Course correction: Making hospital food heal

“He was a military guy — just give him meatloaf, mashed potatoes and gravy and he was in heaven,” Sauer says. But when he visited his father, he was appalled. “The potatoes were gray, the sauce was clumpy — I wouldn’t have even given it to my dogs,” he recalls. “The last few months of his life, my dad couldn’t even enjoy his favorite foods. That’s not what I wanted for him.” 

Sauer, then a chef at a high-end restaurant in Manhattan, wished he could make a change for people like his father. And he found that opportunity about four years ago at Northwell Health, where leaders had begun to reconsider the importance of hospital food. How was it, they asked, that a health system could offer the most advanced treatments while ignoring the quality of the meals patients were eating throughout their stay? 

As Sauer discussed joining a newly formed team of executive chefs, it became clear that the health system had embarked on a radical initiative. Northwell Health’s food transformation project was based on the idea that wholesome meals were central to the mission of improving health and quality of life. And that wasn’t all. Northwell’s leaders were proposing that hospital food should taste good, too. Restaurant-level good.

Transforming hospital food with a top chef

From rubbery mashed potatoes to unidentifiable protein patties covered in glutinous gravy, hospital food has long had a reputation for being flavorless, uninspired and sometimes downright awful. Before Northwell’s great food challenge began, the meals served at its hospitals were no exception. 

“For years, hospital administrators looked at food not as a benefit to the patient, but purely as a number on the balance sheet,” says Sven Gierlinger, senior vice president and chief experience officer at Northwell Health. ”Everything we were serving was processed, with much of it frozen or canned and containing all sorts of unhealthy ingredients — which is completely counterintuitive to good health.” 

That began to change in 2017. Research had been mounting for years about the key role that nutrition plays in preventing sickness and helping people heal. Northwell president and CEO Michael Dowling, together with Gierlinger, decided it was time to act. “If you have patients telling you they were satisfied with the care but horrified by the food, why wouldn’t you do the easy thing and improve the food?” says Gierlinger. To do that, they needed a leader and a role model. Someone who could teach, as well as bring in a new stable of talent. 

They found their leader in Chef Bruno Tison. A culinary master, Tison had run the kitchen at the luxurious Plaza Hotel in New York City and was at that point serving as executive chef at the Fairmont Sonoma Mission Inn and Spa in California’s Napa County. There, he’d earned Michelin star recognition for three consecutive years. 

Tison was clearly passionate about food. But what really caught Gierlinger’s attention was that he was equally passionate about helping patients. “A lot of people think you come to a hospital because you need medical attention. That’s true, but it’s important to realize that food is part of that,” Tison says. “Food is health. Food is medicine,” Tison was named vice president of Northwell’s food services and corporate executive chef. But his real role was to lead a revolution.

Converting "farm to table" into "farm to bedside"

When Tison arrived at Northwell, it had been decades since most of the system’s hospital kitchens had been updated in any significant way. Freezers outnumbered refrigerators, and pots and pans were virtually non-existent. “All the staff could do was reheat purchased food, drop it on a plate and send it up to the floor,” says Gierlinger. 

“Cooks weren’t really cooking,” says Tison. “The most used kitchen tools were a can opener and pair of scissors.” So step one was to empty the freezers and convert many of them to refrigerators. Step two: Stock those refrigerators with fresh meats, fruits and vegetables. “Instead of farm to table, I call it farm to bedside,” Tison says. 

Staffing came next. “It takes a different skill set to prepare fresh, healthy food with whole ingredients,” says Gierlinger. Tison hired 15 new executive chefs, tapping talent from leading restaurant and hotel kitchens. 

Sauer was one of those hires. “I really wanted to make a difference,” he says. “Here, I could help train, motivate and work alongside a team of chefs to create healthy and delicious meals for people who need it most.”

The procurement process got an overhaul, as well. Previously, the purchasing staff could select only among mostly frozen, processed and sodium laden chicken products, for instance; now, chefs were able to order antibiotic-free poultry and seafood, free-range turkey, grass-fed beef and humanely raised, hormone-free pork. 

