Serving up a healthier hospital

When Healthy Hospital Workgroup co-chair Shari Nethersole, MD, presented the Centers for Disease Control's (CDC) statistics on obesity trends among U.S. adults at September's hospital-wide Open Meetings, there was an audible gasp from the audience. The numbers are startling, skyrocketing from an obesity rate of 10 to 14 percent in only eight states in 1985, to obesity rates above 20 percent in 49 states in 2009.

As one of the 25 hospitals that make up the National Association of Children's Hospitals and Related Institutions' (NACHRI) obesity workgroup, Children's Hospital Boston is committed to focusing on obesity clinical services, but also to looking for new ways to improve a healthy hospital environment. The Boston Public Health Commission has also identified hospitals and healthcare institutions as a major target for promoting system-wide change.

With increasing national and local interest in making hospitals healthier, Chief Administrative Officer Dick Argys asked Nethersole and co-chair Sarah de Ferranti, MD, MPH, to assemble the Healthy Hospital Workgroup (HHWG), a multi-disciplinary team gathered from departments throughout the hospital to review and make recommendations for hospital practices and policies regarding environmental factors that affect the health of staff, patients and visitors, including food and beverage offerings, tobacco and smoking, access to physical activity and noise. Their first focus: sugar-sweetened beverages (SSBs).

"In the land of obesity, sugar-sweetened beverages have become the big topic," says Nethersole. "There is now clear data that shows an association between sugar-sweetened beverages and some of the rise in obesity." The HHWG sent out a survey last summer to find out what Children's employees were drinking, and where they were getting it.

Both the response and the results were encouraging: "The survey generated a lot of passion and interest," says de Ferranti. "Nearly 25 percent of our employees responded, and we're really not doing badly in the choices we make." Fifty-nine percent of those surveyed said they drink water regularly, while SSBs (soda, sports drinks, energy drinks) made up less than 10 percent of the reported consumption.

The comments indicated that most Children's employees agree that SSBs are a public health concern, that some effort should be made to reduce SSB consumption and that Children's should set a positive health example for our patients. There was also a strong belief that changing what you drink should be a personal choice--an opinion that the HHWG supports. "People don't want to be told what to do or forced to do things," says Nethersole. "They want to have choices. So as much as possible, we're encouraging people to make appropriate choices rather than just saying you can't have that."

The HHWG's first steps are gradual ones--SSBs are not being taken away from employees or patients, or eliminated from the hospital completely. With the help of Shawn Goldrick, director of Patient Support Services, and Cathy Hudson, director of Food Services, the Children's Cafe has already implemented the Stop Light Program--a system of labeling that puts healthy beverages (water, skim milk) behind a green door, drinks that are okay occasionally (diet soda, 100-percent juice) behind a yellow door, and drinks that are probably best avoided (sodas, energy drinks) behind a red door. Food Services hopes to expand the Stop Light Program to the hospital's vending machines. The idea is not to take away a consumer's choice, but to encourage them to think twice about what they're drinking. "Maybe we can't be green all the time," says de Ferranti, "but that doesn't mean we have to go red."

Since a majority of Children's employees are already making the healthy choice and drinking water, a number of new moves are afoot to encourage that choice. The Children's Cafe has introduced two new Hydration Stations, making water more easily available, as well as water frequent-buyer cards which give you a free bottle for every five bottles purchased. Catering and Food Services are both reducing the price of water, and the Cafe has removed the option of getting SSBs with their reduced-price meal deals. With 20 percent of employees saying they get their beverages from the patient floors, Children's is scaling back the size of sodas supplied to those floors to smaller 8 oz. cans.

Nethersole reiterates that none of these changes are about taking away anyone's choice of what to drink. "As a hospital, we're supposed to be comforting people, and if a can of Sprite is part of someone's way of coping, we need to be able to provide that to them," she says. "But as a hospital, we should be providing a good example of how to be healthy, which is why we're working to give people the knowledge to help them make the right choices."