Improving the Hospital Nutrition Landscape

What did you eat the last time you visited a hospital? Most of us — especially when we’re under stress — are more likely to pick up a bag of chips than a salad, particularly if the former is significantly more plentiful than the latter. The same is true of hospital employees, clinicians and administrators — many of whom are faced with subpar nutrition options every day.

At the Society for Public Health Education (SOPHE) 65th Annual Meeting in Baltimore, Partnership for a Healthier America (PHA) Food and Nutrition Strategic Initiatives Manager Courtney Winston, RD, talked to attendees about ways to make the hospital nutrition environment more conducive to wellness. Recent trends in care delivery and administration have positioned hospitals to be standard-bearers for health and wellness for the entire community — including its employees — rather than simply a site for acute care or a workplace. “It has not always been the traditional approach,” Winston noted, adding that the shift toward improved hospital nutrition wouldn’t happen overnight.

When it comes to workplace wellness, hospitals are a particularly tricky case. To start, they employ approximately 5 million people — about 1.5 percent of the entire U.S. population — many of whom face long, stressful shifts and a fast-paced work environment. Further complicating the issue, hospitals also employ or support many different people with varying levels of responsibility and education, from student volunteers to GED-certified staff to M.D.’s and Ph.D.’s. And most of these people, said Winston, aren’t eating very well at work. The average registered nurse eats five pieces of chocolate per shift — often treats from grateful patients and well-intentioned colleagues — and less than five servings of fruits and vegetables. Physicians, alternatively, report poor access to healthy foods. Considering the negative impacts of poor diet on cognitive function, she added, it’s crucial that health care leaders cultivate improved access to better nutritional choices.

With all this in mind, how do we quantify and describe a hospital nutrition requirement? To start, Winston partnered with the Centers for Disease Control and Prevention (CDC) to develop theHospital Nutrition Environment Scan for Cafeterias, Vending Machines and Gift Shops (HNES-CVG), which evaluates four distinct food environments in a given hospital. Each area receives a rating based on different criteria. Cafeterias were evaluated based on factors such as menu review, grab-and-go products and point-of-purchase items, while vending machines were scanned for things like healthy food and beverage access. After testing the process with an inter-rater reliability study and scanning 39 hospitals in California, how did hospital nutrition environments stack up? “The short answer is ‘pretty bad’,” Winston reported. Cafeterias, on average, scored about 28 percent of possible points; vending machines performed slightly better with 32.7 percent; and gift shops were a disaster, earning less than 1 percent of possible points.

Re: advocating for change – “make it a social case, make it a health case, make it a business case.” @CWinstonRD #SOPHE2014

— MHA@GW (@GWonlineMHA) March 21, 2014 

Although the findings are disappointing, partnerships like the Hospital Healthy Food Initiative are helping hospitals find solutions. The initiative, which already boasts more than 700 members, teams up with hospitals and hospital food providers around the country to deliver more healthy options throughout their facilities. Member hospitals commit to three to four years of working to improve the nutrition of patient meals as well as that of the food options in on-site cafeterias. The guidelines — which range from nutrition labeling, removal of fryers, wellness meals for children and adults and increased spending on fruits and vegetables — are stringent but effective.

One major issue on conference-goers’ minds was related to the financial impact of such a program. Food from fryers, unfortunately, makes a lot more money than fruits and veggies — at least in the short run. Winston acknowledged that sales at the first cohort of hospitals did bottom out initially, but then increased as staff acclimated to the new dietary repertoire. Part of the reason the program lasts for as long as it does, she said, is so health leaders can spend the first year ramping up enthusiasm among staff, clinicians and administrators and build momentum for positive change. Hospital and hospital food provider partners include:

As the structure of our health care delivery system continues to change, managing the physical, mental and emotional health of providers and staff will be a key issue for many health administrators. Learn how you can lead the discussion — and shape the future of health care — with a Master of Health Administration (MHA) from the George Washington University.

How has your organization supported — or discouraged — better nutrition among employees? Tell us in the comments.