Environmentally sustainable hospital foodservices: Drawing on staff perspectives to guide change (2021 January)

Citation: Carino S, Collins J, Malekpour S, Porter J. Environmentally sustainable hospital foodservices: Drawing on staff perspectives to guide change. Sustainable Production and Consumption. 2021/01/01/;25:152-61. https://doi.org/10.1016/j.spc.2020.08.003 (note: there is a paywall to access the full study)

Relevant to: 

Dietitians-Nutritionists working in hospitals or in food services.


Forty-six stakeholders working across the hospital supply chain in three Australian hospitals were interviewed regarding their perspectives on: (1) sustainable and unsustainable practices in hospital food provision; (2) barriers and enablers of sustainable practices; and (3) future recommendations for implementing sustainable foodservice practices.

Bottom line for nutrition practice: 

This paper identifies specific sustainable and unsustainable practices across the hospital food chain under the following categories:

  • procurement;
  • food processing (central production kitchen);
  • food service model/ menu design;
  • meal ordering and selection;
  • food preparation;
  • patient consumption;
  • food waste;
  • waste management.

The abstract below summarizes current sustainable and unsustainable practices as well as barriers and enablers to improving sustainability. Future recommendations were generated under 3 themes:

  • (1) practice recommendations;
  • (2) knowledge generation/ sharing recommendations and
  • (3) leadership and policy recommendations. 

The authors emphasize the importance of involving staff in making changes, and suggest that creating best practice guidelines for sustainability within food services could address one of the key barriers identified.


Foodservice is a key contributor to environmental impacts of the healthcare sector, in particular hospitals. Driving towards sustainable solutions in foodservices can bring financial and social benefits, whilst allowing hospitals to position themselves as leaders towards a sustainable food system and healthcare sector. Such a change depends on those working directly or indirectly with foodservices. Staff possess valuable knowledge, ideas, motivation and responsibility for improving the environmental sustainability of the foodservice system.

The aim of this study was to explore the perspectives of staff working across the hospital food supply chain towards: (1) sustainable practices in hospital food provision; (2) existing barriers and enablers; and (3) recommendations for implementing sustainable foodservice practices in the future.

Through qualitative inquiry, semi-structured interviews were conducted with individuals at operational and management levels responsible for policy, purchasing, production, onsite plating and delivery and waste disposal at three hospitals in Australia. Framework analysis was used to synthesise transcribed data into practices, barriers and enablers, and recommendations. Interviews (n=46 participants) identified current sustainable practices including those related to recyclable packaging, effective equipment and technology and efficient processes.

  • Unsustainable practices included restrictions on sourcing food, packaging that cannot be separated or recycled, rigid foodservice models and menu, waste production and processes.
  • Enablers to improve sustainability included the power of individuals to influence change, education on recycling, knowledge generation, audits and grants for innovative research, rebates and quality improvement processes.
  • Barriers included competing priorities, poor communication, lack of training opportunities and knowledge, infection control restrictions, lack of policy, funding, and time between meal ordering and delivery.
  • Participants proposed practice changes across the food supply chain and recommended generation and sharing of knowledge, leadership and policy support.
  • Perspectives of individuals within foodservice reveal shared motivation and desire for sustainable foodservices, with support needed from leaders and policy.
  • Future research should use a co-design approach involving staff to create and implement sustainable strategies within hospitals. To see widespread and timely change, action is needed towards effective and meaningful policy.

Details of results: 

In providing a background to the study, the authors note that the health care supply chain accounts for 71% of health care greenhouse gas emissions, and food is part of the supply chain. In addition to emissions, food also accounts for freshwater and land use, among other environmental impacts, so it is an important consideration for sustainability. The authors stress that examining the way food is managed in hospitals, including studying decisions points at each part of the hospital food supply chain, is important to effectively mitigating environmental impacts. They also suggest that there is a lack of research examining this issue from a systems perspective.

Interviewees included: policy makers; group purchasers; health service managers; central production kitchen staff; food preparation (food services staff, managers and supervisors); nurses; dietitians and waste management staff.

Some specific sustainable practices identified but not listed in the abstract include: “use of water technology to prevent the need for chemical cleaning products”; “use of metal trays”; “electronic menus”; decreasing time between ordering and delivery; “chemical free kitchen”; “patient meal time assistance”; “food waste audit and research”; waste management innovation (p. 155). Other unsustainable practices identified include: lack of organic meat or cage free alternatives; not following standardized recipes; relying on meat and dairy for protein; plastic packaging for individual pre portioned meals; patient difficulty to open items (leading to food waste); food waste technology not provided or working. 

Key barriers and enablers were categorized under several themes. First, under “people and their power and motivation” (p.156), individuals who advocated for change as well as the power of a sustainability team were identified as enablers; it was also noted that patient feedback on food quality enables change, as this is required to meet performance indicators. Second, “competing priorities for action” (p.156) was noted as a barrier, such as infection control requirements which restricted the reuse of unopened, individually pre-packaged foods. Third, while “education training and knowledge generation/ sharing” (p.156) can be an enabler (noting the powerful influence of data), gaps exist (e.g., in orientation training; lack of awareness of best practices). Next, many gaps exist under “policy influence”, including lack of best practice standards. Sustainable procurement can also be difficult as a result of supply contracts. Interviewees also noted that sustainability should be legislated if governments consider it a priority. Finally, foodservice systems can present opportunities (e.g., opening a new kitchen), but gaps were also identified (e.g., food waste resulting from delays between meal ordering and delivery, and as a result of offering a wide range of meal options).

Future recommendations were generated under three themes. First, “practice recommendations” (p. 158) included strategies such as reducing the frequency of meat on the menu and including more plant based options; reducing time between ordering and meal delivery; soliciting patient feedback; reducing food packaging; creating a vegetable garden on site and using generated compost on it. Second “knowledge generation/ sharing recommendations” (p. 158) included recommendations such as the creation of best practice guidelines, increased communication about effective strategies, using business cases to support practices, learning from other institutions, and including sustainability information in orientation sessions. Third, “leadership and policy recommendations” (p. 158) included actions such as funding a sustainability officer and creating a hospital sustainability policy which includes food.

Of additional interest: 

Editor’s comment:  

Interested Dietitians-Nutritionists may want to access the full article, as it identifies many practical actions at various points along the hospital food chain. 

Open access link to article: 

N/A – there is a pay wall to access the article (see citation above)

Conflict of interest/ Funding: 

The authors reported no conflict of interests.   

External relevant links: 

Corresponding author:


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