Vanguard Health Chicago | Healthy Beverage Case Study

Benefits

“People feel good about what they are eating and drinking. These changes have been good for our business, but more importantly good for the health of those we serve and employ. It’s a win-win. I think some people wonder why we didn’t do this sooner.”

Theresa Rudnick
Senior Director for Support Services

  • Many benefits have come from this effort. Vanguard Health Chicago employees have shared improved health benefits including weight loss. Many have shared how proud they are to work at a place that puts its mission into action and genuinely cares about them.
  • Community partnerships have been strengthened and expanded. Working partners like the American Heart Association, Illinois Public Health Institute, and Health Care Without Harm shared tools, resources and their expertise, making the planning and implementation process much easier.
  • The media campaigns have garnered positive stories depicting the Vanguard Health Chicago system as one that is caring and committed.

The Problem

In Illinois, the obesity rate has nearly doubled since 1995. Nearly two-thirds of all Illinoisans are overweight or obese. Illinois has one of the ten highest obesity rates for adolescents in the nation and the fourth worst child obesity rate. Sugar-loaded beverages are a major contributor to obesity and obesity-related diseases. Consumption of these drinks contributes approximately 46% of the added sugar in the American diet and may account for one-fifth of all weight gain between 1977 and 2007. Reducing consumption of these drinks can improve health outcomes.

Hospitals are role models for the healthy choices that lead to better health outcomes. They can build better health care delivery systems and create better workplaces by changing their food and beverage environments to support and encourage healthier choices.

Addressing the Problem

The Vanguard Healthy Beverage Work Group was comprised of:

  • Senior Management Team Members
  • Food & Nutrition Directors
  • Human Resources
  • Community Relations
  • Senior Administration Team Member, Market Office
  • Clinical Management
  • Marketing/Public Relations

In April, 2012, Vanguard Health Chicago created a Healthy Beverage Work Group to assess the beverage environment and create a healthy beverage program and policies. This group represented all business units in the market (see sidebar) and worked with technical assistance and support from the Illinois Public Health Institute, American Heart Association and Health Care Without Harm.

On July 1, 2012, Vanguard Health Chicago removed all drinks that were high in sugar, including regular soda, energy drinks, sports drinks, pre-sweetened coffee and tea drinks, juice drinks with added sugar in addition to whole or 2% milk. Sugary beverages were replaced with drinks that have moderate amounts of sugar, fat and sodium or containing artificial sweeteners like low sugar drinks, 100% fruit juice or vegetable juice (in small portions), diet drinks, low-sodium sports drinks, soy milk and 1% milk. Large quantities of water, seltzer water and 1% or skim milk are offered. The prices for healthy drinks were lowered to encourage consumption.

A color-coded system (patterned after a stoplight) was used to make the distinction between the drinks and educate the hospital constituents (patients, employees, visitors, volunteers and community members) about the drinks. Red drinks are high in sugar and sodium with 12 grams or more of sugar. Yellow drinks have between 6 and 12 grams of sugar or contain artificial sweeteners and green drinks have 5 grams or less of sugar.
Access to potable water was increased, with one hospital offering infused water during lunch hours at the cafeteria.

An implementation plan was developed incorporating five evidence-based strategies of MAPPS (media, access, point of purchase information, price and social support/services).

Implementation Process

Vanguard’s process was multi-disciplinary and collaborative, which made the transition fairly seamless. The following lists the implementation steps:

  • In April 2012, the Healthy Beverage Working Group began biweekly meetings. Sub-groups were assigned specific tasks to plan and implement between team meetings.
  • The members of the Healthy Beverage Working Group attended the April 25, 2012 symposium, Rethink Your Drink: The Impact of Sugar-Loaded Beverages on the Obesity Epidemic & Clinical and Environmental Strategies to Reduce Consumption.
  • On the day of the Rethink Your Drink symposium, a major media announcement was made about the Vanguard effort that received coverage from Chicago Tribune, WBBM-TV and WLS-TV.
  • An inventory was taken of the drinks served and sold and at what access points. A decision was made not to purchase any more sugar-loaded beverages as they sold out.
  • All vendor contracts were reviewed. Meetings began with vendors to share the decision to create a healthier beverage environment and the new parameters of their relationship with Vanguard. Vendors were asked to consider what beverages they would supply that were less sugary or contained no sugar.
  • Vendors supplied several new options. The Healthy Beverage Work Group gathered to taste the drink options and vote on which had the best taste and met the criteria for amount of sugar and serving size.
  • Sugary drinks advertisements were removed from vending machines and coolers.
  • Meetings were held with on-site providers (Walgreens at one site) to let them know about the new policy and ask that they join Vanguard in the healthy beverage campaign. Walgreens agreed to sell only healthy beverages and implemented the Vanguard criteria.
  • Communication and educational materials were developed with the same color-coded definitions used by the Boston Public Health Commission.
  • On June 21, 2012 Bill Foley, Market President sent a message to all Vanguard Health Chicago constituents about the environment change, describing it as a demonstration of “our commitment to our mission through our action.”
  • During the week of July 9, each hospital hosted a taste-testing of the healthy beverages that replaced the sugar-loaded ones.

Challenges and Lessons Learned

There are four hospitals in the Vanguard Health Chicago system; each with a different organization style and culture as well as their own set of priorities and challenges. This meant that communication was an essential part of the process. Understanding the nuances of each place was necessary for the success of the effort. One implication of these differences meant developing overall strategies with differing timelines. For example, the food environment was the first place that changes were made at Vanguard MacNeal; the other hospitals are just beginning to make food changes.

Many of the things that were concerns prior to the process turned out to be fairly easy to manage. Discussions about revenue losses and backlash from the employees, patients, volunteers and community members were more intense that the actual responses. Yes, there were complaints at every stage of the transformation, but there were not many and they did not last for long. Over time, there was more vocalized positive feedback and support.

Next Steps

Now that the beverage environment has been transformed, three of the four hospitals will work on changing the food environment. Since the implementation of the program was so quick, tracking tools were not developed. A tracking system was launched in September 2012. The education efforts will be intensified and expanded, ensuring that the message of the negative impact of the drinks is emphasized.


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