When it comes to nutrition and taste, hospital food certainly doesn't have a good reputation.
Just ask registered dietitian Paule Bernier of Montreal's Jewish General Hospital, who co-authored a study on how poorly designed Canadian hospital food is, as well as the hundreds of former patients who wrote in to CBC News online earlier this week to agree.
Canada appears to be lagging countries like Britain and the U.S. but there is a campaign to bring a change to what's on the hospital plate and there are signs of improvement.
In fact, there's even talk of a "hospital food revolution" that sees patients getting tasty, nutritious food from local sources.
One example is a new network called Farm to Cafeteria Canada, which is trying to get more local food into hospitals as well as into grade schools and universities.
It describes itself as "part of a broader movement to support healthy and sustainable regional food systems."
Britain is following suit, reactivating a hospital food program the former government discontinued in 2006, much to the delight of Janice Gillan, the head of the Hospital Caterers Association in the U.K., who told CBC Radio, "Food is the simplest form of medicine."
Meanwhile, the London tabloid, The Sun, is campaigning for minimum dietary standards in hospitals.
In Canada, Ontario probably leads efforts for better hospital food, thanks to the provincial government making grants available to hospitals to purchase local food through its Broader Public Sector Investment Fund, Brendan Wylie-Toal of the Canadian Coalition for Green Health Care told CBC News.
St. Joseph's Health Centre in Guelph, Ont., has received some of that grant money and it is an example of what's happening in that so-called hospital food revolution.
Before 2005, nearly all the patient meals at St. Joseph's were pre-made and outsourced. Now, the hospital prepares about 75 per cent of them from scratch.
When St. Joseph's opened its modern new building in 2002, it had no kitchen to prepare meals for the patients in its 240 long-term care beds and 91 specialty hospital beds.
At that time, the trend in food-service systems was to outsource, so the province approved plans for a kitchenless hospital. But that's a trend that now appears to have changed.
The move to home-style meals has not only seen patient satisfaction increase to 87 per cent but it's also had "a huge positive impact on morale," Leslie Carson, the manager of food and nutrition services at St. Joseph's since 2005, told CBC News.
"There's really no joy or sense of ownership in taking a box of lasagna and moving it from A to B.
"But when a cook is making the meat sauce for the lasagna and feeling a sense of control over the destiny of that lasagna, there's a sense of pride in the creation of the food and the serving of the food," Carson added.
Another benefit of on-site preparation is that it seems to be cutting wastage.
It has been estimated that about 30 per cent of hospital food ends up in the garbage. But Carson says that at St. Joseph's plate waste is about half that amount.
Because St. Joseph's tries to be customer-focused, they avoid packaged meals. So milk comes in a glass and patients get an apple that the staff has washed rather than a sealed package containing apple slices.
As a long-term care facility, as well as a hospital, another concern is the difficulty some patients can have opening packages.
"Nothing is more humiliating than to be given a tray and to have to ask for help, and sometimes that help is not there," Carson said. With conventionally prepared meals, "people can eat independently and maintain their dignity while eating."
She identified fresh salads and comfort foods, especially dishes made from grain-fed beef they get from a local supplier, as patient favourites.
St. Joseph's now estimates that 20 per cent of the food it serves is grown locally, contributing at least $140,000 per year to the local economy.
According to Carson, buying local and cooking at the hospital has been more cost effective than buying pre-made meals.
St. Joseph's is spending pretty close to the amount the Ontario government requires long-term care facilities to spend on food for their patients, which in 2012 is about $7.60 per patient per day, not including the cost of labour to prepare and serve that food.
The province does not stipulate an amount for patients in acute hospital care but the average is about $8 a day.
At St. Michael's Hospital in downtown Toronto, patients get their food through what's called "retherm." That's a technology where the food is assembled cold on a tray and then reheated on a cart before it is served to the patient.
Retherm was the trend 10 to 15 years ago and is being put back into service at St. Mike's to keep food tasting fresher, Heather Fletcher, the hospital's manager of food services told CBC News.
Butter chicken, fresh garlic-roasted Parisienne potatoes and fresh-baked oatmeal fruit crisp are some of the popular dishes that have replaced packaged foods on the St. Michael's menu.
Like at St. Joseph's in Guelph, Fletcher says that the same budget parameters apply to the tastier, more nutritious dishes they have developed. "Seventy per cent of them either cost the same or less than the items they replaced."
Over at St. Joseph's they also had to figure out how to make the changes to fresh and nutritious without a proper kitchen. There was already an infrastructure for cooking in their cafeteria and that's where they do the cooking for patients, although there are no floor drains or ventilation for cooking. "We do things creatively in a small area," Carson explains.
When she hears from staff at other hospitals who say their hands are tied because they also don't have proper cooking facilities, she points out that, "We had nothing either but where there's a will there's a way, you can bring it back if you feel strongly about something."
This recipe is a scaled down version of one that St. Michael's Hospital will soon be using to make soup for their patients.
If you are in Toronto, this and other recipes are in the cookbook St. Michael's Enjoys the Ontario Harvest, which is for sale for $10 in the hospital gift shop. All proceeds go to the SMH Philippines Mission.
Preparation and Cooking Time: 1 hour and 15 minutes
Makes 20 servings
Heat butter in a large pot over medium heat, add onion, 1 tsp of salt and cook until golden brown.
Add garlic, butternut squash, carrots, peaches, water, apple cider, and vegetable stock.
Cook over medium heat until the vegetables are tender.
Add salt and pepper to taste.
Cool soup and puree in batches or use a hand blender to puree the soup in the pot.
Heat soup and top each bowl with a thinly sliced fresh peaches (arrange with the peach ends touching in the centre of the bowl to form a flower shape).
This soup could be served chilled or at room temperature on a hot late summer day.
Note: If this is more soup than you need, take the opportunity to freeze the remaining soup for later use.
This trifle (photo above) is very popular with patients at St. Joseph's, according to Carson. Here's the recipe for 100, 200 and 250 servings, portioned with a #12 scoop.
Reconstitute pudding with milk as per directions.
Place thawed berries in a bowl/mix with flavouring.
Drain oranges and mix with berries.
Cube sheet cake and set aside.
Assemble trifles in greased 2' pans: