Hospital food is a punchline. In New York, fine-dining chefs are redefining it.

Clockwise from top right, île flottante, monkfish osso bucco, a fruit plate, honey-mustard-glazed Atlantic salmon, egg shakshuka, miso-glazed cod loin and herb-encrusted rack of lamb at Lenox Hill Hospital in New York. (Jeenah Moon for The Washington Post)

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NEW YORK — Before she arrived at the hospital in early January for a scheduled C-section, Alivia Dalal conducted a little recon. She scouted the restaurants around the medical center on New York’s Upper East Side so her husband, Keenan, could bring her something to eat that didn’t qualify as, you know, hospital food.

Her spouse meal-delivery system never materialized. Instead, Alivia and Keenan ordered from the menu in their hospital room and savored a housemade chicken noodle soup, chilled soba noodles (twice), coriander chicken and, one morning, a fruit plate with a cheerful row of alternating cantaloupe and honeydew slices lounging next to blueberries, strawberries, grapes, hand-cut figs and pineapple. The plate was garnished with an orchid, its vibrant, reddish-purple petals suggesting that the fruit was as freshly harvested as the flower, even in the dead of winter.

When Alivia sent a photo of the couple’s newborn son to a friend, the fruit plate happened to be in the background. The friend FaceTimed her back. “She didn’t call about the baby. She called about the fruit plate. I swear,” Alivia said. “She said, ‘Where are you?!’”

The Dalals were at Lenox Hill Hospital on E. 77th Street, just a short walk from Central Park. The medical center is part of Northwell Health, a nonprofit network that operates more than 20 hospitals in the New York City area. The kitchens at these hospitals, including Lenox Hill, have undergone a dramatic transformation over the past five-plus years, ditching institutional frozen foods in favor of meals freshly prepared by chefs who previously spent their careers catering to heads of state and one-percenters, not patients in medical gowns.

Michael Dowling, Northwell’s chief executive, made the call to overhaul the food service. He had had enough of the patient emails and survey responses describing Northwell’s offerings as “hardly edible,” “not fit to feed my dog” and “maybe the worst hospital food I’ve ever had.” But more than that, Dowling had been grappling with a contradiction faced by many hospital administrators: How can staff dietitians promote the benefits of good nutrition when their own kitchens are serving reheated processed food, the kind that has been linked to the diet-related chronic diseases that help fill hospitals?

Or as Dowling said, “If I run programs out in the community to encourage people how to improve their diets, I can’t be doing that then provide crappy stuff inside the hospital.”

In short order, Northwell has become the model of hospital food service in the United States. Administrators from other health-care companies now pay visits to Northwell to learn how it made the transition. Dowling tells them it’s easy.

“Decide to do it,” he says.

Creating a sense of well-being

Hospital administrators, it would seem, have plenty of motivation to improve their food service programs. The federal government has incentivized hospitals to improve patients’ experience, and, back in the 2000s, a pair of agencies developed a survey to collect data from Medicare patients about their hospital stays. Conducted by approved vendors such as Press Ganey, the Hospital Consumer Assessment of Healthcare Providers and Systems Survey poses a variety of questions about such issues as doctor communication and environmental noise — and also asks about food service.

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For consumers, the HCAHPS (or H-caps) scores are converted into stars, and the results are publicly available to provide a measure of transparency about hospitals. But since 2013, the scores have also been a determining factor in whether a hospital is rewarded or penalized for its performance. Higher-performing hospitals receive a percentage bonus on their annual Medicare reimbursements; the lower-performing ones receive a penalty.

“For hospitals which are billion-dollar-a-year companies, you’re talking millions of dollars” in bonuses or penalties, said Timothy Harlan, executive director of the Culinary Medicine Specialist Board.

When Sven Gierlinger joined Northwell in 2014, the company was one of those underperforming networks penalized under the Medicare incentive program, he said. As chief experience officer, Gierlinger had only so much control over Northwell’s operations. But by February 2016, he had data from an in-house survey indicating that food service figured into how patients responded to an important H-caps question: How likely would they be to recommend a hospital?

