Farm to School and Healthy Hospitals Initiative: Change Agents in Food System Reform Marydale DeBor JD, Lecturer, Yale School of Medicine, Department of Psychiatry Managing Director, Fresh Advantage™ LLC New Haven, CT

1. Farm to Cafeteria Conference
August 2-5, 2012
“Farm to School”
and
“Healthy Hospitals Initiative”:
Change Agents in
Food System Reform
Marydale DeBor JD,
Lecturer, Yale School of Medicine, Department of
Psychiatry
Managing Director, Fresh Advantage™ LLC
New Haven, CT

2. Overview
• Solving “Weight of the Nation” NEJM, August
2, 2012
• Health Care Sector- Where are We?
• One Model: Plow to Plate
• National Hospital Initiative: HHI.org
• Partnership with Farm to School Movement
• Key points of possible collaboration identified
at this conference

3. We all know what the problem
is……………starting with
those ubiquitous sugary
beverages .

4. 1 out of 3 children born in 2000 or after
will develop Type 2 Diabetes

5. The Moral Dilemma
• Given the evidence of harm done by consumption
of food and beverages that contribute to obesity
and related disease,
How do we, as health care professionals….reconcile
our mission, the oath that physicians take, with
this:
“Food served in children's hospitals rated
largely unhealthy”
UCLA News December 1, 2001

6. Two Interdependent Systems:
Food and Health Care are Broken
• Illness (physical and mental), hunger,
malnourishment, comprising ability to learn
and function
• Require leadership to be fixed
• Health care sector should be leading,
not absent..BUT
• Farm to School is the true Pioneer

7. One Hospital’s Experience
See: “Plow to Plate: The Hospital as Change Agent
Sustainability: The Journal of Record, April, 2012

8. Caveat:
• Plow to Plate is far from the norm. The model is premised
upon the notion that hospitals (and physicians) must
become public health practitioners---foreign to how system
works now, but will be compelled by the economics of
current situation and the implementation of reform policy
and regulation. It will take generations of hard work and
advocacy.
• Fletcher Allen is the goal, but it is exceptional

9. Start with the Basics: Think…
“[Local] Food is Primary Care™”

10. Use the resources available: Local,
Regional Farms.. Supporting local
economy

11. Physicians & Local/State
Department of
APRNs Policymakers
Agriculture
Social
Service Hospital
Agencies as
(Youth & LEADER
Seniors) Community
Coalition
Local Media
Department
of Health Farmland
Preservation
Advocates
Schools
Farmers
FIRST!
Parks and
Farmers’
Recreation
Markets
Churches
Copyright 2012 Marydale DeBor
Restaurants / Chefs 11

12. RFP process, new vendor, community and
hospital programs with health objectives
• Make it a “food movement”
• Make it fun, delicious, engaging
• Don’t preach, don’t use the “N” word
• Ingredient, calorie count and weight watcher data
on all menus (nobody cared, or read them)
• Make it taste good, and look beautiful, above all
• Engage the media

13. FACULTY: Doctor, Chef and
Fisherman

14. New Milford Youth Agency
Program: after school
www.youthagency.org

16. Consumer Supported
Agriculture- Our
Employees
30 Shares Guaranteed by Hospital
Sold Out in Less Than 1 Week

17. Healing/Learning Culinary
Garden

18. Building a Food Learning Hub, Not Just a
Food Service

19. Success Documented Widely
• April, 2012 “Gold Award” Connecticut Quality
Improvement Partnership
• In May 2011: CHANGE COMES TO DINNER by Katie
Gustafson
• 2011 –Connecticut Magazine; NY Times
• 2010 –Greening Food and Beverage Services, by Cheryl
Baldwin, GREEN SEAL Guide to Transforming the
Industry
• 2009 Planetree Award for Nurturing Foods
• 2009 Glynwood Center for Sustainability/Good Food for
Health Award

