 This is some kind of gourmet gourd. The next time I go over time, Deborah, I want you to bonk me on the head with this right at the end of my time. Isn't this gorgeous? Holy cow. All right, that was phenomenal. Margie, I have one extra comment for you. I can promise you these are not average Stanford students just randomly selected. These are stunning Stanford students and to a certain extent they're outliers, but they're leaders and they're really proud of what they're doing, which is really fun. It's really great to work with. In fact, students is a way that we drive the faculty to collaborate. Would you do this for me as a fellow faculty person? No, I don't have time. Would you do this for your student? Oh, yes, I would do it for my student. That's how we suck them together. Okay, anyway, that's my plan. So Freddie Cronenberg is gonna lead this next panel, this hospital panel to redefine hospital food. She's a physiologist and international leader in women's health and research in complementary and alternative medicine. She has particular expertise on herbal and nutritional approaches to optimizing women's health. She received her PhD from Stanford University and subsequently connected research in women's health for more than 25 years at Columbia University's College of Physicians and Surgeons as professor of clinical physiology. She was founding director and for 14 years headed the Rosenthal Center for Complementary and Alternative Medicine at Columbia. Freddie initiated a groundbreaking continuing medical education course called Nutrition and Health, State of the Science and Clinical Applications, the most recent of which was in San Francisco. This last spring she co-directs with Andy Weil. They've trained more than 5,000 health professionals in eight years to date. She's interested in people being better informed with a growing body of evidence on the health benefits of specific foods and whether changing food in hospitals can do more than just increase satisfaction scores but can actually improve health outcomes. She enjoys getting her hands dirty in the garden and cooking fresh produce. I think they're still getting miked. Freddie, you don't need a mic. You can come up here. Freddie Kronenberg and her panel, everybody, please. Yeah, she's here. Well, the first panel this morning were a beautiful lead-in to this one because as you'll see, there are common themes that run through all of these discussions and that our speakers here will pick up on from the morning. Now, why are we educating our young children, our college kids? Well, obviously, hopefully so they'll make more informed choices in their food and therefore will become healthy adults and hopefully not have to enter our hospitals when they become older. But for those who do find themselves in hospitals, does the food being served hasten their recovery? Hospitals should be equated with health and healing but for most hospitals, it really seems that food is kind of there because the patients happen to be staying overnight and we kind of have to feed them. And it's almost an afterthought without the primary goal of healing the patient and little to do with modeling healthful eating. And that's what quite a number of people now are trying to make dense in and changes it. Now, as many of you are aware, the role of nutrition and the science of nutrition and health is really increasing exponentially and more and more we are aware that we actually are what we eat and that the research in Nutrigenetics and Nutrogenomics is showing us that not only do our genetics influence and impact what we metabolize and how we metabolize it but the food that we eat influences which genes are expressed and how they're expressed. So we can in fact influence the functioning of our bodies through what we eat more directly than we've ever been aware of in the past. And you may be surprised to hear or maybe not in this group that very few hospitals today, medical schools today offer any teaching about nutrition in the medical school curriculum. This is pretty surprising and that's why a number of us about 10 years ago decided that if doctors are going to lead in helping their patients not only get better from their hospital experience but go home and not return to the hospital, they need to know something about nutrition and the role of nutrition. If you just say to your patient, well, you should be eating more beans and the person says, well, I don't know what to do with the bean, what do you do with it? And the doctor says, well, I never cooked a bean in my life. That's not going to help very much. So our course has been training doctors to know about nutrition and there are very few others around the country that are starting to teach doctors how to cook so that they can model this behavior. So what can the role of hospitals be in the future of healthcare with respect to the relationship to food, creative approaches to, and creative approaches to this are really taking root across the country. It's quite amazing the grassroots movement that have now really beginning to come into the mainstream in terms of thinking about, addressing and challenging hospitals to change the way they think about food and implement visions for what hospital food can do. And the panelists today are really leaders in saying what is that vision? What can hospitals be in the future and how can we demonstrate the possibility? So we're gonna talk a little bit about what are the challenges, how some examples of steps people are taking in the right direction, different phases of development and what's going on on a national scale that people at hospitals around the country can look to for enthusiasm, for inspiration and advice on what they can do in their own schools. So I'm going to introduce the panelists now in the order of sort of their comments and they're each going to give you a little introduction to what it is they have been working on and then we'll have a discussion in more detail about some of the challenges, some of the solutions. And again, you'll see themes from the morning very much the same in hospitals as they are in the other settings that we've already discussed about. So our first speaker will be Jesse Cool who is a writer, chef, restaurateur and known to many of you locally who consults in the area of eco-conscious food service and has worked with Stanford Hospital to create a fresh farm program offering organic locally sourced food. And as you've heard in the first panel this morning her own kitchen and garden has served as a locus for work with Stanford's Department of Education and this Masters of Education for elementary school teachers program to build a curriculum from the garden to the kitchen and beyond. And you most, most of you also probably have sampled her food at the Cool Cafe at the Cantons Arts Center and her Flea Street Cafe restaurant. Marydale DeBoer comes to us from across the country in New Milford, Connecticut. She's passionate about changing the way we think about food in relation to healthcare. She's worked as a hospital executive to bring nutrition and community-based wellness to focus in the New Milford Hospital in New Milford, Connecticut. Making profound changes in the hospital's approach to food. She founded