Use this change-management approach to make the case for prioritizing food-related initiatives.
Identify a decision-maker
A hospital's food service can be self-operated or contracted out to a food service management company – it is important to determine this to understand who makes decisions about budget and operations. Hospital community benefit program directors or leads are important allies to work with to address community food needs.
Self-operated food service
The food and nutrition services director (or similar title) is managing the food service budget and operations and makes decisions within the budget and other parameters set by leadership. (Note that there may be divergent entities for patient and cafeteria). The executive chef is often an important decision-maker for menus and procurement. Purchasing will either be managed within the department or in cooperation with the procurement and supply chain department. Budgets and financial targets are most often set by the chief financial officer (or similar title), and for changes with budget implications, these positions are important allies.
Contracted out food service
There will still be a food and nutrition services director (or similar title), however they may have less local control of menus, purchasing, and operations, as these may be standardized across company operations. The executive chef is often an important decision-maker for menus and procurement. Hospital decision-making on contracted operations lies with the chief financial officer and contracts departments.
Community benefit
Nonprofit hospitals are required to provide community benefit programs to maintain their tax-exempt status. To identify the community benefit lead at your facility, a good first step is to obtain your hospital’s community health needs assessment (CHNA), implementation strategy, or report. While some hospitals have an established community benefit department, it is fairly common for community benefit functions to be incorporated into other areas of the hospital. See our guidance for identifying your community benefit lead.
Identify stakeholders and allies to create a vision
After determining who the decision-makers are, focus on enlisting allies. A listening tour is a great way to identify stakeholders or champions who can help create a vision or steer the direction of which values align with organizational priorities. Many hospitals in our network have taken the following steps to identify the right people and build ownership in the direction of the work.
Build relationships
Reach out and share your interest in supporting their work and what drives that interest – health of your patients, your membership in the green team, or your work with local food system partners. Get a meeting to discuss the following.
Understand priorities & history
Ask about policies or priorities they have developed involving sustainability or environmental issues, local economic impacts, community health, or other related areas. Find out how they came to focus on these issues and what progress they have made.
Identify opportunities
Ask about areas where they need champions or support to achieve their goals. Are there any that align with your particular interests and leverage points? Share efforts you would like to see undertaken, how they would address the issues you see, and how you can help.
Focus on developing urgency by identifying initiatives that align with organizational goals or priorities
Align with other initiatives that are already prioritized and people who are working on them. Health care institutions can invest in food solutions to achieve sustainability, staff and community health and well-being, and business outcomes.
Sustainability & climate change
Your organization likely has sustainability initiatives with staff leads, committees, and boards that assess opportunities and develop priorities. Identify and engage with these individuals and structures to make the case for how food initiatives can further their goals. Also look for leadership focused on initiatives, policies, and plans for reducing the institution's climate impacts and increasing community resilience – food programs are an excellent way to achieve results on these priorities.
Consider these talking points for engaging with stakeholders:
Our food system both contributes to and is impacted by environmental degradation. Institutional food purchasing decisions can drive changes in the way our food is produced and processed, and menu design and food resource management in the kitchen can reduce greenhouse gas emissions for food. We know that:
- Food production is responsible for approximately 25% of global greenhouse gas emissions. The Science Based Targets Initiative estimates we need to reduce emissions from food production by 67% by 2050 in order to avoid catastrophic climate change. Livestock production is responsible for approximately 14.5%, and wasted food for roughly 8%, of global greenhouse gas emissions.
- Numerous studies have found farmworkers are at elevated risk for cancer, likely due to pesticide and sun exposure. Pesticide exposure is also implicated in Alzheimer’s and Parkinson’s disease, as well as various disorders of the respiratory and reproductive tracts.
- The rise of antibiotic-resistant infections, which impact more than 2.8 million people and kill at least 35,000 people in the United States each year, has been linked to overuse and misuse of antibiotics in animal agriculture.
Social (DEI, local economies and community)
Food solutions can be a powerful asset to your organization, supporting community health and wealth through purchasing, contracting, and programs. Consult with your supply chain and procurement departments to identify aligned priorities for utilizing diverse and local vendors including farmers, fishers, food manufacturers, and other food businesses.
Consider these talking points for engaging with stakeholders:
- Supporting local and regional food systems can address these interrelated, complex issues by giving communities greater control over food production, providing jobs and opportunities, and increasing access to healthy, fresh foods.
- Black farmers make up only 1.4% of farmers in the United States today due to a legacy of systemic racism limiting access to land, resources, education, and ultimately markets for their products. Directing health care food purchasing to food and farm businesses owned by people of color can help build economic development and generational wealth.
- Local foods can have positive health impacts – one study found the nutrient content of broccoli was cut in half when it was purchased out-of-season from national markets compared to when it was sourced locally while in season.
Staff and community health and well-being
Providing healthy food access through food service and community food initiatives and addressing food insecurity as a social determinant of health in clinical care has profound impacts on health and well-being. HR and employee wellness programs can leverage cafeteria and campus health food access initiatives to achieve their wellness goals. Hospital community benefit departments identify community health needs and work with community partners to implement collaborative solutions to address food insecurity and diet related disease, presenting powerful partnership opportunities for food service sustainability initiatives.
Consider these talking points for engaging with stakeholders:
- A poor diet contributes to four out of 10 of the leading causes of death in the United States.
- One in 10 people in the United States experiences food insecurity.
- Poor nutrition and diet-related conditions affect academic achievement and worker productivity.
- Food insecurity affects mental health, contributing to anxiety and depression. Low wages for food chain workers undermine their ability to access healthy food.
Business case
Food service operations and food initiatives that prioritize patient, community, and planetary health can increase patient satisfaction, reduce health care costs, increase revenue by drawing in more patrons to your eating establishments, and attract and retain a valued workforce.
Consider these talking points for engaging with stakeholders:
- An estimated 85% of health care costs are associated with management of diet-related conditions. The federal government alone spends $160 billion on diabetes care and management, which is more than the budgets for multiple agencies including USDA, EPA, FDA, the Department of Homeland Security, and the Department of Justice.
- Healthier diets, including the consumption of plant proteins, could save $50 billion in health care costs.
- Plant-forward menus can lead to increased patient and employee satisfaction – 83% of diners in hospitals say they would choose plant-forward options at least sometimes.
- $218 billion is spent on food that is never eaten. Food waste source reduction efforts create savings that can be invested in local, sustainable, and diverse purchasing.
- More than 60% of millennials are intentionally looking for employers whose sense of corporate responsibility matches their own.