20. Poster Presentation: Institute for Health Care
Improvement National Convention-2011
Building and Sustaining a Healthy Dining Experience:
A Quality Improvement Initiative to Implement a Healthful, Sustainable
Food System with Exceptional Customer Service
Team Members: Dan Amendola, Guest Service Representative / New Milford Hospital; Marydale DeBor JD, Cofounder Plow to Plate, Vice-President of External Affairs /
New Milford Hospital; Beth Falder: Quality Data Analyst / New Milford Hospital; Wayne Frisbee, Guest Service Representative / New Milford Hospital; Kerry Gold,
Dining Service Director Unidine Corporation / New Milford Hospital; William Hart, Cook / Unidine Corporation; Michele MacDonell, RD, CDN Clinical Nutrition Manager /
Unidine Corporation / New Milford Hospital; Laura Olson, Guest Service Representative / New Milford Hospital; Noemi Rushton, Dining Service Administrative
Assistant / New Milford Hospital; Bob Sommer, Vice-President of Human Resources / New Milford Hospital; Rafael Walters, Executive Chef / Unidine Corporation
Introduction Results Methods
Faced with low Press Ganey Developed a coalition with community
Scores, complaints from leaders and local farmers to create the Plow
employees, and increasing to Plate®program, promoting healthy foods
concerns about the health and through a two track strategy of community
well being in the communities and hospital-based programs.
we serve, New Milford Hospital
Signede Hal th Care Without Harm’s
the
decided to make food service a
“Healthy Food i Health Care” pledge as a
n
top priority and use our food
service program as a tool to statement of commitment to reforming the
help prevent disease and hospital food system.
improve public health. We Conducted a thorough assessment of the
reevaluated our philosophy hospital food service, issued RFP based on
and committed to the belief the results, and retained Unidine Corporation
that a healthful, sustainable
National Patient S atisfaction as the vendor-partner for the hospital.
food system and exceptional ranking increased from the 51st Integrated the Plow to Plate®philosophy as
customer service are integral to
healthcare practice and the Percentile to the 93rd Percentile the foundation for te hospital’s food service
h
delivery system. Worked with several local
patient experience. for Meals Overall, and from the farms and dairy co-op to provide
38th Percentile to the 95th “Connecticut grown” produce, dairy and
Project Aims meats.
Percentile for the Quality of Food. Eliminated all fried foods, soda machines,
Target improvements to trans-fats and high fructose corn syrup.
increase patient satisfaction Trained existing staff in culinary, customer
and utilization of hospital café. service and communication skills.
Initiative involved collaborating Instituted a room service model , obtaining
with food service vendor and patient selections prior to each meal.
creating a coalition with Renovated the kitchen to promote maximum
community leaders to develop efficiencies and Á La Carte cooking, leading to
a sustainable food system and improved temperatures and freshness of
patient meals.
patient education program.
Instituted meal rounds to understand patient
preferences.
Reviewed and streamlined therapeutic diet
orders to eliminate unnecessary restrictions
while meeting patient needs.

21. What still needs work
• Supply and Distribution
• Knowledge deficit on part of physicians
• Cardiologist insists we put soda back in
cafe…….a matter of individual “choice”
See NEJM article re : food industry messaging strategy
• Vending machines; 24/7 healthy food
service

22. Opportunities for Hospital-
School Collaboration
• Establish and Foster dialogue with local
hospitals and physicians, nursing
organizations: The
Communication/Relationship Imperative!
Saturday plenary
• Tell your story: to physician groups in your
states (state and local chapters of American
Academy of Pediatrics, Family Medicine,
Psychiatry, Internal Medicine….) Friday

23. FTS and Health Care Sector:
Collaboration Opportunities
• Supply/Distribution/Procurement
– Include hospitals in
• your purchasing coops (Friday sessions: Jeremy
West, Greely CO)
• Clean, cut, prep processing centers (Doug Davis,
Burlington)
• Long term storage facilities
• Training of food service workers

24. Hospital-School Collaboration:
Metrics
• We don’t need (only)high tech interventions
to fix this!
– But let’s get distributors to adoptllicense Black
River’s tracking methodologies! Saturday
plenary
– HHI has data collection system; join forces
– Health care has resources: they have to measure
everything! Maybe can help with metrics, esp if
academic center

25. Collaboration Opportunities
• Advocacy, Advocacy, Advocacy !!!!
• Join New England Farmers Union—or your
state chapter of National Farmers Union
– Progressive policy platform
– advocates at federal level for family farms and
all of the policies and programs upon which
Farm to School depends!
www.nfu.org
newenglandfarmersunion.org

26. Our Future: Our Children
Plow to Plate Youth Chef Advocates, 2009

27. To learn more….
• Contact: Marydale DeBor JD, Founder, Managing Director
• MDeBor@freshadvantage.com 203-745-1796 Cell: 860-248-9854