Beth Loney, looking like a restaurant server in her tuxedo shirt, tie and vest, busily assembled a lunch tray for a patient at Mercy Hospital’s Fore River campus in Portland.

On the tray was a roast turkey club sandwich, Lay’s chips, a crock of soup – covered with a ceramic lid to keep it hot – apple pie and vanilla ice cream. Condiments for the sandwich came in cute little jars that patients have been known to save and take home with them. The salt and pepper came in (again, cute) mini glass shakers. At the last moment, she placed a coffee butler on the tray so the coffee wouldn’t get cold and the patient could have a hot refill at the ready.

When everything was set, Loney delivered the tray to the hungry patient just as any waitstaff would. She carried a wireless credit card processor with her so the meal could be paid for right away, at the bedside.

The entrée ordered that day could just as easily been beef tips bourguignon – tender beef tips braised with red wine,

mushrooms and onions, served over egg noodles (a patient favorite) – or fresh butter crumb haddock served with steamed broccoli and risotto. But there was no lime Jell-O, mystery meat or instant mashed potatoes in sight.

Hospital food is no longer the butt of jokes in health care facilities around the country. Medical centers are hiring trained chefs, upgrading their menus, and offering room service-style (sometimes called hotel-style) dining in hopes of hastening the healing process and raising patient satisfaction rates. Hospitals hope those higher patient satisfaction rates influence consumers shopping around for a place to have a baby or get elective surgery.

“There’s no question, people do make choices about their health care now, and not just about the clinical outcomes,” said Mike Sabo, director of hospitality services at Southern Maine Health Care in Biddeford. “Clearly, that’s primary, but they’re also looking for the rest of the package that goes with it, and food is a part of it.”

And there may be more at stake than simply attracting new “customers.” Under the Affordable Care Act, federal reimbursement is increasingly being linked to patient satisfaction scores.

Last fall, Geisinger Health System in Pennsylvania launched a pilot program called ProvenExperience at one of its hospitals that refunds part of a patient’s co-payment if they are unhappy with some aspect of their care. The refunds cover critical aspects of care, such as long ER waits and communication between patients and staff, but they also address complaints about food being too cold, or a meal that took too long to arrive. The organization has also hired an executive chef to help upgrade all of its menus.

“There is no strategy for any health care organization or hospital to say ‘Our food is so great, you should come here because the food’s so good,’ ” said Eric Eisenberg, corporate executive chef at Swedish Health Services in Seattle and, according to the Association for Healthcare Foodservice, a national leader in transforming hospital food culture. “Are there places using good food and training chefs to do really great work in hospitals? Yes, it’s happening all over the country.”

While hospital food is not yet marketed overtly on billboards and the sides of buses, “that could happen in the future because there are a lot of extremely competitive health care markets out there,” said Ryan Conklin, executive chef at UNC REX Healthcare, a hospital in Raleigh, North Carolina, where Conklin has gained a national reputation for elevating hospital cuisine. Conklin has been known to organize summertime heirloom tomato tastings for patients, and spreads the gospel of good food through his blog, newschoolhospitalfood.com.

“Patients are becoming much more educated about food,” Conklin said. “They’re sitting in their beds watching cooking shows with cooking demos. The expectations are so much higher now. You’re seeing a lot more of a chef presence coming into the health care scene, and it’s only going to get stronger in the years down the road as the baby boomers become more reliant on health care organizations.”

CHEFS ON STAFF

Maine hospitals are among those that are turning to professional chefs to help upgrade their menus. Bruce Turner, the director of dining services at Mercy Hospital in Portland, was executive chef at the Portland Country Club for 16 years, and the chefs who work for him have worked at the Regency in Portland, the Black Point Inn in Scarborough and the Woodlands Club in Falmouth.

While hospitals are looking for better food, chefs are making the transition to health care because they can make “an immediate impact, immediate change for good,” Conklin said. In exchange, they get a better quality of life that doesn’t include long hours and working every weekend and holiday.

“Health care is a little different,” Conklin said. “You can still do what you love, you can still craft things and still make people feel good through food, but you can still have a quality family life as well.”

The impact of chefs can be seen in hospital menus. Where once Conklin’s hospital might have served a pre-cooked turkey thrown into a steamer and served with pre-made gravy, today the roast turkey on the menu is expected to taste as good as mom’s on Thanksgiving. They find ways of making food flavorful without stuff like salt and loads of fat. They use fresh herbs and marinades, citrus zest and smokers. If soup is on the menu, Conklin said, “we meed to make it an amazing soup because it may be the first thing they’ve eaten in three days.”

Maine’s hospitals do have some restaurant-quality food on their menus. Central Maine Medical Center serves “Pollock Parisian” with julienned garden vegetables, a dish developed in partnership with the Gulf of Maine Research Institute’s initiative to promote under-used species of seafood. Maine Medical Center has an herb-crusted chicken dish. Mercy serves three-cheese tortellini with Tuscan-style meat sauce, and a Mediterranean chicken sauté.

