Harnessing the pillars of institutions to drive environmentally sustainable hospital foodservices

Abstract

BackgroundThe cultural-cognitive, normative and regulative pillars of institutions influence the ability of hospitals to change how they function at an organizational and operational level. As more hospitals and their foodservices instigate changes to address their environmental footprint and impact on food systems, they move through the “sustainability phase model” from no response through to high level action and leadership. The aim of this study was to describe and compare the pillars of institutions between hospitals in different stages of achieving environmentally sustainable foodservices (business-as-usual vs. exemplar hospitals).MethodsFor this qualitative inquiry study, interviews were conducted with 33 hospital staff from 3 business-as-usual hospitals in Melbourne, Australia and 21 hospital staff from 14 exemplar hospitals across 9 countries. Participants were asked questions about their perspectives on environmental sustainability in foodservices and the barriers, enablers and drivers they experienced. Each data set was analyzed thematically and then compared.FindingsThere was a clear and distinct difference in responses and behaviors within each pillar between the exemplar and business-as-usual hospitals. The cultural-cognitive pillar identified a similarity in personal belief in the importance of addressing environmental impacts of foodservices, but difference in how staff saw and acted on their responsibility to drive change. The normative pillar uncovered a supportive culture that encouraged change in exemplar hospitals whilst business-as-usual hospital staff felt disheartened by the difficult processes and lack of support. The regulative pillar reflected business-as-usual hospital staff feeling restricted by government policy vs. exemplar hospital participants who were motivated to internalize government policy in different ways and work with other hospitals to advocate for better policy.InterpretationThese findings highlight strategies related to each of the three pillars of institutions that can be used to drive effective, sustainable long term change within hospitals. This includes staff education and training, revisiting hospital culture and values around environmental sustainability, embedding sustainable foodservices in internal policies, and a comprehensive government policy approach to sustainable healthcare.

Benefits, limitations and implementation issues for integrating organic foods into hospital foodservices: a systematic review

“…These beliefs diminished staff motivation to fully engage in organic conversion processes along with an increased workload, stress and unfamiliarity with organic food preparation. This finding mirrors the experience of previous research into sustainable foodservice interventions in hospitals where the support of leaders was a critical factor to success 7,40,41 …”

“…This finding mirrors the experience of previous research into sustainable foodservice interventions in hospitals where the support of leaders was a critical factor to success. 7,40,41 Increased staff training to support organic food implementation was also identified as a consistent theme throughout the included papers. Despite the need to decarbonise the entire health sector, 5 access to training regarding sustainability initiatives and opportunities remains limited.…”

Dietary Provision, GLIM-Defined Malnutrition and Their Association with Clinical Outcome: Results from the First Decade of nutritionDay in China

“…Hospital staff should keep this in mind and carry it out flexibly as part of the nutrition management process for patients [ 44 ], even though they are malnourished with poor meal intake [ 45 ]. Specifically, the nutrition education framework should be created for patients, and the availability of a dietary provision practice platform for healthcare professionals should be increased in a benchmarking program designed for nutrition care [ 46 , 47 ].…”