A Landmark Year for Washington: 2011 was an important year for Washington’s Healthy Food in Health Care Initiative. We welcomed good food proponents from around the country to FoodMed, toured sustainable family farms, and shared ideas on how Washington hospitals can change the direction our national food system is headed. We welcomed two new Healthy Food in Health Care Pledge signers, Washington’s first Balanced Menus Challenge takers, and witnessed the state’s first comprehensive sustainable food purchasing policy endorsed by foodservice and administration. For those of us on the front lines of the good food movement, it is an exciting time. The shift toward fresh, local, humane, sustainable foods in hospital cafeterias and patients meals is setting national standards for excellence that will save both lives and livelihoods. What will 2012 bring? I can’t wait to find out. Thank you for another inspiring year. Kathy Pryor Washington Healthy Food in Health Care Coordinator

Table of Contents United General Hospital Wins National Award…...2 Overlake Hospital Launches Food Policy………...3-4 Swedish Medical Center Opens Café 1910………….5 UW Medical Center’s Nutrition Advisory Team…..6 WA Hospitals Take Balanced Menus Challenge…...7

Washington Welcomes New Healthy Food Pledge Signers! Swedish Edmonds Swedish Issaquah Washington Healthy Food in Health Care Pledge Signers Now Include: Seattle Children's Hospital Group Health Cooperative Island Hospital MultiCare Health System: Allenmore Hospital Covington Outpatient Center Good Samaritan Hospital Mary Bridge Children's Hospital Tacoma General Hospital Northwest Hospital & Medical Center Overlake Hospital Medical Center Providence Sacred Heart Med. Ctr. & Children's Hospital Swedish Medical Center: Swedish Cherry Hill Swedish First Hill Swedish Ballard Swedish Edmonds Swedish Issaquah United General Hospital University of Washington Medical Center

Group Health Commits to Cage Free Eggs…………..8 Jefferson Healthcare Hires New Chef………………...9 Northwest Hospital Creates Green Training……….10 Tacoma General Hospital Transforms Cafeteria…...11 FoodMed Visits Seattle………………………………..12

United General Hospital Wins National Food Award United General Hospital in Sedro-Wooley won second place in the nation in the first-ever Sustainable Food Procurement Awards from Health Care Without Harm. United General Hospital was selected for the diverse array of sustainable products they are buying, often directly from farms. Executive Chef Chris Johnson started purchasing directly from farmers through Puget Sound Food Network’s Wholesale Farmers Market, and he continues to purchase produce, dairy, meat, and other items directly from several farmers throughout the year,

with an emphasis on local sustainable meats through the winter. He purchases Organic grassfed beef, wild Alaskan salmon, local shellfish, and pastureraised poultry.

of people from other departments share in the pride of the award—of being aligned with a socially just foodservice.”

When asked about plans for next year, Chris says humbly, United General Hospital also “We’re just going to keep doing buys Fair Trade, Rainforest Alli- what we’re doing. We’re always ance Certified coffee and 95% looking to expand the amount rBGH-free dairy in all categoof local & Organic products we ries. Chris estimates that 25% of serve. I never really had this as the meat they purchase is raised a goal—I just keep doing what without non-therapeutic antibi- feels right.” otics. “The people in the community have always been supportive,” Chris says. “We’ve had a lot

2011 National Healthy Food in Health Care Award Winners The inaugural Healthy Food in Health Care Awards were announced at FoodMed 2011 (see page 12) and included hospitals from around the country:

United General Hospital Chef and Food Services Director Chris Johnson and Washington Healthy Food in Health Care Coordinator Kathy Pryor

Sustainable Food Procurement Awards: Fletcher Allen Healthcare, Vermont United General Hospital, Washington John Muir Medical Center (Concord), California

Public Policy & Advocacy Awards: Fletcher Allen Healthcare, Vermont Sparrow Hospital, Michigan Oregon Health & Science University, Oregon

