Palomar Health: Measurable progress

Dana Moran, Managing Editor

plant-based burger

Often, the catalyst for major change can be difficult to pinpoint. But Jim Metzger, director of hospitality at Palomar Health, remembers the exact number that sparked a revolution at the San Diego hospital system.

“About two years ago, the [American Journal of Medicine] found that 85% of the morbidity rate in the U.S. is determined by diet,” he says. “It’s more important than smoking, regular fitness, alcohol consumption.” And diet was the part of peoples’ lives that Palomar’s foodservice was poised to change.

In northern San Diego County, 57% of the deaths are linked to obesity, diabetes, cancer and heart disease—the so-called “big four.” “All men must die,” Metzger says (in a nod to “Game of Thrones”). “I just don’t want to be a victim of the big four.” With that in mind, it was time for a major change to both menus and mindsets.

Going green (and orange and yellow and red)


In April, Palomar announced another number—60%. It’s the percentage of the retail and patient care menu that Metzger and his team hope to be plant-based by the end of summer. At that time, Metzger estimated about 25-28% of the menu was plant-based; by late June, it had reached 35-38%. 

While Metzger says the average stay at a Palomar hospital is 2.8-3.2 days, “Looking at our employee profiles, we know we employ a staff member for a generation,” he says. “If we can help familiarize them with food as medicine, we can influence healthy habits.”

That started with a revival of Meatless Monday—hardly a new idea. But Palomar took it even further by offering a Frequent Monday card; participating for a month earns the fifth meal for free. Dining services went all out with promotion, from aprons and signage to press coverage, and representatives of the city of Escondido, Calif., reached out about creating their own program. “It’s exciting to see that kind of fire ignited and be aware that we’re doing something,” Metzger says.

But Palomar isn’t going to hit its 60% goal with one meatless day a week. Kathryn Vasaeli, program manager for Palomar’s Healthy Hospital Initiative, found a vendor to bring in gluten-free vegan cookies. System Executive Chef John Medall rolled out a new menu for all three of Palomar’s cafes with options like a portobello burger and a vegetable quesadilla. An open action station at the largest cafe promotes meat-free meals three days a week; a recent cold soba noodle bowl with tofu and coconut curry sauce caused a flurry of requests for the recipe.

Medall readily admits he’s not a vegetarian, and understands the misconception that plant-based food just doesn’t taste good. Relying on his fine-dining experience with San Diego-based The Patio Group, he’s working to bring the restaurant mentality to the hospital environment. Restructuring the menu meant analyzing best-sellers and duds while moving salads and stir-fry to center stage on room service menus. “If [diners] make even one smarter food choice a week, I think we’ve accomplished something,” Medall says.

Better sourcing—and training

If you’re going to up your menu share of produce, it needs to be the kind diners want to eat. Fortunately, the system’s Southern California location gives dining services “a tremendous opportunity to follow the seasons,” Metzger says. Produce is no longer being harvested half-ripe and put on a truck before arriving at the docks. As a result, “We get patient feedback that it’s like staying at a resort,” he says. 

With the goal of patients taking those healthy habits home, the foodservice team worked with Palomar doctors to create a series of on-site cooking classes for patients and community members. Doctors Sabiha Pasha and Farah Hamdard have so far tackled topics like heart-healthy eating, diabetes, weight management and cancer, cooking up dishes like Moroccan-spiced salad, anti-inflammatory turmeric dressing and fennel tea.

“We wanted ... to be a role model to the community,” Vasaeli says. “We marketed to community leaders as well to get the word out.” The classes were so successful in the first three months that they were moved to a larger location to accommodate more attendees.

Staff, too, are receiving training to fit a healthier end goal. Every new Palomar dish now comes with a recipe card, followed by a demo that’s conducted either one-on-one or in a group setting. “I’m getting excited, because some folks we’re training are taking recipes back home and sharing them with their families,” Medall says.

Pulling together patients, community and staff toward a common goal has required support from partners both internal and external, and Metzger says he’s proud of the way people have stepped up. “Patients know with assuredness that they’re not just working with a clinical team for medical guidance, but also … for nutritional guidance,” he says.

Meet the FSD: Jim Metzger

jim metzger

Director of Hospitality, Palomar Health

Q: What’s a specific area of change that’s easy to spot right away?
A: I took a walk through a cafe today, and the deli station—where we used to have potato salad, coleslaw and pasta salad—had orzo and edamame, three-bean salad and chickpea salad. The mix of sides has changed so dramatically without even announcing it to the buyer. What you see is a profile that’s tastier and more attractive.

Q: What’s coming in the next six months?
A: Optimally, we’ll be bringing in a new dietary management system to let us be more nimble with changes, and certainly on a seasonal basis so we can follow those trends even more closely for our patients.

At a Glance: Palomar Health San Diego

  • Percentage of plant-based meals that Palomar is aiming to menu: 60%
  • Number of years Palomar has completed of a five-year health plan: 1
  • Number of Meatless Mondays Palomar diners must participate in monthly to earn a free meal: 4
  • Partnered with doctors to create a series of cooking classes focused on targeting different health concerns
  • Moved chips and candies from 5-foot impulse-buy radius around cash registers and replaced with healthier snacks
  • Created frequent buyer program for Meatless Mondays to encourage participation
  • Offers bedside guest meals so patients can dine with their visitors

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