DIANE IMRIE has revolutionized foodservice at FLETCHER ALLEN HEALTH CARE by:
• CHANGING the way the term healthcare is viewed, by making it inclusive of nutrition and sustainability
• CREATING a nationally recognized sustainability program, which includes spending nearly 40% of the department’s annual budget on food produced in Vermont
• BECOMING a community leader in sustainability through educational opportunities in the hospital’s four gardens
• 419 beds
• 2 million meals served each year
• 131 FTEs in foodservice
• Five retail foodservice outlets
When a hospital boasts about its foodservice program on its website, you know you’ve done something right. In a world full of bad hospital food jokes, Diane Imrie, R.D., director of nutrition services, has turned that stereotype upside down at Fletcher Allen Health Care, in Burlington, Vt.
“In 2006 is when the [healthcare] community started talking about obesity and climate change, kind of at the same time,” Imrie recalls. “Those two factors brought it home for me that we really needed to be making some big changes if we wanted to be a role model in terms of health, environmental health and public health.”
Imrie signed the department up for Health Care Without Harm’s Healthy Food in Health Care pledge, the signers of which promise to promote healthy food items in their patient and retail services and to change purchasing practices to include more locally grown and produced items.
After signing the pledge, Imrie knew her team needed to make changes. “We decided that we needed to take it up a notch and to not serve things that we didn’t recommend to people,” she says. That manifested itself in the development of a two-year antibiotic reduction plan in the animal proteins the department serves. All beef is locally sourced. Half of the department’s poultry purchases are from organic farmers. Some cheese is produced with milk from cows that haven’t been treated with the growth hormone rBST.
Imrie also initiated a different pricing scheme. Healthier items are priced lower than the limited selection of less healthy items the department still offers. “We keep our salad bar and vegetables extremely low [in price] to encourage consumption,” Imrie says.
But changing the product mix wasn’t enough for Imrie. She wanted to create a new definition of healthy, one that connected health in people with health in the environment.
“Every person on the management team sees healthy food as our mission,” Imrie says. “Healthy food isn’t just part of our mission. It is our mission. We all have a commitment to environmental health and the impact that climate change will have on public health.
“Everyone here recognizes that environmental health is health,” Imrie adds.
Following the success of the department’s antibiotic-reduction plan, Imrie then created a network of Vermont growers and producers to stock her shelves. The department has partnered with more than 70 local companies to purchase locally grown or produced items.
Once a year Imrie meets with eight to 10 of the largest farmers in the area to let them know what foods the department plans to focus on in the coming year. “We use those meetings as an opportunity to learn from the farmers and influence them in a way of what we’re after for the next year,” Imrie says. “If they are growing organic but they aren’t certified, we talk them through that and educate them [on
The department spends more than $1.5 million each year—or 37% of the department’s budget—on food that is produced in Vermont.
Earlier this year, Fletcher Allen’s foodservice program was honored by Health Care Without Harm with its Sustainable Food Procurement Award. “By instituting sustainable food procurement programs that support local producers and show preferences for foods produced in ways that protect the environment and the health of the individuals and communities, Fletcher Allen is showing a commitment to health that goes far beyond the hospital walls,” says Gary Cohen, founder and president of Health Care Without Harm.
In addition to local purchases, the hospital has a comprehensive waste-reduction program, which encompasses more than foodservice. Imrie says she thinks her department was the first in any hospital in the U.S. to compost food from the kitchens. The department also purchases compostable paperware.
What better way to get local produce than to grow it on site? When the hospital decided to develop a healing garden several years ago, Imrie asked if the foodservice team could have a portion of the garden to grow produce. The hospital agreed and Imrie’s team, under the leadership of Executive Chef Richard Jarmusz, planted items like tomatoes, green beans and basil.
After the success of that garden, the department planted its production garden at the Fanny Allen rehab campus. Snap peas, spinach, radish and pole beans are some of the items grown at the garden, which the department uses in meals. A beehive is also located at the production garden.
The next garden to crop up was the rooftop garden, which Imrie calls “the jewel in the crown.” The garden is on top of the radiation/oncology unit, a new building that is LEED certified. The garden played a role in the certification, as it helps with heat island effect and rainwater runoff. The garden is planted in raised beds.
Last month the rooftop garden was relaunched as a community garden. “We decided we weren’t meeting our education mission up there,” Imrie says. The garden has 12 members and each member receives a section of the garden to plant. In addition, a farmer, in collaboration with one of the hospital’s dietitians, will provide educational seminars for members. The farmer will teach members the ins and outs of gardening, and the dietitian will connect the food to healthier eating.
Still another garden is located on the hospital’s campus. The lasagna garden is named for the seven-layer planting process that is used. Instead of digging into the sod, the gardeners can plant seeds on top of the sod, by layering organic material on top of each other.
While Imrie admits that one of her next goals in the sustainability program is to better market the department’s success, Theresa Alberghini PiPalma, senior vice president of marketing and external relations, says Imrie’s influence is already felt in the state.
“There’s not a person who’s involved in sustainability in Vermont who is not familiar with the work she has done,” Alberghini PiPalma says. “Her ability to connect opportunities is so terrific.
“Diane sets a goal and then develops a plan on how she’s going to get there. When she comes to people saying, ‘this is what I want to do,’ it’s been very well thought out. Perhaps one of the reasons she’s so successful with her team is that she never lets the size of the challenge affect things. She looks at what are the small steps that we can take to help us achieve our goals. That started with taking the Healthy Food in Health Care Pledge [in 2006.]”
Imrie isn’t satisfied just yet. Her next plan is to further the health as environmental and nutritional message even further. Imrie, along with other partners, has received funding to provide health shares, access to a group of physicians and other healthcare providers to receive one-on-one education. The 24 participants selected for the group will also receive information on nutrition. The project’s goal is to see if any positive health results come from these health shares. Biometric data will be collected before and after the 12 weeks.
Alberghini PiPalma says Imrie has already been able to accomplish these health-related results—although not scientifically measured—in the hospital’s employees.
“A lot of people have said anecdotally that Diane and her team have had a huge impact on the way they think about food and what they eat,”she says. “Many people have lost weight and gotten healthier as a result. That’s a pretty nice outcome.”