Ready, Set, Measure!

Hospital food service is using metrics to support sectorwide change.

By Thresa Pattee on July 28, 2016

apple + tape measureYou can’t be sure how far you have come if you don’t know where you started. When deploying sustainability initiatives, understanding what you want to accomplish, where you currently are, which internal systems to leverage and how to partner with vendors for assistance will help to streamline the often challenging practice of measuring progress.

Over the past 10 years, the Healthy Food in Health Care Program has seen many hospitals launch programs and maintain momentum and support by using metrics to quantify their progress and inform decision-making. Metrics highlight the progress of individual facilities and, when aggregated, can be used to drive changes in the marketplace. Aggregate data benefits the whole sector by supporting new certifications such as Certified Responsible Antibiotic Use, signaling the market to increase supply, and influencing vendors to more accurately track local and sustainable products.

Four Practice Greenhealth members have each tackled one of four steps in the metric creation process.

Step 1: Setting Goals and a Plan for Measuring Progress

According to Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, the keys to effective goal setting are to start with a vision, align with the organization’s strategic priorities and involve key stakeholders. The facility has developed a comprehensive set of five-year environmental sustainability goals for all areas of operation, including a Healthier Food domain. Advice and guidance from Health Care Without Harm and Farm to Institution New England helped the medical center clearly define sustainability criteria and determine which goals were attainable.

“Having conversations with the staff at HCWH, who better understood sustainability criteria and market movements, enabled us to set ambitious goals,” said Jessica Wolff, environmental sustainability advisor at Dartmouth-Hitchcock.

Strategic planning was led by the Environmental Sustainability Council, which includes high-level representation from across Dartmouth-Hitchcock. Each sustainability domain had its own work group, involving both internal stakeholders and external subject matter experts.

Using a “value-effort” assessment, which weighs how much sustainability value a goal would create against how much effort (time and resources) is needed to achieve it, the domain work groups narrowed the list of goals. The goal set was then presented to facility leadership and received official endorsement from the Board of Trustees in December 2015.

Dartmouth-Hitchcock’s Healthier Food goals include increasing local and certified sustainable food purchases to 35 percent of total food purchases and sourcing 100 percent antibiotic-free chicken. “Now that we know where we want to go, we are planning backwards, figuring out what we need to accomplish each year to get to our 2020 goals,” said Deborah Keane, food and nutrition services director at Dartmouth-Hitchcock. “And luckily, we have the team and support both inside and outside our organization to make it happen.”

Step 2: Knowing Your Starting Point: The Importance of Baselining

The University of Vermont Medical Center began its sustainability journey more than 10 years ago. One skill it has mastered is taking careful stock of its current practices and situation before launching new initiatives.

In 2006, UVM decided to re-evaluate its seafood purchasing practices. To do so, it built a close relationship with its seafood purveyor to understand the current purchases, including the amount of seafood, species, harvest location, harvest method and more. With this comprehensive baseline, UVM worked with the purveyor to identify substitutions that would meet the defined criteria. Understanding which purchases already qualified as sustainable reduced the potential for duplication of efforts and focused efforts instead on replacing unsustainable products.

Along with six other facilities in New England, UVM has been working with a consultant who investigates the facilities’ purchases and helps sustainability and food service staff determine what qualifies as sustainable and local. She also helps facilities establish baselines using 2015 data so tracking is easier moving forward, and facilities only need to input new products into the system.

Tracking can be a time-intensive process, but movement in the marketplace is showing that more vendors are putting resources into sustainable product tracking. Establishing a comprehensive baseline and tackling projects in small chunks can ease the workload.

Step 3: Leveraging Internal Systems

Recognizing the current shortcomings of sustainable attribute reporting by vendors, The Department of Nutrition and Food Services at the University of California, San Francisco Medical Center looked to create an in-house solution to track purchases that aligned with the department’s sustainability definitions.

With the 2015 grand opening of UCSF Medical Center at Mission Bay, its third campus, it became increasingly necessary to enhance the reporting available to support the health and wellness initiatives across multiple campuses. In alignment with HCWH, these initiatives include meats raised without antibiotics for patient and retail menus, the purchasing of more local and sustainable foods and the elimination of sugar-sweetened beverages.

The solution was to leverage Computrition, the software suite UCSF uses to control and report on a wide array of procurement and production functions. Inputing an asterisk in the Computrition description enables the procurement team to flag each sustainable product. In addition, custom inventory subgroups allow items to be coded with a sustainable attribute while still being part of the larger food group. The resulting data lead to easier reporting of sustainable food and supplies across vendors and UCSF campuses.

Updates to Healthy Food Resources at Practice Greenhealth

Increasing access to healthy, sustainable food in health care is a high priority. Practice Greenhealth has many resources for members to learn more about tracking sustainable food options and to make the best choices for patients and hospital staff. Click here for more information and to access these resources.

  • Healthy Food in Health Care’s newest Menu of Change Report, which includes aggregated data from more than 100 hospitals.
  • Healthier Hospitals modules for Less Meat, Better Meat; Local and Sustainable Food Purchasing; and Healthy Beverages include guidance on baselining and tracking tools. (Login required.)
  • Greenhealth Academy offers new and archived sharing calls around food, marketing and sustainability best practices. Use the Healthier Foods filter within Greenhealth Academy to search for all things food related.

tape measure + apple + salad

Step 4: Working with Suppliers to Track Progress

Kaiser Permanente, a health system with hospitals in eight states and the District of Columbia, has made strategic use of its supply chain to meet sustainable purchasing goals and to support detailed tracking of its progress. Kaiser found that one of the greatest opportunities to shift and share the burden of tracking was at the point of vendor-supplier selection and in the contracts that codify these business relationships. Kaiser developed a sustainable food scorecard to use with vendors to assess potential suppliers and to identify products that best meet Kaiser’s sustainability criteria. The scorecard is included in all food-related requests for proposals sent to potential vendors.

“The scorecard has been an instrumental tool in requiring an upfront commitment from potential vendors to track and report on sustainable spend,” said Kathleen Reed, Kaiser Permanente’s sustainable food program manager. The scorecard, which aligns with HFHC criteria, is helping to standardize and hardwire sustainable food purchasing standards within the health care industry and beyond. Kaiser has made this tool and related resources available to other facilities.

As Kaiser embarks on its 2025 goal to buy all of its food locally or from farms and producers that use sustainable practices, including the responsible use of antibiotics, vendor partnerships will be more important than ever. The scorecard will help pave the way for more robust data collection by providing an RFP component that supports purposeful vendor selection and fosters deeper and more dynamic relationships with business partners.

The Future of Food

Metrics tracking is one of the most important components of a robust and meaningful sustainability plan. Data creates the foundation for the rich story being written by each health system and facility as they heal their communities and help to bring about changes in the modern food system. Being on the leading edge of sustainable sourcing means using creative solutions to fill the transparency and tracking gaps that exist in current supply chains.

Practice Greenhealth members can access tools to support goal setting, implementation, tracking and continued education. Together, we can gather accurate metrics that will support facility level goals. These metrics will provide examples and guidance to help manufacturers and distributors build out new reporting systems which support the environmental nutrition movement. As we move this great work forward together, remember the importance of metrics in understanding where we’ve been, celebrating where we are and preparing for where we’re going.