B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

Linda Hansen, CDM, CFPP,  Director of Nutrition Services St. Joseph Health System, Sonoma County Linda.Hansen@stjoe.org

Started with the Creekside CaféStaff and visitor meals• Added vegetarian beans/legumes to menu in addition

to chili and soup• Instead of 2 days per week, offered vegetarian dish

everyday in addition to the main entrée • Improved salad bar offerings: more fresh local

produce, protein alternatives (tofu, beans, cheese)• Kept pricing low for “healthy” items, and raised prices

on “unhealthy” items to maintain margin

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

 Cafeteria Menus   Sustainable Protein   Vegetarian Entrées

Prior to Fall 2008   0%   8%

Fall 2008   5%   32%

Increase : 5%   24%

Cafeteria Results

EXAMPLES ♣Tofu Stir Fry ♣Lentil Stew ♣Spicy Sesame Noodles ♣Vegetarian Chick Peas ♣Stuffed Tomatoes W/Couscous ♣Bean and Rice Stew ♣Asparagus, Leek And Gruyere Quiche ♣Cheese Polenta ♣Brazilian Black Beans ♣Quinoa, Corn & Black Bean Stew ♣Bean & Kale Ragu

Increased revenue by $89,220 (11%) from 2006 to 2009 Vegetarian entrees are well accepted by customers in Café (They had been requesting them for awhile!) Almost 5,000 pounds less meat prepared per year in Café; ~150 tons of GHG Emissions saved!

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

Looked at Patient MenuThree pronged approach to achieve

“Balanced Menu” 1) changed some of the existing

vegetarian entrées to first choice Avg. ~100 less meat servings/meal

2) replaced unpopular meat entrées with vegetarian or casseroles with less meat

3) used the cost savings to replace meat entrées with sustainably raised beef or poultry

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

• $12,000 projected savings by reducing meat, poultry and fish

• $6,000 in increased costs for free range chicken and grass fed beef

• Despite a 35-50% price increase for the “sustainably raised” proteins, the menu overall will save the hospital over $5,000 per year, some of which will be used to offer more fresh, local items on patient menu

This is important because, unlike cafeteria items, we can’t charge more when we spend more on patient meals

PROJECTED SAVINGS, PATIENT MENU

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

CHALLENGES (Mostly on Patient Menus) Procurement

Our primary vendor does not supply or carry sustainable proteins/meats When we found “natural” or “free range” meats, they were industrially raised Sysco does not carry California Rice; had to find an alternative source. The rice was a different grain than cooks were used to. Production

challenges. No one has locality information for produce (except Country of Origin) One vendor promise local, and we received squash from Mexico!We decided to use local vendors at first, and then work on having primary vendor

stock specific items for us when we establish weekly volumes

Nutrition The clinical dietitians had concerns about our elderly patients’ acceptance of

vegan dishes and the effect of less consumption on healing The vegan & legume recipes we proposed were lower in protein than

traditional meat entrées (patients need protein to heal) They were considered more difficult to digest Nurses had concerns about the bookmarks; they thought they meant we were

giving less protein per meal.For this round of changes we stuck with more traditional vegetarian entrees that

include cheese and dairy. Did not use vegan recipes for patients.

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

Used $$ savings to buy sustainable proteins

Changed Tri Tip to Grass Fed Chuck Less expensive cut of meat was acceptable

because of the braising process; minimized cost impact

Changed Grilled Chicken Sandwich to a Grilled Free Range Chicken Breast Saved the expense and time of assembling

sandwiches, and offered local rice as a side dish Very challenging to prepare; dries out quickly.

We’ve had to make adjustments on trayline Changed Meatloaf and Taco Salad ground

beef to Grass Fed

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

ACHIEVED GOAL OF DECREASING CARBON FOOTPRINT

Patient  Trayline  

SustainableProtein   Vegetarian

Prior to Fall 2008   0%   14%

Fall 2008   20%   20%

Increase per category: 20%   6%

Based on the “Food and Diet Greenhouse Gas Emissions Calculator” from HCWH, Santa Rosa Memorial will reduce GHG emissions by about 200 tons by reducing meat on patient menus by 7,400 pounds/year

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

Result in overall expense: Meat Category

Baseline 2007: $312,000

After “Balanced Menus:”in Café & Catering (2008): $276,000for Patients & Café (2009): $270,000*

(Annualized)

*These amounts do not represent savings to the hospital. Costs for vegetarian items are allocated to a non-meat food category.

B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.

MARKETING AND EDUCATION

A “Balanced Menu” pamphlet from SF-PSR was distributed throughout the hospital to educate staff, visitors, physicians and patients on the rationale for the changes.

An informational bookmark that explains the health benefits is sent on patient meal trays to continue the education process.

Articles were placed in “Noon News,” “Nuts News,” “Connections” and other communications within the hospital

Took pamphlets and bookmarks to outside meetings and community events