How to create healthier hospital food, beverage and physical activity environments

healthier food

Healthier hospital food, beverage and physical activity environments can be achieved in six steps, as outlined by the National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity:

  1. Engaging stakeholders and partners.
  2. Forming a team.
  3. Conducting policy and environment assessments.
  4. Assessing needs and identifying goals.
  5. Developing implementation and maintenance plans.
  6. Evaluation.

Any given hospital serves 1.7 million meals on average to inpatients, outpatients, visitors, and employees a year. Ironically, most hospitals do not support healthy food and beverage systems – either healthy alternatives are not promoted properly or are non-existent. Similarly, a recent focus group (Phipps E, Madison N, Pomerantz SC, Klein MG. Identifying and assessing interests and concerns of priority populations for work-site programs to promote physical activity. Health Promot Pract. 2010;11(1):71-78.) reported that more than 50% of employees of a large urban hospital did not meet recommended physical activity levels.

1.      Engaging stakeholders and partners

Stakeholders include:

·         Hospital leadership team and executives.

·         Human resources.

·         Clinical staff.

·         Support services.

·         Community coalitions working on nutrition, wellness, or obesity.

·         Food, beverages, and vending purchasers or contractors.

Identify individuals and groups that are willing to create awareness and make a change, such as senior personnel or directors or other non-leadership staff; union leadership in unionized hospitals; and state or city-level hospital associations, public health departments, and nontraditional community partners, like food policy councils, community coalitions, or nonprofit organizations. Develop a business case to underline the importance of policy and environmental strategies to promote healthier choices – for instance, how healthy food and beverage policies can improve employee health and reduce employee healthcare costs. Stakeholders can offer input into the development of a program, leverage resources for future change, share with other similar groups, and play a key part in the evaluation of work.

2.      Forming a team

From Seven Samurai to The Avengers, assembling a team has been essential to getting things done. This team should include stakeholders who have roles in promoting healthier choices – or their representatives – and members of groups that may be affected by any changes. Additionally, a sustainability officer may be appointed to assist in the development of strategies to sustain change in the long run. Communication is indispensable within the team and with other groups as well as with the members’ parent organizations. Team members can procure support from staff, human resources, or executive leaders, and help spread information.

3.       Conducting policy and environment assessments

There may exist in the hospital policies regarding nutritional standards and the promotion of physical activity. The team may have to perform an environment assessment to determine the extent to which these policies are being implemented – if at all. The environment to assess includes such venues as cafeterias, vending machines, and physical settings like stairwells and walking trails. Consider the following questions when choosing which venues to assess:

·         Does the venue serve a large portion of hospital staff or visitors?

·         Who monitors policy adherence?

·         Who supervises the venue?

·         What are the barriers or priorities of the group supervising the venue?

·         How viable is it to change policy and environment in the venue?

These resources may be helpful in conducting an assessment:




Collate the results of the assessment and the hospital’s current policies to establish where the latter have been properly enforced and where changes could be made to provide better food, beverage, and physical activity alternatives.

4.      Assessing needs and identifying goals

Identifying and addressing the needs of staff and visitors as soon as possible can go a long way in creating good will for your future efforts. Each need is a goal to achieve; ask these questions about each goal:

·         Who (individual or group) will be in charge of accomplishing the goal?

·         What policy or policies need to be implemented to accomplish the goal?

·         What changes in environment need to occur to accomplish the goal?

The Specific, Measurable, Achievable, Realistic, Timely (SMART) objectives format can help specify how the short, intermediate, and long-term goals are going to be met.  

5.      Developing implementation and maintenance plans

Implementation plans should adapt to the hospital’s opportunities, barriers, and needs, and identify specific activities that have to be achieved in order to meet the team’s objectives. Each activity – for which a responsible person or group should be named – should be accompanied by a timeline, a list of partners, a measure to determine if progress is being made, and action steps, such as resource identification, that have to be taken to complete the activity. The following tools may be of help:



 The team must develop a model that will not only help its members visualize how and when goals are meant to be accomplished, but also serve as an aid for stakeholders to understand the plan. The sustainability officer can help develop a maintenance plan by listing in a logical order how each implemented goal will be sustained in the long run.   

6.      Evaluation

Team members and stakeholders and partners who might be involved in the operational facets of plan should be engaged in an evaluation to determine if policy and environment strategies have yielded the desired results. The CDC Evaluation Framework highlights a number of elements that allow describing the program in detail:

  1. Outline the program.
  2. Explain the effects of the program on the problem being addressed.
  3. Describe all program activities.
  4. Define the resources that the program will require.
  5. Provide a full depiction of the program’s level of development.
  6. Depict an understanding of the context in which the program will operate.
  7. Provide a logic model outlining the inputs, activities, expected results, and general objective of the program.

The team, stakeholders, and partners can establish the focus of the evaluation with the following questions:

·         What is the purpose of the evaluation?

·         What are the evaluation questions?

·         How do evaluation questions relate to the outcomes?

 Strong evidence from different sources should be compiled to accurately and honestly answer the evaluation questions, which in turn should be prioritized based on the importance of users and uses of the evaluation; for example, what the most critical users want to know. The collected evidence should be analyzed in the context of related studies and the program’s objectives, and summarized in a way that is relevant, accessible and useful to stakeholders. Finally, the findings of the evaluation should spread effectively to all intended audiences, some of which may require summary reports, while others may require a presentation with open comment available. See the CDC’s Developing an Effective Evaluation Plan for reference.