Rehabilitating hospital food: aiming for healthy, sustainable and savory

A group of San Francisco hospitals are working to transform hospital food — and getting rave reviews. But can they make it tasty for patients and healthy for the environment?

In reviews on Yelp, San Francisco’s Moffitt Café averages four-and-a-half out of five stars. “Unbelievable variety, farm to table fresh food, wide produce selection, and great prices!” enthuses one customer. “I’m really happy with eating here, they have SO many options,” gushes another.

Not bad reviews … especially for a hospital cafeteria. Moffitt Café, also known as “the Moffitteria,” is the main dining hall of the University of California at San Francisco (UCSF) Medical Center. Since undertaking a $6.5m café renovation in 2010, the nutrition and food services department at UCSF has been working to renovate the menu as well, attempting to integrate eating choices that are tasty, healthy and good for the environment.

Even though a short hospital stay is unlikely to change anyone’s bad eating habits, it’s “a big educational opportunity,” says food-service project manager Jack Henderson. “We need to lead by example, because we are a teaching institution.”

The medical center has become a leader in a growing movement amongst hospitals countrywide to add more fresh, organic and sustainable foods to their patient and cafeteria trays. Seven years ago, Henderson, along with food service representatives from several other San Francisco Bay Area healthcare systems, joined with Physicians for Social Responsibility, a nonprofit organization, to brainstorm ways to change hospital food.

UCSF's Moffitt Cafe tries to integrate healthy, attractive and sustainable food options.
UCSF’s Moffitt Cafe tries to integrate healthy, attractive and sustainable food options.

Creating a food community

The group realized that, by pooling their purchasing power, they could prod the mainstream food distribution chain to include more sustainably produced items – and, in the process, maybe turn the stereotype of bad hospital food on its head.

Part of the solution has also been buying higher-quality ingredients, but in smaller amounts. In an innovative plan cooked up with Lucia Sayre of Physicians for Social Responsibility in 2008, UCSF and a few other hospitals trimmed conventional meat purchases by at least 20% in 12 months. They then used the savings to buy sustainably raised meats and produce, which are often pricier.

Sayre is also an organizer for Health Care Without Harm, a global coalition that has since adopted the Bay Area meat-reduction strategy as part of a national campaign promoting healthy food in health care. Nearly 500 hospitals across the US have joined the Health Care Without Harm campaign — and more than 150 of them have been cutting meats or switching to sustainable sources for it.

Between its move toward less conventional beef, its establishment of “Meatless Mondays,” and its efforts to reduce food waste, the UCSF Medical Center’s food services department has managed to divert a significant portion of its budget to more sustainable food sources. In 2014, sustainable edibles — ranging from local, organic yogurt and strawberries to cage-free eggs and antibiotic-free chicken – comprise roughly 25% of its $5.3m food budget.

Serving multiple missions

While most restaurants only have to focus on making attractive entrees, the UCSF Medical Center also has to keep an eye on a variety of patient needs. Not surprisingly, changing its menu has taken “a lot of gradual, progressive, hard work,” says Dan Henroid, director of nutrition and food services at the Medical Center. A major challenge has been ensuring food safety and meeting nutritional requirements, a critical issue for an institution that serves sick patients.

At UCSF's Moffitt Cafe, receipts come with nutritional information.
At UCSF’s Moffitt Cafe, receipts come with nutritional information.

Another challenge is size. The UCSF Medical Center’s kitchen staff prepares around 1,500 patient food trays a day, along with thousands of meals for cafeteria patrons, Henderson says. An operation of that size has a major carbon footprint, and the food-service supervisors are tasked withmeeting sustainability goals set by the broader University of California system.

One way they’ve done this by challenging the industrialized system of food production. The kitchen staff has been buying more locally produced foods, which means fewer fossil fuels burned for transport. Their move to cut back on conventionally raised beef also translates into fewer greenhouse gas emissions from industrial cattle feedlot operations.

Making such changes is also tricky because Henroid and his staff have to navigate complicated institutional purchasing contracts, which provide huge volumes of food products at discounted prices. Under its contract with a national group purchasing organization, UCSF is obligated to buy most of its edibles from distributor US Foods. Unfortunately, the supplier offers relatively few sustainable ingredients in its catalogs.

The Bay Area hospitals’ strategy has been “to put enough gentle pressure” on distributors to make sustainable foods more available, Sayre says. When the largest healthcare facilities in a region pool their purchasing dollars to ask for an aggregated volume of a particular organic food item, they can be “incredibly influential,” she says.

How market pressure can make a greener burger

A good example of the hospital group’s gentle pressure is the new $4.50 grass-fed beef burger that Moffitt Café debuted in February. Last year, a UCSF task force, concerned about the overuse of the medicines in livestock, called for the university to completely switch to antibiotic-free meats.

Moffitt Cafe's grass-fed hamburger
Moffitt Cafe’s grass-fed hamburger

At the time, Henroid’s department was buying antibiotic-free beef patties from Oregon through US Foods, but he wanted a vendor that offered a lower price point and stronger marketing support. Ultimately, he convinced US Foods to start carrying patties from Uruguay-based Estancia Beef, which grazes its cows on pasture and doesn’t routinely dose them with antibiotics.

Volume buying was key to this process: Henroid negotiated a favorable pricing deal with Estancia after identifying six hospitals in the Bay Area and Southern California that were interested in buying a collective 80,000 pounds of the company’s stew meat and ground beef products each year. All told, they represented a potential $120,000 in annual orders.

US Foods agreed to stock the Estancia products when UCSF committed to buying 20,000 pounds a year. “Our commitment has opened the door for others to now be able to buy these products,” says Henroid, noting that many other hospitals, schools and colleges also order from US Foods’ California catalogs.

Another example of collective purchasing power is the university’s collaboration with the nonprofit Community Alliance with Family Farmers. Ariane Michas, manager for the alliance, worked out an arrangement that lets the hospitals, as well as other customers, buy from smaller growers via two produce distributors that were already supplying the institutions.

The partnership has already borne fruit. In the past two growing seasons, UCSF, the San Francisco VA Medical Center and four other hospitals served 67,000 pounds of green beans, pesticide-free strawberries, squash and other crops that were grown by 10 local family farmers. And the benefits go both ways: With the financial commitment from the hospitals, the family farmers can plan better for the seasons ahead, Michas says.

“It’s been really good,” says UCSF’s Henderson. One local grower, Coke Farms, had to increase its acreage devoted to organic strawberries by more than 30% “because they couldn’t keep up with us,” he says.

Given that the US healthcare industry spends an estimated $12bn a year on food procurement, Sayre hopes other hospitals will replicate the Bay Area’s pooled-purchasing strategy to shift the mainstream marketplace towards more sustainable foods. In some areas, the process has already begun. Healthcare institutions in Los Angeles, San Diego, Portland and New England have started taking the same team-based approach.

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