Podcast transcript

Sandra Lindsay:  0:08
Hello and welcome to 20-Minute Health Talk. I’m Sandra Lindsay. Today I’m excited to kickoff a three-part series all about one of my favorite topics, food as health. I’m a foodie. I love food, and I love a nice healthy meal that is presented well, as I eat with my eyes.

I am from Jamaica, and in my culture food is an important part of health and healing. We have plans and food that we cook or use to make teas for different ailments, so I had this idea of taking a holistic look at the role food plays in the healing process. And my guests today are the perfect duo to get us started on this journey. Bruno Tison is a culinary master. He earned Michelin Star recognition for three consecutive years as the executive chef at the Fairmont Sonoma Mission Inn and Spa in California. 

Add on the 14 years at the Plaza Hotel in New York City, and his experience cooking for kings, queens, and presidents, and you’ll get an idea of the significant role he has played in the food industry over the last 35 years. His latest role is right here at Northwell Health. As the Vice President of Food Services and Corporate Executive Chef, he is overhauling what hospital food and how we all think about it.

Our other guest is Sven Gierlinger, Northwell’s Chief Experience Officer, a self-described disrupter in the healthcare space. He brought Chef Bruno to the health system to spark this radical transformation seven years ago. 

On today’s episode, Sven and Chef Bruno explain how they brought restaurant-quality food to Northwell’s 21 hospitals and why food as medicine is their guiding light. Over the next few weeks, we will bring you conversations with other inspirational leaders who are finding innovative ways to address food insecurity in our communities, but for now, let’s get started on part one of this series. Here is my conversation with Sven Gierlinger and Chef Bruno Tison.

And then they get the food, and it was a huge disappointment. That was the impetus for us to make sure that we do something about that. 

Sandra Lindsay: 5:18
In health care, I’ve been a patient twice, and I remember telling my family make sure you bring me food from home please. I’ve also served as a clinician at the bedside, and I remember to fluff in the potatoes that looked brown so that it would look more palatable. Organizing the tray so the presentation looks well because I was embarrassed with bringing in some of the trays to the patients. 

Sven Gierlinger: 5:50
I believe it. That is another great reason why it is important for us to do that because it took you away as a leader on the unit to focus on the things that you should be focusing on. It took the staff away to do that, and like you said, it took the patient’s family away so they have to worry about to bring food to the patient.

When we serve food that gets thrown away, it makes no sense whatsoever, so the burden is on everybody around it. If we just get it right in the first place, then it frees up everybody else to focus on what they need to do. 

Sandra Lindsay: 6:24
Chef Bruno, you have cooked for kings and queens and celebrities and presidents. How did you get to Northwell?

Bruno Tison: 6:37
After 35 years in the restaurant industry, I was still enjoying myself. I had worked in five-star hotels, such as the Plaza Hotel, Michelin-Star restaurants, and myself and my team we received a Michelin Star in a resort in California where I was working. I had an experience where I was cooking for wealthy people, and I thought to myself, if you were not wealthy, you would have enjoyed that meal tremendously.

And I did some type of a clique where I said one day I’m going to cook for people who either cannot afford it or really are in need of it, and when I was introduced to Northwell by a friend who worked with me at the Plaza Hotel I said that is what I need to do. I need to change healthcare food. I need to cook for people who are suffering or recovering or in pain, people who really need to enjoy a good meal. 

Sandra Lindsay: 7:41
Sven, how did you find Chef Bruno?

Sven Gierlinger: 8:35
Yes, that became very clear that we needed somebody that brings a completely new fresh mindset to the work and to transform it. I think otherwise we would have made some incremental change probably. We would have gotten better, not to where we are today. And having worked myself for almost two decades in the hospitality industry and working for Ritz Carlton, I think when we met – although he speaks French and I speak German as native languages, we spoke the same language of hospitality on food and clicked on that.

That is when I realized, yes, that is what we need. We need to run it like in a hotel, a hotel kitchen where there is passion for the food and where the staff truly care about every dish that goes out of that kitchen goes to somebody that will eat that and that it fills them with joy and happiness because the food tastes so good. 

Sandra Lindsay: 9:46
You started this transformation about 6 or 7 years ago. At that time, were there other health systems doing this kind of thing, and how unique is this?

Sven Gierlinger: 10:00
Yes, not to – I would say in my humble opinion -- the caliber that Bruno is. I think there are certainly hospitals across the country that have taken on that challenge and that have improved their food services, so we are not the only ones. I think what sets us apart is the rapid transformation and Press Ganey has told us that they haven’t seen an entire database this rapid improvement from the bottom percentile to almost the top percentile now, and I think it is the scale that we’ve done. It is an individual hospital. It is two or three hospitals that have improved their food. To do it for 21 is a whole different ballgame. 