Still, most of what you’ll find on menus at southern Maine’s largest hospitals is not fancy foodie fare. It’s casual favorites done well, like mac-and-cheese, pot roast and pudding. Chefs are using the techniques described by Conklin to add flavor to and elevate simple dishes.

“Our patients are not looking for five-star dining,” Sabo said. “They typically gravitate toward the comfort foods – something that’s going to make them feel better.”

CATERING TO PATIENT NEEDS

Southern Maine’s three major medical centers have all adopted the room service dining model. They use similar software, but have tweaked their service in their own ways.

“Room service has really increased patient satisfaction scores,” said Turner, director of dining services at Mercy Hospital, where the perk has been offered since 2008. “Our customers are the people who eat down in the Old Port, so they know good food. When they come in here, even though they’re sick or are having a knee replacement or whatever, it’s got to look good, taste good and be presented well.”

Turner said Mercy saw an immediate 10 percent increase in patient satisfaction scores after going live with the room-service program.

With room service, patients choose what they want from a menu in their rooms, when they want it. They call their order down to a call center near the kitchen, which is typically open about 12 hours a day.

“Anytime between 7 a.m. and 7 p.m., if you feel like eating, just call us up and we’ll send it up to you,” Sabo said. “It’s prepared to order, so it’s fresh- made rather than sitting in a steam table somewhere.”

The Southern Maine Health Care “waitstaff” follows a script of sorts when they deliver a meal. They introduce themselves to the patient, and make sure their order is correct.

“They take the dome lid off and say, ‘Oh, I see you’ve ordered the haddock today. That’s one of our best dishes here,’ ” Sabo said. “It’s kind of a marketing piece.”

At Mercy, the call center is in the State Street building and orders for patients in the Fore River complex are printed on an expeditor’s ticket in the Fore River kitchen, just like at a restaurant. When patients call in – whether it’s at Mercy or Maine Med or CMMC – their dietary restrictions pop up on the computer so the staffer taking their order can be sure they aren’t, for example, ordering too many carbohydrates if they are diabetic. If a patient orders something they can’t have, the call center staff try to help them choose something that does fit into their diet. The patient still gets a choice, and the staff makes it work nutritionally.

Mercy Hospital allows patients’ visitors to order from the menu as well, sending out 300 to 400 “guest trays” a month. Occasionally the chefs make a steak-and-lobster “celebratory meal,” usually ordered after the birth of a baby, that feeds six to eight and can be enjoyed in the patient’s room. (Nursing mothers, Turner and other food service managers say, are the hungriest customers they serve. Every time a baby is born at Mercy, a bell rings throughout the entire hospital, and the kitchen knows to expect an order worthy of a famished football player.)

MaineHealth, the health care group that includes Maine Medical Center, makes a concerted effort to provide healthier options – serving whole grain wraps or pizza dough, for example, or baked chicken tenders instead of fried – following guidelines set by the Partnership for a Healthier America. And while most patient menus are a la carte, they’ve also created a “wellness meal” that makes it easier for patients who are overwhelmed by all the choices to choose a healthier meal.

“Most of our organizations, except for a couple of our smaller community hospitals, do a room-service option for food,” said Naomi Schucker, senior director of Community Health Improvement at MaineHealth.

National patient satisfaction surveys usually do not include specific questions about food, but some hospitals occasionally add on food-related questions, or visit patients personally in their rooms to get their reviews. At Central Maine Medical Center, they do their own separate, third-party food survey a couple of times a year. Was the hot food hot? Was the cold food cold? Was it served on time? Was everything ordered actually on the tray? If a patient was on a restricted diet, was that explained to him?

Patient satisfaction is “a big thing for us,” said Larry Adams, director of food service at Central Maine Medical Center in Lewiston. “If a patient comes in, it doesn’t matter whether it’s food service or nursing care on the floor, if they’re not happy where are they going next time they need a procedure? They’re going somewhere else.”

WHAT’S NEXT?

Health care organizations are now entering culinary competitions, Conklin said, and hospitals are bragging about their food on social media. Hospitals have herb gardens, and hospital chefs are doing cooking demonstrations and appearances at farmers markets. The University of Vermont Medical Center has a rooftop garden on its new radiation oncology facility.

Eisenberg said some health care facilities are opening freestanding restaurants and full-service food courts.

“There are lots of places that are trying to capture the local community’s interest with food,” he said. “It may not necessarily be a way of getting them into the hospital as a patient, but it is a way of capturing additional revenue in retail.”

At Swedish, a restaurant called Cafe 1910 serves fresh, high-end, from-scratch meals made with the best ingredients, from free-range chickens to San Marzano tomatoes. The café is attached to the lobby of the hospital and something that resembles a small shopping mall. The idea, Eisenberg said, is to bring people in for daily needs – drugs from the pharmacy, a gift from the gift shop of mom-and-infants boutique. There’s even a day care center and yoga studio. Near those same storefronts are the hospital’s imaging and day surgery facilities, a catheterization lab, and other medical services. The café is the cornerstone of that facility, Eisenberg said.

“The goal is that you would come on a daily basis – maybe eat in the café, maybe pick something out from our shop or from Starbucks – and then when you’re in need of clinical care, it’s less of a negative experience for you.”

 

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