Why People Are Choosing to Eat at Hospitals

April  4, 2017

For post-skiing food, Mary and Jeff Howser (names changed) favor the Castle Creek Cafe. These retirees, who are avid skiers and outdoor enthusiasts, appreciate the healthy options, the low prices, and the freshness and quality of the food. They also like the fact that they can enter the cafe directly from the street (which is convenient when wearing skiing gear). This little detail may not sound like much, but it makes a difference when a restaurant is located within a hospital, as Castle Creek is.

The Howsers are far from the only regulars at the Castle Creek Cafe, located inside Aspen Valley Hospital. It’s a popular breakfast spot for city workers. It also feeds people on both sides of the law; police officers visit daily, and the cafe delivers to inmates at the local jail 7 days a week. The cafe makes a point of welcoming community members with no hospital affiliation. And its menus, made available to view a month at a time, include items like herbed farro pilaf, corn soufflé, and panko crusted cod. We’re a long way away from institutional slop.

Left: Quinoa patty with mango chutney and blueberry vinaigrette at the Castle Creek Cafe; Right: Salmon, coconut grits, burnt onion, and togarashi Photo by Kristy Bates; Manna Restaurant

The Howsers discovered the cafe, which Mary calls “the best kept secret in Aspen,” after having some tests done in the hospital. She says, “Never in my wildest dreams did I think hospital food could be tasty!” The experience has even inspired them to check out restaurants at other hospitals.

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One Colorado hospital restaurant that should be next on their list is Manna, within Castle Rock Adventist Hospital. Tim Davis, a 37-year-old Coloradoan, heard about the restaurant through his sister, who was having a treatment at the hospital. Now it’s a favored destination for Davis, even though he doesn’t live in the area. “Their menu has real gourmet style food you would expect from a high priced restaurant, but sold to you at a much more affordable price,” he says. One dish is maple glazed duck confit, consisting of a maple glazed duck leg served with swiss chard and spätzle, for $9. The grilled Thai cabbage steak, with marinated cabbage, spicy lime dressing, and shishito pepper, is even cheaper. Their burger buns even come adorned with a monogrammed M.

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Top Comment:
“I found that the hospital patient food was as healthy as the choices you made. Most options seemed to veer toward comfort food and nothing was particularly standout (except for the peanut butter and jelly sandwiches, those were amazing). The cafeteria is really for visitors, staff, and outpatients. Again, lots of comfort/junk food with an occasional salad bar thrown in. It all seems to be pretty standard institutional food. ”
— Clelia

One reason for its affordability is that the restaurant is partly subsidized by the hospital. Even without a subsidy, hospital restaurants are able to keep prices low because they make large volumes of food. In a cafeteria-style setup, customers also save money by not tipping.

Photo by Manna Restaurant

Davis isn’t exactly a hospital food junkie. “I’ve sampled the cuisine on occasion but it’s not something I go out of my way to do on purpose… Hospital food in general has a reputation, and you could say it's very well earned. It’s terrible.” But Manna, he says, “is a complete 180.”

High-quality food at reasonable prices make hospital restaurants like Manna shine, but one might consider hospital dining for a host of other considerations, like convenience or the ability to be left alone for long stretches (if that’s what you’re into). Hospitals are also more mindful of dietary requirements than an average restaurant.

However, enthusiasm for hospital dining is not without its issues. Having the choice to enter a medical facility for non-essential reasons is a privilege—one that doesn’t extend to chronically or terminally ill patients. Relishing a meal amidst other people’s pain and grief just seems intuitively wrong. But, for those who are unbothered by these possibilities, the value and convenience of hospital dining can be hard to beat. Take Rob Dinos (name changed), who lived in a dorm as a college freshman in Vermont. One problem was that there were no places on campus to eat after 10pm. But as he and his roommates discovered, “The hospital cafeteria was open very late! What a relief! ... It was much more convenient than going all the way downtown for food.” Besides, the quality was good. As a vegetarian, Dinos “took advantage of the salad bar, which was always fresh and well stocked.”

