Clinicians, chefs collaborate on hospital meals

How 3 hospitals are going antibiotic free

Clinician enjoys a salad at Children’s Hospital Colorado (Children’s Hospital Colorado)

By Melanie Giangreco, Health Care Without Harm’s Healthy Food in Health Care program assistant

As a fellow, Dr. Rosemary Olivero was responsible for fielding phone calls from physicians wanting to use antimicrobials for their patients, and listening to their stories about why they thought these prescriptions were necessary.

Eventually, she says, “I realized that there is a fair amount of antimicrobial prescribing that comes out of fear and the lack of knowing what is going to happen to your patient. I remember thinking, there’s such a better way to do this on more of a systems level.”

Now, a pediatric infectious disease specialist at Helen DeVos Children’s Hospital in Grand Rapids, Mich., Olivero’s interest in creating a more comprehensive approach to antimicrobial stewardship led her on a winding route that eventually brought her to the hospital cafeteria. She was pleased to connect with a chef who was enthusiastic about providing a better quality product. They identified a supplier who was able to provide chicken and turkey raised without routine antibiotics at a comparable price.

Chef-physician duo at Virginia Mason Memorial, Washington (Veggie Fit Kids)

The transition was made possible by a concerted effort to work across departments to understand the values, motives, and constraints of making changes to hospital menus.

Together this dream team — and similar ones made up of physicians, nurses, chefs, dietitians, food service directors, and sustainability managers at hospitals across the country — is collaborating to create and serve hospital food that is healthier for people and the planet.

Olivero provided information to the lead chef on food’s contribution to antimicrobial resistance at a population level.

“On the other side,” she says, “it was really important for me to learn about the budgetary aspects and…the decisions that someone like the lead chef has to make. Hearing that perspective was really instructive.”

It takes a team

“When working to make menu changes that impact patient and visitor health, there is the operations piece, there is the culinary piece, and there is the clinical piece,” says John Miller, the system director of culinary wellness for Henry Ford Health System in Detroit. “All three work hand in hand.”

Growing up on a farm, Miller has always had a vegetable garden.

“Food has been an integral part of my life, my upbringing,” he says.

And Miller brought his love of fresh, nutritious food to his career. When he began working at Henry Ford Health System 14 years ago, Miller developed an action plan for improving food service system-wide. Over the years, his strategy for improving food procurement has adapted to keep up with demand for meat raised without routine antibiotics, in part in response to growing concern about antibiotic-resistant infections, which are responsible for approximately 23,000 deaths in the United States each year and cost billions in direct health care expenses and lost productivity.

Fact sheet created by Health Care Without Harm and Clinician Champions in Comprehensive Antibiotic Stewardship Collaborative explains the use of antibiotics in agriculture.

Miller says clinicians have been an integral part of making changes to the culinary program that support human and environmental health.

“We have a monthly system culinary wellness meeting. Dieticians, managers, and chefs, all sit down to review product choices, new vendor contracts, menu development, and new recipes. The clinicians are an integral part,” he says.

Miller says physician support helped the hospital transition to U.S. Department of Agriculture process-verified No Antibiotics Ever poultry products by providing research and supporting the initial launch of the new program.

Likewise, at a forum of nurse managers, Miller asked for their opinion of changing the menus to include No Antibiotics Ever poultry. They were supportive even if it would result in a price increase.

Key piece of the stewardship puzzle

Dr. Sarah Parker, medical director of the antimicrobial stewardship program at Children’s Hospital Colorado in Aurora, says healthy hospital food is a key piece of the puzzle in creating better health outcomes for patients.

Parker is working closely with Katie O’Connor, the hospital system’s health promotion programs manager, who has also spearheaded several health and sustainability initiatives.

Eggplant parmesan with a side salad served at Children’s Hospital Colorado (Children’s Hospital Colorado)
“We’ve made some great strides in improving the nutrition environment here at the hospital,” O’Connor says. “As a pediatric facility, we try to model the behaviors that we’re advocating for the community, and it just makes sense to me that we shouldn’t be using meat that has been raised with antibiotics at the hospital.”

The fruits (and veggies) of collaboration

Cost is always a concern, but both Helen DeVos Children’s Hospital and Henry Ford Health System have shown there are financial and other benefits to transitioning to meat raised without routine antibiotics. At Helen DeVos Children’s Hospital, the transition to a new poultry supplier was relatively quick, and the hospital actually managed to save money in the process.

The hospital’s food service department provides food for other nearby facilities, such as daycare centers, so those locations benefited from the switch to poultry raised without routine antibiotics as well, Olivero says.

Henry Ford Health System increased sales by offering healthier options.

Chef prepares stir-fry (Henry Ford Health System)

“I knew there was a market that we were missing, and it was the dining guests that wanted healthier options,” Miller says. “Once we brought healthier options into the menu, we actually increased sales because there was a part of the market that we weren’t capturing. We didn’t have enough healthy options.”

Collaboration is key for clinical and culinary teams who want to cook up innovation one recipe at a time, according to Parker.

“You really do need champions from all the different areas,” she says. “Once you can get that to align, that’s when you’ll finally make some change.”

Throughout Antibiotic Awareness Week (formerly known as Get Smart Week), Nov. 13–17, Health Care Without Harm will be featuring recipes created through clinical and culinary collaboration with a focus on ingredients produced without antibiotics.

Hospitals across the country are taking this collaboration to the next level by participating in the Health Care Culinary Contest. They are reimagining hospital food’s potential one meal at a time and earning recognition for their hospitals’ role in combatting antibiotic resistance, climate change, and other threats to human health.

The contest, which closes Nov. 30, is an opportunity for hospital chefs, food purchasers, and clinicians to connect and create a recipe that reimagines protein on the plate. Participants can earn points when a physician, pharmacist, nurse, or another allied health professional participates in the event by assisting with promotion and education.

Whether a hospital is competing in the contest or looking for ways to connect clinical recommendations with hospital food service, a clinician sponsor is a powerful way to sharpen and amplify the conversation around hospital food, showing how small changes can have an impact on individual and public health.

“Any time I can get some clinical support, specifically one of our physicians, to champion something, it’s always really helpful,” O’Connor says. “It certainly gives an initiative we’re proposing more clout.”

Learn more about the Health Care Culinary Contest. No purchase necessary, void where prohibited. U.S. residents only. Ends 11/30/17. This is not a game of chance; winners selected based on stated criteria. Official Rules and details available here. Sponsored by Health Care Without Harm U.S., 12355 Sunrise Valley Drive, Suite 680, Reston, VA 20191.