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The overall aim of this thesis was to advance the knowledge of food and meal provision for hospital inpatients, with particular emphasis on organisation and practices, as well as associated improvement initiatives. Paper I, a scoping review, summarised two decades of research on improving hospital foodservices. Using a modified version of the model Linked Aims of Improvement, most of the aspects identified fell within the System Performance and Patient Outcomes domains, while fewer addressed Professional Development or Leadership, revealing research gaps. The studies in Papers II and III explored initiatives in Swedish hospitals using qualitative semi-structured interviews with 18 nutrition leaders. The interviews were audio-recorded, transcribed and analysed thematically. Paper II showed that a wide range of facilitation activities supported change, but challenges persisted, particularly the low priority given to hospital food and meals and limited collaboration across the organisation. Three themes were formed: Building Relationships, Placing Food and Meals on the Agenda, and Cultivating Skills. Paper III, drawing on the same interviews, highlights core values for food and meal improvement across four dimensions of mealtime care: Flexible, Hospitable, Quality Management, and Nutritional Mealtime Care. These values reflected both established practices and emergent approaches, from individual-level actions to broader systemic strategies. The study in Paper IV involved the translation, cultural adaptation, and validation of an Australian questionnaire for use in the Swedish context. The adapted tool captures the perspectives of hospital ward staff on nutrition and mealtime care across four factors: Foodservices to patients, Staff roles in various mealtime activities, Family involvement in mealtimes, and Organisational support for mealtime care. After an expert review, the original 17 items were increased to 19 in the Swedish version (SWEMEAL) after splitting two items. Despite high content validity and test-retest reliability, weak model validity indicates the need for further tool development. In conclusion, food and meal improvement relies on collaboration, leadership, and continuous feedback, which is valuable knowledge that can guide future efforts.