Plow to Plate, a grassroots organization partnering hospitals, local farmers and community organizations to position healthy hospital foods as a center place for better medicine and community health. Chef Frank Turner comes to us from Bloomfield, Michigan where he is the guiding light for the Culinary Wellness Program at the Henry Ford Hospital in West Bloomfield bringing sustainable locally grown produce into the hospital with the hospital brand new state-of-the-art demonstration kitchen where patients can learn to prepare food to optimize their health. He is at the forefront of building a greenhouse at the hospital creating a new Culinary Wellness Academy and has a social catering program to take fresh food concept not only throughout the Henry Ford Hospital system but into the community. Lena Brooke is a senior program advisor associate at the San Francisco Bay chapter of Physicians for Social Responsibility and the Northern California Coordinator for the Healthy Food and Healthcare Campaign which you'll hear about in more detail. She's working with the California healthcare sector to help redefine hospital food and facilitate a move again towards sustainable community-based food system. Again, a theme you've heard all morning and she's also the founding board member of Urban Sprouts, a garden learning organization serving low income middle and high school students in San Francisco. So all of our panelists are avid cooks, gardeners and have a passion for food not only as a culinary delight but as an agent for change in healthcare in the United States. So, Jesse, why don't you start us off here? Thanks, Reddy. So, I'm gonna talk about Farm Fresh at Stanford Hospital, one of the first programs that tried to put organic local food on patients menu. So I want you to imagine being a patient in a hospital and your tray arrives and on it is made from scratch chicken noodle soup, seasonal or a seasonal vegetable puree, a salad with cooked and raw local veggies, a small sensible portion of crusted organic chicken or grass-fed meatloaf, a baked potato or brown rice, whole grain bread with olive oil or real butter. And then for dessert, a baked stuffed apple or fresh fruit, herbal tea, free-trade coffee, ginger ale, unprocessed sugar or sucanade. And everything is local and organic. Imagine when you're sick, scared and needing nurturing, a tray of delicious, beautiful, alive food without preservatives, artificial chemicals, growth hormones, coloring, and that's what's put before you. It's just the right food made from ingredients that have no artificial anything, the perfect fuel to revitalize your body and make you happy and fill you with love. Imagine your food thoughtfully arranged on a colorful placemat with a take-home recipe of that yummy soup that you're eating, printed on the back of the menu, to encourage you to cook when you get home because it's easy. And how cool that everything on that tray can be recycled or composted. And wow, you don't have to struggle with those plastic unwrapping whatever they put in front of you. And most of your meal can be eaten with a spoon or a fork because I don't know about you, but I'm not very good about cutting food in bed. And your meal is low sodium, lactose-free, gluten-free except the bread. And all of it is easy to digest because that's what you need when you're in a hospital and you just aren't moving very much. Does this have to be expensive? The answer is absolutely not. And in my 36 years of working with organic food, every time I write a book or talk about this, and the question is what about the expense I want to answer, which I do, you are asking the wrong question. You're taking this completely from the wrong perspective. At Stanford Hospital, it was free to every patient. So the price was a little tiny bit above everything else. The cost, it wasn't really much more than the budget they had for the food they were already serving. And I don't want to think that they weren't doing anything right. We were just doing something different. I want to be very careful about making that statement. But considering how much is spent on everything else on the tray in the hospital, how much waste exists in hospital kitchens and what is spent on all that stuff that you get when you go into a hospital, they need to turn it the other way around. And that question would never be asked about how expensive it's an organic apple. And you can't serve that because it's expensive. It just wouldn't happen. So what's happened since then? Two years ago, this was a situation. People did not know how to cook in the kitchen at Stanford, I'm sorry to say it, but when we made homemade organic chicken stock, we kept wondering what was wrong with it. It was that they put the whole chickens with the gizzards and the livers and everything in this giant pot and they made brown stock. The taste is disgusting. The first day we rolled it out, the chef in charge of food service, and they told me to give you a good and a bad, the chef went on vacation for 11 days, leaving me in the kitchen by myself. I was told by food management that no one cares about organic and I was the enemy. My children asked, what did I do? I said, I took notes and went and had a cocktail. What do you, why do you think a lot of those people, they said to me, why do you think a lot of those people are up in those beds? They want pork and gravy and mac and cheese. We give them what they want. It is hard to break old ways, dietary and nutritional requirements within the government, the state, and health systems, but it was very interesting when we did this program that the nurses and the doctors and the staff wanted the soup and the food with farm fresh. It never, ever showed up in the cafeteria. Small farmers had to go through brokers because buying direct from them, which would have meant optimum freshness and nutrition, they were ready. We had them set up, was not being done. They had to go around and around because of insurance reasons. And yet Dr. Bobby Robbins, who was a part of Starting Farm Fresh, who is the chair of, let me say this right, cardiothoracic surgery at Stanford Hospital made the quote, once people are in the hospital, especially when they have major surgeries, their digestive systems do not work as well. This kind of food is perfect. Solutions. I would ask every hospital to again flip things and consider that the patient comes last. The patient does not come first. Take care of your staff, take care of the cooks, take care of the people who are actually feeding others first and watch it spill over. That's the philosophy of my restaurants, the customer comes last by the way. If we take care of the farmer and everyone else, you will get fed right. Start with ingredients that are free of artificial anything. Our bodies don't know how to process plastic or artificial. We know how to process oils and fats and sugars and salt in the right quantities. We don't know how to process artificial. Get the doctors to prescribe something like Farm Fresh along with their pharmaceuticals. They should be writing out prescriptions when they're in the hospital. Even if they sneak and get McDonald's, they're still doing it. Commit and make it easy to use more local ingredients. Subsidize