Having the choice to enter a medical facility for non-essential reasons is a privilege—one that doesn’t extend to chronically or terminally ill patients.

While salad bars and attempts to make food more nutritious attract some, they alienate others. Like Dinos, Carol Gee found her way to hospital food through a university connection. After serving in the military, both Gee and her husband worked at Emory University (where he was the Assistant Director of Hospital and Restaurant Services). University staff often opt to eat at the hospital cafeteria, as it accommodates short lunch breaks. For a time, she said the food at the hospital was “wonderful.” The setup was in the style of a food court, and Gee was partial to turkey burgers, cream of broccoli soup, fish, and fried chicken. This was a treat for her: “Because my husband has some chronic health issues, I seldom fry foods, so I could enjoy an occasional chicken drumstick or a couple wings at lunch.”

In step with a larger national push to make hospital food more nutrient-rich, this particular hospital established healthier, but blander, menus with less choice—and lost Gee as a customer. “Things are not the same,” Gee told me, and she's not the only one who lost interest. According to her husband, after the push, the hospital “started losing money when folks stopped coming to eat [and] sales naturally went down.” More people started to bring their lunches from home or eat from vending machines.

This choice between nutrient-rich food and income-generating food is an ethical issue, which especially affects hospitals where food service is an important source of revenue. Is it hypocritical for hospitals, which are supposed to promote health, to have fast food chains like McDonalds and Chick-Fill-A on their premises, or use a multi-national catering giant like Sodexo, which also services private prisons? On the other hand, isn't it important for hospitals to be fiscally responsible? Many point out that fast food in hospitals are meant for visitors, not patients. Additionally, meals prepared by hospital chefs might not be much healthier than fast food.

Someone who’s seen this first-hand is Christopher Gerhart, who used to be the chef at a church-affiliated hospital in central Texas. He explains, “For the families, visitors and staff, there was a huge disconnect between knowledge and practice. It was a heart hospital, and one of the best-selling meals was a deep fried chicken breast, smothered in cheese sauce, served with macaroni and cheese and green beans soaked and slathered in bacon grease.” Gerhart’s own specialty was a chili, served daily, that garnered awards in cook-offs and was written about in a local paper.

One advantage for the regulars at the hospital cafeteria was the ability to catch up with familiar faces without being hurried out. As Gerhart says, “At a traditional restaurant, having three to eight people congregated around a $0.50 cup of coffee and the occasional sandwich or bowl of soup for several hours at a time is just bad business. In a hospital cafeteria, not so much … Most hospitals have rather large cafeterias, with larger than needed seating areas.”

Hanger steak Photo by Banner Desert Medical Center

So low costs, central locations, and uninterrupted time to linger can make hospital dining appealing. Increasingly, so can the variety of the food on offer. Arizona’s Banner Health is one non-profit medical group that prides itself on culinary innovation—and for surprising visitors when it comes to hospital food. Its facilities offer Mongolian grill, sushi, hummus bars, wood-fired pizza, and other things that go against the cheap-coffee-and-sad-pasta image some people have of hospital restaurants. While these restaurants are always going to be secondary to the patient focus, Miriah Smith, Executive Chef at Banner Desert Medical Center and Cardon Children’s Medical Center, acknowledges that “revenue generated within our retail segments is critical to offset operating expenses generated by the [medical] department.”

This is why Mark Milek, Director of Culinary & Nutrition Services at Banner Desert and Cardon Children’s, says: “Most if not all of the facilities allow and welcome local residents to dine in their facilities. Visitors that have no connection to staff or patients are always welcome to enjoy a meal.” So it’s “safe to assume that most hospital restaurants/bistros are open to the public,” although Milek recommends calling in advance to make sure.

Revenue generated within our retail segments is critical to offset operating expenses generated by the [medical] department.
Miriah Smith, Executive Chef at Banner Desert Medical Center

Rob Dinos, the former Vermont college student, can back up this advice. On one of his and his roommates’ trips to the hospital cafeteria, a hospital employee asked them if they were staff or visitors, and told them they weren’t supposed to be eating there. When they went back to the hospital, they found that the entrances closest to the cafeteria were locked.

