Purpose: The healthcare sector is an important area for sustainable food initiatives, given its inherent mission to heal and its substantial impact on the food system. Foodservice managers can take part in these initiatives by using sustainable menu practices (SMPs). This study aimed to explore managerial perceptions of barriers and facilitators to adopting SMPs in Québec healthcare institutions. Methods: Seventeen foodservice managers were recruited through purposeful sampling to participate in a qualitative semi-structured interview. The Diffusion of Innovations theory was used to assess the main determinants of the diffusion of an innovation (SMPs) through a complex social system (healthcare organization). Results: Participants reported more barriers than facilitators. Lack of support at many levels was recognized as a major hindrance to SMP adoption, as were shortfalls in political directives. Increased collaboration between all food system actors and better communication in healthcare were perceived as needed for increased SMP adoption. Conclusions: This research contributes to an in-depth understanding of managerial experiences in SMP adoption in various regional and healthcare settings. Findings suggest the need for support and strategies that would remove important barriers for foodservice managers and contributed to the development of a guide to support foodservice managers in implementing SMPs.

Abstract from Dagenais B, Marquez A, Lavoie J, et al.: Adopting Sustainable Menu Practices in Healthcare Institutions: Perceived Barriers and Facilitators. Can J Diet Pract Res. 2022;3:1-8.

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Background

In recent years, the importance of environmental protection and a shift towards a more sustainable way of living has become more emphasized. Sustainable nutrition, a way of providing nourishment that has low environmental impact while contributing to a healthy lifestyle now and in the future, has been recognized as a viable way to enhance food equality and environmental protection [1].

Nutritional guidelines, apart from focusing on the impact of foods and nutrients on health, now also include the parameter of protection of the environment and overall sustainability of diets. In healthcare institutions, where the provision of nutritious and healthy food is of paramount importance, sustainability is also a parameter that needs to be addressed [2].

Study Result

In the study by Dagenais et al. [3], possible barriers and facilitators to adopting sustainability as a parameter to be considered when planning a hospital menu were identified. In this survey, 17 foodservice managers were asked to report their point of view regarding the use of Sustainable Menu Practices (SMPs). The survey was conducted as part of the Nourish Initiative, which has supported sustainable food initiatives since 2016, and included a semi-structured interview comprising 27 questions. The foodservice managers were mainly dietitians (n=11), dietetic technicians (n=4), and culinary specialists (n=2) [3, 4].

The participants were asked to report possible barriers and facilitators to the reformulation of menus with a focus on sustainability. The main barriers reported were workload and lack of time, problems with applicability due to limited resources from local producers, and overall higher costs. Moreover, hesitance was reported regarding the applicability and acceptability of SMPs in older populations compared to younger groups that tend to be more informed and sensitive about environmental issues.

Facilitators reported included the need for unity in pursuing the goal of more sustainable diets. Moreover, collaboration with external organizations and institutions specializing in sustainability would make the transition smoother. Improvement in quality and provision of less processed foods would decrease food waste and at the same time have a positive impact on overall patient satisfaction, nutritional status, and health. Finally, overall community engagement in a more environmentally friendly handling of food waste was stressed as essential for the successful implementation of SMPs in the healthcare sector.

Conclusion for Clinical Practice

Sustainability in healthcare menu provision is a new area of practice for dietitians. This paper provides a guide to avoiding obstacles and finding viable solutions for the application of SMPs in healthcare institutions where menu provision is an integral part of patient care. Highlighting the barriers and facilitators may enable hospital dietitians and nutritionists to tackle possible problems and work proactively towards their solution, especially since similar difficulties tend to be encountered in comparable settings across different countries [3, 5].

Enhanced provision of nutritious and environmentally friendly meals in hospitals requires significant steps besides the willingness of the dietitians. Close collaboration with specialized organizations will provide significant help, and communication with governmental authorities will encourage amendments to legislation and policy to facilitate sustainability change [6].

Finally, continuous education of dietitians is vital to facilitate a timely transition to the new reality they will have to face in order to promote menus that are culturally acceptable, accessible, economically fair, and affordable – in other words, sustainable [7].

Dr Poulia has no relevant financial or nonfinancial relationships to disclose.

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