food along with prescription drugs. Far less costly. What a concept. Consider a model like Farm Fresh, but expand it. Distill, make it simple. There's so many options in the hospital. There's so much ways you wouldn't believe it. It's scary. And then they're fighting us on paying too much for organic real food. Get rid of all that. Distill less options, simple food. And if you'd like to know more about Farm Fresh, because I would love to talk to more people about it, I'd love to see it brought back to Stanford. There's a video and lots of information at stanfordhospital.org, backslash, backslash, Farm Fresh, stanfordhospital.org, backslash, Farm Fresh. This was the menu. It was beautiful. They gave them, I'm sorry, I don't use slides. I have one with me though. They gave them a recipe to take home that was quite beautiful. And I hope this all is brought back to Stanford Hospital and we start nurturing them of food through really, really healthy food again. Thank you for inviting me. Okay, Mary, okay, good. Okay, great. So first of all, I wanna say to the students who presented, or maybe one is here, that you hit the nail on the head. It is, food is love. And I just thought that was the greatest system and paradigm that you came up with and that is really the little story I'm gonna tell you now about the work that we have been doing at the hospital where I was an executive for the last seven years. So I also wanna thank you for being here and I wanna thank Freddie and her colleagues for having this. For me, it's like coming out of the Northwest Woods of Connecticut in an 85-bed hospital and coming here is like such an abundance of riches. I'm so excited I have post-its all over my notebook. So with that, let me give you some context about the work that we did at New Milford Hospital. Again, it's an 85-bed community hospital in Northwest Connecticut, mixed semi-rural environment. I'm going to hit only the high points of how we approached the issue of changing our food system, why we did it. Keep in mind that this is now almost six years of work and it's like layers of an onion. We started with certain steps and we layered things on as we had our small baby steps of success. There is a website, it's somewhat robust, you should refer to it and I'm always available to talk more about it. But we did in 2006, I was really advocating for thinking about what our future would be as a community hospital with what was coming down the pike in the degradation of what we call a healthcare system in this country. Where would a hospital like ours be in five years, 10 years, how did we look at ourselves and how could we reinvent ourselves because I was convinced we wouldn't survive. So at that time we had a leader who, and I thought very strongly about the food system because I felt that a community hospital, the front lines of giving basic medical and surgical care, most people get their care in this country was what really had to be rethought and redesigned. So at that time I thought intuitively, I didn't have the skills or the experience of the really brilliant people who've spoken today in methodology and theory, but an intuitive level I felt well we have to at least not feed people food that will make them feel worse when they're in here and we ought to set an example. Then the major thing that made it possible changed, we got a new leadership team. That's huge. All that goes on at Stanford Hospital at my community hospital is the responsibility of leadership. It's not the responsibility of food vendors who are hired, chefs who are hired to operate the system. It's a leadership exercise. Advocates should advocate but the leadership owns it and we had the good fortune to have a doctor whose field was preventive cardiology who started a clinic at our center be appointed as CEO after we experienced some really severe difficulties. So I bolted to his office and he said, okay, you can go now. You can work on this. So what we did was we did an assessment of our current situation. We hired a technical expert on institutional food to help us because I am a fully recovered attorney, I'm glad to say, but I don't have the skillset. It was not my responsibility to acquire. It was my job to set the goal and reach the goal and put together a team. So what we did is we did an assessment of our current situation, found it to be sorely lacking and we got together and decided we would issue a request for proposals. This is important. We wanted to challenge the industry. 85 beds in Litchfield County, we could have gone self-op like that but that wasn't the point. The point was to do something creative which would posit to the industry our various publics that we thought about food in a hospital in a very different way. It was mission-based, it was value-based, it was proscriptive in terms of saying we don't want any fried foods this, this, this and that and it had various other technical requirements which aren't critical for this discussion right now. So we worked very hard on that. We pulled it together, we sent it out, we sat down with a glass of wine and said, nobody is gonna bid this, what are we gonna do? We didn't have that result. We had eight bidders, which was really exciting, two dropped out because of scale issues and we made a final selection which was a vendor that was different from the one with which we had been working. At the same time, we're working on two tracks. Plow to Plate is a trademark program of this hospital. That's the recovering lawyer part, I knew to protect it, but anyway, as a sort of a political matter, we knew that we would have to have a second track of grassroots. So while this sort of one-year plus process of trying to order compliance with an existing agreement, then having to go to RFP, we started sponsoring things in the community, food learning sessions in partnership with a farm that had a cooking school. Luxury is being, again, in Lichfield County, but it can be done elsewhere. And what we did, it was a new kind of, we didn't call it cooking school, we didn't use the word gourmet or organic, we called it food learning and the faculty was a farmer, a chef, a whole food chef, studied with Ann Marie in New York at a very special culinary school there and a healthcare provider, starting with our own CEO position. And it was like gangbusters, people were coming out of the woodwork to go to this, because this teacher who first started and brought the harvest was the farmer. We also developed a community coalition. The first people we invited to talk about the work we wanted to do with the food system at the hospital were the farmers. Maybe New England farmers are a breed apart, but they are not an easy crowd. They sort of look at you like this. Right. And that goes on for a couple years, you know, so you're like, anyway, how do we go to the next slide? Do I press it? Oh, can you press it so it goes to the next slide? Because I, oh, I'm sorry. Okay, so, yeah. Okay, so the next step after we get our new vendor in is we say, okay, we're gonna be a food hub. We're gonna do all kinds of projects and put this around the hospital as leader and the center of learning. We're gonna do a 180. We're gonna have the best food in town. So we did a variety of things in