Of course, even for the many people with a local hospital restaurant that welcomes non-patients, eating at a hospital, when you don’t need to be there, just sounds depressing. Not even a stellar view, like the one the Royal London Hospital touts on their website, can change that. More importantly, it might be disrespectful to the people who do need to be there, or in poor taste. Iola Kostrzewski recently spent an extended period of time in a Minnesota hospital due to a post-surgery infection, and her main reaction to the idea of willing hospital diners is surprise: “I have never met anyone who volunteers to eat hospital food, at least [here], where [people] are apparently allergic to seasoning.” She’s unfazed, though, by the prospect: “It doesn’t bother me. People need food, and a hospital is a community asset.”

Any thoughts on hospital food? Tell us in the comments.

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ralph May 13, 2017
Only some people eat hospital food. All are average at best. I cooked in one and you'd be surprised how things are cooked, pre-made and held. Good hopital food is not in hopitals.
zahavah April 17, 2017
A longtime F52 reader and contributor, I was surprised to find a link to the site from The Advisory Board Company, a healthcare care consulting firm where I used to work. I'm an MD who never practiced, and after spending time as a maitre d' at Union Square Cafe, I've re-directed my career towards incorporating principles of hospitality into care delivery. Many people think that means making the food better and giving people fancy robes, and those may be some of the components but it's really about how you treat people - patients AND staff. It's about creating a partnership and dialogue with patients, far different from the old patriarchal system our parents and grandparents experienced where the doctor is revered and is always right.

But back to food, you've really identified a lot of interesting trends and issues. With respect to the financial benefits of co-locating in a hospital, this seems like an extension of the trend towards cool hotel restaurants, which if also serving room service can make the kitchen very complicated. But in terms of restaurant real estate costs, it can be a winner. Case in point, USHG's GreenRiver is at the top of one of Northwestern Memorial buildings. When an in-house restaurant is also charged with patient meals, one "innovation" I've seen is rather than only delivering meals at 3 prescribed times a day, hospitals have on-demand (within reason) ordering so if you, say, had surgery and were NPO (can't eat anything) since midnight the night before, you could get food at 2 rather than waiting unit 6 for the official dinner time. It makes a huge difference for the patient experience, but hospitals are typically slow to make changes and this one that seems like a no-brainer could create a logistical and operational nightmare.

The ethics issues and social dynamics you mentioned are also great to keep in mind. Thanks so much for writing about this very unexpected topic.
Christine R. April 18, 2017
Thanks for your comments! You clearly have a unique perspective on the topic.
Liza's K. April 12, 2017
NYU's relatively new cafeteria is fabulous. Truly great food, and cheap.
Anna B. April 7, 2017
It is worth noting that in some very remote communities, the hospital might be one of the only dine-out options in several miles. I live in Alaska (Anchorage) and have visited Barrow and Kotzebue, two very small remote communities that are the local hubs for surrounding villages, and therefore have services like the only hospital in the entire region. When traveling for work we ate there for lunch, not just because it was convenient, but it was one of the only restaurants in town and it is one of the main community-oriented buildings, along with the school and the grocery store. People congregate there to see relatives, visit people working, and just to get a meal out. While not 100% healthy, it also has healthier options than most typical restaurants in rural Alaska, with fresh produce, sandwiches, etc. at a good price since it is prepared in bulk, sometimes the same price or cheaper than the equivalent in the grocery store. This article is more about people choosing to eat at a hospital when they have other dining options, but there is also a reality that it may be one of the only dining options!
Christine R. April 8, 2017
This is fascinating, thanks for mentioning this Anna. I hadn't thought about hospitals as much-needed public spaces (even apart from their main medical functions) in remote locations.
CGRIF April 7, 2017
At a major private Hospital in Mountain View, right on the border of Sunnyvale and Mountain View, there is a downstairs cafe which is fantastic. It serves and prepares excellent gourmet food for a fraction of what it might cost in a restaurant outside the hospital. There are cushy old style booth seats at a table.

