Northwell Health serves patients, employees and visitors beef short ribs, wild flounder filets, and bread from a critically acclaimed bakery. It serves everyone a reminder that deficiencies can become delights.
“Did you try the food before you accepted this position?”
Chef Bruno Tison took a sip of water before answering this question. “Yes,” he says.
Pause. I follow up: “What were your thoughts?”
“I just could not believe that we could serve such bad food,” Chef Bruno says. So bad, he says, that his boss, Northwell CEO Michael Dowling, received letters from patients describing the food as unfit for a dog.
On a recent Tuesday morning, Chef Bruno — Northwell’s vice president of systems food services and corporate executive chef — connects with me by video from the office of a purchasing director at Lenox Hill hospital. “It was the only office available,” he notes. Later, he would participate in a chef’s tasting at the hospital, a requirement of all executive chefs and executive sous chefs.
A native of northern France, Chef Bruno joined Northwell six years ago. It was a landmark hire following the system’s 2014 addition of Sven Gierlinger as senior vice president and chief experience officer. When he joined, Chef Bruno was the nation’s first and only Michelin star chef hired by a healthcare organization. He spent 15 years as the executive chef at the Plaza Hotel in New York City. Fairmont Sonoma Mission Inn and Spa in California’s wine country earned Michelin star recognition for three consecutive years under his leadership; he was with that establishment for 13 years.
Now, in healthcare’s version of the acclaimed FX television series “The Bear,” the classically trained chef is finalizing the Thanksgiving menu for Northwell’s 21 hospitals across New York, among other responsibilities. The health system serves more than 10 million meals per year to patients, employees and visitors — a figure that makes it “a massive food and beverage operation,” in Mr. Gierlinger’s words. One thousand Northwell employees work in food services.
“He was willing to make a career change, join us and come to redesign the food for our patients,” Mr. Gierlinger told me about Chef Bruno. “The passion that he brought to the work — and continues to bring — and the talent he’s attracted have been phenomenal.”
There is now a wait list of chefs who want to work at Northwell, outshining even its vastly improved patient satisfaction scores. It is proof that strong leadership begets strong leadership. It is evidence that punchlines — I’d rather eat hospital food! — can become points of pride. It is a reminder that certain disappointments can seem inevitable until the right talent with the proper kind of transformational thinking shows how to defy expectations.
Food has long been a weak spot for hospitals. In 1982, Walter Matthau went on “The Tonight Show” and told Johnny Carson a two-minute joke about hospital food. A patient requests orange juice in a cup used for urine specimen so it has a hint of the body odor, two eggs cooked in Pennzoil for 3 seconds, and rare — or better, raw — bacon. Oh, and coffee from last week.
“I can’t serve you a breakfast like that,” the nurse responds.
“Well, you did yesterday,” the patient says. Mr. Matthau’s delivery of the line is met with roaring laughter from Mr. Carson and the audience.
Budget constraints, dietary restrictions, nutritional requirements and mass production are inherent obstacles for hospitals’ food programs. Additionally, dining typically takes a back seat to other priorities during a hospital stay. Quality of medical care, pain control and pace of recovery tend to top the list of patients’ primary concerns.
The low value placed on food in traditional medical education also spills over to hospitals. After the National Academy of Sciences recommended in 1985 that medical schools provide at least 25 hours of nutrition education, a 2010 survey found just 27% of programs complied.
“Doctors have historically received almost no nutritional training, which limits their ability to effectively talk to patients about it,” Lloyd Minor, MD, dean of Stanford University School of Medicine, wrote in 2019.
A critical turning point for Northwell occurred when its leaders realized how much food — treated as a bare necessity — colors people’s perceptions of quality care. In surveys, focus groups and listening sessions, patients told Northwell leaders the food was so poor “it basically diminished all the great work that we’ve been doing in clinical care,” Mr. Gierlinger said. “It was a big ‘Aha!’ moment for us.”