the, I'm doing this chronologically, so you can see the layers of the onion. We started with a youth chef advocate project where we had kids in an after-school program. These are public school kids who enrolled with the partner of the youth agency. We're big on community partnerships. And we worked with a cohort of 22 kids for a full year, teaching them farming and sustainability, culinary skills, they had to be very proper. We taught them a full range of skills that culminated in going to the conference of healthcare without harm. And these kids actually delivering the reception for 250 people at the MGM Grand in Detroit. So that was another thing. This program continues. We approached a younger children's education with the commissioning of a wonderful book about the farmer's market. And we worked with childcare centers. We've distributed 10,000 along with a strategic distribution plan in the state. We created a robust farmer's market in the town in a coupon system branded at Farm Bucks. We're big on branding. We have t-shirts. We have tent cards, tray cards, everything being educating people. We used all the classic beast, well, your beast school's different. It's a little more fun and creative, but we used a lot of marketing tactics that are familiar in other settings. To approach the geriatric population, 70% or more of whom when they come to my hospital and on a national average, over 70% are clinically malnourished upon admission for primary diagnoses of fractures and whatnot. We find out they're really malnourished. So we started a senior supper program using the downtime in our cafe to bring them in, have them learn to trust the hospital and interact with us about healthy eating. Then we got to move to the really juicy part, which is real public health practice, where we collaborated with our pediatric practice. That was the only group that we really could engage. And we worked with the state health department and funding sources to actually launch a seniors' diabetes prevention, education and management practice. That was very classic as a public health practice. We also borrowed a program from Louisiana State University evidence-based Trim Kids. We adapted it and it's a very effective family-based intervention for families at risk of obesity and diabetes. We also worked very heavily with, we have a robust program with the Girl Scouts that we're going statewide. We partnered with all the existing programs in the town with the recreation department and the like as a value-added learning tool. We built a culinary garden on the top of a loading dock because we had no money and very little support really, but we felt it could be done. And this is where a lot of our learning takes place. It was all volunteer and it's quite the attraction. So you can imagine how I felt this summer when the New York Times wrote up an article about defying the stereotypes in hospital food and talked about how the town now eats at our hospital. All comers come, we fax the menu to the post office and Home Depot and the like. And we are continue the expansion of this effort so that we can sustain public health practice programming and we can keep inspiring our patients, inspiring the public even if we have to continue with the fill and profit and grant dollars to feel the love. Thanks. One second. Okay, Frank. Well, good afternoon and thank you for having me here. I came to healthcare in 2006 as a chef. The company that I was working for in Detroit, Michigan was approached by Gerard Van Grinsven who is the newly recruited CEO of a yet unbuilt hospital, Henry Ford West Bloomfield. Gerard was a CEO of the hotel. He's a hotelier. And he was actually the world's kind of in the top five hoteliers in the world. So Gerard is kind of a man behind our hospital. He was recruited by our healthcare, our system leader, Nancy Schlichten, who wanted to make Henry Ford West Bloomfield a kind of a think tank on a lot of different areas, not just the food, although we're very proud of where we have come from on the food. And so our mission is clearly always been to take health and healing beyond the boundaries of the imagination, as you can see right there. We do wanna challenge the healthcare industry. And so what we did, we think it's the right thing to do. It has clearly been a complaint for a long, long time. And groups like this and groups in Detroit as well are finding that the correlation is just scary. This is a, our children are gonna live a shorter life spans than we are. Isn't that something? And I kinda think that pain is the ultimate motivator, right? And when it touches us on a personal level, no matter what the issue is, then we start getting truly seriously motivated. Perhaps enlightened groups like this might get a little bit ahead of the game, but the rest of the country's catching up. Pain's always been the ultimate motivator, even when we were hunters and gatherers. We didn't go out to hunting until we had stomach pain, right? Well, there's some serious pain coming very quickly and success favors the prepared mind. This group of people are men and women of influence and I please wanna implore you to take lessons that you learn here today and share them. This isn't a one day seminar. This is a life changing moment. When we started the hospital, we started two years beforehand to research the local food shed. We wanted to make sure as a chef and as not a healthcare person, we wanted to make sure we had flavor compliancy. And so we wanted to make sure that the food tasted right. So we first went to our physicians and nurses and hospital leaders. We wanted to have the kinds of interviews to know what our framework for constructing the new culinary vision was going to be, focus groups and whatnot. And then we divided our recipe assignment. We ascertained how many recipes we would need and divided it up between the restaurant group that I was the corporate chef of at the time, the Matt Prentice restaurant group. We took those recipes and vetted them out throughout our special process. And so seafood recipes went to our seafood house and deli recipes went to our sandwich houses for example. And the highest sold ones and the most popular ones were the ones that we then considered for tastings for each food station and each meal period including the pediatric menu. And so system leaders and hospital leaders all came in and had the chance to participate as diners, specifically diners on absolutely everything that we started with. And then, okay good. And then this is what we ended up seeing. We have a 24 hour room service inpatient dining so that there are no meal periods because isn't it ultimately important to get nourishment in your body when we need it the most when we're in the hospital. Henry's Healthy Retail Cafe has seven chef man stations, all of it's interactive, all of it's made fresh to order and you actually wait in line less than you do at a Burger King. Weekly farmers markets indoors with an extended season using the select Michigan farmers market trade agreement whereby it has to be grown in our state or if you're gonna sell it in our hospital. We have a vibrant catering and events entity and I think it's very important as food service providers for us to maximize our ability to