Healthy Food in Healthcare – Food Matters
Healthcare Domain- Annual Work Plan
June 2013— March 2014
[Updated and Archived October 2014]
COI Strategic Plan Goal(s) and Objective(s): 1,3
Healthcare
Action Plan Strategy(ies) and/or Overarching Strategy: 2C, 2K, 2L - SSB
Project description
& estimated
completion date
Describe your overall project including project goals.
Conduct a training for hospital and healthcare professionals on the connection
between the food system and individual and community health
Identify a timeline for completion of the project.
November 2013 (formerly September 2013). This project is complete.
How does this project impact health equity?
Access to healthy, sustainable food for those interacting with hospitals and clinics
(employees and patients).
Population(s)
served
Describe the primary population impacted by project activities.
Hospital and clinic employees and patients
Do any of these activities affect children aged 0-5? If so, please describe.
Yes, patient and patient families can fall into this age group.
Lead person &
partners involved
Identify the lead person & any other primary partners involved in the project.
Lead: Julianna Arnett, COI/CHIP
Other partners: Health Care Without Harm/Physicians for Social Responsibility,
Scripps, Palomar Health, Sharp, Kaiser Permanente, Rady Children’s Hospital, UCSD
Level of COI Staff
Involvement and
support activities
Please check the option that most closely describes the required level of COI staff
support:
Minimal (e.g., domain partners primarily lead and conduct work)
Intermediate (e.g., administrative support, technical assistance, resources, etc.)
Significant (e.g., COI staff manage or are highly involved in project
implementation)
Please specify anticipated COI staff support activities: meeting coordination,
research, presenter recruitment, forum planning, general communication
Other domains
involved
Updated October 2014
Identify any other domains involved in the project.
Project activities &
estimated
completion date(s)
List the specific activities/tasks you will undertake to complete your project and list an
estimated completion date for each one.
1. Plan the Food Matters training through regular NHLT meetings and special
planning meetings, as needed. (ongoing)
2. Recruit and secure all event speakers. [October 2013 (formerly June 2013)]
3. Submit an application for CME and/or CEU accreditation. [October 2013
(formerly June 2013)]
4. Host a Food Matters training. [November 2013 (formerly September 2013)]
5. Create and administer an event evaluation. [November 2013 (formerly
September 2013)]
Evaluation
measures
Specify how you plan to measure your project’s success, including activities. Refer to
your project activities to organize your information.
1. Attendance list and agenda for Food Matters training.
2. Event evaluation
Updates
Provide an update on progress towards or completion of project activities and
overall project goal. Refer to your project activities and evaluation measures to
organize your update.
Update 6/13:
1. The Food Matters training has been a standing line item on the NHLT
agenda since 3/14/13. A draft agenda has been created. A tentative date of
September 20th has been selected for the training.
2. The following speakers have been secured: Dr. Ted Schettler (Topic: Health
Impacts of the Industrialized Food System), Cheri Fidler (Topic: SSBs),
Barbara Hamilton (SSBs). Others have been invited but have not confirmed
participation.
3. COI staff are currently investigating CME and CEU accreditation through a
number of facilities. Several challenges have been identified. A facility has
not yet selected for the submittal of an application.
4. N/A
5. N/A
Update 3/31/14:
Activity 1. Complete.
The Food Matters training planning was a standing line item on the NHLT agenda.
Activity 2. Complete.
The secured presenters are listed below with the training agenda.