Food Climate Health Connection Awards: Carroll Hospital Center, Maryland John Muir Medical Center (Concord), California Oregon Health & Science University, Oregon

Clinical Engagement Awards: Lisa McDowell, RD, Michigan Tim Goltz, MD, Maine Amy Collins, MD, Massachusetts

Overlake Hospital Medical Center Launches Sustainable Food Purchasing Policy Since signing the Healthy Food in Health Care Pledge in 2007, Overlake Hospital has become a leader in Washington’s sustainable procurement efforts. They have worked diligently to make sustainable and humanely-raised products available to hospitals throughout the region, and share their practices and strategies publically.

Highlights Include:  Document will be shared with all existing and potential new vendors  Prioritizes local, antibiotic-free, hormonefree, and third-party certified products  Provides alternatives to beverages including high fructose corn syrup  Reduces meat purchases 20% In November 2011, Overlake Hospital received  Aligns recipes and menu items for inpatient approval for a comprehensive sustainable food and retail services with “2010 Dietary Guidepurchasing policy created by Executive Chef lines for Americans” Chris Linaman. Portions are being published here  Promotes the humane treatment of animals verbatim with permission.  Promotes the health & safety of farmworkers Many thanks to the staff of Overlake Hospital for  Requests readily available way to identify creating and sharing this visionary document. region of origin & sustainability criteria individual and environmental health, the procureOHMC Comprehensive Food Policy to ment staff within Hospitality Dining Services is committed to the above principles. These Promote Individual & Environmental principles will be applied to all major purchasing deciHealth sions. Departmental leadership will evaluate the health and environmental impacts of both current and potential food products in an effort to select healthy Purpose and safe products that are also environmentally Overlake Hospital Medical Center seeks to improve sound. Procurement staff will also expect our current the health of our patients, employees, our communiand future suppliers to continuously develop price ties and the environment by increasing access to competitive products that conform to those principles fresh, healthy food in the hospital environs. We will outlined above. do so in conjunction with "Healthy Food in Health We recognize explicit and ordered priorities in OverCare" pledge signed in 2007 and in a manner that lake's comprehensive policy. First, we seek to inpromotes agricultural practices that are ecologically crease the availability and consumption of fresh fruits sound, fiscally viable, culturally appropriate, and so& vegetables. Second, to purchase food that is free cially responsible. from pesticides, hormones, and non-therapeutic antibiotics. Third, to increase the proportion of locallyFood Purchasing Guidelines sourced foods. Fourth, to reduce procurement of any ingredient or ready-to-eat food that contains any In support of Overlake Hospital's policy to promote GMO.

Sustainable Food Policy at Overlake Hospital: An Interview with Executive Chef Chris Linaman Why did Overlake create this policy? [We have] been working on "sustainable" initiatives for last 5 years, but had no formal policy just lofty ideals. After the FoodMed 2011 conference, I realized that official policy was needed to help focus and sustain efforts and to provide accountability. Also [we] knew that we would have the support of great organizations like Health Care Without Harm, Washington Physicians for Social Responsibility, & WA Healthy Food in Health Care Initiative to help carry policy to full fruition.

them as to what products they might try to bring in to not only our account, but also to those other accounts within their customer base that have similar interest and passion for REAL food. How has Overlake's administration supported this policy? Both Marketing VP and Professional Services VP have voiced their approvals - highlighting the economic responsibility language. What do you anticipate will be your largest hurdle?

