A qualitative exploration of barriers, facilitators and best practices for implementing environmental sustainability standards and reducing food waste in veterans affairs hospitals

BackgroundTo improve the healthfulness of foods offered while accelerating the use of environmental sustainability practices, it is important to engage hospital food service operators in the adoption of such practices. The purpose of this study was to explore barriers, facilitators and best practices for implementing environmental sustainability standards in food service among veterans affairs (VA) hospitals in the United States.MethodsWe conducted an online survey with 14 VA hospital food service directors and then 11 qualitative interviews. The survey assessed motivations for initiating sustainability standards and included a self-rating of implementation for each of five standards: increasing plant-forward dishes, procuring and serving sustainable foods that meet organic/fair trade and other certifications, procuring and serving locally produced foods, reducing food waste and reducing energy consumption. Interviews were transcribed verbatim. Qualitative analysis, including coding of themes and subthemes, was conducted by two coders to determine barriers, facilitators and best practices for each of these five standards. Quantitative methods (counts and frequencies) were used to analyse the survey data.ResultsParticipants had an average of 5 years of experience implementing sustainability standards. The top three motivators cited were reducing food waste, serving healthier foods and increasing efficiency or cost savings. Barriers revolved around patient preferences, contractual difficulties and costs related to reducing waste. Facilitators included taste testing new recipes that include more sustainable food options and easy access to sustainable products from the prime vendor. Best practices included making familiar dishes plant-forward and plate waste studies to prevent overproduction.ConclusionsAlthough there were many barriers to implementation, food service directors had solutions for overcoming challenges and implementing food service sustainability standards, which can be tested in future sustainability initiatives. Veterans affairs hospitals ranked themselves as more successful with reducing food waste and increasing plant-forward dishes compared to reducing energy consumption and procuring foods that meet organic/fair trade and other certifications. Implementation facilitators included leadership support, chefs and dietitians to develop recipes and identifying products that meet specialty certifications. image There have been several studies of sustainable food service standards in hospital settings, yet few have examined how these sustainable food service practices are implemented in day-to-day operations in veterans affairs hospitals throughout the United States. The study findings revealed many best practices that can be tested in the future, including increasing plant-forward dishes by modifying familiar dishes and making them plant-forward, procuring locally produced foods by beginning with the highest-quality product to purchase locally and having a garden onsite at the hospital and reducing food waste by food tracking studies to prevent overproduction and a food donation programme.