seek and gain out profit revenue streams. We have fully stocked kitchens, we have walk-ins and we have trained culinarians and if we're going to do best by our patient we need to maximize our revenue stream as much as possible so that we can then do right by the patient. I mean it's kind of an analogy of let's buy the cheapest band aid or let's buy the best band aid, yeah. We are now, right now in construction on a greenhouse. We'll have a 1200 foot meeting space with interactive kiosk for our completely green building to be able to use it as an educational tools to our children and our culinary institute for health and healing. The inpatient dining as I mentioned 24 hours, everything's healthy made from scratch. We use organic produce throughout the building wherever practical and prudent. We have 21 farms that we use to keep up with our produce needs during the winter or during the summer and during the winter we use from here in California earthbound farms for our organic foods. Everything, absolutely everything, everything, everything is made from scratch and so we have no box mixes whatsoever. I could go without a can opener for until I need tomato paste again and then, because I don't like making and it's just way too hard. But the fact is this is not rocket science. This is just a hotel that happens to have X amount of rooms and it's happening across the country in hotels. It's been happening for a long, long time. We just have to use a specific set of ingredients. It's not really that hard. We have an apprenticeship program with local culinary schools and so my entire culinary force is half students. And so in that way we're saving healthcare dollars but we're also seeding the culinary community of tomorrow. One in three of the students that come through my kitchens will at some point in their career run their own restaurant and their skill set is now based on vegetable purées, fruit purées, you know, vinegars, infused oils as opposed to miner's chicken base, miner's beef base, miner's mushroom base, and et cetera, et cetera. We actually also use chef consults. We'll go up to a room if a patient is having a challenge finding something they like, they're not feeling well, there's bad interactions with their stomach and they're not happy and they're in pain and I can't find anything on the menu that I recognize. I'll go up and talk to them or one of my chefs will go up and talk to them and provided they're not on a specific diet we will get them to buy into a choice that we make special to order for them and we found that that touches their family quite a bit later on. So, you know, how can we argue with that? Well, we have a demonstration kitchen, 80 seat kitchen auditorium, it's beautiful, we keep the very busy schedule and it's community engagement and it's finest. And so, long story short, we found that it's budget neutral, we've successfully flipped two other hospitals in our healthcare chain and we found that it is budget neutral. In fact, it's 7.2 favorable to budget right now which is $45,000 to the good. In February, we flipped this over this year so we're not quite through the year yet and we're at 99% prescanny since we opened, customer satisfaction and likelihood to recommend and blended meal scores and so it can be done. Hi everybody, can we try to get the slide? That works, perfect. Thank you, technical difficulties solved. Thank you so much for having me here today, I'm really excited to be a part of this conversation and this panel. So, I just wanna take the next few minutes to share with you some basic kind of framing information about the National Healthy Food and Healthcare Campaign. This is a project of an organization called Healthcare Without Harm which has close to 500 members around the world actually that work together to green the healthcare sector and it's been around since the mid-1990s and my organization, the San Francisco Bay Area of Physicians for Social Responsibility, is a member of Healthcare Without Harm and I work as part of a team of folks on this campaign and we're situated in about six or seven regions around the country at this point. So, just by way of snapshot, the Healthy Food and Healthcare Campaign really does challenge the healthcare sector to recognize that they have a crucial role as advocates for a healthier and more sustainable food system in the United States. Through our work, we catalyze a variety of sustainable procurement efforts. We also more recently are working to create clinician advocates and in a broad sense, again, inspire healthcare institutions and especially the leadership of healthcare institutions as Mary Dale had mentioned to become leaders in shaping this food system that's grounded in preventive medicine. The Healthy Food and Healthcare Campaign formally launched in the fall of 2005 with the Food Med Conference that was held in Oakland here and about six months later, we launched our first initiative which is this Healthy Food and Healthcare pledge and it now has about 350 hospitals around the country that are signatories to this set of goals and initiatives that are framed in creating a sustainable and health-promoting hospital food service operation and a lot of hospitals use this Healthy Food and Health pledge as sort of an institutional food policy that then drives a lot of their food procurement decisions. Just to give you a sense of who's involved and committed to this campaign, we have a whole lot of large and influential healthcare systems around the country that committed to the pledge over the years including all of the Kaiser Permanente hospitals, all of the Catholic Healthcare West hospitals, St. Joseph Health System, Bonsecourt on the East Coast, Henry Ford in Detroit, New Milford and unfortunately Stanford Medical Center has not yet signed on but we'd love to have them involved in this campaign for any of you out there that can kind of see this message. We have the campaign staff's organizers around the country to assist hospitals with implementing a lot of the tenants of this Healthy Food and Health Care pledge, a lot of the concepts built in and we always like to say that there's no one right solution as hospitals begin to enter into the sustainable food procurement arena. We really like to support facilities to take on projects that make sense for them relative to where their facility is in terms of capacity or in terms of budget, in terms of the food that's available in their surrounding food shed, et cetera. But this slide gives you a sense of the kind of projects that hospitals have entered into over the years and I'm certainly happy to share more details during the panel discussion. One of the core goals of our work through this many of options approach though is to build replicable models that facilities can share with each other over time and that hospitals who enter into this work later can begin to implement without having to kind of reinvent the wheel from the ground up over time. One of the first projects that we launched nationally is called the Balance Menus Challenge and we heard earlier some work that was happening in Stanford Dining Services focused on getting the students to eat less meat and this is the healthcare version of that to some extent which grew