Restraining my excitement to do the right thing I realized that official NOW - not trying to tackle all at policy was needed to once, but rather help focus and sustain sustaining what efforts and to provide we have already been doing, accountability. while steadily taking on new What has been your reaction from vendors? initiatives in phases. This will [I] have been sharing draft versions with all cur- increase the oprent vendors as we meet on a regular basis - the portunity for sucvast majority already knew where we stood, so cess, and help no real surprises but appreciated the formality of prevent flamethe plan. New vendors have been very suppor- out. tive - mostly because I am only talking to those that I believe have a real chance to meet our standards. I have asked for feedback from both curChef Chris Linaman speaking at the rent and new vendors, and all agree that this pol2011 Obesity Prevention Summit icy is thorough and provides good direction to Tukwila, WA

Swedish Medical Center Opens “Café 1910” in Issaquah was founded: 1910. One hundred years later, the health system is obviously still thinking up new ways to promote health for its patients. There are no fryers in the hospital, and Swedish Issaquah is pioneering a “no soda” pilot—the first in Washington state. There was one compromise: one soda vending machine in the staff lounge, out of public view. “It’s how we’re keeping everyone happy,” says Candi. Washington’s newest Healthy Food in Health Care Pledge-signer—Swedish Issaquah—opened its doors in July 2011. This newly constructed hospital bills itself as a re-visioning of what healthcare looks like, and this is certainly true of its foodservice—particularly Café 1910. “It is not designed to be a cafeteria,” says Candi Johnson, Swedish’s Director of Nutrition Services. “It’s much more interactive.”

One truly notable feature of Swedish Issaquah is the kitchen, which Executive Chef Eric Eisenberg designed with consultant Jean Michel Boulot. Candi offered input on the one-piece flow of the room service line. “We basically sat down with the consulting firm and designed this kitchen based on years of experience.”

The plans they came up are designed to save time, space, and heavy lifting. The room service line is continuous, and allows hot and cold items There are themed stations throughout the café, to be plated simultaneously. The floors are soft, each staffed by a chef. Each station will eventuso there is no need for mats. There is ample dish ally have cameras to showcase chef demos on the room space, complete with water-saving features. café’s message screens. Meals are plated on They are currently setting up composting of all china, and everything is prepared from scratch, food waste. down to the wood-fired pizzas. “It’s our dream kitchen,” says Candi. “We’ve really prioritized local foods,” Candi says, pointing to the menu, which features Washington beef, chicken, and vegetables. They have even partnered with Sol to Seed, a small farm in Carnation, WA to create the “Sol to Seed Pizza” featuring seasonal vegetables from the farm. They offer “dessert bites” from Theo Chocolate, a Fair Trade chocolate maker in Seattle, rather than full size desserts. The name “Café 1910” refers to the year Swedish

Corbin Sears demonstrates the new pizza oven at Café 1910

University of Washington Medical Center Brings Back Nutrition Advisory Committee As the University of Washington Medical Center works to dramatically increase its offering of Organic and whole foods, the nutrition team has decided to bring back a tradition many thought was left in the past—a multi-disciplinary Nutrition Advisory Committee. The committee will consist of stakeholders throughout the hospital, including a pharmacist, physicians, nurses, speech therapist, the head of outpatient services, and several dietitians. “We’re doing this to help create ambassadors to departments throughout the hospital,” says Chuck Zielinski, Director of Food & Nutrition. “We also want to communicate the evidence that drives the changes we’re making—why we’re doing what we’re doing.”

says. They see the room service menu as an arena to educate patients about healthy eating habits, and are actively seeking ways to use their room service trays as educational tools. Other proposed changes include creating their own line of Organic grab-n-go foods in-house, increasing vegetarian and legume options, reducing sugar-sweetened beverages, and ensuring all dairy products are rBGH-free. Ultimately, Chuck dreams of pairing the hospital Nutrition Advisory Committee with researchers at the University of Washington to study patient outcomes in connection with food. “We’re right next door to a world-class university with topnotch researchers,” Chuck says. “We should be working together.”

The committee will serve two primary purposes: 1. To identify areas where early nutrition intervention can improve patient outcomes, and integrate those into the hospital’s foodservice. 2. To make sure the food being served promotes wellness and health, and meets the mission of the hospital. The University of Washington Medical Center food and nutrition team is very interested in serving evidence-based foods with proven track records, but wants to make sure they’re communicating why those changes are important. “If we’re serving fresh Organic blueberries in our room service meals, we want to communicate why we’re serving Organic blueberries,” Chuck

UWMC Dietitian Beth Adamsen Marcondes serves up quinoa salad and healthy lunch samples for National Nutrition Month.

