Healthy Hospital Food Initiative

A Survey and Analysis of Food Served at Hospitals by the
Physicians Committee for Responsible Medicine and ADinfinitum
September 2005

Intro: Methods and Findings | Background
Survey Details and Results | Discussion | Recommendations
References | Tables | Questionnaire 

Appendix A—Survey Instrument

ID# ______

HEALTHY HOSPITAL FOOD INITIATIVE QUESTIONNAIRE

Thank you for agreeing to participate in this survey and for helping all of us become change agents for healthier food in hospitals. The information you provide will help Spirit of Women in conjunction with the Physicians Committee for Responsible Medicine (PCRM), a non-profit organization that promotes preventive medicine through healthy eating, and ADinfinitum, a communications group promoting the healthy hospital initiative, to identify areas of excellence in hospital food service and potential needs for improving the nutritional value of foods served in hospitals.

Your name and hospital or health system information will be removed from the questionnaires by Spirit of Women staff and will be kept confidential. Identifying information will not be included when surveys are submitted to PCRM for analysis.

1. Please answer the following questions about your hospital or health system:

A. How many beds does your hospital or hospital system have?

B. In what state is the hospital or hospital system located?

C. Is it in an urban, suburban, or rural area?

D. How many cafés/cafeterias/snack bars (excluding fast-food restaurants) are in your hospital or health system?

E. Are there any fast food restaurants or snack bars at your hospital or health system? (Please do not include vending machines.) Please circle one:             Yes      No

If yes, please specify by name and indicate number of each.

2. Please answer the following questions about the main or busiest eating establishment in your hospital or hospital system:

A. Please indicate if your main or busiest full-service eating establishment is a café, cafeteria, or snack bar.

B. Please describe the top three selling entrée items in your main or busiest eating establishment.

3. Please circle the appropriate answer for each of the following questions:

a.   Is fresh fruit served daily?    

Yes      No       Don’t Know

b. Are fresh or cooked vegetable side dishes (not fried) available daily?

Yes      No       Don’t Know

c. Are any organic ingredients used in food preparation?

Yes      No       Don’t Know

d. Are reduced fat products such as skim milk, low-fat cheese, baked chips, reduced fat snacks offered to customers?

Yes      No       Don’t Know

e. Are low-fat entrees and side dishes, such as baked potatoes, steamed rice, marinara sauce, steamed vegetables, and cereal offered to customers daily?

Yes      No       Don’t Know

f. Is soy milk available?

Yes      No       Don’t Know

g. Are 100 percent juices available?

Yes      No       Don’t Know

h. Are any vegan dishes (made from only plant-foods) served daily?

Yes      No       Don’t Know

i. Are any bean dishes served daily?

Yes      No       Don’t Know

j. Are whole-grain products offered?

Yes      No       Don’t Know

k. Are sugar-free snacks offered?

Yes      No       Don’t Know

l. Is information about healthy eating or nutrition provided in your dining area?

Yes      No       Don’t Know

m. Is nutrient information available to customers for entrée items served?

Yes      No       Don’t Know

4. Please also provide the following information:

This is very important:

Please attach a copy of an actual daily menu from each eating establishment in your hospital or health system.

• Please attach a recipe for one of the healthiest entrée menu items available from your main or busiest eating establishment.

• Please provide a copy of a typical purchase requisition form (cost information not needed). Please include the amounts and variety of foods ordered.

THANK YOU FOR YOUR PARTICIPATION
And for supporting this healthy hospital food initiative