Hospitals aren’t typically associated with fine dining. And even though hospitals are in the business of health care, the beverages and foods they offer — especially when the cafeteria is closed — often lean more toward junk food than healthy fare. But a group of Kansas hospitals is out to change that. The initiative is called Healthy Kansas Hospitals. The three-year effort, which runs through June 2016, is sponsored by the Kansas Hospital Education and Research Foundation, a branch of the Kansas Hospital Association. Harold Courtois, administrator of Russell Regional Hospital in central Kansas, is enthusiastic about the program. “We feel like, as a health care institution, we should be following what we tell people to do,” Courtois says.
He admits hospitals haven’t always done that in the past. Before he signed the Healthy Kansas Hospitals pledge, the cafeteria serving line featured many more foods that didn’t meet basic nutritional guidelines. “You would find all kinds of cakes and pies, and things that are really a lot higher in calories,” Courtois says. “So we’re trying to provide a better option, maybe not the perfect option.” The Russell hospital has expanded its salad bar and offers a variety of leafy greens with more nutrients than iceberg lettuce. Fried foods are still available, but there’s always a healthier grilled or baked option. Courtois emphasizes that word: “option.”
Providing options
“I just hate mandated healthy options,” he says. “What we should do is educate people, and urge them to do it.”
One thing that’s not optional: portion sizes. “We bought smaller plates, and at first everybody complained. And now it’s the norm,” Courtois says. “It used to be, people filled the big plates full. Now they fill the small plates full, but there’s much less food.”
As a result, the hospital has been able to hold meal prices around $5 — even though the price of food has gone up.
Dietary manager Sarah Depiesse concedes the changes entail compromises, especially with elderly patients in the long-term care unit upstairs. For example, the hospital’s cooks haven’t made the switch to whole-grain pasta and bread.
“Well, there’s still some things that we have to do in order to keep our patients happy,” Depiesse says. “I mean, they’re a meat-and-potatoes community upstairs.”
But the healthier meal options in the cafeteria are starting to catch on with the hospital staff and visitors, however gradually.
“It’s really hard to make people change their ways and to go from the more fulfilling, hearty, homestyle meals to kale, and peppers, and really bright, vibrant vegetables and fruits. All we can do is show them, and hope that they make the better choice,” Depiesse says.
The changes have even generated a new, albeit small, line of business for the hospital. Depiesse says several members of Russell’s business community have started showing up for lunch.
Beyond hot meals
The changes promoted by the Healthy Kansas Hospitals initiative go beyond hot meals. Russell Regional Hospital is also making an effort to include healthier options among the snacks and drinks that are available at all hours. In some cases, they’re even rearranging the line-up of snacks and drinks in vending machines, giving unsweetened drinks prime “real estate.”
“So, everywhere there’s a sugary or a high-fat drink, we also offer the low-fat or non-sugared drinks,” Courtois says. “And when we get into our vending machines that we own, we actually provide all of the healthy drinks in the middle rows that everybody looks at. You have to look way up at the top to see the ones that have sugar, or way down at the bottom, and that’s not what people see. They have to really be after that to go get it.”
Courtois says those changes caused a slight drop in sales at first, but vending machine revenues quickly returned to their previous level.
That reinforces dietitian Linda Yarrow’s view that, over time, people will come to appreciate having healthier food options. Yarrow is an assistant professor of nutrition at Kansas State University.
“The public is becoming more and more aware, because they know that obesity and overweight is a problem,” Yarrow says. “Everybody can name somebody that’s got diabetes or high blood pressure. And I am seeing people becoming more interested in maybe what can I do as a preventive measure, instead of waiting until they’re diagnosed.”
In addition to her teaching job, Yarrow is the dietitian for Clay County Medical Center, in Clay Center, which joined the Healthy Kansas Hospitals initiative this summer. One of the changes the hospital has implemented is to provide nutritional labeling for all of the entrees and side dishes served in its cafeteria.
Educating consumers
“We have seen employees reading the labels,” Yarrow says. “Occasionally, I’ve seen them put back a few items, or they’re asking questions about it. So that’s good, because our goal is to increase awareness. We want them to realize they have other options now, and we want them to see the benefits of making some different choices.”
Yarrow says it will be a very gradual process, but she thinks educating the public and leading by example can ultimately make a difference.
Josh Mosier, who heads the healthy hospitals initiative, thinks so too. “It’s the mission of the hospital to not only treat and diagnose, but to prevent chronic disease from ever happening in the first place,” Mosier says. “It’s not always going to be about the bottom line. Sometimes it’s about the mission, and what’s best for your patients and the community you’re serving.”
Mosier says he can already see some momentum.  
“Maybe right now what they’re doing is they’re posting nutritional facts,” he says. “Maybe they’re providing free drinking water all day, every day. Maybe what they’re serving at their employee meetings is no longer doughnuts and cookies, but fresh fruits with coffee, tea or water as the beverage, instead of pop. Whatever it is, we’re helping hospitals to identify those areas they’d like to focus on that are going to be accepted by their staff, have an impact, and hopefully lead to larger changes at some point.”
His goal is to get at least 50 of the 126 members hospitals in Kansas to change their food and beverage policies. So far, 77 have pledged to at least review their policies. And Mosier says feedback from those who have signed on has been positive.
As employees have seen that the effort is not about taking away anything, but rather offering healthier options and choices, their initial wariness has faded and, Mosier says, many of them have now bought in to the initiative.