Hospitals and medical centers are in the healthcare business, obviously. But the general understanding of that term has been undergoing an evolution, from a reactive model — we treat you when you are unhealthy — to a proactive one — we try to keep you from getting unhealthy in the first place.
Like many large healthcare organizations, Maine Health has supported a variety of wellness initiatives over the years. But over the past five years or so, it has expanded that effort with a major initiative to address obesity — a particularly timely program, given that experts say two-thirds of Maine residents are overweight or obese.
Maine Health, with 11 member or affiliated hospitals, serves some 75 percent of the state's population of 1.3 million. It has relationships with more than 1,500 physicians, including over 350 in primary care.
Maine Health's wellness initiative, called Let's Go, targets six different sectors in order to ensure a broad reach: healthcare, schools, child care, businesses, the media and communities. This means that the message is conveyed not only to its in-house audience of staff and patients, but is taken “on the road” to workplaces, schools and even the political arena.
What makes Maine Health's program even more unusual is the thought and commitment given to Let's Go. First of all, it is actively funded not by the usual outside grants but directly by Maine Health along with a number of partners: private nonprofit entities like the United Way of Greater Portland and the Harvard Pilgrim Health Care Foundation, plus private businesses like the Hannaford grocery chain, TD Bank, Unum and Anthem Blue Cross and Blue Shield of Maine.
The other distinction is the carefully honed message, created specifically to be an effective marketing tool. That message consists of the simple formula 5-2-1-0.
Those numbers distill the essence of Let's Go's anti-obesity message into four simple-to-understand-and-follow maxims: each day, one should…
- Eat 5 (or more) fruit/vegetable servings
- Spend no more than 2 hours of recreational screen time
- Get at least 1 hour of physical activity, and
- Consume 0 sugar-sweetened beverages.
“Our goal is to improve the health of the communities we serve,” says Deborah Deatrick, vice president for community health with Maine Health. “To do that, we made the decision that we had to be in multiple sectors in order to bring a consistent message.”
The original goal of the program, Deatrick says, was to address childhood obesity, “but we soon came to the conclusion that we didn't want to blame kids when adults were also failing to maintain a healthy weight.”
So now Let's Go reaches out to adults in businesses and the community, as well as in the schools. The workplace component of Let's Go focuses on exposing employees to the same 5-2-1-0 message their kids get in the schools, child care centers and doctor's offices. The program offers businesses a toolkit with components like a healthy snacks for meetings list, a Let's Go packaged snacks list and local workplace wellness resources list.
One business that has embraced the program is Anthem of Maine, where there were not only significant changes made in the cafeteria and onsite vending to increase the number of heathy items, but in workplace habits as well.
For example, the company now encourages “walking meetings” in which the participants take a walk while they talk rather than sitting in a room. Staffers are also encouraged to walk the stairs, and the number of employee athletic challenges have increased significantly.
Meanwhile, in the schools, teachers are encouraged to eat with children in the cafeteria and to provide examples of choosing healthy dishes, and they are discouraged from using unhealthy enticements — candy, cupcakes, pizza parties — as rewards and celebrations. Instead, says Deatrick, “we encourage them to substitute physical play time, or a game, as a reward. Make the healthy activity the fun activity.”
Working With the Schools
The part of the initiative involving school nutrition programs began in 2006 with a period of “learning and listening,” says Heidi Kessler, Let's Go's school project manager. She initiated a series of monthly meetings with foodservice directors from school districts around Portland. “We found that they needed help to get the message out about what they were already doing — the whole wheat crust in the pizza, and local produce on the salad bars.”
Kessler says Let's Go was willing to help, but it needed the schools to pass what she terms the “straight face test.” “We told them that would be willing to help if they were willing to take a look at some of the things they were serving — hot dogs, chicken nuggets, etc. — that we thought didn't pass the straight face test.”
In response, the group came up with five areas where schools would try to improve what they serve: substitute skim milk for whole or 2%, reduce French fries to no more than once a week, limit the automatic serving of dessert to no more than once a week, replace fried potato chips with baked, and substitute healthier competitive food items for traditional, unhealthy favorites.
Schools could tackle all or some or even only one, depending on individual circumstances. “Even if you couldn't cut fries to once a week,” she says, “maybe you could cut it to three as a start. The point was to make some progress.”
More recently, the partner schools have taken up the challenge of qualifying under the voluntary school lunch standards of the USDA's Healthier U.S. School Challenge. In January, 39 Let's Go partner schools submitted applications (which were in the approval process at FM press time).
Let's Go's success with the initial group of eight districts in the Portland area (including the city of Portland) led to calls from other districts across Maine. That in turn has since led to relationships with districts in two other Maine metro regions. In all, there are now 28 districts representing 161 school sites with 65,840 students participating in Let's Go.
Making Good Food Taste Good
The foodservice operations at Maine Health hospital sites had their own collaborative effort going on even as the institution was pursuing its macro vision of taking the wellness message to the larger community.
To get the ball rolling, a task force made up of representatives of the various hospital nutrition departments met to hammer out some goals with the recognition that no cookie-cutter approach will work.
The first act of the task force was to design a healthy choices pledge, signed by representatives of all the member institutions (including CEOs), that commits each to a number of goals, including increasing access to healthier options in their retail and catering operations, adding farmers markets and local product sourcing, implementing nutrition navigation systems to guide customers to making better meal choices, promoting sustainable practices like recycling and composting, and initiating community education programs.
At the core of the task force’s mission is making healthier foods more appealing. “It’s the standard dilemma,” explains Michael Sabo, director of hospitality services at Southern Maine Medical Center, who chairs Maine Health’s foodservice director task force. “When you ask people if they want healthy items, they say yes, but if you menu them beside something like fried chicken, they’ll choose the fried chicken every time. Our challenge is to override that.”
Each hospital has its own initiatives, which are shared with the group to spread best practices. At Southern Maine, Sabo instituted a monthly promotion of new healthier items and put fruit cups at impulse buy locations. St. Andrews Hospital offers gourmet bag lunches once a month because it lacks a traditional cafeteria. St. Mary’s Health System adopted patient “right size” portions for its retail operations.
It’s made a difference. For example, at Mid-Coast Hospital, despite removal of the fryer and the popular dishes it used to make, there has been a $70 increase in evening meals, many of them healthier choices.
