When you work for a healthcare company that puts patient care first, there tends to be all sorts of resources at your disposal. I recently discovered that our Wound Care Advantage CFO Rylan Smith’s brother is a chef at a hospital in the state of Washington. Brandon Smith is dietary manager/executive chef at Summit Pacific Medical Center —CAH, in Elma, Washington.
I decided to reach out to Smith to find out what goes into the planning of meals for patients in a hospital setting. He discussed his role in healthcare, the farm to hospital trend, his passion for his work and more.
James Calder (JC): How many beds are in your hospital and how many patients is your team feeding on an average day?
Brandon Smith (BS): We are a 10 bed Rural Hospital. Our average census is 6 patients.
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JC: How long have you been a chef in a healthcare setting?
BS: I have worked in the healthcare setting for 29 years. I started working as a pot washer in a small acute care facility in Lancaster, CA and worked my way into management. I worked at various facilities throughout the Southern and Central CA market. I spent the majority of my career as Food and Nutrition Services Director.
JC: How and why did you get into this line of work?
BS: Initially it was a consistent paycheck to support my wife and I at the beginning of our marriage, and it was flexible to allow me to attend school. As I became more involved in preparation, menu planning, ordering and receiving, I found that it was enjoyable work, that I could provide a service, and have a profound effect on people in both their physical health and social/emotional outlook.
JC: What specific challenges do you face for creating menus for people with all types of health conditions?
BS: There is so much conflicting data that is constantly churned out by business, media, special interest, emerging diet trends, scientific research. The challenge is to educate the consumer and provide a balanced approach that can be sustained throughout the patient’s life. Many health conditions require differing diet approaches. Diabetes requires attention to sugar and carbohydrates. Cardio-vascular disease typically requires adjustments to salt, fat, and cholesterol intake, diseases affecting the kidneys require limits to potassium, sodium, and sources that are rich in those. More and more people are being diagnosed with food allergies, or food intolerances. Much of the time patients are self diagnosing based on fad trends or recommendations by friends and family, so getting beyond misconceptions can be challenging. Staying abreast of current research and weeding through what is accurate data and what is the latest short lived plan can be cumbersome as there is so much information available.
JC: Why do you find the work you are doing rewarding?
BS: Primarily it is the psychological side of preparing and serving meals that I find most rewarding. It is satisfying to create and serve a meal to a patient who may have difficulty eating, or who chooses to eat inappropriately and witness the shift in their paradigm as they realize food that benefits them, that has nutritional value, that supports their healing can actually be a pleasure for them to eat. It’s great to see people realize that they won’t have to make a tremendous sacrifice in flavor or enjoyment when having to make a diet change, that it can be something they are able to sustain long term. I love to hear, comments like, “this is healthy?” or “I could eat like this every day.”
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JC: What changes have you witnessed in healthcare culinary arts over the years?
BS: It is great to see healthcare food service taking a more responsible role in educating the public on what healthy consumption is, from appropriate portion sizes to finding balance, to sustainable product sourcing. At the beginning of my career the focus was more on treating meals as clinical, much of the products hospitals used were processed with nutrition added, many of these products were not available to patients once they left the hospital so it could not help them to sustain a diet change. Many of those clinical products it turns out were not all that healthy in the first place, and the majority lacked in taste or texture appeal. More recently diets have become more liberalized to encourage poorly nourished patients to increase intakes, and patients who consume too much are encouraged to moderate portions and enjoy a more balanced approach, some of the sweet things they crave prepared using fresh and beneficial ingredients, rather than the processed variety. Much of the battle is helping patients to overcome their fear of losing their comfort foods, of changing routines (not stopping for fast food as often), and in providing education and encouragement in making positive nutrition choices.
JC: Are there any health or food trends that you follow closely for your work?
BS: I suppose the trend would be called Farm to Hospital. I try to lead by example; we seek to encourage balance, appropriate portion sizes, emphasis on the fresh, responsibly produced, and sustainable, minimal use of processed foods, limits on empty calorie products that provide no nutrition, such as soft drinks, or refined sugar products. There are organizations that we are committed to such as Healthy Food in Healthcare, which is a part of Healthcare without Harm, and the Healthier Hospitals Initiative.
JC: What types of things does your team have to pay close attention too when prepping food for diabetic patients?
BS: We practice a liberalized diet, we want to make sure our patients eat; getting nutrition into them is the most important step in the healing process. We count carbohydrates to help patients keep their blood sugar under control; we encourage patients in the choices that they make when choosing the items that will make up their meal. We menu items that can be reproduced easily at home, we feature comfort foods to help patients get into a positive frame of mind. We portion appropriately. We use fresh ingredients when possible, with an emphasis on color and contrast. Appearance and texture go a long way to encourage the appetite. Having food that looks good also helps the patient to more readily make a change in diet from one that is focused on convenience, processed carbohydrates, and sugar to one that is fresher, nutrient rich, and balanced.
JC: What advice do you have for chefs that want to cook in the healthcare setting?
BS: Know that you are always in a state of learning. Healthcare chefs have to know a lot about what makes up the food they are preparing. Certain diagnoses prohibit some foods that are high in certain minerals, proteins, fats, carbohydrates. Learn to make the things that people like in a new way to bring out the nutritional benefit. We work in a highly regulated industry, there are a tremendous amount of laws and rules that must be adhered to and demonstrated. Know what it is you’re getting into… hospital food comes preloaded in peoples’ minds as negative, plan to change their expectations. As much as there is opportunity for the art of preparing great food, there is the responsibility of educating and encouraging your customer. There is a great deal of variety in our field, I can go from making a pancake slurry and pureed scrambled eggs with Nectar thick Milk in the morning, to a $75 a plate Moroccan themed fundraiser later that evening.
JC: Do you have anything else that you would like to add?
BS: As chefs working in healthcare as a part of the interdisciplinary care team, it is our goal to promote healing in the patient by preparing and providing the nutrition that the patient needs presented in a way that will provide pleasure in the meal and improve intake.