Tison also brought in fish vendors, companies providing fresh produce and local bakeries.

The goal was to prioritize fresh ingredients — organic and local when possible, and always of the highest quality. Hospital kitchens began serving from scratch mashed potatoes, fresh-caught salmon, lamb chops and crisp tender vegetables. Menus became seasonally based and culturally diverse. 

Better hospital food when you want it

It’s a restaurant model and philosophy, one that extends to the way patients pick their meals. Instead of having to make selections for breakfast, lunch and dinner the night before, they receive what looks like a restaurant menu each morning and can choose whatever they want whenever they want it, from 7 a.m. to 7 p.m. 

The move helps reduce food waste and gives patients more choice and flexibility. And if someone has a request that’s not on the menu, the kitchen will do its best to accommodate them. 

“The chefs are really willing to cater to patients’ specific needs, which wins their hearts,” says Syeda Nahid, a registered dietitian at Long Island Jewish Medical Center. “Recently I had a patient who was vegan, so the chef made her bean and lentil-based meals throughout her hospital stay. She was so appreciative.” 

Do these changes matter to patients? Deeply, judging from the notes the culinary staff receives. It “changed my entire experience,” said one. The team “not only met our physical needs but...our emotional needs as well,” said another. 

“Patients have very little control in the hospital,” says cardiologist Jill Kalman, MD, Northwell’s chief medical officer. “If we can provide them with a meal that brightens their day, makes them smile or they can share with a family member — that can change a day. That could change an outcome.”

The patient experience: More than just tasty food

Back in 2016 — before the health system’s food transformation journey began — Northwell ranked in the 9th percentile for food quality scores on national patient experience surveys. Today, the health system as a whole is in the 81st percentile when compared to all other hospitals in the U.S. Seven Northwell hospitals now rank in the 90th percentile nationally.

“The food tastes good, but the impact goes beyond that,” says Gierlinger. “Some patients have told us that their meals distracted them from the pain they were in. Some have said ‘I couldn’t wait for the next meal to come.’ This is bigger than just giving people great food. It’s truly part of their care and their healing journey.” 

Other major hospital systems in the U.S. have not only taken note, but are reaching out to follow Northwell’s lead, says Gierlinger. In October, he reported on Northwell’s food transformation progress at the Teaching Kitchen Research Conference in Los Angeles, an international event hosted by the Harvard T.H. Chan School of Public Health and Teaching Kitchen Collaborative, which was attended by representatives of hospitals, medical schools, universities and other organizations worldwide.

Gierlinger will soon be hosting executives from a multi-state care system headquartered in Florida, who are coming to see Northwell’s approach in person. 

“Northwell is a pioneer — when you think about the way food and nutrition were being handled before and see what we have accomplished, it’s just amazing,” says Tison. “We’re now motivating other health care systems to do what we did.” 

There’s still more to be done, Tison says. Northwell is working toward sourcing 100% of products from American farmers and selecting even higher-quality foods (think beef that’s not only grass-fed but also grass-finished, meaning the cattle were never fed any grain at all).

The health system also plans to launch teaching kitchens where employees and community members can learn about food safety, nutrition, and cooking. But the changes already implemented have made a tremendous impact. Just ask Chef Sauer. 

Like all executive chefs at Northwell hospitals, he makes his daily rounds, visiting patients to get feedback on the meals they’ve received — taste, temperature, presentation and menu variety. “I ask how their food experience was — what they liked, what we can do better. And I ask them to be honest,” he says. “I’ve heard about how the smell of our chicken soup reminded a patient of home, which makes me feel good. Another once told me I need to offer more options — and I’ll take that too. 

“The reality is many patients come into the hospital on the worst day of their lives,” says Sauer. “But when you have a moment to yourself in your room and you have a good meal, it can bring a sense of normalcy and comfort. “Every day that I put on my chef jacket, I imagine my dad is watching over me, and that inspires me to serve the healthiest, most delicious meals I can to patients. I think he would be proud.”