Updated October 2014
The schedule of the event was as follows:
8:30 a.m.:
9 a.m.:
9:10 a.m.:
9:45 a.m.:
10:35 a.m.:
11:10 a.m.:
11:40 a.m.:
12:30 p.m.:
1:00 p.m.:
1-1:30 p.m.:
Registration & Breakfast
Welcome & Introductions
Kendra Klein, PhD(c), SF Bay Area Physicians for Social Responsibility
Barbara Hamilton, Systems Sustainability Manager, Palomar Health;
Co-Chair, Nutrition in Healthcare Leadership Team
JuliAnna Arnett, Community Health Improvement Partners
The Five Pillars of a Healthy Diet
Gordon Saxe, MD, PhD, MPH, UC San Diego,
Center for Integrative Medicine
Food Matters- A Clinical & Public Health Framework for
Food-Related Health
Ted Schettler, MD, MPH, Science and Environmental Health Network
Food Matters- Impacts of the Industrialized Food System on Maternal and
Child Health
Melanie Fiorella, MD, UC San Diego, Center for Integrative Medicine
Healthy Food in Healthcare: Moving from Ideals to Action
Kendra Klein, PhD(c), SF Bay Area Physicians for Social Responsibility
State of Healthy Food in Healthcare Panel*
Kaiser Permanente San Diego- Joseph Libertucci, RD
Kindred Hospital- Sadiya Hasan, MS, RD
Palomar Health- Barbara Hamilton
Scripps Health- Britta Ortlieb, CDM, CFPP
Sharp Health- Lauren Blacker, MS, RD
Call to Action- Advocacy
Christine Wood, MD, FAAP, CLE, KidsEatGreat
Close
Networking
Activity 3. Complete.
CME/CEU credits were acquired for the training through accreditation with
PAC/LAC (Perinatal Advisory Council: Leadership, Advocacy, and Consultation).
Nine of the attendees received CME/CEU credits, including 4 dieticians, 4
registered nurses, and 1 physician.
Activity 4. Complete.
A Food Matters training was held on Saturday, November 9, 2013 from 9 a.m. –
1 p.m. in San Diego, CA at the Balboa Park Club, Santa Fe Room (2144 Pan
American Rd W, San Diego, CA 92101). The San Diego training was developed by
the Nutrition in Healthcare Leadership Team, a subcommittee of the San Diego
County Childhood Obesity Initiative, a program facilitated by Community Health
Improvement Partners (CHIP), Health Care Without Harm, San Francisco Bay
Area Physicians for Social Responsibility, and University of California San
Francisco's Program on Reproductive Health and Environment. The training was
jointly sponsored by Community Health Improvement Partners and PAC/LAC
(Perinatal Advisory Council: Leadership, Advocacy, and Consultation). The event
Updated October 2014
was attended by 72 individuals, including: 12 food systems professionals, 6
hospital food services, 5 nurses, 11 physicians, 17 public health professionals,
and 21 individuals describing their profession as other.
Activity 5. Complete.
An event evaluation was completed and administered at the event. In addition,
CME/CEU credit recipients were required to complete a pre- and post- test.
A summary of the event evaluation results are provided below:
 The event was very well-liked overall.
 Overall, respondents’ least favorite session was the panel; their favorite
session was Christine Wood's presentation, which received full marks.
 Out of 26 respondents, 9 learned about the training through an email
forward from colleague, 10 learned about the training through an email
from the event organizers, and the rest learned about the training
through other means (including internal work emails). Considering this
last, the vast majority of respondents learned about the training through
email.
 One respondent gave both Gordon Saxe and Melanie Fiorella poor marks;
another respondent gave the panel poor marks. Otherwise, there were no
strong dislikes throughout the data.
 A commonly quoted most useful part of the event was the 5 Pillars of
Healthy Eating, often because of its simplicity and accessibility.
 Suggestions for improvement included: adding other partners/industries
to panelincluding schools; adding a scheduled break in the middle;
having fewer speakers to keep it from feeling rushed at the end; offering
nuts, seeds & cheese instead of croissants; and including participation
from the County.
