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Hospitals take steps to set healthy examples for patients

Healthy patient meals at Spaulding Rehab Hospital include salads in the cafe.

John Tlumacki/Globe Staff

Healthy patient meals at Spaulding Rehab Hospital include salads in the cafe.

In an effort to practice what they preach, Boston-area hospitals have begun to adopt widespread changes to encourage healthier eating among patients, visitors, and staff and to make their own facilities less damaging to the environment. Sugary sodas, candy bars, harsh cleaning agents, and disposable surgical tools are being phased out in favor of more local produce, fruit-infused water stations, solar panels, and reusable instruments.

More than 40 hospitals in Massachusetts, including all 10 in the Partners HealthCare system, and 900 hospitals nationwide have joined a healthier hospitals initiative, launched in 2012.

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“Hospitals have healing as their core value, yet they unwittingly contribute to chronic disease in our society by selling junk food, being enormous users of toxic chemicals and energy resources, and generating a ton of waste,” said Gary Cohen, president of the nonprofit group Health Care Without Harm that organized the initiative.

Participating hospitals pledge to take on certain challenges such as providing more produce and less red meat to patients, staff, and visitors; using safer chemicals in their cleaning products; increasing recycling efforts; or installing energy-efficient heating and cooling systems.

Many hospitals have started rooftop vegetable and herb gardens, and kitchen staff are purchasing more local produce from sustainable farms and seafood from local fishermen. Food waste composting has become more common, and new facilities now routinely incorporate green design elements to save energy and reduce waste.

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Some area hospitals have implemented more sweeping changes than others. “Each hospital is moving at its own speed, but all are moving in the right direction,” said John Messervy, director of capital and facilities planning for Partners HealthCare, which is a sponsor of the initiative.

On one end, Boston Medical Center has focused its efforts on reducing red meat consumption among patients, visitors, and staff and organizing weekly farmers markets in the hospital lobby. Hospital staff plan to implement more nutritious menus during the coming year.

Fried foods are no longer served to Spaulding visitors, staff, or patients — nor is any kind of sugar-sweetened beverage, and bread is wheat or whole grain.

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Spaulding Rehabilitation Hospital, on the other end, implemented a variety of healthier upgrades after moving into a new environmentally friendly building in Charlestown last April. It has a roof partially covered with vegetation to reduce storm water runoff — a source of pollution — and provide extra insulation. Its raised floor and landscaped lawns protect against a rising sea level and storm surges due to climate change.

Fried foods are no longer served to Spaulding visitors, staff, or patients — nor is any kind of sugar-sweetened beverage, and bread is only wheat or whole grain. Dunkin’ Donuts, which occupied the hospital’s old lobby, is nowhere to be found in the new one.

Spaulding vending machines now contain bottled water or diet beverages, baked chips, and sweets with less added sugar.

“There’s been some resistance to the changes” from hospital staff, said Paula Hereau, vice president of hospital operations at Spaulding. “People ask the most about the loss of their favorite French fries.”

But patients have few complaints: Dave Whitty, a 62-year-old patient who lost both his arms in a motorcycle accident last summer, proclaimed his meals to be “excellent”; his favorites include vegetable soup, whole-wheat pasta dishes, and a small slice of cake for dessert. “I can still feed my sweet tooth,” he said. Whitty arrived at the hospital after the menus were revamped to reduce red meat, chicken, and pork offerings in favor of more fish and vegetarian entrees.

Hospitals participating in the initiative have promised to decrease their carbon footprint not only by serving fewer animal products but also by reducing the medical waste they contribute to landfills. When four Partners hospitals switched last year to reusable “sharps” containers to get rid of used needles in patient rooms, that move alone led to the removal of more than 112,080 pounds of plastics from the disposable containers every year from landfills.

“We’re always looking for alternative products that are better for the environment,” said George Player, director of engineering at Brigham and Women’s Hospital, which made the switch to the reusable containers. The hospital also uses only green cleaning products and eco-safe paint that contains no volatile organic compounds; converting to LED lighting, he added, has led to a 2 percent reduction in the hospital’s electricity usage over the past year compared to a typical increase of 2 percent every year.

Quantifying such benefits of these changes — which often have high upfront costs — has taken on greater importance as more hospitals join the effort to set healthier examples.

Massachusetts General Hospital added a traffic-light labeling system to its cafeteria fare four years ago — with foods labeled green, yellow, or red depending on their nutritional value — and researchers there found that it has led to more nutritious purchases: 33 percent of cafeteria customers reported looking at nutrition information before making a purchase compared to 15 percent who did so before the labeling system was added, according to research published last October in the Journal of Preventive Medicine. Researchers also found that 61 percent of cafeteria customers reported that health and nutrition were important factors when considering what to order, compared with 46 percent of customers previously.

Some hospitals, though, have hesitated to banish some of their best sellers. “We use the red, yellow, and green system to label our beverages — and we’ve seen an increase in water and juice sales,” said David Maffeo, vice president of support services at Boston Medical Center. But, he added, the hospital isn’t ready to ban Pepsi and Gatorade at this point.

Newton-Wellesley Hospital isn’t either. “We work in a high-stress environment, and people get annoyed when they can’t get Coke and Snapple,” said Chris Minette, director of the hospital’s nutrition and food services. “These drinks bring in a profit.”

In fact, Beverly Hospital experienced a 40 percent loss in profits from their vending machines after they removed candy bars, potato chips, and soda in 2012 and replaced them with bottled water, nuts, and Kashi Go Lean bars. “Our hospital executives supported us because it’s a conflict of interest for us to profit from poor eating habits like selling a bottle of Coke or fried chips,” said Lynn Larsen, clinical nutrition manager at Beverly.

Such economic losses could, though, lead to an ultimate savings in medical costs if employees, visitors, and patients experience improved health. The health care system will also see fiscal improvements from hospitals that practice conservation: A 2012 study by the Commonwealth Fund, a nonprofit health care research organization, calculated that the nation’s medical care costs would be reduced by $15 billion over 10 years if all hospitals switched to energy-efficient systems; reprocessed and reused operating room supplies; and reduced medical waste through more recycling. The study — which based its projections on changes made by Massachusetts General Hospital, Brigham and Women’s Hospital, and 16 other hospitals nationwide — challenges the assumption that the high upfront costs will cancel out any savings, Messervy, of Partners HealthCare, said.

Spaulding’s new facility was designed to run on 42 percent less power than what the average hospital in America uses. Newer buildings at Massachusetts General Hospital and Brigham and Women’s Hospital — and one being designed at North Shore Medical Center — also meet the US Green Building Council’s standards for energy and waste conservation.

In developing the healthier hospitals initiative, Cohen said he believes it’s the larger mission of hospitals to lead the way toward sustainability. “We started with hospitals, but we’re hoping this idea will spread to other institutions.”

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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