Two Washington Hospitals Take Balanced Menus Challenge Overlake Hospital & Medical Center and the University of Washington Medical Center are the first hospitals in Washington state to sign the Balanced Menu Challenge. The Balanced Menus Challenge is a voluntary commitment to reduce meat procurement by 20% over a one-year period. By reducing the amount of meat a hospital serves, the hospital is able to reduce its carbon footprint, offer serving sizes in alignment with USDA dietary guidelines, and use the cost savings to invest in sustainable Beth Adamsen Marcondes, RD, and UW Medical Center Food Services meat purchasing. Director Chuck Zielinski signing the Balanced Menus Challenge.

Both hospitals plan to meet their goals by implementing Meatless Mondays in their cafeterias. The University of Washington Medical Center also plans to increase legume protein sources, and reduce the size of their hamburgers from 5 oz. to 4 oz. The U.S. produces about 8.7 ounces of red meat and chicken per person per day, while federal dietary guidelines recommend consuming 5.5 ounces of protein each day (including meat, poultry, nuts, beans, and eggs). That means Americans consume 33% more meat on average than is recommended. U.S. beef cattle are responsible for 160 million metric tons of greenhouse gas emissions every year -- equivalent to the annual emissions from 24 million cars and light trucks. Beef has largest carbon footprint, followed by pork, then poultry. In a Johns Hopkins study of four California hospitals who piloted the Balanced Menus Challenge in 2008, the authors found that the hospitals were able to reduce their meat-related CO2-equivalent GHG emissions from 2,637 annually to 1,648 tons annually—the savings equivalent to CO2 emissions from burning 102,454 gallons of gasoline or sequestering carbon by growing 23,354 tree seedlings over 10 years.

Group Health Commits to Cage-Free Eggs Group Health Cooperative’s Capitol Hill campus has made a commitment to using cage-free liquid and shell eggs. The hospital will be purchasing Wilcox liquid eggs and Davidson’s shell eggs.“We've used pasteurized shell eggs for years to avoid having to have a physician order to use shell eggs, and now Davidson's pasteurized shell eggs are available as cage free so we've changed over,” says Mary Hanson, Manager of Nutrition Services. Wilcox Farms is a Food Alliance-certified, 100-year old family farm located in Roy, Washington. Davidson’s is a national company based in Illinois. Their cage-free eggs are Certified Humane. Group Health began purchasing the Washington-produced Wilcox cage-free liquid eggs when they became available through US Foods. “We made the change to Wilcox liquid eggs because they were a local producer.” For the last two years, The Humane Society of the United States has sustained a massive effort asking hospitals and other major foodservice sectors to purchase cage-free eggs. In July 2011, the Humane Society of the United States and The United Egg Producers (the egg industry’s trade group) announced an historic agreement whereby both organizations will support—and work toward enactment of—federal legislation to improve the lives of the 280 million hens used in the U.S. egg industry each year. Many thanks to the hospitals and businesses whose support made this possible!

The Washington Association for Healthcare Foodservice tours Wilcox Farm in Roy, WA