Sandra Lindsay: 10:48
Sven, you mentioned Press Ganey. And just to explain for listeners, this is a survey that, upon discharge, is sent to patients for them to rate us about their experience in our hospitals, and really what this is is the voice of our customers. They give us their feedback, and that gives us an opportunity to address whatever issues that they identified in their experience in our hospitals.

One of those questions has to do with hospital food. With that said, what has been the feedback from patients and their families?

Bruno Tison: 11:30
Well, the scores six years ago, six-and-a-half years ago were in the ninth percentile on the Press Ganey scale, which means that 91% of the other hospitals in the country are performing better than us, so it was pretty low. As of yesterday, our score was 83%.

Sven Gierlinger: 11:56
And that is the average for the health system. There are seven hospitals, seven or eight that are above the 95% percentile. That is close to perfection. 

Sandra Lindsay: 12:05
That’s extraordinary. 

Sven Gierlinger: 12:07
The numbers are one thing I think.

Bruno Tison: 12:10
Yes.

Sven Gierlinger: 12:11
When they check the box in terms of the quality of the food, it is really the qualitative feedback we’re getting now, the stories we’re getting from patients. That is what makes a difference and I think keeps us motivated because now they’re talking about it helped me forget about the pain that I was in. It is heartwarming to know that I had fresh healthy food available to me. My family didn’t have to bring it in. All those things we talked about earlier on the negative side have now turned on the positive side.

Food in healthcare, food in hospitals was viewed as a liability, and we have to do it. And everybody was just thinking about cost when it came to it, and I believe we turned it into an asset where it is something that we can be proud of that the patients celebrate and love, and it changes their perception about that hospital stay where they didn’t really want to be in the first place.

Sandra Lindsay: 13:15 
Chef Bruno, let’s talk about your transformation strategies. You had never worked in health care before. 

Bruno Tison: 13:23
Never. 

Sandra Lindsay:  13:24
Here you are. You come in. How did you transform this place?

Bruno Tison: 13:31
It’s like when you build something one brick at a time so I adopted that method if I may say. I know that Northwell was a huge company, and I cannot do everything at the same time. Basically, it was step by step. It was first of all spending a lot of time in each hospital because each one is different. There is different equipment, different layout, different setup, different staff, different issues, different demographic of patients.

So it was about studying case by case and deciding what I could do for each hospital and at the same time what I could do for all the hospitals at the same time. 

We brought in 15 different executive chefs that came from hotel/restaurant background. Some of them have worked in famous places, such as the French Laundry, the Ritz Carlton, the Plaza Hotel, Four Seasons. We can be compared to a small restaurant/hotel company, and there are many other restaurant companies in the United States that would envy our team.

When I arrive, one of the first questions they ask me is are we going to have the same menu for everybody in the company? Are we going to have a standard menu? I said, well, I like standard, but at the same time, they are the enemy of creativity. I said I want each chef to really understand the demographic and the need of each patient and create the menu around that. 

Sandra Lindsay: 15:14
What are some other strategies? Were the kitchens up to your standard? Did we have all the tools and equipment?

Bruno Tison: 15:20
No. We had decades of what I would say, not only Northwell but in the healthcare system in this country for decades has neglected the food and nutrition aspect of the business. They didn’t look at it as an asset, so the list is long, but we had to improve the equipment. We had to improve the layout of the equipment. We had to improve the quality of the ingredients that we were buying. We had to bring in talented chefs. We had to recreate menus. The menus were shocking to me. They looked like a medical prescription, you know, five, six pages. You had the picture of the entrance of the hospital. You had the name Northwell, and the word diet was everywhere on the menu, and then you look for the food.

I said "Where is the food?" You know, call this, call that for that, and so I said we’re going to create menus that look exactly like a restaurant menu. 

There is going to be no more Northwell logo on the menus because they know they are at Northwell. The doctors have the logos on their vest. We don’t need another one on the menu. We’re going to have beautiful art pictures on the menu. We are going to have shorter menu, less choice but better quality. We are going to remove all medical and clinical terms from the menu, and one of the biggest resistance was from the team. They said, well, how are we going to communicate that to the patients? I said you’re going to come on the floor, and you're going to have contact with the patient. Again, it is bringing the hospitality industry into human contact with the patient, and you know what? We haven’t had a single complaint. 

And actually, what is happening right now is that our nutritionist worked very closely with our chef, but now they feel really included in the success story that we’re having with food because they hear it from the patient. And I’ve seen them personally taking pride in advising the patient on what they should eat and what they shouldn’t eat, and the patient will listen a lot better, a human being but will not read on the menu what they should eat or should not eat because it is not only about food. You can serve the best food in the world. If you don’t have great service, you won’t go back to the same restaurant. 

Sandra Lindsay: 17:56
We’ve evolved. I can tell you that one of the highlights of any restaurant experience for me is when the chef visits to say how was the food? How was the experience? I really love that. 

