Stephanie Cook

Patients and staff enjoy traditional foods at Saskatchewan Health Authority Regina on National Indigenous Peoples Day

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To celebrate National Indigenous Peoples Day on June 21, Stephanie and her food and nutrition staff at Saskatchewan Health Authority facilities in Regina served up delicious traditional dishes to both staff and patients. We interviewed Stephanie to learn about how she and her team planned this menu and what inspired her.
 

What got you thinking about Indigenous food in care?  
Nourish! It was the collective knowledge and the passion of my Nourish colleagues that inspired me to start thinking about how I could incorporate more traditional foods into the menus where I work. I had a moment around the Colton Boushie trial where I thought to myself, ‘If everyone did one small thing to move this forward, we could change things.’ And then I realized, ‘Well, what am I doing?’ So I decided to dedicate a large portion of our new Wellness Garden to Truth and Reconciliation, where we will grow traditional medicinal plants in partnership with local First Nations communities and Elders. Doing this menu was another step we could take to put our learning into practice.

Why does it matter to you?
It matters because many of the people in our care have Indigenous roots and sadly this has been largely overlooked in our menu planning. I believe that every person has the capacity to contribute in a positive way to truth and reconciliation.
 

Nutrition and Food Services employee, Lee Bannister, dishing up the bison stew for patients at the Regina General Hospital in celebration of National Indigenous Peoples Day!

Nutrition and Food Services employee, Lee Bannister, dishing up the bison stew for patients at the Regina General Hospital in celebration of National Indigenous Peoples Day!


What's on the menu and how did you develop it? Where did you source the food? 
At our Nourish retreat in April, my group had the good fortune to visit the Squamish Lil'wat Cultural Centre in Whistler as a part of our learning journeys, and have lunch from their café. I had the most amazing salmon sandwich on bannock and wondered if it was something we could do in our cafeterias here in Regina. I described it to one of my Food Services Managers (Garnet Roberts), who is also an amazing chef, who said “no problem.” Garnet used Traditional Foods and Recipes from the Wild Side, a publication by the Native Women’s Association of Canada as a resource for recipes.

Our Food Services Manager used ‘Traditional Foods and Recipes from the Wild Side,’ a publication by the Native Women’s Association of Canada as a resource for recipes.

 

With National Indigenous Peoples Day on the horizon, we selected this day for its debut and learned to create a recipe for salmon on bannock sandwich with arugula and a juniper dill aioli. Using bison sourced locally from Saskatchewan, Garnet also prepared a dish of bison stew, served with corn and bannock to honour the day while also celebrating local ingredients. The stew was perfect as it could work with nearly all diet types (although we did have to relax our restrictions for sodium and fat). We served this meal across our four Regina sites to nearly all patients and residents and featured this item in the cafeteria as well. We lost count after 1000 servings! It was a big hit.
 

Joyce Wong serving up the salmon on bannock sandwich in the hospital cafeteria

Joyce Wong serving up the salmon on bannock sandwich in the hospital cafeteria


What reactions did the residents give? What about staff?  
There was a real buzz in our kitchens. Staff was excited about serving something new and different and we had never really done anything in celebration of National Indigenous Peoples Day before. Many of the staff tried the stew before we served it and they felt proud – proud of our department for making the day special for the people in our care and proud of themselves for being a part of it.

Will you do it again? Same or different?  
We will absolutely do it again, but we will have to find a different recipe for next year.  The bison stew and bannock was such a hit we are planning to add it into our regular menu rotation. As for the salmon sandwich, I’m pretty sure we will see it in our cafeterias again soon – it sold out too!
 

The bison stew and bannock was such a hit we are planning to add it into our regular menu rotation.
 
Paul Neiman, a cook at the Wascana Rehabilitation Centre (Regina) , proudly displays the salmon on bannock sandwich prepared in honour of National Indigenous Peoples Day. Wascana joined the Pasqua Hospital, the Regina General Hospital and Regina Pioneer Village in this celebration, serving more than 2000 servings of bison stew and salmon sandwiches to our patients, staff, and visitors.

Paul Neiman, a cook at the Wascana Rehabilitation Centre (Regina) , proudly displays the salmon on bannock sandwich prepared in honour of National Indigenous Peoples Day. Wascana joined the Pasqua Hospital, the Regina General Hospital and Regina Pioneer Village in this celebration, serving more than 2000 servings of bison stew and salmon sandwiches to our patients, staff, and visitors.


What advice do you have for others who are thinking of bringing traditional foods into their own menu? 
My advice to others is, especially if this is for a special occasion like National Indigenous Peoples Day, would be set aside your dietitian hat (or work with your dietitians) and relax your nutrient goals for the day. We decided we wanted something special for everyone, including our patients on more restrictive diets (like cardiac and renal), so they too could experience the meal as close to the ‘real thing’ as possible. We made a version with ground bison and veggies so even our folks on soft and minced diets could enjoy the same meal. We were so pleased to hear we got it right, with colleagues from Native Health Services sharing… “that was some top quality bannock today”.

Thank you Stephanie!

The Long and Winding Road – Creating a New Story of Hospital Food

By Stephanie Cook, Regina Qu’Appelle Health Region, Saskatchewan

Stephanie Cook is the Director of Nutrition and Food Services for the Regina Qu’Appelle Health Region. She is passionate about food and nutrition and has spent the last two decades leading initiative aimed at improving nutritional well-being, such as programs for overweight children, developing healthy food policies and combating malnutrition in hospitalized patients.