A summary of the CME/CEU pre- and post- test results are as follows:
CME/CEU Evaluations
Among the 9 attendees seeking CME/CEU credit who filled out both pre- and
post-training surveys:
 The number of attendees who rated that they felt very confident or
confident “in describing the food system and the components that make
up the food system” increased from 7 (2 very confident, 5 confident) in
the pre-test to 9 (5 very confident, 4 confident) in the post-test
 The number of attendees who rated that they felt very confident or
confident “in describing the relationship between diet and chronic
disease” increased from 6 (5 very confident, 1 confident) in the pre-test
to 9 (9 very confident) in the post-test
 Attendees rated their patients’ dietary health primarily as fair and poor (5
fair, 3 poor) both in the pre- and post- tests
 The number of attendees who rated that they felt very confident or
confident in discussing health concerns related to the industrial food
system with patients increased from 5 (2 very confident, 3 confident) in
the pre-test to 9 (3 very confident, 6 confident) in the post-test
 The number of attendees who reported that they were likely to advise
Updated October 2014
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Updated October 2014
patients or families all of the time or most of the time about six diet and
nutrition behaviors, including, but not limited to eating a balanced diet,
eating an assortment of fresh fruits and vegetables every day and
avoiding sugar sweetened beverages, ranged from 44% (4 attendees) to
66% (6 attendees) in the pre-test; attendees who reported that they were
likely to advise patients or families all of the time or most of the time
about 5 food related exposures, including but not limited to nontherapeutic antibiotics in meat products, rBGH, and pesticides, ranged
from 22% (2 attendees) to 11% (1 attendee) also in the pre-test
Attendees ranked 15 food issues, ranging from getting enough vitamins
and nutrients to avoiding rGBH in dairy, from very important to not at all
important in both the pre- and post- tests; the number of attendees that
ranked the food issues as very important increased in 14 of the 15
categories; the number of attendees that ranked avoiding or limiting fish
high in mercury, avoiding non-therapeutic antibiotics in meat products,
avoiding arsenicals in chicken products, avoiding pesticide exposures by
eating organic foods, avoiding rBGH in dairy products, reducing meat
consumption to reduce environmental impact, and eating locally to
reduce “food miles” significantly increased (20% or more) from the pretest to the post-test
The number of attendees who rated that modeling a healthy food
environment was very important or important to their workplace
increased from 8 (6 very important, 2 important) in the pre-test to 9 (8
very important, 1 important) in the post-test
The number of attendees who reported that they were very likely to
advocate for a healthy food environment in their workplace increased
from 6 in the pre-test to 8 in the post-test
The number of attendees who reported that they were very likely to likely
to promote healthy eating practices with their patients increased from 6
(3 very likely, 3 likely) in the pre-test to 9 (4 very likely, 5 likely)
All 9 ranked the presentations as excellent (7) or good (2)
8 reported that the information presented was useful to their practice
7 reported that they will make changes in their practice as a result of the
information presented
7 reported that the day was very successful or successful in helping them
meet the following educational objectives:
o Identify what our food system is and all of the components that
make up our food system
o Identify health impacts associated with our food system, both in
terms of the human life cycle, with a focus on maternal and child
health, as well as ecological health
o Describe the role of the healthcare sector, including clinicians, in
obesity prevention and the development of a healthier food
system
o Communicate key messages related to healthy eating and
nutrition to patients and their families
o Implement interdisciplinary strategies to model healthy eating
best practices within their healthcare facility
Barriers
Explain any difficulties/challenges to implementing your project. Be specific. If an
activity or the overall project was cancelled, explain the circumstances.
COI staff has currently explored CME/CEU accreditation through UCSD and Scripps.
The process at Scripps cost $2,500. Staff are continuing to investigate less expensive
options at UCSD and the County.
3/31/14 Update: Accreditation was secured for $750 for both CME and CEU credits
through PAC/LAC. (See above).
Promotion/ PR
opportunities
Identify any promotional or public relations opportunities you see might arise from the
project or might assist the project.

There are a lot of PR opportunities related to this workplan:
o Spotlight hospitals and/or hospital and healthcare professionals in
monthly newsletter
o Media spots on the changes hospitals are adopting
o Press at the food service forum
Press releases to some hospital / healthcare publications on local efforts
The event was featured in an article by local writer Lydia Wisz that
appeared in East County Magazine and Food Day Blog on January 2014 and March
20, 2014, respectively.
Desired recognition
Identify any specific recognition you would like to see either for the project or the
people involved in implementing the project.
5210 Campaign
Please describe how you have used the 5210 campaign as a part of workplan
activities (If you have not, please so indicate). If you have used the 5210
materials, please specify which materials, languages, target audience(s),
approximate # of people reached, geographic region(s), dates:
N/A
Do you plan to incorporate the 5210 campaign into workplan activities in the
future? If so, please describe:
The NHLT will use the 5210 messaging whenever appropriate.
Updated October 2014