Jefferson Healthcare Hires Chef Arran Stark

Jefferson Healthcare’s new Chef and Food Services Director Arran Stark

Port Townsend’s Jefferson Healthcare has set a lofty goal for itself—a complete re-visioning of what their foodservice looks and tastes like. This summer, the hospital hired Chef Arran Stark to revamp the hospital menu. Although he was initially called in as a consultant, the hospital soon offered him the position of Food Services Director. The decision to hire Arran was a radical departure from the hospital’s status quo, and required a major remodel of the kitchen. “We went from a reheat kitchen to a space you can cook in,” Arran says. They have had to add additional cook and prep spaces, and train long-time staff members in new techniques. Arran teaches community cooking classes in his spare time at his commercial kitchen, Cultivated Palette. Arran believes that getting people cooking is one of the best ways to reverse negative health trends in the U.S. To that end, he plans to offer internships to teenagers and seniors in the hospital kitchen, where they can learn how to prepare and season fresh meals from scratch. Arran is a proponent of seasonal, local menus, and uses organic ingredients whenever he can. “I call up Nash’s [Farm] and ask them what they have a lot of—what can I get a lot of for a good price.” He builds menus around availability and local flavors. “We want to be a destination in the community,” says Arran. “We want people to choose to eat in our cafeteria.”

Northwest Hospital & Medical Center to Offer Sustainability Trainings To Foodservice Employees

In January of 2012, Northwest Hospital & Medical Center will begin the first of six sustainability trainings for its approximately 50 foodservice staff. The program is based on a Green Grant developed in 2010 by Northwest Hospital, Swedish Medical Center, and SEIU, which was designed to train EVS workers on sustainability issues. The 2012 version will focus on foodservice staff, and address issues like overproduction of food, composting, water, energy, chemicals, and food sustainability criteria. “All the staff compost and measure waste but they don’t necessarily understand how important their efforts are,” says Mary Porter, Northwest Hospital Food & Nutrition Services Manager. Northwest Hospital is working with North Seattle Community College to develop the curriculum for six 90-minute courses, and the grant will pay for interested foodservice staff members to attend a 5-credit course at NSCC titled “Environmental Sustainability in Healthcare.” The community college will provide English as a Second Language (ESL) and Adult Basic Education (ABE) support—which the hospital recognizes as vital to employees who may have limited English skills or experience with higher education. Northwest Hospital will also be recruiting standout students from this program who can take part in a “Train the Trainer” class, to make sure there is a continuity of sustainability messaging when training new hires. They are optimistic that this program can lead to promoting sustainability leaders from within, and help staff work toward common goals.

Tacoma General Hospital Transforms the Cafeteria For Earth Day 2011, MultiCare’s Tacoma General Hospital did something unusual to celebrate— they shut down the cafeteria hot bar and brought in a farmer. They brought in Fred Fleming, one of the founding farmers of the Shepherd’s Grain cooperative, and Carla Berst of Pink’s Original Bakery, which uses Shepherd’s Grain flour, to talk about the farm to fork process. They also introduced a market where the hot bar had been, selling fresh vegetables and fruit, local cheeses, crackers, and teas. “It’s really been a big hit,” says Pam Theimann, Manager of Food Operations and Retail Nutrition Services. “We did chef demos of the products we brought in, which people loved. We wanted to promote cooking with whole foods, which is the direction we’re going.” Tacoma General maintained the cafeteria market all summer Michelle Gessner, Mutlicare Director Nu- long, Monday through Friday, into September. They have since trion Services; Patricia Franco, Allenmore brought the hot bar back, but there is a new emphasis. They have Hospital Nutrition Supervisor; Pam Thie- changed some of the entrees, and there is no more fried food. mann, Tacoma General Manager of Food There is a curry bar, a pasta bar, and changes to the recipes in the Operations and Retail Nutrition Services old standbys, like the taco bar. “We’ve added turkey,” Pam says, “So people don’t have beef as the only option. Really, the key is fresh, made-to-order food.” Pam and her team have also been working hard to make sure there are sustainable options available. They’ve brought in Wilcox eggs and Draper Valley chicken, which is raised without antibiotics. (See sidebar.) Pam remains passionate about supporting Do you want antibiotic-free chicken? Washington farms whenever she can. Although the products were slightly more expensive, they have been able to Pam Thiemann is interested in talking to other hospital foodservice managers who offset the costs by offering more vegetarian options, and are looking for antibiotic-free chicken. She is selling entrees a la carte. Although they won’t have a daily market next year, Tacoma General’s foodservice team will work with MultiCare’s Center for Healthy Living to create recipes and work on the educational side of changing eating habits. Pam credits MultiCare’s administration for pushing the cafeteria to make healthy changes. “They’re very concerned with obesity, diabetes, and high cholesterol in the workplace….We’re looking at food as preventative medicine.”