Ringo Starr does not seem pleased with his hospital meal. 

Ringo Starr does not seem pleased with his hospital meal. 

It’s hard to pinpoint that place in time when hospital food, once a cornerstone of treatment and recovery and considered wholesome and healing, changed in the public’s opinion to its current lackluster reputation.  I suspect it has steadily declined as medical science and technological advancements began to trump food as the primary therapy and budget expense.  I can’t say for sure what Ringo Starr was thinking when this photo was snapped in 1964, but if his expression is any indicator, I think he was less than impressed with what was on his plate.  Fast forward more than half a century later and the perceived dissatisfaction with hospital food is only growing, with those consuming it not shy about sharing their discontent. Any patient with access to a cellphone can take a photo of their meal and post it online, sometimes creating nothing short of a media firestorm about the deplorable state of hospital food.

But then, I wondered, is the food really that bad or is its reputation so tarnished by rhetoric that we never considered the possibility it could be anything different?

For years I believed it too - hospital food sucks.  In my time as a clinical dietitian I would nod, knowingly and sympathetically, as staff joked and patients complained about the food.  What could I do? This is a hospital, a publically funded institution with an ever-shrinking food budget and fewer staff to prepare it. With pre-packaged out-sourced foods and fancy re-therm equipment taking the place of real cooking from scratch, of course food quality suffered.  How could we be expected to strive for anything more than mediocrity? But then, I wondered, is the food really that bad or is its reputation so tarnished by rhetoric that we never considered the possibility it could be anything different?  Was it possible that any attempts at quality improvement were simply going unnoticed, mired down by an impenetrable narrative?  When I looked around I saw many patients cleaning their plates and asking for larger portions. Considering that the context is a hospital, where people are sick, away from home and family, in a strange and sometimes frightening environment; I had to wonder, is the food really that bad?

Admittedly, the food served in hospitals may not be exactly like our grandmothers. However, think about the task at hand - serving patients, most of them unwell, with different food preferences, coming from different cultures, and with varying nutritional needs — that’s no small feat!  So when we put this in perspective, is the negative narrative that engulfs hospital food warranted? Or, is it simply a self-fulfilling prophecy?  If we think that what we are about to eat is going to be terrible, then chances are it will be.

This issue bubbled to the surface in my health region not long ago when the results of the Canadian Malnutrition Task Force clearly identified how prevalent malnutrition is in hospitals and the many barriers that prevent patients from getting the nutrition they need.  This led us to re-look at our food and assess is it really that bad or are we, hospital employees, so committed to the notion that hospital food is terrible that we unwittingly create yet another barrier that prevents patients from eating well?

4 dietitian students who were running the empty carts back to the kitchen to restock their supply of food (they had planned for about half as many participants!)

4 dietitian students who were running the empty carts back to the kitchen to restock their supply of food (they had planned for about half as many participants!)

 

We devised a plan to try to measure this.  The first step was surveying hospital staff to see what they thought. Predictably, staff rated the food negatively, describing it as unappetizing, lacking nutrition and of poor quality. As our second step, we decided to conduct a blind taste test in order to solicit more unbiased reviews. We advertised throughout the hospital that we were trialing some new items for our cafeterias and invited staff to sample six different entrees and rate their level of satisfaction (and ended up testing a total of 352 portions – reminding us to never underestimate the power of serving free food!).  What we didn’t tell participants was that these were six entrees regularly served to our patients. The results were surprising with over 85% of participants indicating the entrées were “good”, “very good” or “excellent” for all quality measures (smell, taste, appearance, healthiness and overall acceptability).  What’s more, over two-thirds of staff indicated they would purchase these entrees if they were offered in the cafeteria.  That’s right, actually pay money for the very same meals we serve to our patients!

We have had a lot of fun sharing these results both within and outside of our health region. However, the greatest value without question has been sharing our findings with the food services staff.  The positive reviews have helped validate what they know to be true — that every day they prepare and serve good food and they are proud of what they put on the plates.

This is not to say we don’t have opportunities to improve. In fact, listening to our patients was key to having our food so well-received. Patients have suggested they want to see more wholesome comfort foods made from fresh ingredients on the menu. While this sounds like a tall order, especially for hospitals that rely heavily on pre-prepared foods, there are a number of relatively simple fixes that can make a big difference. For example, in my health region we recently changed from buying pre-made broth soups to making them from scratch.  We chose to focus on soup because it is a comfort food, fits most therapeutic diets and tends to be universally well-liked.  We also saw an opportunity to pack in more nutrition using big pieces of vegetables, fresh herbs, noodles or rice and more protein. Not only do our patients approve but food services staff members feel good about making and serving it.  We are also finding opportunities to include more locally grown foods on the menu, and spread the word to our patients and staff about our commitment to building a more sustainable food supply. Inviting staff to “come dine with us” and enjoy the patient meal of the day is another way to start engaging others.

Bridging this gap is going to take more than just improving food -  the healthcare sector needs a new commitment and an updated story of what goes on the plate, and how meaningful this can be to patients.

In order to combat the long-time negative stereotypes surrounding hospital food, we must recognize the gap between where we are and where we want to be. Bridging this gap is going to take more than just improving food -  the healthcare sector needs a new commitment and an updated story of what goes on the plate, and how meaningful this can be to patients.

I asked staff at one of our hospitals the question “why does serving good food matter to you?”.  No matter how they said it, the message was clear.  Food is medicine and medicine heals.

Join me in creating this new story of hospital food!