Hospitals around the world delivering environmentally sustainable foodservices: What is their recipe for success?

Internationally, there are increasing examples of hospitals that are delivering food to patients in an environmentally sustainable way. To make this transition widespread, we were interested in understanding the recipe for their success.

The smell of freshly baked bread in a hospital. Roomservice food delivery from your hospital bed. Food waste turned to electricity. Vegetables grown in a rooftop garden and served to patients. Traditional Indigenous foods on the hospital menu. Entirely plant-based menus. Sounds too good to be true? This is the reality of outstanding hospitals around the world who are delivering environmentally sustainable foodservices.

We wanted to learn from the best, to understand the drivers for success to build a framework to guide practice and policy change. Our study is the first to do this. We spoke to 21 staff from 14 hospitals across 9 different countries. These hospitals were featured in relevant reports, webinars or listed online for receiving awards. They had a range of sustainable food practices such as procuring local, organic and traditional Indigenous foods. They had vegetable gardens onsite and were cooking meals from scratch, using minimal packaging, providing well designed plant focused menus, allowing patients to order what they like when they want it. There was minimal food wastage, but responsible management of food waste such as composting, sending to farms or to produce electricity.

The drivers for their success

We asked them what drove their change and enabled their success. From this, we developed a framework.

First there was an initiating driver, something that sparked the hospital’s desire to change. Amongst all hospitals were values that drove hospitals to prioritise these changes, such as desire to improve food quality for patients, lessen environmental impacts, or were aligned with the hospitals religious identity. Some hospitals were also driven to find solutions to a problem they had such as high levels of food waste or patient dissatisfaction.

Next there were a range of internal and external supporting enablers that allowed implementation of practices. The combinations of these factors were unique and dependent on the hospital’s context. However, all hospitals had an individual who drove changes supported by various personnel and had support from leadership. These individuals were highly motivated, had existing networks, prior education or experience and worked to create a shared vision and motivation in their teams. For these hospitals, the way they delivered their foodservices became part of their identity and something that staff were proud of.

“It has been a place where people come in the mornings with pride, to actually exercise their skills so it's a whole other way of being a professional” (Case 8)

They embedded these practices into organisational policies and protocols to ensure continuity.

In terms of external supports, many hospitals were part of sustainability networks such as HealthCare Without Harm, Nourish and the Soil Association providing useful resources, toolkits and networks. There were examples of government requirements for example to meet a certain level of organic food procurement. Lastly, these hospitals were well connected with other hospitals and learnt from their experiences and successes too.

Their success was not without challenges however. The two most significant challenges related to staff resistance and policy. In some situations staff, including senior staff were resistant to change. Policy was often inadequate and lacking detail and guidance or conflicted with other policies.

 

Influence beyond the hospital walls

An interesting finding of the research was the wider impact these hospitals were having. For example using their sustainable practices as a talking point to educate patients and the hospital community. They had information sessions and cooking demonstrations on plant based and low waste cooking as well as farmers markets on site. They were able to support other hospitals to make changes and widely shared their success through resource sharing and webinars. These individuals were effective policy entrepreneurs, with one hospital in particular successfully advocating for a local food act to be mandated. 

What this means for practice

With the increasing movement and push for sustainable healthcare and sustainable food system transformation, there must be greater support for hospital food transformation.

The framework can be used to identify structural and organizational areas within hospitals that could be strengthened to support success. It is clear that dedicated individuals can effectively drive change, and so we must embed sustainability into healthcare professional education, nurture emerging leaders and provide professional development opportunities to strengthen individuals’ skills in the area of sustainability.

However, given continuing worsening environmental conditions and reliance on our healthcare system, we cannot continue to solely rely on individuals for urgent change. A systems level approach is needed to embed sustainability into foodservice functioning, spanning across education, professional development, community engagement, organisational and government policy.

By Stefanie Carino APD, PhD candidate.

Publication information-  You can find more about this research here.

Stefanie Carino, Shirin Malekpour, Judi Porter, Jorja Collins. The drivers of environmentally sustainable hospital foodservices. Front. Nutr. https://doi.org/10.3389/fnut.2021.740376

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Stefanie Carino is an Accredited Practising Dietitian and PhD candidate in the Department of Nutrition, Dietetics and Food at Monash University. Her research focuses on exploring the environmental sustainability of hospital food services. She is also a Sustainable Food Systems Dietitian at Eastern Health. You can follow Stefanie on Twitter via @StefanieCarino.

 

Jorja Collins is an Advanced Accredited Practicing Dietitian who works in foodservice at Eastern Health and as a lecturer and researcher in the Department of Nutrition, Dietetics and Food at Monash University. She was awarded a Churchill Fellowship to explore environmentally sustainable hospital foodservice. You can follow Jorja on Twitter via @Jorja_Collins.

Shirin Malekpour is a Senior Lecturer at Monash Sustainable Development Institute. She develops and leads interdisciplinary research on planning and governance for sustainable development. You can follow Shirin’s team on Twitter at @MonashMSDI.

Judi Porter is a Professor in Dietetics at the Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University. You can follow Judi on Twitter via @JudiPorter_.

Stay up to date with the Monash University Department of Nutrition, Dietetics and Food on Twitter via @MonashNutrition.

Read more about our research in the area of environmentally sustainable hospital foodservices. 

Sustainable hospital food - a reality or merely a dream?

The next step towards environmentally sustainable hospital food: capturing the perspectives of those working at the forefront.

Images: Sourced from Unsplash. Image 1 and Image 2.