Better Beverages

By Vanguard Health Chicago on April 25, 2013

Vanguard Health delivers healthy options to its patients, staff, and community.

OrangeJuiceAlthough New York Mayor Michael Bloomberg’s attempt to ban super-sized sugary soda drinks fizzled this past March, the mayor vows to keep fighting for the health of the city’s residents. While we wait to see if Bloomberg will win an appeal, another major organization has jumped on the soda ban bandwagon. Vanguard Health Chicago has 6,000 employees and 1.5 million inpatient and outpatient visits annu­ally at its four sites. Embracing its mission to “help people achieve health for life,” Vanguard is committed to creating lifelong relationships by changing the way health care is delivered in its communities—and this includes providing healthier beverages in its health care facilities and offices. As part of its Healthier Hospitals Initiative Healthier Food Challenge, Vanguard Health Chicago will be eliminating sugar laden beverages. Here are the steps it took to begin the process.

 

The Problem 

In Illinois, the obesity rate has nearly doubled since 1995. Almost two-thirds of all Illinois­ans are overweight or obese. Illinois has one of the 10 highest obesity rates for adoles­cents in the nation and the fourth worst child obesity rate. Sugar-loaded beverages are a major contributor to obesity and obesity-related diseases. The consumption of such drinks contributes approximately 46 percent of the added sugar in the American diet and may ac­count for one-fifth of all weight gain between 1977 and 2007. Hospitals should be role models for the healthy choices that lead to better health outcomes. By changing their food and beverage offerings, they can build better health care delivery systems and create better workplaces.

“Sodas, sports drinks, and other drinks that are artificially loaded with sugar are associated with a host of negative health effects and increase the risk of obesity, diabetes, heart attacks, dental problems, and even cancer. The health care community has an obligation not only to treat, but to help prevent, these conditions, some of which are at epidemic levels.”

—Dr. Anthony Tedeschi, Chief Medical Officer Vanguard Health Chicago

Addressing the Problem 

In April 2012, Vanguard Health Chicago created a Healthy Beverage Work Group to assess the beverage environment and create a healthy beverage program and policies. This group represented all business units in the market and worked with technical assistance and support from the Illinois Public Health Institute, American Heart Association, and Health Care Without Harm.

On July 1, 2012, Vanguard Health Chicago removed all high-sugar drinks, including regular soda, energy drinks, sports drinks, presweetened coffee and tea drinks, juice drinks with added sugar, in addition to whole or two percent milk. Sugary beverages were replaced with drinks that have moderate amounts of sugar, fat, and sodium, or ones that contain artificial sweeteners, like low-sugar drinks, 100-percent fruit or vegetable juice (in portions less than 16 ounces), diet drinks, low-sodium sports drinks, soy milk, and one percent milk. Large quantities of water, seltzer water, and one percent or skim milk are offered. The prices for healthy drinks were lowered to encourage consumption.

A color-coded system, patterned after a stoplight, was used to make the distinction between the drinks and educate hospital constituents (patients, employees, visitors, volunteers, and community members) about the drinks. Red drinks are high in sugar and sodium, with 12 grams or more of sugar. Yellow drinks have between 6 and 12 grams of sugar or contain artificial sweeteners, and green drinks have five grams or less of sugar.

Access to potable water was increased, with one hospital offering infused water during lunch hours at the cafeteria. And a plan was developed incorporating five evidence-based strategies of MAPPS (media, access, point of purchase information, price, and social support/services).

 

Implementation Process 

Vanguard’s process was multidisciplinary and collaborative, which made the transition fairly seamless. The implementation steps were as follows:

In April 2012, the Healthy Beverage Working Group began biweekly meetings. Subgroups were assigned specific tasks to plan and implement between team meetings.

The members of the Healthy Beverage Working Group attended the April 25, 2012 symposium, Rethink Your Drink: The Impact of Sugar-Loaded Beverages on the Obesity Epidemic & Clinical and Environmental Strategies to Reduce Consumption. On the day of the Rethink Your Drink symposium, a major media announcement was made about the Vanguard effort, which received coverage from the Chicago Tribune, WBBM-TV, and WLS-TV.

An inventory was taken of the drinks served and sold and at what access points. A decision was made not to purchase any more sugar-loaded beverages as they sold out. Sugary drink advertisements also were removed from vending machines and coolers.

All vendor contracts were reviewed. Meetings were set up with vendors, who were asked to share the decision to create a healthier beverage environment and the new parameters of their relationship with Vanguard. Vendors were asked to consider what beverages they would supply that were less sugary or contained no sugar. They supplied several new options; the Healthy Beverage Work Group gathered to taste the drink options and vote on which had the best taste and met the criteria for amount of sugar and serving size.

Meetings also were held with on-site providers (Walgreens at one site) to let them know about the new policy and ask that they join Vanguard in the healthy beverage campaign. Walgreens agreed to sell only healthy beverages and implemented the Vanguard criteria.

Communication and educational materials were developed with the same color-coded definitions used by the Boston Public Health Commission. In June 2012, market president Bill Foley sent a message to all Vanguard Health Chicago constituents about the environment change, describing it as a demonstration of “our commitment to our mission through our action.” During a week in July, each hospital hosted a taste testing of the healthy beverages that replaced the sugar-loaded ones.

 

Benefits 

Many benefits have come from this effort. Vanguard Health Chicago employees have seen improved health benefits, including weight loss. Many have shared how proud they are to work at a place that puts its mission into action and genuinely cares about them.

Community partnerships have been strengthened and expanded. Working partners like the American Heart Association, Illinois Public Health Institute, and Health Care Without Harm shared tools, resources, and their expertise, making the planning and implementation process much easier.

“People feel good about what they are eating and drinking,” says Theresa Rudnick, senior director for Support Services. “These changes have been good for our business, but more importantly, good for the health of those we serve and employ. It’s a win-win. I think some people wonder why we didn’t do this sooner.”

 

Challenges and Lessons Learned 

Because there are four hospitals in the Vanguard Health Chicago system, each with a different organization style and culture, as well as their own set of priorities and challenges, this meant that communication was an essential part of the process. Understanding the nuances of each site was necessary for the success of the effort. One implication of these differences meant developing overall strategies with differing timelines. For example, Vanguard MacNeal made changes to its food environment first; the other hospitals are just beginning to make food changes.

Discussions about revenue losses and backlash from the employees, patients, volunteers, and community members were more intense that the actual responses, but those complaints didn’t last for long. Over time, there was more vocalized positive feedback and support.

 

Next Steps 

Now that the beverage environment has been transformed, three of the four hospitals will work on changing the food environment. Since the implementation of the program was so quick, tracking tools were not developed. A tracking system was launched in September 2012. The education efforts will be intensified and expanded, ensuring that the message of the negative impact of the drinks is emphasized.

For more information on HHI, visit healthierhospitals.org.