Diane Imrie, RD, took the pledge in 2006 and has never looked back. She is the director of nutrition services at Fletcher Allen Health Care in Burlington, VT, which was one of the first signatories to the Healthy Food in Health Care (HFHC) pledge that commits an institution’s dining services to moving forward a series of sustainable and health-promoting practices.
Today, over 370 hospitals and medical facilities across the country have taken the same pledge but it’s safe to say that few if any have made the progress toward the initiative’s goals that Fletcher Allen has. That was vividly demonstrated when it won first place honors in both the Sustainable Procurement and Public Policy and Advocacy categories at the most recent Sustainable Food Awards competition of the Health Care Without Harm Healthy Food in Health Care Program last fall.
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Currently, the nutrition services team at Fletcher Allen…
• purchases close to half of its food from local and/or sustainable sources
• manages its own rooftop and herb gardens and even its own beehives
• operates one of the most sustainable retail cafes in the healthcare segment, which made heavy use of recycled materials in its construction and features energy efficient equipment and HVAC systems
• emphasizes nutritionally dense, minimally processed foods, including locally sourced fruits, vegetables and meats, while eliminating deep fried offerings in both its retail and patient dining operations
• works with local suppliers to source product and in some cases helps them plan some production planning for future crops
• promotes healthy and sustainable dining practices through an active outreach agenda, including its Center for Nutrition & Healthy Food Systems that works with other institutional foodservice providers.
Fletcher Allen is a major academic medical center affiliated with the University of Vermont’s Colleges of Medicine and Nursing/Health Sciences. It is licensed for 562 beds spread across two hospitals and employs some 7,000 onsite staff.
The dining program serves about 1.44 million meals a year between its patient and retail dining operations, including a room service program implemented in 2007 at the main hospital. Retail dining is offered through the main Harvest Café venue, which is open 22 hours a day, and four smaller cafes. Two are in the main building, one in the offsite Fanny Allen rehab hospital and one in the nearby University Health Center medical office building. The Fletcher Allen dining team also provides catering services across the facility.
The Grower You Know…
Much of the meat served at Fletcher Allen is sourced locally from nearby farmers. “More than 90 percent of our beef is raised locally,” Imrie says. “There are only a couple of beef products we need to get from elsewhere. We know the farmers and how they raise their cattle, so we feel really engaged with them.”
All of the milk, most ice cream and almost three quarters of the chicken is sourced from local producers, and half the eggs are organic. A four-year-old local seafood sourcing program (one of the benefits of being located in the Northeast) brings seasonal catches to Fletcher Allen menus. Haddock has been on the menu through early spring.
“We have such direct contact with the fishermen that we can tell customers the boat a particular fish was caught on and sometimes even the captain’s name,” Imrie says. Shrimp from nearby Maine is brought in by the pallet (for the purposes of “locally sourced” designation, Fletcher Allen counts seafood caught anywhere in New England as “local.”) The only seafood on the menu not caught in New England waters are trout from Idaho (farmed in a sustainable manner, Imrie is quick to note) and wild-caught Alaskan salmon.
Produce needs are met in the growing season the same way. Imrie says the management team meets annually with farmers, reaching “handshake deals” on product the hospital will buy. “They like having steady customers to take some of the uncertainty out of their business,” Imrie offers.
A recent new initiative is a partnership with a local frozen storage house that receives, processes and stores fresh produce during the growing season for use in the winter months. This past winter, Fletcher Allen was able to menu dishes using locally grown blueberries, green beans, corn and broccoli.
“The reason we became involved in the program is to encourage investment in their infrastructure,” Imrie explains. “We want to see them succeed, so we even agreed to a somewhat higher price for the first year. They contract with different farmers to store their products so they can be used year–round, and that helps everybody.”
Working With the Locals
Price is of course a major concern for anyone looking to go outside of established supply channels to procure what is seen as premium product, but Imrie begs to differ. “It’s a misconception to think that all local product is more expensive,” she says. “In season, local produce is very affordable and all of our fish comes in at under $7 a pound.” This allows the café to serve fish dishes priced at $5.25 (other entrees are $2.50).
Imrie requires all suppliers to carry liability insurance. Delivery is arranged by the supplier. Some of the larger growers deliver their own while others, such as the hospital’s local beef supplier, contract with a distributor.
Fletcher Allen is a member of the Vermont Fresh Network, a nonprofit that brings in-state producers together with potential customers like hospitals to build a market not just for crops and meats but products like maple syrup, cheese and other dairy items.
