Nutrition is a top priority these days at many Southland hospitals with the focus clearly on food — offering healthful choices, and ones patients actually will eat.
Hospitals believe that beyond working to make people well, they also have a responsibility to serve nutritious dishes to make the body and mind sound. And healthful doesn’t mean bland anymore. Pureed beef and strawberry gelatin have been replaced. Fryers have been pitched out and replaced by sealed food packets heated in warm water baths. Instead, patients and visitors are more often encountering restaurant-style selections, made-to-order entrees and, in some cases, room service.
At the giant MemorialCare system — including Memorial Medical Center of Long Beach, Miller’s Children Hospital and Community Hospital — the specialized diets are also targeting employees.
Long Beach MemorialCare’s Food and Nutrition Services and Clinical Nutrition are in the process of updating patient menus based on the 2010 Dietary Guidelines for Americans, according to Elizabeth Batalao, MemorialCare’s food services director.
However, she added, the hospital’s Good Life committee has already been offering more healthful choices to employees and cafeteria visitors and using the MyFitness Pal mobile app, free online calorie counter and diet plan. Also, dietitians conduct on- and off-campus nutrition and exercise training, Batalao said.
The big culprit in patient diets is salt, and that’s been reduced dramatically, she said, adding that more changes in patient menus are expected next spring.
At St. Mary Medical Center, nutrition services director Toni Wichita said most of the diets focus on healthful foods.
“We have a one-week cycle menu, including various ethnic foods,” she said.
The options include therapeutic or modified diets to meet individual needs or preferences, according to Wichita. “We are always reviewing our menus to make sure we offer the healthiest, best-quality options for our patients.”
Both medical centers use a Dietary Reference Intake system for different age groups.
Patients of different ages have varying requirements of vitamins, minerals and macro nutrients, Batalao said.
“Children would need smaller amounts of vitamins and minerals, and a pregnant woman would need more than a woman not pregnant,” Batalao added.
The nutritional policies of the hospitals are monitored by several agencies, including Medicare and Medi-Cal, accreditation agencies and the Academy of Nutrition and Dietetics.
At Kaiser Permanente hospitals in Ontario and the newly opened hospital in Fontana. Fontana Chef Todd Engel said he knew he and his staff were doing something right when he started to routinely get asked for his recipes from former patients.
“I try to do rounds throughout the hospital, meeting patients and asking them about the food, and I’ve found they are eager to talk about it. Many ask for the recipes, so I give them my business card and tell them to call,” said Engel, who was an Air Force chef for 23 years and then spent years working in hotels and country clubs.
Kaiser Permanente offers an integrated food service program, which brings together chefs such as Engel and registered dieticians such as Vivien Choi, who is the director of Food and Nutrition Services at both Ontario Medical Center and Fontana Medical Center. Together they come up with menus designed to be easy on the eye and delicious when eaten. Some menu items include salmon with lemon caper sauce or mango salsa, vegetable pasta, home-style meat loaf and even pot roast.
The hospital uses what’s called the Precision cooking method, the latest in temperature cooking technology. Meals are vacuum-sealed in small amounts to lock in freshness, then heated in a warm water bath. Hospital center clerks take patient orders and enter them into a computer system, which then calculates nutritional values. And patients can ask for meals at specific times.
“By offering good-tasting healthy options our patients will eat more so they can get better faster,” Choi said. “Food is a therapy after all.”
The needs of those with special diets are considered as well.
“All patients have a choice unless they are not in a position to communicate,” she added. “We like to discuss what they are eating and see this as an opportunity to educate.”
It appears to be working, at least while the patients are hospitalized, Engel said. More and more trays are coming back empty. Waste is minimal.
“I find this whole experience exciting to be a part of,” said Choi, who has been in food and nutrition management for 25 years.
So does Engel. The Fontana hospital recently invited local vendors and farmers to set up a market on site. It has become a staple every Friday. The chef said he routinely peruses the offerings and then incorporates them into the menus.
According to an August article in the London Telegraph newspaper, a Campaign for Better Hospital Food report from some of England’s well-known chefs and cuisine writers said the lack of minimum standards for food served on hospital wards meant many patients were being served poor meals with little nutritional value. It also reported that more than 82,000 hospital meals go uneaten and thrown away every day, and that 67 percent of hospital staff would not want to eat the food they serve patients.
That’s not the case here on this side of the pond.
Providence Little Company of Mary Medical Center in Torrance recently introduced an extensive cardiac patient food program designed to help them not only follow a low-fat, low-sodium diet but to enjoy it as well. So far, the program is meeting with success from both patients and hospital employees. Nikki Robles, a registered dietician and clinical nutrition manager, said she expects the program to expand to include all patients within the next six months, with room service offered in time.
“Patients were complaining about the food being blah and heavy,” Robles said. “Now it offers eight different recipes, all grilled, four fish and four chicken dishes.”
Patients now can order such luscious-sounding offerings as grilled chicken with an apricot glaze; chicken with a mushroom burgundy sauce; tilapia with a tomato and ginger sauce; or orange salmon.
The hospital also has tried to cater to its patient population, which has a large Asian, Hispanic and Korean bent. Offerings include Udon noodles, steamed white and brown rice and lots of fish. All this may sound too good to be true, Robles said, but every dish is light, low-fat and low-sodium.
And the delicious servings aren’t just for patients. The Torrance hospital has a cafeteria for visitors that incudes a large salad bar, a wrap/sandwich station and even a demonstration area where dishes are made to order, Robles said.
“These are all healthy, but are also very tasty,” she said. “When we first talked about possible menus we included our physicians. Many said they couldn’t wait to try the dishes themselves. I know hospital food has a reputation for not tasting very good, hopefully we can change that.”
The same is true at sister facility Providence Saint Joseph Medical Center in Burbank where even the hospital vending machines must provide a certain percentage of healthful choices.
“Times have changed,” said Carol Granados, a registered dietitian and director of hospital services at Saint Joseph. “The Internet has made everyone a nutrition expert, but I believe California is leading the way to try and promote healthier choices.”
Hospitals are emphasizing all the subtle and not so subtle niceties of simply doing business. Buildings and grounds need to be maintained and kept clean. Employees need to be pleasant and courteous. And food needs to taste good, Granados said.
“What we need to do is to provide a positive experience, and do the best job possible because a hospital’s lifeblood depends on people and families coming back,” she said. “Hospitals are rated according to patient satisfaction and food is a consideration.”
Patient satisfaction is taking on added importance as changes come to all facilities as a result of the Affordable Care Act. Patient-satisfaction scores help improve both the image and reputation of a hospital, but can also make hospitals eligible for Medicare bonuses.
Saint Joseph recently introduced more of a restaurant-style menu of 12 daily choices that vary as well as gluten-free and vegetarian menus. Granados and her staff also recently introduced “Meatless Monday” meals that have been met with rave reviews.
All this emphasis on food choices isn’t new at Loma Linda University Medical Center, said Margie Carson, director of clinical nutrition. The Seventh Day Adventist hospital has offered restaurant-style items and options for years. Vegetarian dishes have been the norm not the exception, although if patients request meat they can have it as long as their diet restrictions allow.
“We’ve noticed that when we are able to cook from scratch, patient satisfaction and the oral intake of meals increases,” Carson said.
Planning menus and patient choices should be seen as a vital teaching tool, she said, especially with the rise in the number of patients who are obese or who are dealing with diabetes or cardiac issues.
“It’s nice to see the focus moving toward nutrition,” Carson said. “Our patients will see that this is what they should be serving at home.”
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