The document outlines efforts by the St. Joseph Health System in Sonoma County to implement more balanced, sustainable, and cost effective menus. It discusses expanding vegetarian and plant-based options in their cafeteria and patient menus, which has resulted in increased revenue, significant reductions in meat consumption and greenhouse gas emissions, and projected annual savings of over $5,000. Some challenges included working with vendors to source sustainable and local ingredients and addressing concerns from nutritionists about protein levels in new menu items. Marketing and education efforts helped promote the changes.

1. B A L A N C E D M E N U S
Serve healthy food. Mitigate climate change. Reduce costs.
Linda Hansen, CDM, CFPP, Director of Nutrition Services
St. Joseph Health System, Sonoma County
Linda.Hansen@stjoe.org

2. Started with the Creekside Café
Staff and visitor meals
• Added vegetarian beans/legumes to menu in addition
to chili and soup
• Instead of 2 days per week, offered vegetarian dish
everyday in addition to the main entrée
• Improved salad bar offerings: more fresh local
produce, protein alternatives (tofu, beans, cheese)
• Kept pricing low for “healthy” items, and raised prices
on “unhealthy” items to maintain margin
B A L A N C E D M E N U S
Serve healthy food. Mitigate climate change. Reduce costs.

3. B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.
Cafeteria Menus Sustainable Protein Vegetarian Entrées
Prior to Fall 2008 0% 8%
Fall 2008 5% 32%
Increase : 5% 24%
Cafeteria Results
EXAMPLES ♣Tofu Stir Fry ♣Lentil Stew ♣Spicy Sesame Noodles ♣Vegetarian Chick Peas
♣Stuffed Tomatoes W/Couscous ♣Bean and Rice Stew ♣Asparagus, Leek And Gruyere Quiche
♣Cheese Polenta ♣Brazilian Black Beans ♣Quinoa, Corn & Black Bean Stew ♣Bean & Kale
Ragu
 Increased revenue by $89,220 (11%) from 2006 to 2009
 Vegetarian entrees are well accepted by customers in Café
(They had been requesting them for awhile!)
 Almost 5,000 pounds less meat prepared per year in Café;
~150 tons of GHG Emissions saved!

4. B A L A N C E D M E N U S
Serve healthy food. Mitigate climate change. Reduce costs.
Looked at Patient Menu
Three pronged approach to achieve
“Balanced Menu”
1) changed some of the existing
vegetarian entrées to first choice
 Avg. ~100 less meat servings/meal
2) replaced unpopular meat entrées with
vegetarian or casseroles with less meat
3) used the cost savings to replace meat
entrées with sustainably raised beef or
poultry

5. B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.
• $12,000 projected savings by reducing meat, poultry and
fish
• $6,000 in increased costs for free range chicken and
grass fed beef
• Despite a 35-50% price increase for the “sustainably
raised” proteins, the menu overall will save the hospital
over $5,000 per year, some of which will be used to offer
more fresh, local items on patient menu
This is important because, unlike cafeteria items, we can’t
charge more when we spend more on patient meals
PROJECTED SAVINGS, PATIENT MENU

6. B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.
CHALLENGES (Mostly on Patient Menus)
 Procurement
 Our primary vendor does not supply or carry sustainable proteins/meats
 When we found “natural” or “free range” meats, they were industrially raised
 Sysco does not carry California Rice; had to find an alternative source.
 The rice was a different grain than cooks were used to. Production
challenges.
 No one has locality information for produce (except Country of Origin)
 One vendor promise local, and we received squash from Mexico!
We decided to use local vendors at first, and then work on having primary vendor
stock specific items for us when we establish weekly volumes
 Nutrition
 The clinical dietitians had concerns about our elderly patients’ acceptance of
vegan dishes and the effect of less consumption on healing
 The vegan & legume recipes we proposed were lower in protein than
traditional meat entrées (patients need protein to heal)
 They were considered more difficult to digest
 Nurses had concerns about the bookmarks; they thought they meant we were
giving less protein per meal.
For this round of changes we stuck with more traditional vegetarian entrees that
include cheese and dairy. Did not use vegan recipes for patients.

7. B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.
Used $$ savings to buy sustainable
proteins
 Changed Tri Tip to Grass Fed Chuck
 Less expensive cut of meat was acceptable
because of the braising process; minimized cost
impact
 Changed Grilled Chicken Sandwich to a
Grilled Free Range Chicken Breast
 Saved the expense and time of assembling
sandwiches, and offered local rice as a side dish
 Very challenging to prepare; dries out quickly.
We’ve had to make adjustments on trayline
 Changed Meatloaf and Taco Salad ground
beef to Grass Fed

8. B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.
ACHIEVED GOAL OF DECREASING CARBON FOOTPRINT
Patient
Trayline
Sustainable
Protein Vegetarian
Prior to Fall 2008 0% 14%
Fall 2008 20% 20%
Increase per
category: 20% 6%
Based on the “Food and Diet Greenhouse Gas Emissions
Calculator” from HCWH, Santa Rosa Memorial will reduce
GHG emissions by about 200 tons by reducing meat on
patient menus by 7,400 pounds/year

9. B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.
Result in overall expense: Meat Category
Baseline 2007: $312,000
After “Balanced Menus:”
in Café & Catering (2008): $276,000
for Patients & Café (2009): $270,000*
(Annualized)
*These amounts do not represent savings to the hospital. Costs for vegetarian
items are allocated to a non-meat food category.

10. B A L A N C E D M E N U SServe healthy food. Mitigate climate change. Reduce costs.
MARKETING AND EDUCATION
 A “Balanced Menu” pamphlet from SF-PSR
was distributed throughout the hospital to
educate staff, visitors, physicians and
patients on the rationale for the changes.
 An informational bookmark that explains the
health benefits is sent on patient meal trays
to continue the education process.
 Articles were placed in “Noon News,” “Nuts
News,” “Connections” and other
communications within the hospital
 Took pamphlets and bookmarks to outside
meetings and community events