To get people to eat salad, make it cheaper than a cheeseburger.
That idea is one of dozens of incremental changes executive chef Ellen Ritter, 41, has overseen over the past few years at UW Health. Each update is designed to improve dining options for the thousands of patients, families and medical staff who eat in UW cafeterias and hospital rooms every day.
During Ritter's tenure, the food at large-scale facilities like the American Family Children’s Hospital and UW Health at The American Center has been getting fresher and more sustainable. More and more, the food is locally sourced, too, from farms like Vitruvian Farms in McFarland or Peacefully Organic Produce in Waunakee.
Meanwhile, prices for the healthiest things have gone down. A trip to the salad bar at University Hospital now costs $4.99 (down from $8 two years ago). Beef is still available, but a burger made with a pasture-raised patty costs more than a sandwich made with organic chicken or salmon.
“The biggest challenge for institutions is this idea that food should be a benefit,” Ritter said. “It should help people. It should be preventative; it should make people feel good. It’s not a revenue center.
“We shouldn’t be profiting off poor food choices.”
Even before Ritter took her job in October 2015, UW Health had simultaneously dropped fryers and sugar-sweetened beverages. In 2016, Ritter's team came up with “52 Weeks of Wellness,” highlighting culinary additions like microgreens, gluten-free cookies, antibiotic-free chicken and high protein snacks.
A new farmers’ market with eight to 10 vendors is held every Thursday during the growing season from 2 to 5 p.m. near the Wisconsin Institute for Medical Research on University Bay Drive. Even the frozen vegetables now come from Wisconsin farms.
Ritter trained in restaurants but has been working in health care for more than 15 years. She stopped by the Cap Times in April, when the “Harvest of the Month” — 2017's big food promotion — was leafy greens.
A major challenge for making our national food system sustainable has been getting institutions like schools, corporations and hospitals on board. Why did you decide to join that movement?
What’s unique about UW is we’re self-operating. A lot of hospitals and universities have gone to contract managed food service.
The autonomy and independence in a self-operating environment is amazing, where you have the ability at the institution level to make decisions and impart change as opposed to a big company that “you have to buy this chicken because it’s the chicken we’re contracted with.”
Also unique to UW Health, and a big catalyst, was the senior administrative support. Dr. (Jeffrey) Grossman was the interim CEO when I started.
It was my first or second week on the job, and he came through the cafeteria. He said, “We need to have better quality. We need to have food be a benefit to staff here.”
Usually in a hospital it’s about revenue and budget: “Sell more slices of pizza because they’re cheap to produce but people will pay $5 for it.” Dr. Grossman said, “Cover operational costs but we don’t need to profit off of food. We don’t need to encourage bad habits so we can profit from the revenue it’s generating.”
That was our green light.
What are some of the changes you’ve made?
The biggest bin on the salad bar when I started was iceberg lettuce. There was probably a small little half bin of romaine. Now the iceberg is in the smallest pan and we have mixed greens and microgreens and baby spinach and romaine and these beautiful greens. When you can locally source lettuce, the quality and the flavor is amazing.
Around the same time we took the salad bar price from $8 a pound to $4.99 a pound, and we are just going over volume numbers. At the end of 2015, we were selling just about 12,000 salads a month. A year later, we’re selling 21,000 salads a month.
That’s almost double!
What’s amazing to us is how pricing strategies can change behavior. We saw people that were probably getting a cheeseburger going to the salad bar because they can get more food for less, and good food.
We lowered the price of milk, bottled water, cans of sparkling water. Anything that fit our wellness criteria we wanted to incentivize financially. On our grill menu for breakfast, you can add all the veggies to your omelet for free but if you want bacon, ham or sausage it’s 90 cents.
You should see, people are like, “Give me all the veggies, they’re free!”
We’re seeing more and more this idea of doctors prescribing food, or people using their diet as a form of medicine. What’s your stance on that?
Food is preventative medicine. You look at our population across the country and more people have sedentary jobs and sedentary lifestyles. Our population at UW Health, you have people in high stress jobs, working 10-12 hour shifts with a 30 minute break.
They’re going to come down to the cafeteria and grab what they see and go back upstairs. We want to create a retail environment where it is a benefit. You shouldn’t have to pay out the nose to get a salad. Food is a wellness benefit to our 18,000 employees.
I heard recently from a food director at the University of Wisconsin-Madison that getting local produce in large quantities can be tough, especially out of season. How have you addressed that?
The biggest challenge for us is our volume. We have to have multiple partners. We can’t go to one farmer and say we have to have 300 heads of romaine every other day. But we don’t want to partner with people of a certain size. We want to partner with everybody that meets our criteria. We do a lot of farm visits.
It’s the logistics, like I have six farms I need lettuce from. This guy can only do 20 pounds and this guy can do 30 pounds and I need 1,000 pounds for the week. A food hub is something I’ve heard a lot about. How do we aggregate these resources and make them more accessible to everyone?
One of our solutions was we went to Sysco, our broadline distributor, and asked them to become a member of Fifth Season, a cooperative that works with veggies and yogurt. All of our frozen vegetables, most organic, we get through Sysco but it all comes from Wisconsin. It’s great because the economic impact stays here in the state.
You have a background in restaurants. Why did you go into health care?
Everybody we feed at UW is there for not a great reason, and we’re full all the time. You don’t have any choice as a patient in a hospital. Nobody’s going to ask if you want this IV, this treatment.
The one choice you do have most of the time is food. Food is emotional for everyone — it conjures up a memory, if there’s that special dish somebody in your family used to make for you. If you’re not feeling well, it's so individual what you crave to bring you comfort. I liked the idea that my work was benefiting, outside of just giving somebody a check on the table.
Patient feeding is why we’re there. The retail is secondary. We have a pretty extensive menu and we try never to say no.
I saw one of our supervisors last week over a burner stirring a pot. There was a patient going through cancer treatment who really wanted a good broth-based soup, so she was making a pot of soup.
It’s the compassion you find with people that are drawn to health care, whether you’re a nurse or working in a kitchen, that sense of trying to do something for someone else.
I can’t see myself doing anything else.