currently buying Draper Valley chicken through US Foods, but it has limited availability due to low sales. “I’d like to get more hospitals buying it so the price goes down, and more people can carry it. We’d like to offer it in our patient meals, but right now, it’s not even a possibility.” If you would like to talk about buying antibiotic-free chicken for your cafeteria, please contact Kathy Pryor at [email protected].

FoodMed Visits Seattle FoodMed 2011, held at the Hyatt at Olive 8 Hotel in downtown Seattle, drew approximately 200 attendees from across the United States, Canada, and Switzerland. The 2-day conference focused exclusively on the Healthy Food in Health Care Initiative, and ways hospitals can work to shift our regional, national, and global food systems to support health and the environment. The preconference sessions included a tour of Dog Mountain Farm, tours of Overlake Hospital and Seattle Children’s Hospital, and a Nurses Workgroup session on food and health. Workshops included case studies in direct farm purchasing, healthy beverage policy, buying sustainable meat and seafood, strategies for hosting farmers markets on hospital grounds, hospital cooking demonstrations, waste reduction, the overuse of antibiotics in animal agriculture, creating hospital leadership teams, working with distributors and foodservice companies to increase sustainable food options, the importance of Fair Trade coffee, and the frightening truth about GMOs. Washington presenters included: Chris Johnson (United General Hospital) and Chris Linaman (Overlake Hospital) spoke on the role chefs can play in training their staff to prepare fresh ingredients and create seasonal menus, and the positive impact their sustainable food purchasing has had on morale and community support. Pam Thiemann (Tacoma General Hospital) spoke with Kathryn Gardow, Cathy Buller, Lucy Norris, and Karen Mauden on how hospitals can support local farmers in an effort to preserve Washington farmland. Cindy Krepky (Dog Mountain Farm) spoke about her experiences holding farmers markets at multiple hospitals in Seattle, and was joined by speakers from Baltimore and Boston hospitals in an effort to share best practices from around the country. Keith Edgerton (Providence Southwest Washington) and Andrew Meyers (Providence Centralia) spoke about how they have implemented waste reduction strategies at Providence hospitals, including eliminating Styrofoam and launching recycling and composting programs. Daniel Shewmaker (Caffe Vita) spoke about the global implications of the coffee trade, and explained how to understand sustainability criteria for the world’s second most traded commodity. FoodMed is held every other year in a new region of the country, and is hosted by Health Care Without Harm. Previous locations have included Oakland, Boston, and Detroit. Stay tuned for information on FoodMed 2013!

Want to get involved? Over 360 hospitals across the country have signed the Healthy Food in Health Care Pledge “As a responsible provider of health care services, we are committed to the health of our patients, our staff and the local and global com-munity. We are aware that food production and distribution methods can have adverse impacts on public environmental health. As a result, we recognize that for the consumers who eat it, the workers who produce it and the ecosystems that sustain us, healthy food must be defined not only by nutritional quality, but equally by a food system that is economically viable, environmentally sustainable, and supportive of human Health Care Without Harm provides dignity and justice. We are committed to the free resources for improving goal of providing local, nutritious and susthe health and sustainability of your tainable food.” Additional Resources:

hospital:

Healthy Food in Health Care: www.healthyfoodinhealthcare.org

www.noharm.org

FoodMed: www.foodmed.org

Questions? Please contact Kathy Pryor, WA Healthy Food in Health Care Program Manager: [email protected] (206) 714-0813

Practice Greenhealth: www.practicegreenhealth.org Washington Physicians for Social Responsibility: www.wpsr.org