“It was glaring that the patients rated us down on the ‘likelihood to recommend’ because of food,” Gierlinger said. A “lightbulb went off there.”

Gierlinger is perhaps ideally suited to rethink hospital food, the kind usually left to behemoths such as Sodexo, Aramark and Compass Group. Before moving into health care, he worked in the hotel industry, including eight years with the Ritz-Carlton, where he held a variety of jobs: restaurant manager, director of housekeeping and assistant general manager, among others. At the Ritz, Gierlinger said, the focus was on creating a sense of “well-being” among guests.

“You can directly translate that into health care: instilling well-being. I think about that. Patients need that more than anybody else,” said Gierlinger, who worked as vice president of hospitality and service culture at Henry Ford Health in Detroit before joining Northwell.

Gierlinger, 51, first had to understand the scope of the task ahead of him, so he pulled together an advisory committee. But he also had to find someone to oversee food services at Northwell’s 21 hospitals, whose kitchens basically acted as independent fiefdoms complete with their own uniforms.

There is a book that could have helped Gierlinger with his mission: the “Foodservice Manual for Health Care Institutions,” a nearly 600-page tome by Ruby Parker Puckett, a dietitian and food service management consultant with more than 50 years of experience. The fourth edition of Puckett’s manual offers clear-eyed advice on the type of people who make the best managers, among other things.

Gierlinger never read it. Metaphorically, he says, his goal was to throw out the book and start from scratch, which explains his thought process when hiring the vice president to lead Northwell’s next-gen food program. He was not interested in anyone with a background in institutional cooking.

So in 2017, Gierlinger hired Bruno Tison, a chef who, while not a household name, has amassed an impressive résumé: He earned a Michelin star at his previous job at the Fairmont Sonoma Mission Inn & Spa in California wine country and, before that, managed the kitchens at the Plaza Hotel in New York for more than 13 years. He has worked under some of the most august figures in French gastronomy, including Roger Vergé, Alain Chapel and Michel Guérard, three of the masterminds behind nouvelle cuisine.

Tison left that exclusive world behind to take on a new title: vice president of systems food services and corporate executive chef for Northwell.

Just weeks into his new job, Tison confronted the hard reality of a company that had farmed out its food services, one of countless hospitals that did the same in the name of cost-cutting, consolidation and a laserlike focus on acute care, not cooking. Inspecting freezers at the Long Island Jewish Medical Center, he found packages that had been stored in the walk-in many years before his arrival.

“We threw away food from 2012. Cases and cases and cases,” Tison said. “You wonder how you could serve that.”

The stockpiled products were, he said, an inevitable consequence of a health-care system that didn’t place any importance on food. The evidence was everywhere in those early months, and not just at the Long Island hospital. Freezers in other kitchens were packed with expired food, too. Equipment was falling apart from neglect. The cooks who labored in these decaying spaces didn’t have many skills, and they didn’t need them. They mostly opened cans and reheated food.

The food service program, Tison says, was basically run by dietitians. The chefs had little input on menu planning, and the patients had little interest in eating what they prepared. The food waste could be as high as 40 percent, says Ambika Chawla, assistant vice president of nutrition services for Northwell.

Little by little, Tison, 63, transformed these kitchens, in whole or in part, a process that’s still ongoing. He tapped into his chefs network and found trusted colleagues to join his rebellion. They include Georges Masraff, a former physician who earned a Michelin star at his Paris restaurant, Au Quai des Ormes, before moving to New York to serve as executive chef at Tavern on the Green. At age 76, Masraff is now the executive chef at Lenox Hill Hospital.

Tison has enticed other accomplished chefs into his fold: Andrew Cain (executive chef of Northern Westchester and Phelps hospitals) worked at the French Laundry in Yountville, Calif., and Michel Richard Citronelle in Washington. Brian Sauer (executive chef at South Shore University Hospital) was once the chef de cuisine at Gramercy Tavern in New York. Christian Schmidt (director of dining services at North Shore University Hospital) used to be the executive chef at the Plaza Hotel and the Mandarin Oriental in Washington.