The hospital also boosts local farmers and producers by hosting a series of onsite farmers markets (including some indoor markets in the winter). The nutrition services department has committed to have a table at each of the events where it features a dish made with local products. The most recent (at FM press time) winter market drew 17 vendors and more than 500 shoppers. Purchasing is made easier with an electronic payment option that allows customers to use debit and credit cards as well as payroll deduction. The option also makes it easier to sign up for CSAs (Consumer Supported Agriculture contracts that connect customers to regular supplies of fresh product over the growing season from a specific farmer: two programs deliver directly to the hospital).
Some product is so local it doesn’t even come from off site. For the past several years, Fletcher Allen has been tending its own garden, so to speak, as several onsite growing patches—one on a rooftop, others in unused spaces on the grounds—have yielded crops that supplement the local purchases. One fairly unique product produced directly on hospital grounds is honey, courtesy of a staffer who is also a beekeeper.
Fletcher Allen launched the first Healthy Food in Health Care Leader Workshop to promote sustainable food usage among hospitals in the region, and also initiated its Center for Nutrition & Healthy Food Systems to promote healthy and sustainable dining in institutional settings and foster food partnerships between institutional customers and local producers. Launched through a grant from the Centers for Disease Control and now backed by private funding, it regularly brings decision makers together to discuss issues and best practices, and it provides training opportunities. For example, it offers three culinary classes a year—this spring it focused on salads and sandwiches—that teach ways to menu healthier, more sustainable dishes.
Fletcher Allen also sponsored HCWH’s Food Matters conference this past April focused on a clinical perspective on nutrition and environmental health. A food show the following day highlighted local suppliers. Attendees ranged from senior care centers to public school districts. “We’ve become a leader in these kinds of things and feel it is important to continue to serve as a role model,” Imrie says.
A Most Sustainable Café
Fletcher Allen's main cafeteria was totally renovated three years ago with a goal to make it “the most sustainable café in the country.” Now called the Harvest Café, it menus organic chicken, almost all locally raised beef, soy milk, vegetarian selections, seasonal produce based sides and organic free-trade coffee, all served from stations that emphasize from-scratch/to-order cooking to minimize food waste.
Harvest Cafe also boasts a “free cooling” refrigeration system that uses cold air from the outdoors during the winter to cut down on energy costs. “We also didn’t waste a lot of materials on décor,” Imrie notes. The art on display is all local and reflects an agricultural theme. Also, most of the equipment removed when the café was renovated was donated so as not to end up in landfills. Also not ending up in landfills is most of the waste that Harvest Café generates. Instead, most of it is composted or recycled.
With its unique ambiance and quality offerings, Harvest Café is evolving into a destination eatery. “One farmer I deal with told me he came in for dinner one evening after being here a couple times, and we recently took our first reservation for a group of about 30,” Imrie reports. “We also draw people from the university and even from downtown.” Overall, she says 15 to 18 percent of the retail business is from visitors.
Serving Different Populations
Each of Fletcher Allen’s five retail sites runs its own menu with the exception of centrally produced items like soups. This helps make each a destination facility and allows it to serve its specific population better.
Harvest Café gets the most traffic as the main facility’s primary cafeteria. Open 22 hours (5 a.m. to 3 a.m.) a day to provide even third shift staff with fresh food options, it sees almost 2,700 customers a day, most during the lunchtime rush. It also operates its own kitchen facility.
Also located in the main facility is the Main Street Café, which serves primarily in-house staff. It is open only for breakfast and lunch during the week. Main Street’s kitchen also serves as the catering outlet for the complex.
Café Express is the main facility’s third retail operation. Located along a busy corridor, it offers grab and go food options as well as hot and cold beverages—including espresso and latte coffee drinks—from early morning through late afternoon five days a week.
Imrie also oversees a small cafe operation in the adjacent University Health Center, a medical office complex that sees a stream of visitors each weekday. The dining outlet here is called the Pavilion, which serves breakfast and lunch five days a week from its own kitchen.
Finally, there’s the Dunbar Café in the Fanny Allen complex, which serves breakfast and lunch Monday through Friday from 7 a.m. to 4 p.m. Dunbar was recently renovated and serves as a dining site for patients in the building’s 40-bed rehab center. It now features a restaurant-like standing menu plus specials, so that patients can dine communally or with their families. They can also choose to take meals delivered from Dunbar’s menu to their rooms.
The main hospital offers room service dining off a set menu that emphasizes seasonal fresh produce and other healthier profile choices. The program was implemented in 2007 following a full kitchen renovation (using a local vendor) and helped boost patient satisfaction scores from 42 to 90 percent after implementation. Today, the kitchen serves about a thousand room service meals a day in a window that extends from 6 a.m. to 7:15 p.m. Delivery is within 45 minutes of receiving the order.