Healthier Environments

By Janet Brown, Director of Facility Engagement on June 13, 2013

Screen Shot 2013-06-12 at 5.50.39 PMA patient’s perspective with John Kendle, St. Joseph’s Medical Center, Stockton, California

 John Kendle is the director of support services operations for Dignity Health’s St. Joseph’s Medical Center, a 359-bed not-for-profit regional hospital specializing in cardiovascular care, comprehensive cancer services, and women and children’s services. He oversees parking, security, laundry, environmental services, grounds, and other ancillary areas. John has worked at the Stockton, California, facility for seven years and lives in Patterson, California, with his wife and five children ranging from a 24-year-old daughter to triplet boys, age 20.

On April 20, 2012, John Kendle had a heart attack. He woke up in the middle of night with pain in his chest, jaw, and neck. He woke his wife, dialed 911, and was placed in an ambulance headed to St. Joseph’s. “It’s a horrifyingly scary experience to have your shirt ripped open, a nitro patch [put on], chew on aspirin in the ambulance, have paramedics leaning over you. I work in a hospital and see people coming in all day long, but I never understood what it felt like,” explains John.

John had always been healthy, had regular well visits, and had never been rushed to the hospital with an emergency situation. However, he was overweight, smoked, and didn’t exercise. With a 98-percent clogged artery and a new stent, John had no permanent damage and returned home in just a few days. After about a week at home, he went to CleanMed, the conference on environmental sustainability in health care, and he started thinking about healthy environments with his new perspective. Why did it take this health crisis to make him think about his hospital as a model of healthy living? What could he do to make the hospital healthier?

With his personal aha moment behind him, and the need to change his lifestyle in front of him, he took a fresh look at his health care facility—looking for signs of prevention and healthy lifestyles. He was amazed by the number of healthy food choices in the cafeteria that he just hadn’t noticed before. In addition, there were healthy programming opportunities for staff—gym membership, cardio fitness classes, healthy heart training—but staff didn’t seem to take full advantage of them. John’s new eyes saw that something was very wrong.

Prior to his awakening, John was one of those people who, upon entering the cafeteria, headed straight for the unhealthy food options. Now, John pays particular attention to the nutrition facts listed on each of the food options. “While we have patients having heart procedures,” he says, “we want to make sure we aren’t just offering the food that contributed to their disease.” It’s a shame that it took a crisis for John to become aware of his habits and surroundings. “San Joaquin County has the highest death rate from diabetes of any county in California, and yet this is where more than 40 percent of the produce sold in America comes from. It’s education. It’s poverty. It’s accessibility,” he says.

At home, his health crisis scared him and his family straight. He lost 40 pounds, stopped smoking, started exercising, and the entire family was right alongside him. This new perspective led John to partner with the Ecology Group, the Wellness Committee, and the Healthier Hospitals Initiative Food Challenge as a framework that was already underway. John’s personal experience changed him, and he was in a position to do something about it.


Getting Started

While transforming food service offerings is a big undertaking and not without its challenges, the Ecology Group and the Wellness Committee explored a parallel strategy. John approached leadership and made the case for a volunteer-run vegetable garden that would directly impact the community through the donation of fresh vegetables at no added cost to the hospital. The solid waste hauler, the local nursery, and others helped to make the garden possible. John was struck by how many came to help. “It turned out that an administrative secretary was a Master Gardener, and we could not have done this without her. Some of the maintenance guys volunteered on a Saturday to build the raised beds.”

With the leadership support they needed, St. Joseph volunteers planted a 4,000-square-foot garden where they harvest and distribute vegetables to those in need through St. Mary’s Interfaith, a local soup kitchen located in downtown Stockton. Thanks to their efforts, St. Mary’s was able to prepare fresher and healthier meals.

The garden also has taken on greater meaning for volunteers and for the community. The local paper makes the garden front-page news. “It’s a breath of fresh air for the entire community,” says John.

As a result of his healthier lifestyle, John feels better in the morning, has more energy, is easier to deal with, and feels nicer. He adds that it really made a huge difference not only in how he feels, but in the way he is interacting with people. His wife lost 32 pounds. She and John go to the gym three times a week. John also takes advantage of the rehab fitness classes two days a week, which are offered free of charge by the Medical Center.

While St. Joseph’s continues on its journey toward a healthier environment and healthier food for its patients, staff, and community, other area hospitals are a bit further along. Healthier food choices started at John Muir Campus in Concord, California, when they built a new tower and a Cardiovascular Center of Excellence. Director of Nutrition Services Sandra Rigney, along with the dietitians, executive chef, and clinical nutrition manager decided that if they were a center of excellence, then they needed to focus on the cardiac menu. They completely redesigned the menus, with about 30 percent of patients now on a heart healthy diet at the Concord campus.

By signing Health Care Without Harm’s Healthy Food Pledge, they took several other steps toward a healthier food service program. They reduced meat procurement at all sites by 20 percent for patient menus and in the cafeteria, and now offer organic and free-range chicken, eggs, whole grains, and brown rice, as well as increased vegetarian options. They added organic yogurt smoothies, green tea, hormone-free milk, and almonds and walnuts as snack options. They designed table tents in the cafeteria and bookmarks on patient meal trays to increase education about healthier food choices and the importance of a sustainable and healthy food system. They updated their cardiovascular education program with a catalog of cardiac health information and an updated nutrition section. Dietitians offer free monthly cardiac educational practices. In the rehab area, spaces have been added to enable sitting outside, and a miniature golf area supports rehab, play, exercise, and stress reduction in a healing garden with fresh herbs and scented lavender.

John Muir Health is part of the Bay Area Hospital Leadership Team, which is made up of food service directors, chefs, and nutrition managers from nine of the Bay Area’s largest health systems. They work to aggregate their procurement volumes to help offset the costs of some locally grown, organic food products. By working together, these hospitals have been able to purchase more sustainably grown, healthier food products at lower costs. During the summer of 2012, John Muir and two other hospitals on the Hospital Leadership Team achieved combined purchasing of more than 6,000 pounds of sustainably grown local produce from family farms. The hospitals are now expanding their efforts to include fall and winter crops with the assistance of the Health Care Without Harm Healthy Food in Health Care program.

The work resulted in winning a Health Care Without Harm Food Award in 2012. In addition to healthier foods, they also have reduced energy use by managing exhaust fan use, switched from disposable to compostable dishware, and used Greenseal Certified products for the majority of cleaning chemicals.

Designing for Healthier Food Services

  • Design cafeteria layout to promote
  • healthier choices (foods, beverages, filtered water stations, salad bars)
  • Install energy- and water-efficient equipment
  • Implement fan and ventilation management
  • Switch to reusable and compostable dishware
  • Ensure proximity to baler or compactor for recycling efficiency
  • Purchase and use less toxic cleaners
  • Implement an integrated pest
  • management program
  • Foster a connection to nature with natural lighting, outdoor patio dining if possible,
  • large windows, and small garden areas
  • Increase healthy food education opportunities
  • Include the cardiac team, nutritionists, and a sustainability lead on integrated design team


Healthier Food Challenge

Learn more about switching to healthier food services for staff and patients by joining the free Healthier Hospitals Initiative’s Healthier Food Challenge and becoming part of the growing movement of hospitals demonstrating their commitment to prevention and setting an example for their communities.