out of work that a number of facilities that I've been working with very closely in the Bay Area had been grappling with around how to bring sustainably produced meat into their operations and we realized pretty quickly into the process that meat reduction has to be the core part of the solution. Hospitals replicating American eating patterns do serve a tremendous amount of meat on their menus on a daily basis and we created this campaign asking hospitals to commit to a 20% reduction within a year's time and then to begin to substitute conventionally raised meat with sustainable. This not only touches on the human environmental and climate implications of meat over consumption but also allows us to then talk to healthcare institutions about the problem of antibiotic resistance and antibiotic use and overuse in agriculture which is a really important part of our mission. The other campaign that we launched more recently is called Food Matters and this was created to really address two key questions. One asks what the responsibility is of the healthcare sector to address the nutritional and environmental origins of the diseases they treat and the second question that's sort of core to this project is addressing the role that healthcare institutions can play in actually reversing the diet related disease epidemics that we're facing today. So on a practical level the Food Matters project works with clinicians on leadership development projects to allow them to become food system advocates both in a political arena within their own institutions and also as they interface with patients and there's also a lot of different social media and videos, calendars, collateral materials that we've developed to enable patient education in a healthcare setting around food system issues. So I'll just close really quickly putting in a quick plug for the FoodMed 2011 conference that's happening in Seattle next week. I know that's probably fairly short notice to pull together a trip to the Northwest but in case any of you are able and willing we invite you to join us and if not definitely check out foodmed.org down the line. There's tons of information on the site from prior conferences and the proceedings from this year will be posted I imagine a few weeks after the conference. Thank you. Thank you all. So you can see the themes that have really infused the whole discussion of the morning and I'd like to maybe talk a little bit about the changing healthcare environment in the country and there are new mandates coming out to hospitals. You have to get patients out faster. You can't get them. You can't admit them for the same thing in short periods of time. There are all kinds of issues about the health of the community that hospitals are being nudged, urged to engage in and I'm wondering if any of you might wanna talk about those kinds of issues, Mary-Dell. Yes, I would and I know my colleagues probably have additional comments. As I explained the trajectory of what we were trying to do at New Milford Hospital and how we became hopefully more sophisticated with real targeted interventions and evaluation. The work most recently that I've been doing with them is that we are looking at the imperatives of regulatory form and the Affordable Care Act. So let me give you one example of how we're finding that working through the reformed food system we have can link to some of the, actually it's going to become a reimbursement mandate and that is readmission. Readmission rates in this country for the same primary diagnosis are off the charts within 30 days and that has a lot to do with the inadequacy of coordinated discharge planning and the lack of a continuum of care in this country for patients. So soon coming down the line, if you have that phenomenon occur with respect to a patient, you will not be paid. You will be expected to take care of the patient again at your own cost, the hospital. So because we had set up this senior suppers and again going back to one of the projects here and Ms. Dunn's effort, we made this fun. We didn't go around saying nutrition to people. We had senior suppers. It was come, we have music. We have try this rakey thing after dinner. Let's do walk around the block. It was all about fun and social and friends and saving money. Was there a method to the madness? To be sure. But our users needed to have fun. They were elderly, isolated people. So they came to really feel comfortable in the hospital. They're the same people who are at the highest risk for readmission. So we are using the platform of credibility established with that user base along with a lot of the very technical sort of healthcare management, kind of orthodoxy that you need to know about to stabilize these people with discharge plans at the center of which is feeding them and having them come back to senior suppers which we got funding to pay for so we can keep an eye on them along with some other nursing tactics that we need to have from a clinical standpoint. But we were inspired to do that because we had changed our food system and we had created a new affinity with a class of users. Am I learning the lingo? A little bit, right? I learned something here today. So that's really important because you can go to a lot of seminars and pay $3,500 and hear a lot of people talk, none of whom have my background or the background of people at my hospital about how you're gonna do this or you can drop back and in an ode to Steve Chubbs, you can think different and you can use resources differently. I also think when you're talking about a fiscal model and fiscal responsibility, the non reimbursement is a big deal and a big motivator, but so is cost per bed per day is the ultimate metric that food service is held to in the hospital system and how about we track and get them out earlier and make sure that they also don't come back. Cost per bed per day is, I don't know what it's at your hospital, but it's much more than a meal would be and at what point did cheap food become a good thing anyway? In America, at some point, we cross this line somewhere around late 50s, early 60s that equated cheap food to a good thing. Cheap is good. And if cheap is good, then why aren't we all living intense? Because gosh, it's cheaper housing than the housing that I live in right now. And so if we can get them out quicker or drive in a Ugo, right? And so get them out quicker and keep them from coming back and whatever it takes to do that is definitely fiscally responsible, but we need those kind of metrics in place that can quantify this kind of logic. It's very intuitive to me. You know, they're not gonna get better if they don't eat. It's a way to establish a dialogue with the medical profession in a way that we have not really succeeded well with. There's a reason why there's a struggle with this in the healthcare setting, that you have stuff going on here, this is phenomenal, but there are very clear challenges at your hospitals. It's that they're overwhelmed. They're living in the middle of chaos with another broken system. So you have to, it doesn't make it okay, but you have to understand that this multidisciplinary concept of the HUD that you opened with, the goal of this conference is absolutely the way to go. The