Mr. Dowling, the longtime leader of Northwell, decided with Mr. Gierlinger it was time to take on the challenge of completely redesigning food in the hospitals. Mr. Gierlinger and Chef Bruno credit their CEO for his support and encouragement to overhaul, not just tweak, the food program, an approach that’s prompted hospital administrators across the U.S. to visit Northwell and take notes.
“He has been a big champion and supporter of this right from the beginning and has allowed us to do this work,” says Mr. Gierlinger.
“All of this would not not have happened if [Mr. Dowling] did not pay attention to it, if he didn’t have the desire and the commitment to change food in healthcare,” says Chef Bruno. “And he took a big risk, because Northwell is a challenging company because of its size.”
The improvements at Northwell’s 6,600 hospital and long-term care beds signal a larger defiance of healthcare norms.
“At some point we’ve lost sight that food is actually part of healing, and good and healthy food has not been a focus area for hospital executives,” Mr. Gierlinger said “It’s treated like a liability and not as an asset that we should invest in because it’s good for the patients.”
Chef Bruno had his work cut out for him. He was nervous when accepting the job and unsure of how and where to begin. He started cautiously, observing and visiting each hospital for one to three days at a time.
“Day after day, you realize that the patient in the hospital is no different than the customer in a restaurant,” he says. “They want good food. If there is a time in their life that they need good food, it’s when they’re recovering or suffering in a hospital bed.”
Chef Bruno also noticed the culinary and nutritional dimensions of Northwell’s program were not in harmony with one another. Nutrition drove most food and menu choices, with cooks in a passive role. As a result, the menu was light on flavor and static for years at a time.
“It was the same menu, and we kept buying the same frozen food,” says Chef Bruno. “We had to change that.”
He hired 15 new executive chefs and led a menu redesign factoring in seasonality, international flavors and fresh — not frozen — ingredients. Even frozen coffee was swapped out for a fresh, organic and locally roasted alternative. On-site hospital gardens were planted and now yield hundreds of pounds of fresh herbs and vegetables each season.
There was also the literal menu redesign — from menus that looked like “a medical prescription,” as the chef described it, to those visually aligned with what you find in restaurants. (Tone down the Northwell branding and hospital photos, the chef advised; patients know all too well where they are.)
Then the operational makeover took hold. Northwell had too many freezers and too few refrigerators, for one. More than 150 teaching kitchens were created for chefs and registered dietitians to collaborate. And the elevators. Oh, the elevators. How much elevator access is required to deliver hot food to hundreds of patients? It’s a question Chef Bruno spent a considerable amount of time on.
“Hospitals were built 40, 50 years ago. They were not designed to serve great food, and most of the time you had one elevator to serve food to 500 to 800 beds,” he notes. The retooled menu accounted for these obstacles, with food and modes of delivery that can hold the proper temperature for the necessary time.
The menu improvements, surprisingly, led to cost savings. The system saved half a million dollars in 2021 because of reductions to food waste. The fresh, not frozen, coffee saved $250,000 across the system. Mr. Gierlinger tells me that the last two years have been more challenging due to higher inflation and increased food prices, with costs increasing above the typical 2% inflation.
“But we are stabilizing now,” Mr. Gierlinger says. “The only investment, really, we’ve made are great chefs in the kitchens, but we did not break the bank on that. The other thing we found is that what we paid chefs in the hospitals was below many line-level positions, below what we paid bedside nurses. If you really step back and look at the whole picture, you see the missed opportunity and the great impact it can have on patient care. It makes you wonder why it hasn’t been done before.”
After Northwell changed menu offerings, patient scores rose from the 9th percentile to the 50th to 60th before hitting a snag. The scores plateaued there — smack dab in the middle — for about six months, confounding the classically trained chef. Food continued to improve, but scores did not.
Facing the new risk of mediocrity, Chef Bruno decided to return to observational mode and study the life cycle of the food after it left the kitchen. The problem was immediately clear.
“We were delivering the food to a member, not a human being,” he says. “There was no eye contact. We were just basically dropping the tray in front of the patient, asking them their name and date of birth, and nothing else.”
