Kirstan Corben, Lead for Population Health and Health Promotion, and Kathryn Collins, Dietitian
When Alfred Health decided to implement the Healthy Choices guidelines, they knew it would take a team to lead the project. A new role was created that reported directly to the Chief Executive to drive this initiative, and other health promotion projects within Alfred Health.
As the Lead for Population Health and Health Promotion, Kirstan Corben’s responsibilities are focused on re-orientating the health service’s approach to embrace preventive health and wellness in the population, in addition to treating illness.
Kirstan and dietitian Kathryn Collins were involved in all stages of the project. There were three initial steps in the implementation process:
1. Establishing a committee
Kirstan and Kathryn, along with Alfred Health’s Chief Executive Andrew Way and Strategic Procurement Manager Steve McBride, formed the core team, along with the managers of the onsite food and retail outlets.
2. Developing the project plan
The committee developed a project plan which was crucial in ensuring everyone had a clear understanding of the overall project goals as well as their individual tasks. It included implementation strategies, a timeline, resources required and expected outcomes.
The project plan was discussed at the Executive Committee meeting on four separate occasions, as executive approval and leadership was considered crucial to the success of the project.
3. Building relationships
Building strong relationships with all parties involved in the project was essential. This was especially important for each of the retail outlets and catering providers. Kathryn and Kirstan agreed that this took the most time, but was possibly the most vital step for success.
The team decided that implementing all three arms of the project – retail outlets, vending and catering – at the same time would be the most efficient approach. This not only minimised the workload, it also ensured the project’s effectiveness in the long run, because having Healthy Choices in one area supported the others and vice versa.
Introducing healthy catering was the easiest to implement, as Alfred Health was able to create an internal policy that required all catering to be comprised of GREEN and AMBER foods and drinks.
Applying the Healthy Choices uidelines to vending machines at the same time as the food outlets was important in promoting a consistent message about healthy eating, and ensuring that the food outlets making healthy changes would not be disadvantaged by what the vending machines offered.
Although it was challenging at first, this approach enabled the committee to implement the Healthy Choices project across the three hospitals in a relatively short period of time.
Kirstan and Kathryn agree that the most demanding elements in terms of time and labour were writing the new hospital policy and guidelines and preparing the vending tender, as well as ongoing engagement with retailers.
Communicating the project aims and progress to staff and retailers was also considered a critical factor for the project to be a success. Regular communication with staff ensured they understood why they were seeing changes in the food outlets and vending machines, which helped to engage their support and minimise complaints.
The committee also developed a range of posters, flyers, and display boards explaining the meaning of the traffic light food categories, and included articles about the project on the staff intranet and newsletters. There were also screen saver messages on all hospital computers, raising awareness of the project.
An evaluation report completed by The Alfred in April 2012 shows that since the implementation of the Healthy Choices guidelines at their four onsite food retail outlets, the overall availability of GREEN choices has increased by 13 per cent and the availability of RED items has decreased by 15 per cent. This is a considerable improvement.
Kirstan’s tips for hospitals considering implementing Healthy Choices:
1. Secure the support of senior management
“Engaging genuine organisational support and encouragement for the project is essential for its longevity.”
2. Build trusting relationships with the retailers
“Understanding the perspective of the retailers, and genuinely respecting it, sets the foundations for a productive working relationship.”
3. Communicate with all stakeholders
“Communication should be on the front foot and explicit to ensure people respond positively to the project and so you minimise any negative attitudes or complaints.
“Often, understanding equals acceptance.”
How much time did it take to implement the guidelines?
Kirstan: The project took about a year to implement, and the workload fluctuated, especially with the vending tender which was intensive, but once that was done, it calmed down for a number of weeks.
On average I spent about half a day a week on this project.
What was your approach to communication?
Kirstan: We tried hard to communicate explicitly about what we were doing. Rather than just change our processes and hope that people wouldn’t notice, we actually said that you will see a change, this is the reason why we’re doing it, and lead by example. We are a health service and we need to be doing the right thing.
With higher awareness about nutrition, people supported and accepted the concept.
What were the biggest barriers that you faced?
Kathryn: The biggest barrier we’ve come across is food availability - access to convenience foods that are healthy, especially GREEN foods. The convenience options are very limited in the snack range for a vending machine where you’ve got shelf life to consider.
Kirstan: We had to give retailers time to jump on board and to actually let them get used to the idea, as they were concerned about losing sales. Relationship building was very important.
How did staff react to the healthy changes?
Kathryn: The reaction was mixed. Most people are actually on side, but there have been a few people that have said that we’re restricting their choice and they should be allowed to have whatever food they want.
We just keep reiterating that we’re not saying what people can or can’t eat, we’ve just expanded the range to include far more of the healthier options, and that when it comes to internal catering for example we’re not paying for the unhealthy food anymore . So staff can still bring in their birthday cakes, slices, or chocolate but the hospital doesn’t supply it (to staff).
We’ve also tapped into a new audience of people who have really embraced the healthy changes, especially through the vending machines. In a hospital setting, people tend to be interested in health, and people looking for a healthy choice would not have used vending machines because all they supplied was junk. Now, we’re giving people the option of healthier snacks and that has definitely paid off.
What’s the plan for Healthy Choices at Alfred Health in the future?
Kathryn: We’ll continue doing what we’re doing across the board. Hospitals need to make a commitment to public health and prevention, but to do that we have to change how we’ve traditionally thought about treating disease. We have to not just consider what we do with people when we look after them on the ward, but what happens when they enter the front door.
I think the ‘RED, GREEN, AMBER philosophy is starting to gather steam in Australia. With wider public awareness of that idea; that will only help us with this roll out.
Kirstan: Policies and guidelines will help this project have a life beyond individuals. In five years’ time I’d like to see it as just the norm. Hopefully by then it won’t take a lot of work and effort to source GREEN items for vending machines.