medical profession needs everybody in this room, every discipline in this room, it's struggling to survive. So let's all get in the tent and help them out because they don't have the skill set or the knowledge or the experience, and we can't blame them. It's not about playing. So we need to get the chefs and the people who went to Yale School of Forestry and the environment, my daughter with her too, and we need this chef and people who are really passionate and all the students who spoke to get on the tree. I think another approach is we always think about business and economics because the only way we're gonna get into them, and I was trying to say that we need to turn it upside down. It kept coming at me about the cost, and yet the cost of what they were doing was so much greater than what we were offering through this simple organic option. I remember speaking to the YPO, the Young Presidents Organization, there were some people there from Finland, and they said, oh, we could not believe, I'm not trying to put down Stanford Hospital, but they said we could not believe the waste in that kitchen. And she proceeded to tell me that in her hospitals, even large hospitals, they were given two or three choices, vegetarian meat option of the day, and soup. And it was delicious, it was beautiful, and there was no waste. And they had no problems paying for that food because they had distilled it to something completely opposite of what we're doing right now. So I think economics is actually, give it to the business school, economics would be a fabulous way to seep ourselves into the hospitals and get them to embrace it. And go ahead, Lina. No, I just wanted to add one point that I think was mentioned in passing earlier, but is really worth reiterating, which is that in most hospitals now, the food service operations are completely disconnected from clinical operations. They're just in these separate silos that aren't working in tandem with the patient's health in mind or staff wellness, or this comprehensive kind of healing model. And I think reconnecting those two pieces of healthcare operations will inevitably lead to people thinking about food in a completely different way, much more aligned with what's happening at New Milford and what you were trying to achieve here at Stanford and what you're working on. You know, right when I talk about this, we're different because I'm a tiny hospital, but we did something, we really blew it out on a lot of levels, so there's a lot to look at there. It might be a good thing to try to get all these folks together to scale up. That'd be a good study. Combining it and looking at what Frank did, but we moved it from a, they call ancillary services. That means nobody thinks about it as anything other than a necessary evil. It's an asset. Reinvent it, make it an asset, and that's what Frank has done. And what we did is we shifted it over, okay, maybe it's an amenity. Frank and I are now on the other side of the line. It's mission-based operations. We're a revenue stream. My catering operations is responsible for over $5 million worth of donations given to us in kind for various different projects just because we were able to say, okay, it's just a party. It's no big deal. I'm a cook, it's a party. Okay, but tastes good? Okay, Mr. Donner, did you know that it's good for you? That there's very low fat, there's no salt in there at all. And actually, if you have arthritis, eat some more of that ginger mousse because it will really help with your joints, right? So I have one other question, but I want to maybe first see if there are any audience questions that we might address. Microphones, there are some hands up here. Up front, there are several hands, Antonelle. So my question comes as a primary care doctor and also post-doctoral fellow at the Stanford Prevention Research Center. During the course of my training and now teaching in practice, I have worked at three different veterans affairs hospitals, San Francisco, Seattle, and now here in the Stanford area. And I wanted to hear if any of the panel members has segwayed with the veterans affairs hospitals. These are obviously a national network. And during the time of my earlier training, they had contracted with Burger King to have little Burger King kind of outlets within the hospitals. I think that that actually has been gotten rid of, but I see this as a potential just wealth of change on a national level, not only for the patients, but for the millions of employees as well. So we have millions of veterans and then various employees of different ills. Can I take this one? So here in the Bay Area, the San Francisco VA Medical Center and Karen Arnold is there, Nutrition Services Director has been an instrumental part of the work that's happened. She's actually then become a national leader within the VA system, helping write their new nutritional guidelines, for example, that were adopted two years ago that included specifications around sustainability, around antibiotic free meets, really integrating into their national guidelines these considerations around how food is produced, how it's processed, et cetera. And I know she's done incredible work at the San Francisco facility, really looking at the dietary preferences of her long-term care patients and they're in the process of transforming their entire cafeteria based on the research that was done with this project about six months ago. They were one of the early adopters of our balance menus challenge, looking at reduced meat diets, but they work with a challenging population. And so I think what's most interesting about the VA's is that they have these long-term care patients in addition to acute, so they have this, patients usually cycle through hospitals, what three to five day average stay, and with the VA's we have this opportunity to really influence eating choices and also make hopefully positive health outcomes among their population who are in the hospital, unfortunately, for a long-term period of time. I'm happy to connect anybody to Karen if you're interested. Good, Deborah. Done again. My question is, is there a way for patients to find information to help them exercise choice about where they go to the hospital based in part on the food available? So I'm in the VA area, I eat healthy food all the time, I surely don't wanna go to the hospital. I mean, now I never wanna go to Stanford. I don't wanna go to the hospital and have no options of healthy food. So are there information sources? Do hospitals market their food options? Is there a way to empower the user, the patient in this case, to become more of a force in driving the availability of healthy food? I just wanna talk about Stanford first because I'm gonna be in deep trouble. Let me just make one comment. So one of the things you saw is that there are these 350 hospitals who have signed the Healthy Food Care Pledge. It doesn't mean they're all there yet, it means they're getting there. And you can be sure, Stanford's building a new hospital and it's building a new children's hospital. And you can be sure that if other hospitals now, if they look at Henry Ford, if they look at other places and say, look what's going on there, we're gonna lose patients to XYZ hospital, you