Here began the portion of overhauling the status quo — that ho-hum food warrants ho-hum service, a transaction with little pride or hospitality. It is the cultural work that Chef Bruno and Mr. Gierlinger confronted head on to ensure they weren’t just changing menus, but also changing the perception of food’s role in healthcare.
With the chef’s intervention, Northwell’s room service employees were retrained to boost expectations for eye contact, introductions by name, explanations of the dish, checking in and checking back on patients’ additional food needs, a smile before parting, and well wishes for the meal to be enjoyed. Meal delivery is now described as room service or in-room dining. With greater hospitality in place, scores began to climb again.
Systemwide, Northwell’s food program is within the top 20% of hospitals nationwide based on Press Ganey patient feedback, with seven of its hospitals sitting in the top 10%.
And patients weren’t the only ones to notice the upgrades.
Northwell’s wait list of chefs eager to continue its reimagination of hospital food and lead high-energy teams is one of the most impressive results of this yearslong effort, and a testament to the fact that transformational thinking serves as a magnet for talent.
Chef Bruno began recruiting others to the health system after he joined in 2016, calling chefs in his network. “I told them, ‘Listen, I’m the one in charge of food now for Northwell, and I’m committed to make changes, and I need great chefs.'”
One of his draftees was Andrew Cain, his former assistant, a Michelin star chef and former executive sous chef of Fairmont Sonoma Mission Inn & Spa, who joined the health system in 2018. Chef Bruno recruited another Michelin star chef shortly after that.
Three Michelin star chefs creating hospital food, and culinary greats start to take you seriously.
“Suddenly I’m starting to receive calls from chefs: ‘Hey, Bruno, I worked with you 10 years ago. Are you hiring? I’d like to work with you again,'” the chef said.
Mr. Gierlinger said putting people in charge of kitchens who are passionate about improving food and patients’ experience — who “truly care about what leaves that kitchen” — is the most important investment of the overhaul. Northwell aims to offer competitive benefits for culinary teammates, which can mark a departure from the inconsistent and demanding work of restaurants and kitchens. It offers a salary range of $62,250 to $100,130 for executive sous chefs, with hours from 11:30 a.m. to 7:30 p.m., which are unheard of in the dining world.
Food is one reliable vehicle for human stories. In healthcare, there are plenty of stories in waiting similar to Northwell’s. Health systems are human-powered organizations, which are inherently imperfect. It may not involve food, but somewhere in your organization is one person with ideas of how at least one thing could be better. Or even good. Excellent, possibly. Talent, passion and transformational thinking are drawn to such possibilities.
I tell Chef Bruno that this story — 10 million meals per year, Michelin star talent waiting to be hired, short ribs on every hospital menu — may be read by some as exceptional, a difficult feat to scale at other health systems nationwide. He closes his eyes and begins shaking his head ‘no’ before I can complete my thought.
“Go ahead,” I invite him.
“Those are all excuses,” he tells me. “Quality is a commitment. If you want to serve good food anywhere in the world, you can serve good food. It doesn’t have to be expensive, it doesn’t have to be very diversified. In a country like the United States, you can get anything anywhere.
“And it’s not about cooking with expensive items. It’s just about looking at what you have available in your area, the demographic of your patients and what they want and like, as well as your employees. And that’s what you serve them. Cooking a good meal doesn’t take more time than cooking a bad meal.”
(Mr. Tison and his team finalized 2023 Thanksgiving menus for Northwell’s hospitals by the time this story was completed. Each hospital has a different menu. A sample menu, this one for its South Shore University Hospital, is shared below. A plant-based version of the menu is offered as well.)
Butternut Squash-Apple Soup
chives, toasted pumpkin seeds, cinnamon crema
Fall Harvest Salad
beets, butternut squash, apples, dried cranberries, maple-balsamic dressing
Oven Roasted Fossil Farms Turkey Breast
cornbread stuffing, sweet potato puree, green beans, fresh cranberry sauce, cider gravy
Junior’s Vanilla Bean Cheesecake
pumpkin anglaise, whipped cream, graham cracker crumble
Caramel Pumpkin Mousse
caramel sauce, graham cracker crumble, cinnamon sugar