Bruno Tison: 18:11
In the beginning, I said I would like the nutritionist, the food and nutrition director or director of dining services, and executive chef to do the rounding to get the feedback from the patient, but now we’ve expanded it because it is doing so well seeing an executive chef versus white shirts and apron and white hat coming to them and asking how did you enjoy your meal, is there anything else I can do for you, or what do you think about my food? It is really impressive for the patients, and they have responded very, very well. 

Sandra Lindsay: 18:49
Let’s go back to the quality of ingredients because it all starts with ingredients. When I migrated here at age 18, I worked in a supermarket, one of my odd jobs to accumulate funds to send myself to school, and I remember customers coming with trolleys of frozen foods. It was a shock for me because, coming from Jamaica where we make fresh food, I didn’t jump on the bandwagon because my minimum wage couldn’t afford to buy TV dinners, and it was also not in my culture to eat frozen foods, but I understand that is what we typically served in our hospitals. 

Sven Gierlinger: 19:41
Can I just jump on that because you just made such a great point that you couldn’t afford the TV dinners. You couldn’t afford the processed food, and it is actually cheaper to buy fresh ingredients, fresh produce/meats, etc., and then cook from that. That is exactly what is happening in the hospitals. We actually haven’t increased the cost, very minimal with inflation because the processed foods were actually more expensive then buying fresh ingredients.

Many health systems that we’re talking to now -- because everybody is inquiring about how we did this -- we noticed, and we can tell that they can’t wrap their head around it how that is possible from a financial perspective, but that is exactly the point. It is less expensive to cook with fresh ingredients.

Bruno Tison: 20:36
If I may add something, the sad part is that our hospitals or indeed the kitchens of our hospitals were designed to reheat food, not to cook food. To your question at the beginning, yes, we did have to improve the equipment and change the layout of our kitchens to be able to serve better food and cook it. We actually converted 90% of our freezers into refrigerators. We don’t need freezers anymore except for the four or five days of supplies that we need in case of emergency. 

Sandra Lindsay: 21:09
We have put away the microwaves and the reheaters.

Sven Gierlinger: 21:15
The scissors and the can openers. 

Sandra Lindsay:  21:19
It’s all gone, excellent. You have been making headlines. I have the People Magazine article here. They did a brilliant feature on you and the journey to transforming food here at Northwell Health.

Sven Gierlinger: 21:39
Can I just point out that, if you go through the index in the front of the magazine, you have Kate and William and movie stars and then Bruno Tison, so that’s awesome.

Bruno Tison: 21:55
I never thought that People Magazine would write stories about hospital food.

Sven Gierlinger: 22:01
I know. I was super excited about it. 

Sandra Lindsay: 22:08
What is next for you? Are other health systems reaching out to you?

Sven Gierlinger: 22:12 
Many of them are. Just today a couple of hours ago we had a call with 20 leaders from a big health system in the Midwest wanting to learn from us. What is next is to continue to get to this perfection because there is a lot of work still that can be done but also to teach others and help to do that because we truly believe that the days of bad hospital food need to be over, and I think there is a reason why we’re getting all this attention because people want better food in hospitals. And we want to play a role in helping others to do that. That is why we are going to all these conferences and presentations to get the word out. 

Sven Gierlinger: There are many other things we’re working on to tie what we’re doing around food with the social determinants of health efforts that we have going on, the community health efforts working with Dr. Debbie Salas-Lopez and her team here at Northwell, working with farms creating partnerships. Once you start, it is almost an unlimited amount of possibilities where you can take this. One other thing which is really exciting is last week I had a meeting with a congressman who reached out to us because he read the Washington Post article. He met with us a few days later in Manhattan at Lenox Hill Hospital because he was so blown away with what he read and that the whole country needs to follow this model, and he said that he will personally speak to the White House, which you are very well familiar with.

Sandra Lindsay: 24:04
I had the opportunity to see the kitchen by the way, amazing. 

Sven Gierlinger: 24:12
Because it ties to the president’s efforts around nutrition and fighting hunger in this country so it is all connected. 

Sandra Lindsay: 24:23
This has been, again, an amazing conversation. Now, I am hungry. 

Sven Gierlinger: 24:29 
Me too. 

Sandra Lindsay: 24:31
Thank you so much again for joining us on 20-Minute Health Talk.

Sven Gierlinger: 24:35 
It has been an honor.

Bruno Tison: 24:37  
It was a pleasure. Thank you. 

Sandra Lindsay: 24:42
Once again, a hearty thank you to Chef Bruno Tison and Sven Gierlinger, the architects of this food transformation here at Northwell Health. I hope you enjoyed part one of this three-part series dedicated to exploring food as medicine.

The next episode features my interview with Debbie Salas-Lopez, MD, MPH, Northwell’s senior vice president for Community and Population Health. We can’t wait to bring you that episode and share with you what she is doing in the community addressing food insecurity. Until then, I’m Sandra Lindsay, and this has been 20-Minute Health Talk.