While the battle between the New York slice and the Chicago deep-dish still wages on, customers have come to expect many more pizza and flatbread options today than ever before. Ethnic and “fusion” varieties have become common, giving operators higher price-point opportunities and daily or weekly rotations, in addition to standard pizza offerings.

Since the University of North Carolina Hospital in Chapel Hill took control of its own pizza operation (formerly, it had been run as a branded franchise) in February 2007, the facility went from selling 30 to 120 pizzas per day. “We upgraded to a better, fresher, more consistent product,” says Angelo Mojica, director of food and nutrition services for UNC Hospitals. Mojica attributes his pizza success to upgraded ingredients and a wider variety.

He implemented quality standards: Quality frozen dough balls; local, organic produce whenever possible for the toppings (spinach, broccoli, zucchini and squash sourced from a broker); and made-from-scratch tomato sauce. Some of the more popular pizzas are Grilled Chicken with mozzarella cheese and pesto sauce; Philly Cheese Steak Pizza with shaved beef, peppers, onions and provolone cheese; and Cheeseburger Pizza with ground beef, mustard, pickles, cheddar cheese and onions.

Pizza pie inspiration comes from the commercial world for some. When Hayward, CA, Unified School District director of food services Al Schieder sees a new pizza by Round Table Pizza, a California-based chain, his gears start turning. He piggybacks on Round Table's advertising by creating close facsimiles with the same appeal. The pizza chain inspired the schools' Garlic Chicken, BBQ Chicken and Hawaiian pizzas.

Schieder says he relates to the way Round Table Pizza thinks about pizza. “It's California. They are proud of being fresh. They don't have freezers in their locations,” he says.

Schieder follows that theme by making the pizza dough fresh each day from the central kitchen (to the take-and-bake level) for the five middle schools and three high schools. Rather than buy frozen dough, his staff makes it up from a mix that only requires the addition of water.

“If you follow the instructions, you can make it in a short time. Our issue with pizza is that it has to be fresh,” Schieder says. The only challenge is that operators are used to baking par-baked pizza crusts at 325°F. His fresh dough requires 475° to 500°F in the convection oven for six or seven minutes.

Taking a peek at the Los Angeles-based California Pizza Kitchen's menu gives creative-topping ideas to John Biswanger, director of nutrition and food service at Lakeland Regional Medical Center in Lakeland, FL. The hospital rotates through 37 kinds of pizza over a four-week period he says, though he admits that out of the 53 pies usually sold each day at lunch, all but about 10 are basic flavors.

But one stands out for its heftiness and perceived value — the Stuffed Pizza. Between two layers of crust, the pizza hosts spinach and three kinds of cheese and a side of marinara sauce to spoon over the top. “It's a true, double-crusted pie and it doesn't cost more. It's $3.95 per slice, which is what we sell any pizza slice for,” he says.

On the opposite end of the hefty stuffed-crust spectrum lays success in a thin-crust program for a few of Chartwells' (Compass Group) Midwest higher-education accounts. Called “Tomato Head Reds,” complete with a shades-wearing tomato character, the brand showcases cool pizza types, starting with fresh, crushed tomatoes and herb seasonings rather than canned pizza sauce, says Larry Posen, regional chef, Central Division for Chartwells. “We use raw, fresh pizza dough pressed very thin, and we're using it only in a deck or brick oven because of its ability to provide much better texture to the crust.”

Many of the pizzas utilize the same ingredients, but with different flavor profiles. For example, in the realm of chicken, there's Tandoori Chicken Pizza, which features grilled breasts marinated with tandoori paste for the Indian profile and including red and green peppers, onions and fresh-seasoned tomatoes. There's also Jamaican Jerk Chicken, Buffalo Chicken, Thai Chicken and the Kansas Barbecue Pit Stop Pizza with grilled chicken, barbecue sauce and red onions.

One Tomato Head Red favorite is Crossin' the Border, which combines seasoned taco meat with a blend of five cheeses, red pepper, jalapeno peppers, salsa and cilantro. The Gilly's Rueben Pizza features “a little herb oil and special red sauce with red snappy seasoning. Then we use sauerkraut, corned beef and Thousand Island dressing when it comes out of the oven,” Posen says. In one school, as many as 500 pizzas sell a night between 6 p.m. and 1 a.m.

He notes that the ethnic ingredients have as much to do with acknowledging the student customer base and where they are from as adding intrigue to the flavor profiles.

Not all is pizza that starts as pizza. At Southern Maine Medical Center in Biddeford, MA, director of hospitality services Michael Sabo turned frozen 7-inch whole wheat pizza dough into a hot-selling panini exhibition station and promotion.

To infuse flavor, the dough is marinated overnight in olive oil, garlic and spices. “We fold it in half and run it through an impinger oven. We don't seal the edges. We sprinkle a bit of Parmesan cheese and sesame seeds on top after it's folded. After it comes through the oven, we take it off and put it under a warmer,” he says. From there, guests can choose a California chicken, Mediterranean, Virginia ham club or pesto chicken panini pocket. “But they pick options they want. If they don't want the spread or onions, they just say so,” he adds. “The station displays very nicely visually; the sandwich is very attractive and commands a good price: $4.50, which includes a side salad.”