The Nourish team of staff, contractors, advisors and Innovators has spent three years working at the intersection of food and healthcare and much has been learned. We share five key insights that have been highlighted from a process of reflection and evaluation.
*If you are interested in an in-depth evaluation of the program, the Nourish Developmental Evaluation report is forthcoming.
1. Changing food service within individual healthcare facilities is necessary but not sufficient to reaching the goal of food being understood as fundamental to health, for people and the planet.
When the Innovator program was launched, our hypothesis was that people who make decisions about food in health care (food service managers, dietitians, supply managers) have untapped potential for making changes via menus, procurement and food programming. Through peer learning and by giving their work greater profile and legitimacy, they could lead and make significant changes in their institutions, and through this changed demand begin to drive market shifts in the food system and paradigm shifts around food in the health system.
Over the past two years, the 26 Innovators and their organizations have improved access to healthy, delicious, local, sustainable and culturally appropriate food. They have reduced waste and increased patient satisfaction scores by changing to ‘room service’ models; increased
Indigenous presence through Elder and Indigenous community engagement and put more traditional foods on menus; and sourced more local food, including through forward-buying contracts with community producers. At the Food for Health Symposium, Innovators showcased their work and their passion for continuing it as they step into greater leadership roles.
More broadly, food is ‘on the agenda’ of healthcare in a way it wasn’t a few years ago. The sustainability director of a major food service company reported having three or four times more requests for baseline studies on local food than three years ago, especially in communities where Nourish Innovators work. Food is also being included in strategic plans as key performance indicators and measures of patient satisfaction at a growing number of facilities. Patients say that food is important to them, and hospitals are beginning to seriously explore the linkages to recovery and wellbeing.
However, these welcome changes are still not yet systemic, in the sense of having a widespread, embedded impact on mindsets, policies and practices. Our assessment is that this work now needs to move up a level and be:
on the agenda of healthcare CEOs, senior leaders and physicians and embedded in institutional policies and practices
backed by supportive federal, provincial and territorial policies, regulations and standards
supported by local communities, patients and Elders
anchored in a living repository of tools, resources, stories and evidence about what works and what doesn’t, to inform widespread uptake
All of this work will need significant communications support to be effective. Nourish’s communications have been compelling and while primarily focused on spreading the work of the cohort of Innovators, its reach has been expanding through other channels.
2. Experiential learning and human relationships are powerful.
Systems approaches have shown us that while rules, regulations, power structures and resource flows are important, equally important is the essential work of building relationships and exploring our own mindsets. Learning is relational; deep and authentic relationships transform us. Experiential learning with peers, such as collaborating on projects, trips to farms and communities, or exchanges with people who grow food or experience food insecurity, change the way we think. Nourish’s Innovator program used an approach that emphasized peer mentorship and collaboration and it is important to maintain it in the next phase of the work to embed change in both personal and institutional cultures.
3. Systemic change requires background infrastructure, coordination and management to provide change leaders with time and financial resources to do their work.
The Nourish collaborative projects were initiatives conceived and developed by Innovators on issues that they identified as critical for advancing food in health and healing. These projects included work around Food for Health Policy, Sustainable Menus, Traditional Food Ways, Measuring Patient Food Experience and Values-Based Procurement. This effort was fuelled by the ambitions and energy of Innovators and advisors, and often attracted external partners who contributed pro bono legal or research hours, but change was slow and difficult, partly because it was often done off the side of the Innovators’ desks. These projects took on ambitious work which is still on-going, despite being constrained by the time and focus that could be given to tackling these big, complex questions. In future, it will be important to include sufficient funds for coordination, as well as fellowships or secondment for innovators within the system.
4. Making significant change will require greater focus – ‘planting our flag’ on specific issues now that we have credibility.
In its initial phase, being responsive to the needs of organizations was effective in generating engagement and credibility for Nourish. It made sense to support a wide diversity of ideas and approaches to get a sense of the overall terrain and what might be possible. It is now time to focus efforts on what is most promising, and to direct our energy on strategic points of leverage that link to larger, critical issues of food security and climate change.
5. To identify leverage points for policy change, the systems that food services are embedded in and the context of provincial/territorial health services need to be considered.
Food in acute care is largely shaped by practices (like menu setting) and infrastructure (like food service operations or food distribution systems) and largely ignored by policy. This creates opportunities for strong effects from policy change efforts. Creating peer learning opportunities for policy makers like the September 2018 Food for Health Policy Workshop for provincial, territorial, and Indigenous governments is a promising strategy for inciting and supporting innovative policy change to bring food into a more central role in health care.
Additionally, the Nourish team observed several trends in health care restructuring even in the short duration of the program. Notably, several provincial health authorities have been created by amalgamating regional health authorities (Nova Scotia, Manitoba, Saskatchewan) creating more top-down decision-making and consolidating food purchasing, For Nourish’s work this creates both opportunities and challenges that need to be considered in future strategy development. The recently launched Nourishing the Future of Food in Healthcare policy scan, and the second annual Food For Health Policy Workshop with policy makers being planned for September 2019 will help provide the context for identifying leverage points and regions that have high potential for making policy changes. For example, BC has local food procurement targets and tracking for hospitals, with Ontario, Newfoundland and Labrador, and Quebec also looking at procurement levers to support growth of the agricultural sector.