The problem is I cannot find any individual who will accompany me to the hospital It is fine. You aren't going to catch diseases eating with staff and doctors.
Christine R. April 8, 2017
Yup, there's definitely a perception problem when it comes to choosing to eat in hospitals!
Windischgirl April 5, 2017
I have spent my nearly 30-year professional career working in hospitals. I have certainly observed a trend toward fresher, more vegetable-focused and ethnically-diverse meals...but there is so much variation, depending on the Hospital system and the food vendors. I just left one job at a 5-Hospital network, where the food was heavy on the calories, not attractively served, and overpriced. I'm now at a smaller system, affiliated with a med school, where the choices are very appealing, veggie-centric, and very affordable. The best food I can recall, many years ago, was at the Mt. Sinai Epilepsy Center in NYC...but I wouldn't want you to have the diagnoses that could get you admitted. On the other hand, my dad recently had vascular surgery and the only food that was available to me while waiting were bacon-egg-cheese breakfast sandwiches...which is rather ironic for a cardiac unit.
Christine R. April 8, 2017
Hmm, it's interesting to see how much variety there is across the board.
ktr April 5, 2017
The hospital I trained at offered a discount to seniors at dinner. It was a way to ensure they could afford at least 1 meal each day and provided a safe, quiet location for them to get together for a meal.
Christine R. April 8, 2017
I heard this from other people as well: that a hospital cafeteria was a gathering space for older people. Thanks for your comment about the senior discount - that's an interesting practice.
Clelia April 5, 2017
This was an interesting discussion. I've been both a patient and a visitor to various hospitals. In my experience, admitted patients aren't allowed in the cafeteria. In all my experiences, the doc will put you on a particular diet (for my loved one with Crohn's it was a clear liquid diet, ugh, and when I had my babies it was a lactation diet - I got to have extra snacks!). There is a menu, sometimes with daily specials, and you order ofd of it within the confines of your prescribed diet. I found that the hospital patient food was as healthy as the choices you made. Most options seemed to veer toward comfort food and nothing was particularly standout (except for the peanut butter and jelly sandwiches, those were amazing). The cafeteria is really for visitors, staff, and outpatients. Again, lots of comfort/junk food with an occasional salad bar thrown in. It all seems to be pretty standard institutional food.
Christine R. April 8, 2017
Surprised to hear that the PBJ was the standout!
Noreen F. April 4, 2017
My experiences with two local hospitals and from the perspective of both a patient and an outside diner kind of illustrate both ends of this spectrum. Worked as a temp at the clinic associated with hospital #1 for a few months and discovered that their cafeteria was delicious and inexpensive. I still go there occasionally and to my knowledge, no one ever checks to make sure you're a worker or a visitor.
I was a patient in Hospital #2 and when on a soft food diet was served a sludgy mess of gravy for lunch. That was it. Nothing else on the tray.
Christine R. April 8, 2017
That sounds unpleasant. There must be ways to meet a patient's dietary requirements without serving what is basically goo.
randii April 4, 2017
How does the quality of food in these hospital cafeterias compare to the food served to the patients?
Christine R. April 8, 2017
It would be fascinating to do a side-by-side comparison...
Dorrian C. April 4, 2017
Hospital cafeteria and restaurant food can be really affordable and tasty. I think the food we are serving to the guest of the hospital is on point, now we need to figure out ways to make the food we serve to the patients even better and more nutritious. Being a diet tech at a hospital and serving lots of patients 3 meals a day can make it challenging to figure out ways to improve patient meal service.
Christine R. April 8, 2017
Yes, it seems logical that patients should be the priority!
David S. April 4, 2017
I worked in a hospital for 31 years. Over that time there were multiple different groups running the cafeteria food. Some were very good and some were very bad. The prices especially for breakfast were low.
Christine R. April 8, 2017
I'd love to hear your thoughts about the growth of massive institutional suppliers of hospital food...