
"Quinoa got big a few years ago. We even take it a step further and get farro and some of the ancient grains. Edamame is on the salad bar now, but it wasn't a few years ago."
Atanasio said they have seen rises in patient and customer satisfaction thanks to their fresh food and other unique initiatives, as well as a positive upward swing in revenue. But he thinks the most significant benefit is the contribution these efforts have made to lifestyle changes.
"When we can, in my opinion, do it the right way and get people to eat healthier, costs come out of the system. Non-productive costs, healthcare costs for our employees. We do a lot of initiatives for nutrition to get people to eat healthier because one, it's good for them and it's the right thing to do, and also because it pulls costs of care out of the hospital," he said.
A chef from Overlook Medical Center gives a demonstration in one of their gardens during their Bee Healthy program.
Cafeterias as teachers
Make no mistake, Atanasio is grateful for the buzz surrounding his beehives.
"It was a great marketing thing. It was something cool, something different. But the real value came by way of being a great tool for education," he said.
Hospitals are thinking beyond the bottom line and focusing on overall population health, not just treating illness and injury one patient at a time. Educating their communities on healthy eating habits and smart food choices only supports that effort.
Watkins said the chefs at Riverside Regional run a demo station where a cook can show interested staff and visitors how they prepare one of the day's specials. But Watkins wants to add another layer to that: educating people on healthy meal options and how to prepare them. It's one of the reasons they are trying to hire a true executive chef.
"I can see us working more with the dietician. We're talking about doing national nutrition month for example. I can easily see us coordinating with the chef to prepare something healthy that's featured for that day. And here's how you do it and here's a recipe card you can take with you."
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In fact, demonstration is becoming a more popular education tool in general. Pastor said St. Charles is seeking funds to build an education and demonstration kitchen at their Madras campus that could host healthy cooking classes. Pastor said it would have classroom seating at tables that double as work stations for about 20, with a stove and oven up front for the instructor to demonstrate cooking techniques and various recipes. Pastor said preliminary estimates are about $300K for the project, which he said is high because it's going into an aging building with insufficient plumbing and other challenges. The same kitchen could cost much less in a new build or existing space without the same challenges.
"The trend in Medicare, Medicaid reimbursement seems to be population health. So the healthier we can make our town and our county the better it is for our bottom line. And that's true with employees too, with our insurance premiums."
Atanasio said his hospital, and the parent system Atlantic Health, tries to lead by example with their gardens and hives and also push education, especially in young people. Their goal is to reach kids' early on, teaching about moderation, eating fresh and local and staying away from processed foods and junk through their Bee Healthy program.
"There's a significant payback although it's not as tangible and measurable in education for the community. When I see kids have an 'ah-ha' moment that it is possible to cook healthy in half an hour or the same amount of time it takes to run to the store or eat McDonald's. It's measurable because I get feedback from folks in the community, and schools and customers. One of the kids that went through our Bee Healthy program a couple years ago, I still hear from the parents on what an impact it made."