Improving Employee Diets Through Incentivized Cafeteria Pricing in Rural North Carolina Hospital

FirstHealth of the Carolinas, a not-for-profit health care system in rural North Carolina, developed FirstFit as an ongoing initiative promoting the culture of health and wellness for its employees. During the course of monthly meetings, a steering committee comprised of members from departments and entities across the healthcare system used a number of tools including employee focus groups to help shape the initiative. Collecting this information was vital to develop employee-supported ideas and areas of interest. As a result, six categories were determined to focus FirstFit activities - healthy eating opportunities, physical activity, education, employee marketing, policy changes and environmental changes. Internal and external walking trail maps were created and an on-site farmer's market was started. One dramatic policy change proposed by the steering committee to FirstHealth administration was to turn the pricing structure in the cafeteria upside down. Healthy foods were more expensive than unhealthy foods; with the policy change the hospital would subsidize healthy food so that it was significantly cheaper than unhealthy food. During the first quarter after the changes went into effect, when comparing food purchases to the prior year, cheeseburger and hamburger purchases decreased by 35% and 43% respectively; sausage, biscuits, and bacon purchases decreased 36%, 21% and 22% respectively; and grilled chicken and salad purchases increased 42% and 45% respectively. Overall, there has been more than a 15 percent increase in healthier food purchases in the cafeteria while increasing the number of customers by more than 500 people.