The Evolution of Hospital Food and Why it Still Sucks

And it does still suck.
When I left the confines of restaurant and club kitchens in 1994 and began working for a kitchen design firm, meal service in hospitals involved dumping vats of hot food into multiple steamwells along a snake-like tray line and stocking up refrigerators with ramekins filled with canned fruit salad. Several hair-netted dietary aides dished out the food onto heated plates inserted into heated, insulated bases, and positioned the covered plate center of a rectangular tray. Other aides assembled the cold portions of the meal, picking items from air curtain refrigerators and sliding the trays into a transport cart which was hurried up to the appropriate floor, the meal trays whipped out like playing cards onto patients’ bedsides by a nurse’s aide.

Specialized hospital kitchen equipment for this style of food service consisted of the wax plate bases and their heaters, and the many configurations of tray lines touted by competing manufacturers as being the most efficient.
As a coincidental sidebar, I happened to be in the hospital in the late fall of 1994. Perhaps my new job was too stressful for I was diagnosed with a brain tumor and needed surgery immediately to relive hydrocephalus. In I went to the local hospital, which was and is one of our clients, and after a long day of surgery and starvation, from ICU I turned my nose up at the Jell-O they brought me for dinner. Hey I was on morphine and I wanted real food ––well, as real as could be from their food assembly line that I had seen in their sterile kitchen just weeks before. They did bring me a steak of sorts, with less identifiable accompaniments. (I survived brain surgery in case you were wondering about that.)

There was talk back then about how robots were going to enter the scene to deliver meal trays and, although this is the case in some very large and high tech hospitals, it is not the norm. What took off instead, driven by food safety/temperature monitoring regulations (known as HAACP) and the need to make more profits by streamlining operations and labor costs, was “Cook Chill” method of food production.
Cook Chill equipment is all about maintaining the 160 degree temperatures of large batch cooking then quickly chilling the food down to 38 degrees in ice baths or blast freezers to minimize the temperature zone comfortable for bacteria growth. Words like “food processing” “batch cooking” and “shelf life” are tossed around a lot in Cook Chill operations and specialized equipment includes a host of huge kettle mixers, vacuum sealers, blast chillers, food banks, more tray lines, and rethermers for zooming that temperature up past the bacteria zone for service to the patient. Sounds yummy, doesn’t it? It may or may not look like food when it gets to your bedside and gee, that food has probably gone through more abuse than you have. You at least have morphine.

Now, here we are in the competitive next century and hospitals are competing for business. “Patient satisfaction” is the buzzword and hospital food service has evolved into a smoke-and-mirrors version of hotel room service. They even call it room service. The person taking your order in the morning for lunch and dinner wears a bowtie. There’s a rotating menu for you to peruse. Gee this is exciting! Is there champagne? (No, there’s morphine, though).

I won’t complain about having to learn a whole new kitchen design system. I’ve muddled through, listening to my hospital clients, modifying their kitchens to accommodate the new room service trend while learning bunches along the way, which I like actually.

But the thing is, the food isn’t any better. A dear friend of mine is in the hospital with a stroke and has trouble communicating. I arrived for a visit this week during a menu selection reconnaissance between nurse, bow-tied steward holding a pen over a pad and my smiling friend, who was certainly thinking things that couldn’t be said anyway. I answered all the questions and reiterated no pasta, no applesauce on anything, he likes meat and can you bring him some coffee?
My friend is a food guy. He cooks a lot at home, makes stocks and demi-glace, roasts meats and throws an awesome Indian curry party. I was insulted to see the careless mush that they brought him. Yes he was on a pureed diet at first but does that mean the food can’t have any flavor? His wife, after long days at the hospital, stayed up late nights making soups, roasting chicken then delivering his meals at mealtime. A 22K hospital stay and the spouse has to slave over a hot stove? Food is love they say and food is healing, I say and there’s no excuse for this.

Image and presentation are important, yes; the bowtied-waiter person, the menu, the term “room service” all are nice touches. But these things don’t magically compensate for the fact that the food delivered to my friend had no love in it whatsoever. But, you say, so many meals from a central kitchen, so many different diets at different times of the day, all the care to ensure the food is safe and profitable. How can they add love to the food also?

Put it on the required ingredient list, I suppose.

Perhaps the one-size-fits-all central kitchen gets replaced with smaller service kitchens, more regional to the areas of the hospital: the international food kitchen for stroke patients; the low salt kitchen for heart patients ––this one with their own herb garden for added flavorings; the steak kitchen for brain surgery patients…etc. Maybe it’ll be the next trend. And I thought of it.


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