To date, Tison has installed 15 executive chefs into Northwell kitchens. It hasn’t always been a graceful transition. Some of the old crew resisted Tison’s restaurant-driven approach, while some of Tison’s new hires struggled to adjust their recipes — such as developing a lobster bisque without heavy cream — to meet the nutritional standards for patients on restricted diets.

At one point, Tison says, the classically trained chefs under his employ started referring to the staff nutritionists and dietitians as “the police.” These cooks, once limited by only their imaginations, sometimes felt handcuffed — until Tison told them to open up their minds and use their training to imagine something different: hospital food that’s both healthy and delicious, not unlike, say, the cuisine minceur that Guérard developed in the south of France.

Together, these chefs and dietitians now produce not one but many menus. Menus designed for patients with heart disease. Menus tailored to the communities around each hospital, such as the “International Health Dining Menu” at Lenox Hill, which features Chinese congee, mapo tofu and Thai basil chicken. The regular “bedside bistro” menu reads like something from a Manhattan restaurant: Dinner entrees include miso-glazed cod loin, seared filet mignon and chicken paillard, while breakfast leans into recent trends, such avocado toast and shakshuka.

Making good food the new standard

In his sprawling kitchen at Northern Westchester Hospital in Mount Kisco, N.Y., Cain explained how he prepares mashed potatoes that pass inspection with “the police.” He has developed a compound butter — one part real butter, two-parts heart-healthy margarine — that he folds into his mashed Yukon Gold potatoes with white pepper and nutmeg. You’d be hard pressed to call it anything but delicious.

Like many of the kitchens in the Northwell network, the one at Northern Westchester has been modified to meet the needs of the new approach. Many of the freezers have been converted to refrigerators. The tray-based production system has been switched to a restaurant-style station operation. The deep fryers have been 86’d. New vendors, including farms in season, supply fresh ingredients to replace the canned and frozen ones.

On a Tuesday morning in early January, the Northern Westchester kitchen looked much like a working restaurant. Drivers dropped off pallets of fresh greens, shiitake mushrooms and whole leeks. A vendor wheeled in a cart of ingredients, including a whole Scottish salmon on ice. Chefs in toques and white jackets chopped fruits and vegetables. A rack of winter tomatoes sat in a corner, waiting to ripen into something edible.

The kitchen was ready for anything, maybe an order from Marilyn Albanese, 32, who gave birth to the first 2023 baby born in Westchester County at 12:41 a.m. on Jan. 1. Albanese awoke later that morning ready to eat. She ordered pancakes, which were made fluffy with organic flour and eggs. The maple syrup was real, not the imitation “breakfast syrup” in tiny containers. She said the pancakes were great — and a relief. She was worried that no restaurants would be open on New Year’s Day.

“I was very, very happy,” she said, “not being able to eat for 24 hours and being able to get a good breakfast in the hospital.”

All of these changes to Northwell’s food service have come with only few additional costs, Gierlinger says, including the creation of Tison’s position and salary bumps to entice better chefs. The food costs have remained essentially the same, a fact confirmed by Donna Drummond, chief expense officer at Northwell.

“A lot of the cost differential had to do with reduced waste,” Drummond said.

The revamped food service has also given chefs like Cain a new career path, one that comes with better hours and benefits, maybe even a renewed sense of purpose. They’re now feeding some of the most vulnerable Americans, not only those who can afford a 14-course tasting menu. “I can not only impact people’s lives but make a major change in an industry that needs my skills, our skills,” Tison said.

Northwell has reaped the rewards of its experiment, too. The network now receives bonuses from the Medicare incentive program, not penalties, though the flip is only partly due to the food service. The company has also leapfrogged many of its competitors in terms of “quality of food,” according to Press Ganey, the survey firm. In 2016, Northwell was in the ninth percentile nationwide. It’s now in the 79th percentile.

In recent years, other hospital networks — notably University of California at Davis Health under executive chef Santana Diaz — and even some of the food service giants have improved their systems, too, but Press Ganey calls Northwell’s “industry-leading.” Harlan with the Culinary Medicine Specialist Board describes Northwell as the “exemplar.” More than that, Harlan says, Northwell’s innovations will eventually become the accepted practice.

“Ten years from now, this will be the standard of care in America,” he said.