In October 2015, University of North Carolina unveiled one of newest pediatric outpatient centers: the Krispy Kreme Challenge Children’s Specialty Clinic. Not officially connected with Krispy Kreme, the name references an annual race benefitting UNC Children’s Hospital in which contestants must run five miles and eat a dozen donuts within one hour. The naming of the clinic drew national attention, with many critics asking how a hospital could implicitly associate donuts with health. UNC Health eventually renamed the clinic a few weeks ago after a new donation from the Park Scholars, which organizes the donut race. The controversy was not an isolated event; across the country, health advocates have demanded hospitals act as leaders in all aspects of health and end their association with unhealthy foods, both in their cafeterias and, as in the case of UNC, symbolically.
Obviously, hospital food comprises so little of the average person’s diet that it can hardly be blamed for conditions like obesity or high-cholesterol, but many hospitals and health systems have recognized that perceptions are important. Last year, Cleveland Clinic removed the McDonald’s in its cafeteria, choosing not to renew the restaurant’s 20-year lease. At the time, a Cleveland Clinic spokesman said “Hospitals, at least the way we look at it, should be a role model.” And while Texas Children’s Hospital still has a McDonald’s, the restaurant’s take-out bags do not feature the Golden Arches or any other branding in order to minimize its visual presence in the facility. Memorial Hermann Health System has taken a middle route, choosing to label cafeteria and vending machine offerings with a traffic-light color code: red for less healthy, yellow for moderately healthy, and green for very healthy. A Memorial Hermann physician explained that the system preserves choice while encouraging a healthy diet.
Other organizations have gone beyond perception and taken proactive steps to improve community and patient nutrition. Initiatives can range from simple wellness promotions like cooking classes or educational materials to organizing a farmer’s market or completely restructuring the hospital kitchen. The Kansas Hospital Association launched a program in 2013 called Healthy Kansas Hospitals, in which hospitals pledge to encourage healthy food choices. Under the three-year initiative, Russell Regional Hospital began rearranging vending machine products to make healthier foods and drinks more visible, revamping the hospital menu, and reducing the size of plates. Though it met resistance from patients and staff initially, officials say they eventually accepted and liked the changes, and food revenues eventually returned to their normal levels. St Joseph Mercy Hospital in Michigan has also experienced success with an innovative program that partners with local farmers markets to “prescribe” vouchers for fresh fruit and produce. In 2015, the program raised patient self-reported fruit and vegetable intake by more than a half a cup daily.
Hospitals can also outsource their nutrition programs to vendors that supply more than cafeteria staff and food. Definitive Healthcare’s RFP database contains dozens of foodservice-related RFPs, many of which specify a nutritional component. For example, a recent RFP from Cook County Health and Hospitals System sought a food and nutritional services vendor that, in addition to standard responsibilities, would oversee Cook County Health’s clinical nutrition services employees. According to the RFP, vendors must identify and intervene with patients at nutritional risk, ensure patients adhere to recommended diet guidelines, and act as a community resource for nutrition education. Several national organizations can also help hospitals build better nutrition programs through guidance and collaboration, such as the Healthier Hospitals Initiative and the Partnership for a Healthier America’s Hospital Healthier Food Initiative.
While some health advocates may say that hospitals have a moral responsibility to promote healthier foods, the financial benefit of keeping patients healthy can be just as persuasive. Physicians have long understood the link between diet and health, and encouraging patients to make better choices makes sense in a value-based reimbursement system. Many hospitals have already recognized social work and community support as a valuable complement to clinical care, and incorporating nutrition education and counseling into existing programs is a relatively easy task. Even if they aren’t where most of us eat our daily meals, hospitals can still have an impact on the country’s diet.
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