Best Practices for Financial Sustainability of Healthy Food Service Guidelines in Hospital Cafeterias

Pitts, Stephanie Jilcott; Schwartz, Brittany; Graham, John R.; Warnock, Amy Lowry; Mojica, Angelo; Marziale, Erin; Harris, Diane M.

doi:10.5888/pcd15.170477

Cited by 14 publications

(8 citation statements)

References 5 publications

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“…Healthier promotions could be developed and tested. Long term monitoring of such schemes is needed to assess whether they are financially sustainable for retailers [40] and capable of delivering increases in healthy purchasing by customers without compromising profits [41]. Consideration should be given to whether the principles behind HRS could be extended to rebalance promotional and provisioning activities between healthy and unhealthy products in the food retail sector more broadly [5].…”

Section: Discussionmentioning

confidence: 99%

Making hospital shops healthier: evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets

et al. 2020

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Background: The range of products stocked and their promotions in food retail outlets in healthcare settings can affect food choices by staff, patients and visitors. The innovative Scottish Healthcare Retail Standard (HRS) is a national mandatory scheme requiring all hospital food retail outlets to change the balance of food products stocked and their promotion to comply with nutritional criteria and promotional restrictions. The aim is to facilitate healthier food choices in healthcare settings. This study examined the implementation of HRS and the impact on foods stocked and promoted. Methods:The study aimed to examine implementation process and changes to the retail environment in relation to food promotions and choice. A sample of hospital retail outlets (n = 17) including shops and trolley services were surveyed using a mixed methods design comprising: (a) structured observational audits of stock, layout and promotions (with a specific focus on chocolate and fruit product lines), and (b) face-to-face, semi-structured interviews with the shop manager or nominated members of staff (n = 32). Data were collected at Wave 1 (2016), at the beginning and during the early stages of HRS implementation; and Wave 2, 12 months later, after the HRS implementation deadline. Results: All outlets, both commercial and not-for-profit, in the sample successfully implemented HRS. Implementation was reported to be more challenging by independent shop managers compared to chain store staff. Retail managers identified areas where more implementation guidance and support could have been provided. The number of chocolate product lines and promotions reduced substantially between Waves 1 and 2, but with no substantial increase in fruit product lines and promotions. Despite initial negative expectations of HRS's impact, managers identified some opportunities in the scheme and positive changes in the supply chain. Conclusions: Positive changes in food retail outlets occurred after hospital shops were required to implement HRS. By creating a consistent approach across hospital shops in Scotland, HRS changed the food retail environment for hospital staff, visitors and patients. HRS provides a regulatory template and implementation learning points for influencing retail environments in other jurisdictions and settings.

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Section: Discussionmentioning

confidence: 99%

Making hospital shops healthier: evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets

et al. 2020

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“…Using cost-adjustment pricing strategies (e.g., increased cost for high-demand unhealthy foods, discounts for healthier items) can maintain financial sustainability while promoting healthier choices. 41,42 Finally, strategic guidance for implementation is available from the CDC for organizations committed to creating healthy hospital food environments for employees, patients, and visitors. 17,36…”

Section: Discussionmentioning

confidence: 99%

Foods and Beverages Available to Nurses in Hospital Cafeterias, Vending Machines, and Gift Shops

et al. 2022

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Purpose Hospitals are important workplaces for nurses with many perceived barriers to healthy eating, but objective assessments are lacking. This study evaluated the healthfulness of hospital consumer food environments. Design Cross-sectional observational; Setting: South Carolina; Subjects: Cafeterias, vending machines (VM), and gift shops (GS) in hospitals of varying size, urbanization, and region. Measures Using the Hospital Nutrition Environment Scan (HNES), primary outcomes of interest included availability, access, prices, and location of healthy foods in relation to nursing units. Analysis Descriptive and inferential statistics by independent samples t-test, ANOVA, Mann–Whitney U, χ2, or Fisher’s exact test as appropriate. Results Thirty-one hospitals were observed from December 2019 to February 2020. Average composite HNES score (n = 28) was 46.3 ± 14.9 (−45 to 173 range), indicating sub-optimal food environments. Cafeterias (n = 31) scored an average of 30.9 ± 10.5 (−33 to 86 range). Average VM (n = 31) and GS (n = 28) scores were 11.6 ± 6.0 (−6 to 55 range) and 2.9 ± 4.0 (−6 to 32 range), respectively. Small hospitals (≤100 beds) had lower average cafeteria score (22.4 ± 10.3) than extra-large hospitals (≥500 beds; 42 ± 5.2, P < .01). Small hospitals also had lower composite HNES scores (34.4 ± 17.1) compared to extra-large hospitals (61.0 ± 14.4, P = .02). Data regarding availability, access, prices, and location were also reported. Conclusion Due to abundant availability of unhealthy foods and beverages, hospital consumer food environments scored low on observations using the HNES, highlighting the opportunity to improve the healthfulness of facility offerings.

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“…Also, it is acknowledged that implementing food service guidelines is a process that may take time. Food offerings need to be adapted to customers’ preferences, and selections offered from retailers can be inadequate [65]. Since the food service guidelines have been established only quite recently in Denmark, it is possible that compliance will increase over time.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Canteens at Elementary Schools, Upper Secondary Schools and Workplaces that Comply with Food Service Guidelines and Have a Greater Focus on Food Waste

Lassen

Christensen

Spooner

et al. 2019

IJERPH

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Policy actions to improve the nutritional environment include the provision of official food service guidelines. This study aimed to examine compliance with food service guidelines for hot meals as well as self-evaluated focus on food waste reduction across settings, i.e., elementary schools, upper secondary schools and workplaces, and different canteen characteristics. The same five criteria for hot meals were applied for all settings with regard to serving of fruit and vegetables, fish, wholegrain product and high fat meat and dairy products. A self-administered questionnaire survey was conducted as a cross-sectional study among 680 Danish canteens. Canteens having a high degree of organic food procurement were more likely to comply with the five criteria for hot meals combined (OR 2.00 (Cl 1.13,3.53)). Also, the use of organic food together with having a meal policy was associated with reported focus on food waste reduction (OR 1.91 (CI 1.12,3.25) and 1.84 (Cl 1.31,2.59), respectively). Compliance with individual criteria varied across settings with elementary schools being more likely to comply with criteria on, e.g., maximum serving of non-wholegrain products, whereas workplaces were more likely to comply with criteria on, e.g., minimum fruit and vegetable content and serving of fish. In addition, specific characteristics, e.g., serving system, were found to predict compliance with some of the criteria. These findings highlight the need to address differences in canteen characteristics when planning implementation support for both guideline and food waste reduction initiatives.

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Best Practices for Financial Sustainability of Healthy Food Service Guidelines in Hospital Cafeterias

Cited by 14 publications

References 5 publications

Making hospital shops healthier: evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets

Making hospital shops healthier: evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets

Foods and Beverages Available to Nurses in Hospital Cafeterias, Vending Machines, and Gift Shops

Characteristics of Canteens at Elementary Schools, Upper Secondary Schools and Workplaces that Comply with Food Service Guidelines and Have a Greater Focus on Food Waste

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