can be sure that the intent are gonna be going up how quickly, how whatever, and I would presume that there will be websites at which people could go and see who signed this Healthy, has my hospital signed that? And if not, me who lives in this community can go to my hospital and say, why haven't you signed that Healthy Hospital Food Pledge or I've made some connections, but. Yeah, also too. Go to the cafeteria if you really wanna do some work on it. We do 100 people a day, every day that treat us as a destination restaurant just because we're good. That's a viable numbers for any restaurant. And so if they're doing that for the public, pretty much you can assume that the integrity of the food will be the same for room service that it will be for the public. So if the patient comes last. Yeah, well. I mean, it sounds silly, but Stanford tried and as you said, the hospital is being built and they are doing things, but I think you as a consumer, they buried this. It was available to Stanford patients. So when I said bring it back, it wasn't just farm fresh, it was I think because we need to be great advocates of people we love and ourselves and we need to go in there and say, I want this kind of food, change it for me. So I'm hoping that through this panel, and I would love Stanford to be a part of that, we try. That through this panel that that voice, that demand just like asking for it in your grocery store, the farmer's market, that we start saying, oh my goodness, the connection of food to wellbeing, doctor, I demand, I want that one, I'm getting better. And hospitals are very, very sensitive to these satisfaction scores that they get. And there, as Frank said, their hospital, and I think Marydale also went from sort of not such great, they're called Prescani scores, to now very high in the satisfaction. And I know Stanford is being attentive to that and they're looking at that and hopefully that will push them towards, going more in this direction. And I think the patients are going to drive it because if they have a choice of hospitals in an area, they'll make that choice with their feet. And I think that will be an additional driver. I do want to add one thing, because I have a little, I share the perspective, not all the experience of my colleagues, but because I was on the senior management team, I think you are too, which is very unusual. I had a bigger job than, I just, food was something I just took it on. I made it my project. You have a hard time convincing, especially at tertiary care hospitals, except it's very tricky. Let me try to state this. The people who are leaving the hospitals will not believe that the patients will make a choice of where to go based upon the food. And I've had this said to me in the most unkind ways you'd ever want to believe, but that's okay. I'm a recovered lawyer, I can take it, right? So that's a very important point because they are not convinced what they are figuring out, hospital administrators is this amenity play. So you'll see the guest services and the people in the little red coats. But that's not mission-based service. That's an add-on, it's cosmetic. Therein lies the difference and therein lies the reason we need more students like yours who are doing data evaluation. And we need to speak with conviction about what the new world of a healthcare system that really works looks like and how it relates to the hospital's very own survival. Unless they get it right, and I don't even know that my hospital existed in five years, we were just acquired and I don't even know if my program will exist. But I tried to shift it to the language of the survival imperative in terms of economics and regulation. And that's the study that your lawyers here and your business people and the designs for, you have so much to give to that intellectual enterprise. You really do. And it can be done. There's no question in, I think, all of our minds that by turning it around, by making it economically feasible, that everything else will fall in place. And it's not just to cover, I mean, I think that the, what's it called? Cut of, what kind of? Press gaming? No, no, no, whenever you can call up and get your food. Oh, room service. Room service is a fabulous way of cutting down waste, sorry. But are they going to also infuse those core soulful heart, community connected, genuine, organic, local, nurturing food along with that model? That's what it sounds like you're doing tonight. You talk to the page. We talk to the page. We don't even call on phone. I think if you look at a hospital as a business, they're not, even a non-profit hospital looks at a bottom line, which has got us in this mess in the first place. We look at likelihood to recommend scores as our primary driving metrics because that means they're coming back. And that's the bottom line. And if a CEO or a senior leadership team has a problem embracing that reality, I would like to issue them the West Bloomfield CEO challenge. Eat your room service for a month. And then tell me you don't need change. So I want to thank our panel. This is, we have plenty of room for discussion, plenty of room for new student projects going forward. And are the panelists are around over lunch to have conversations with any of you who wish to engage them. Thank you. Okay, if I could just have two more minutes before you head off to lunch. This is mostly the end of the program other than enjoying lunch and networking for a couple of hours. I will say there's about 50 of you who are gonna stay later in the afternoon and we have some small group discussions. Not everybody got the word of where that is. It's at the other half of the building. It's called the Fisher Conference Center. So if you know you're invited to this, it's the other half of the room. But we have the hall for the whole day. Stay and have lunch, come back here and talk. What I heard again and again here today was lots of innovators, lots of solutions. Not everything works. How do you fix something that doesn't work? Metrics, I heard metrics again and again. How are we gonna come up with these metrics? How are we gonna assess? How are we gonna improve impact? How are we gonna take the design approach and do iterations and go back and forth? We have some great folks here. We've got all your names on an email list now unless you opt out. So what we're gonna be doing is we're gonna be soliciting projects and trying to match you with faculty and students. We did this last year with no money. We got 12 submissions and we made six matches and some of those are underway. Now thanks to the Blackie family, we've got some startup pilot money. We've got a couple other folks in the audience today who might be contributing more to this cause. That's gonna be part of it. It's gonna be funding this. And the more funded projects that are productive and show progress, I think we'll build ahead of steam here. So what a fabulous room of innovators and solution-oriented people. I didn't hear a whiner among you today. So I hope you will go have a fabulous lunch and stay tuned for a lot more. Thank you for coming today. The preceding program is copyrighted by the Board of Trustees of the Leland Stanford Junior University. Please visit us at med.stanford.edu.