Facilitators and barriers to incorporating nutritious and sustainable foods in health systems

Background: The health care industry is establishing itself as a leader in creating a model of healthy food practices by implementing an approach that involves working with local farmers, purchasing food grown without pesticides and hormone additives, offering other sustainably produced and healthier food choices, and minimizing food waste. However, there is little available information on the processes hospitals used to change their food environments and the factors that have helped or hindered those processes. There is a need to examine these factors to create model food environments and inform practice at health care facilities serving similar populations, in similar settings, or having similar organizational structures. Methods: A case study approach was used. Key informant, semi-structured interviews were conducted with administrators and persons directly involved in food management and service at a mid-sized, regional hospital. Data were then analyzed using the process of identifying, coding, and categorizing patterns and themes and then reducing the number of themes by selecting, ordering, and clustering them, according to commonly practiced methods of qualitative analysis. Results: Incorporating more nutritious and sustainable foods in a hospital is a dynamic process. Successful processes capitalized on institutional strengths and minimized barriers. Individual, institutional, and policy level facilitators and barriers were identified. Hospitals need to be flexible in incorporating more nutritious and sustainable alternatives and dealing with a complex food industry and a myriad of local players. Resource allocation was a key concern. Conclusions: Results can be used to help other hospitals incorporate healthier food environments.