Truman Medical Center is on the front lines of health care in Kansas City. The safety-net hospital treated nearly 100,000 patients last year. But lately, hospital leaders have been trying to figure out ways to prevent people from getting sick and becoming patients in the first place. CEO John Bluford has been waging a wellness campaign, promoting better nutrition and battling junk food.
So what’s a McDonald's doing right inside a main hospital entrance?
The Menu at Truman
There are basically two eating options inside Truman’s main building on its Hospital Hill campus. And with thousands of hungry employees, visitors and patients passing through the area, lunchtime is busy.
One option, the cafeteria, is down the hallway from the hospital’s entrance on Charlotte Street.
“I’ve got a healthy salad,” says Miguel Meneses, Director of Employee Enrichment Operations at Truman, who's carrying a to-go container out of the cafeteria. “It’s got some feta cheese, chicken, your greens, strawberries.”
Tonya Watson, who’s at Truman to help with a delivery, waits in line for a turkey burger with pepper jack cheese and onions. “I love all the food here,” she says.
The other main eating spot (aside from a Quiznos across the street) is the very first place you hit when you walk in the Charlotte Street entrance: a McDonald's.
Lamyia Emmanuel eats her meal at a window table with her mother and brother. “I’m having two McChickens and a medium fry."
For nearby Kameo Burg, whose mom is in surgery, eating a juicy, familiar burger hits the spot.
“It’s more convenient,” she says.
But for Truman CEO John Bluford, who’s been trying to make nutritious food more widely available, deciding where to eat isn’t hard.
“I think I’m going to have some green beans, please," he orders from inside the cafeteria. "And I’d like to try the roasted chicken today.”
A Side of Wellness
While waiting in line for his food, Bluford explains that hospitals need to be setting the example for healthy lifestyles and diet. More than half of patients coming to Truman have at least one chronic disease. Region-wide, about one in four residents is obese, and one in four has high blood pressure.
“You are what you eat. I think it [diet] is critical,” says Bluford. “And many of our disease elements are diabetes, hypertension. Good nutrition has a significant impact on each of those diseases.”
As chair last year of the American Hospital Association, Bluford issued a call to action, mapping out how hospitals can serve as better leaders in creating a culture of wellness. And he says changes in the health system, which have been set in motion by the federal health law, are also motivating hospitals to assume a greater role in prevention and community health.
“We need to find ways to keep people out of the hospital, even though we don’t get paid for that right now,” says Bluford. “But it won’t be too long before it’s reversed.”
This wellness push has brought about several changes at Truman. For example, fitness and nutrition tips are now posted on elevators, in hallways and in staff emails. Baked chips have replaced regular ones in vending machines. The hospital launched a seasonal farmer’s market, opened a specialized cafe on the surgical wing, formed an employee gym and is working to establish a full-service grocery store a few blocks away, where affordable, fresh produce is hard to come by.
Another visible change has taken place right here in the cafeteria. It was remodeled about a year half ago. The salad bar has expanded. That case full of cakes and pies? Gone. You can still get burgers, cookies and fries, but the hospital’s food vendor, Morrison, says it’s now using less sugar, sodium and fat in the foods it prepares.
Some people really appreciate the changes. Eric Frankel, a pharmacist at Truman, is a fan of the new 450-calorie meals. “I’m able to maintain and possibly lose some weight by eating here every day."
An “Inconsistent Message”
Bluford takes a seat at a table in the employee section. He says he eats here a few times a week.
Behind him, a TV screen displays various nutrition facts. One slide cautions about how much bigger a portion of fries is today compared to twenty years ago. Another message then pops up in McDonald's signature red and yellow colors: ‘TMC cafeteria is for patrons only. If you purchase food from an outside vendor, please eat your meal in their restaurant.” That ‘M’ in “meal” looks a lot like the McDonald’s ‘M.’
Meanwhile, a few yards in front of Bluford is the back wall of the McDonalds.
Bluford says the cafeteria is strapped for space and really just needs to have it reserved for customers. But he also says he wouldn’t mind expanding the cafeteria into the space the restaurant currently occupies.
In the last few months, Bluford has become increasingly vocal about junk food and about what it means to have a fast food restaurant inside Truman.
“From an optical point of view, it doesn’t play too well now does it,” he says.
Bluford says there’s a place for fast food, but having it in the hospital goes against the very core of his wellness campaign.
“When you come in, you could be on your way to a diabetic clinic appointment, or your hypertensive clinic appointment, or going to see the bariatric surgeon for your weight problem. And you're passing a McDonald's on your way - that’s an inconsistent message,” he says.
A Long History
The relationship between hospitals and fast food restaurants goes back several decades. There are now 27 McDonald's in hospitals throughout the U.S., according to the McDonald's Corporation.
Bluford says twenty years ago, when Truman signed a lease with McDonald's, putting fast food establishments in hospitals was a popular trend. It made sense from a business standpoint.
“One, because there wasn’t the kind of emphasis on healthy eating and portion size management,” says Bluford. “And those franchises used to pay a nice penny to lease the space. That’s no different than what happened to Truman in 1992.”
Under the terms of the contract signed at that time, which is public record, McDonald's pays Truman $57,750 in yearly rent, plus eight percent of its annual gross sales of over $1 million. Truman also agreed to not bring in any other fast food establishments to the hospital.
The lease is for up to 25 years, with McDonald's making the decision every five years whether to renew it. That means McDonald's could exercise its final, five-year renewal soon. Bluford didn’t want discuss details of the contract situation, but he says in the last year, he’s been looking into a “palatable solution for all people involved.” He says for Truman, the financial benefit of having a McDonald's in the hospital is waning.
“Our mission doesn’t dictate that we generate revenue from our leases,” says Bluford. “Our mission states that we should improve the health of the community.”
Both the McDonald's Corporation and the local franchise owner declined KCUR’s requests for interviews about the situation, but the corporation did issue some statements. The company says it’s proud of its menu, and the evolving choices offered at the restaurant. It’s not about where you eat, the company says, but what and how much you choose to consume.
As for Ralph King, the owner of the McDonald's at Truman, he owns five other McDonalds in the region. He has been involved in several local organizations, including the Heartland Black McDonald's Operators Association, which has been championed by the Black Health Care Coalition for its support of several health initiatives and for its reinvestment in the community.
A Remaining Choice
Standing at the bus stop on Charlotte Street, right in front of both the McDonald's and the cafeteria, Keena Owsley waits for a ride after her prenatal visit. She says she enjoys eating at both places and that it’s nice to have a choice between a burger from McDonalds or a salad or pizza from the cafeteria.
“Most people want a variety, so I don’t see anything wrong with that,” says Owsley.
Charles Henderson, a 38-year-old with two broken ankles, sits in a wheelchair nearby. He’s not sure whether there should be a McDonald’s inside Truman. He says he heals faster when he doesn’t eat so much fast food, but he says McDonald’s tastes better and is quick and economical.
“I like that it’s greasy and hot, and it’s 99 cents,” says Henderson. "I like the deals they've got."
The hospital hopes its wellness efforts will make it easier for employees, patients and the community to make healthy choices. But within its doors, at least for now, food options will still include a quarter pounder, fries and a coke.
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This story is part of a reporting partnership that includes KCUR, NPR and Kaiser Health News.
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