“San Francisco makes the healthy choice the easy choice,” reads the headline for a Reuters article about the University of California, San Francisco Medical Center, which “[removed] all sugar-sweetened beverages from every store, cafeteria, food truck and restaurant on its sprawling campuses.” To boot, the city of San Francisco is working to make the move at all hospitals.
With local government and hospital administrators committing to the cause, it’s not a matter of whether to serve healthier food but rather how to do it. Do you create a customized program or work with a third-party organization? Do you launch an overarching program all at once or gradually make small changes? Are standards implemented in cafés only or in all locations where food is sold such as gift shops, pharmacies and vending? Which people and entities need to be involved for success?
Working with a third party
In conjunction with the Employee Wellness Committee, Bill Barkley, MBA, RD/LD, general manager and food service director for Sodexo at Children’s Mercy Hospitals in Kansas City, Mo., and Overland Park, Kan., opted to work with a third party, the Partnership for a Healthier America (PHA), to implement better food standards. Their relationship started in 2012.
According to Barkley, the initiative to provide a healthier hospital environment started with the idea of removing sugar-sweetened beverages from the campuses. He took the foodservice team’s proposal to administrative leadership and “there was a resounding ‘yes’ by our leadership team that we should set the example in the Kansas City community,” Barkley recalls. That initiative soon evolved into working with PHA to implement its full set of standards.
The campus program is referred to as the PHA Healthy Food Initiative and the goal is to reduce childhood obesity and improve the health and well-being of staff, guests and visitors to the hospital. The team worked over a three-year period to implement PHA’s nine standards of compliance, for which they are also being audited. The standards include: fruit and vegetable procurement, food marketing, healthy checkout, children’s wellness meals, adult wellness meals, overall cafeteria/general menu offerings, nutrition labeling, beverage procurement and food preparation. They also rely on PHA to determine which initiatives get implemented in which order.
The idea that started their journey—ceasing selling or providing sugar-sweetened beverages—was implemented Jan. 1, 2017.
So what are the benefits of working with a third-party for Barkley?
“The credibility of the program was substantiated by the leadership of PHA and included peripheral partners such as USDA and [the] CDC,” he says. “PHA worked with us to train, answer questions and support us with implementation. When there was an area of the standards we were struggling with, PHA helped us find other partners that might suggest how they were implementing that standard.”
Barkley cites some struggles, too. PHA standards require the removal of fryers. It took considerable time and planning to determine and capitalize new equipment. They also hoped to remove candy from the gift shops, but because they are run by volunteers they haven’t had much success in controlling gift shop sales.
Implementing a customized program
Robin Aufdenkampe, MS, RDN is a food and nutrition services director for Intermountain Healthcare in Salt Lake City. Intermountain Healthcare runs self-operation foodservice programs in 22 hospital facilities.
According to Aufdenkampe, Intermountain Healthcare has been working for several years to implement healthier food standards in its cafés and patient foodservice, but the real push for their Healthy Eating Environment initiative came when new senior leadership joined the team, offering broad support for the program.
“The Healthy Eating Environment initiative is meant to improve all Intermountain Healthcare eating environments,” says Aufdenkampe. “This includes cafés, patient foodservice, gift shops, pharmacies and vending.”
The initiative started with removing all regular soda and candy. They are now establishing healthy criteria based on evidence-based literature, setting limits for total calories, fat, sugar and sodium for the foods and beverages offered in retail areas and vending. The team is also evaluating price strategies that will help incentivize healthy food choices.
“By pricing healthy foods at reasonable costs we hope to increase their sales, again making these items the easy choice,” says Aufdenkampe. “In the long term, we hope to promote on-site farmers’ markets and CSA opportunities, hospital gardens and fresh meal kits.”
So what are the benefits of implementing a customized program? According to Aufdenkampe: “We can transition at our own pace and with greater flexibility. We are a large organization and initiatives of this scope take time and careful communication. We were able to make decisions based on our unique populations, facility differences and extensive reviews of healthier food and beverage alternatives.”
Learning from a strategy that didn’t work
Lisa Poggas, MS, RD, is director of nutrition and environmental services for Parker Adventist Hospital, Castle Rock Adventist Hospital and Centura Corporate at Centura Health in Denver.
About four years ago the team embarked on a journey with a third-party partner that proved unsuccessful.
“Even though our associates indicated that they want healthier foods, their purchasing behavior was counterintuitive,” says Poggas. “Our customers want comfort food. So we realize that we need to provide education and options to meet the needs of the health-conscious and those needing comfort.”
Learning from this experience, they are moving forward to better understand the needs and wants of their community.
They have conducted a survey of their associates to determine what they deem healthy/unhealthy about the hospital food environment, which will inform initiative goals moving forward. Foodservice will work in conjunction with administration and the People Council, a committee consisting of front-line staff (including management and human resources) whose goal is to increase the health and satisfaction of associates in the hospital.
“We are going to form focus groups to come up with next steps to ensure that the front-line staff have buy-in,” says Poggas. “So, instead of a top-down decision, we will try to make it more inclusive.”
Tips for implementing a successful program
Barkley, Aufdenkampe and Poggas all agree that success is contingent upon a group approach, buy-in from leadership and associates, and educating staff and patrons as to why such a program is being implemented.
“When starting with an initiative like this, pull together key stakeholders from senior leadership, health and wellness promotion, communications, food and nutrition directors, registered dietitians, education and patient engagement to form a leadership team,” says Aufdenkampe. “By having this initiative communicated straight from senior leadership, everyone in the organization recognized and appreciated the level of commitment to making this a success. A call to action was written to leaders and physicians within the organization, providing them with an explanation for the initiative and action steps that they should demonstrate.”
Barkley adds, “When you start an ambitious program like this, you must face the reality that the journey will not necessarily be an easy one and that you must gain commitment from leadership and employees, and continue to promote the program goals to the patrons of the facility.”