Who would believe the suggestion that well people might voluntarily choose the dine in a hospital cafeteria?
They do at Holy Cross Hospital in Silver Spring. Neighborhood residents and their families, drawn by attractive prices and homecooked food as well, arrive at the hospital for Sunday dinner. Visitors, doctors and staff - more than 1,200 people a day - dine there, too. In addition the kitchen staff prepares four meals - a day for patients who fill the 338 beds.
The patients choose from menus that include such surprises as bagels, garlic bread and homebaked desserts. There is catering, too: board dinners for 30, employee picnics for 1,200 and medical staff buffets for 200 or more. And Meals On Wheels carryout.
Yet there is no nervous maitre d' on hand to direct kitchen activities. There isn't even a traffic cop.Instead two dietitians, Mary Torina and Vidula Glass, supervise a staff of 80 full-and part-time employees. They reacted with pleasure but no great surprise on being told a recent patient had given them a restaurant rating full of smiles and whisks.
"I think it has to do with the philosophy all over the hospital," Torina said. "We're very patient oriented. All our patients, even those on special diets, receive menus and select their own food and we try to accommodate just about any request. Fortunately we can do it because there is a desire to make the patient feel better psychologically and because we have people in the kitchen who can do what's asked."
That is the answer. Holy Cross has avoided the stigma attached to most institutional feeding operations by refusing to follow conventional wisdom and the [WORD ILLEGIBLE] of dollar logic. Toina estimated per day patient food cost of $10 and said the cafeteria, which offers discounts to employees, runs at deficit.
Why don't they use convenience foods? "It requires a different type of preparation and storage than what we have," Torina answered. "We don't have a big freezer. Besides, they are not as good as home-cooked foods."
Why not have a contract supplier provide the meals and save on labor. "We do our own cooking," Torina said. "It's a tradition here. We've had the same cooks for a long time. If we changed we would have to let some of them go. I wouldn't want to do that. Turnover among full-time employees is very low. Working conditions are good. I think they're proud of their work."
There are four food services a day for patients plus two "nourishments" (fruit juices). Each day the cafeteria will offer three hot entries, an equal number of fresh vegetables, one hot and 14 cold sandwiches. But backed by five cooks and a baker, Torina and Glass are able to deal with modern problems in an old-fashioned way. Real people provide freshly made food and flexibility in dealing with patients' needs and requests. For example:
At the range a cook deftly manupulated a sheet of egg at least two-feet square, added cheese strips, rolled and cut it into omelets and then quickly made another - without cheese. The baker, a woman with a ready smile and a reputation for neatness, had just completed eight trays of apple brown Betty - one of them salt free. On the tray assembly line a dozen people dealt out brunch to correspond with individual orders on any of eight different (color-coded) menus. It takes an hour to an hour and 15 minutes to complete the orders and, according to Torina, a maximum of 15 minutes to prepare and deliver a tray. "It is not usual to have complaints of cold food," Glass said.
Torina, a native of the Washington area, studied dietetics at Michigan State and did an internship with the Stouffer company before coming to Holy Cross eight years ago. She has been the chief dietitian for five years. Glass, her assistant, is a New Yorker with a master's degree in nutrition from New York University. Asked about the presence of bagels on the hospital's continental breakfast menu, she replied with some surprise, "Don't you find bagels on most hospital menus?"
They and four other dietitians track all patients on card files, coordinating the orders of doctors, requests of patients and work of the cooks. The obvious pitfalls, such as someone with an ulcer receiving a regular meal, must be avoided as do the less obvious, a full breakfast being delivered by mistake to someone about to undergo surgery. The dieticians circulate through the wards at meal time with directions to check on food service, to check on eating patterns and to encourage and educate patients.
"People are more aware of nutrition now," Torina said. "There are more questions from patients and lots of calls from people outside the hospital. If we observe bad habits, we try to teach the patients. Some aren't receptive but most are.
"There have been problems in the past," she conceded. "What nutritionists teach and what's in the market-place were not the same. It's important to teach patients something practical. Also, the whole profession has changed. We are getting into preventive nutrition. We are more open. Ten years ago we probably would have been upset with a vegetarian patient. Now we say, 'it that's what you want, fine, but you have to know how to balance your diet.' We are the ones who have to change." They are even involved in an effort to extend nutrition education to doctors.
Glass is a specialist in what is known as therapeutic nutrition. The "regular" diet is for patients who may eat normally. The others need special, or theapeutic, diets. (Patient satisfaction with the food is considered psychologically therapeutic as well.) She feels strongly that the policy of providing a menu for all patients, including those on clear liquid diets, and having dietitians visit the patients pay off.
"If they don't like something, we will offer a substitution," she said. "We will even purchase special food if possible, although we won't run to a deli for corned beef. Usually it's not complicated. It means giving someone chicken salad instead of egg salad or giving a child a hot dog instead of roast beef. Our baker makes salt-free biscuits, coffee cake and cookies. She does peach charlotte and pumpkin mousse as diabetic desserts."
Kosher and vegetarian meals are done on request as a matter of course. Rice is provided with each meal for Oriental patients who wish it. But there are limitations. The lettuce is invariably iceberg, though raw spinach may be offered at the cafeteria salad bar; asparagus is canned, in season and out; artificial bacon bits are used.
The most popular items are steak, fish ("a nice baked haddock") and chicken. Portion control is "pretty standard," she said. "You can't eliminate waste. There are really isn't that much. I'm more concerned if we run our of something. It bad psycholigically for the patient if he doesn't get what he's ordered."
A new wing is being constructed at Holy Cross that will add 112 beds to the hospital. The dietitians foresee added work, but no major changes. "It will take an adjustment," Torina said, then added firmly, "but I still think we can prepare most of our own food."