Implementing healthier foodservice guidelines in hospital and federal worksite cafeterias
June 23, 2016
North Carolina Institute for Public Health analyzed data from hospital and federal worksite cafeterias as they implement healthy food guidelines. Photo by Amanda Mills, USCDCP.
Healthy food service guidelines are being implemented in many worksites and hospitals to increase access to healthy foods and beverages for employees, patients and customers. However, little research exists about the challenges faced by nutrition directors and their staff as they implement these guidelines. With this in mind, the North Carolina Institute for Public Health recently completed an analysis of data from hospital and federal worksite cafeteria managers and leaders to better understand the facilitators, barriers, and overall experiences of food service operators as they implement healthy food service guidelines.
This project was undertaken as part of a cooperative agreement with the National Network of Public Health Institutes and the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity, with support from the Partnership for a Healthier America.
Study Design
The study team included NCIPH staff, graduate students from the UNC Gillings School of Global Public Health Department of Nutrition and the UNC School of Journalism, as well as faculty from East Carolina University Brody School of Medicine. Using a mixed-methods approach, the team examined the experiences of five hospital food service operators and four federal worksite food service operators who recently implemented healthy food service guidelines: either the Partnership for a Healthier America Hospital Healthier Food Initiative Commitments or the US Department of Health and Human Services (HHS) / General Services Administration (GSA) Health and Sustainability Guidelines. Participants completed an online survey and an in-depth interview. Several participants also followed up with supplemental information for the project’s success stories (see below).
The team examined: (1) barriers to and facilitators of implementation, (2) behavioral design strategies used to promote healthier foods and beverages; and (3) how implementation of the food service Guidelines and Commitments influenced costs and profitability.
Findings
In summary, key facilitators included leadership support, vendors having adequate food and beverage selections, and dietitians available to help implementation go smoothly. Barriers to implementation included vendors not having food and beverage selections, customer complaints, customer resistance to reduction or removal of fried and high sodium foods, and time and expertise required for menu labeling.
Behavioral design strategies used most frequently included clear signage and icons denoting healthier options, marketing using social media and other promotional materials, an onsite dietitian to answer questions/provide samples, and placement of healthier options in prime locations (e.g., healthy check out, healthier items at eye level).
While most participants noted increased costs related to training staff, food costs, and equipment (to replace fryers), all participants said that sales had either stayed the same or increased since implementation of the healthier food service Guidelines and Commitments.
As the team reviewed responses, they found that there were several common keys to success. Leadership and client support for changes, industry and vendors’ ability to provide the healthier options, regular communication with customers, management, and staff, and a point person at each site were particularly important.
Success Stories
The team created five success stories to highlight the key findings and provide insight into experiences of individual cafeteria operators
Introducing Healthier Foods at the USDA
Henry Ford Health System, Southeast Michigan
Kaiser Permanente, South San Francisco Hospital
Children’s Mercy Hospital, Kansas City
National Institutes of Health, Bethesda, Maryland
The team also published a more detailed discussion of the study in a peer-reviewed article in the Journal of Human Nutrition and Dietetics: “Implementing healthier foodservice guidelines in hospital and federal worksite cafeterias: Barriers, facilitators and keys to success” (J Hum Nutr Diet. 2016 Apr 29. doi: 10.1111/jhn.12380).
For more information, contact John Graham at jwgraham@email.unc.edu.
