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Background & Aim

Various initiatives have been taken and recommended to improve foodservice and nutritional care to hospitals patients. However, a broad description and analysis of what has been done to reach a better foodservice is lacking. Consequently, the aim of this paper is to map aspects highlighted as important in scientific articles pertaining to the improvement of foodservice for hospital inpatients.

Methods

A scoping review was conducted, including literature searches in four databases (CINAHL, PubMed, Scopus, Web of Science) and an article selection process. Included studies were peer reviewed primary research written in English, published in 2000–2023, focusing on quality and improvement work in organisations and practice concerning provision of food and meals to hospital inpatients. Besides data charting of article characteristics, data were obtained for qualitative synthesis.

Results

Out of the 103 included articles, almost all (n=102) contained aspects associated with systems of different kinds. Foremost were systems for ordering, production, delivery and menus. Additionally, there were systems for structures, evaluation, and control. Other frequently occurring aspects concerned patients (n=84), e.g. considering their nutritional requirements, preferences, and cultural habits, as well as empowering patients with freedom of choice, information and guidance. Aspects concerning professional development, e.g. training, competence and teamwork were scarcer (n=46) and even fewer articles entailed aspects regarding leadership (n=21).

Conclusions

The broad spectrum of aspects that were identified may provide guidance to quality improvement of hospital foodservice. It also indicated research gaps in this field, foremost concerning relational competence and leadership.

Background: Recently, numerous initiatives have been taken to improve food and meals for hospital inpatients. Research providing in-depth knowledge on leading such improvement initiatives and implementing changes, specifically through facilitation within this multilevel context, is essential. This study aims to explore nutrition leaders' experiences in implementing changes to improve food and meal provision for hospital inpatients, focusing on facilitation activities.

Method: This is a qualitative interview study within the social constructivist paradigm. Participants were recruited through professional networks, advertisements, and snowballing. Eighteen semi-structured interviews were conducted individually with participants in leadership roles of food and meal improvement initiatives at Swedish hospitals. The interviews were transcribed verbatim and analysed thematically through an i-PARIHS lens.

Results: Three themes of facilitation activities were identified: 'Building Relationships', 'Placing Food and Meals on the Agenda', and 'Cultivating Skills'. Building relationships involved establishing connections between the service and clinical divisions. Creating common structures and multidisciplinary teamwork enabled collaboration across organisational boundaries. Placing food and meals on the agenda involved both initial and ongoing communication activities, as food and meal tasks were often considered low priority. Cultivating skills encompassed creating learning opportunities for implementing lasting changes, tailored to specific contexts and adopted within everyday practices.

Conclusions: Collaboration between foodservice and clinical professionals, along with the dissemination of knowledge, appears to be important for implementing changes. Active leadership supports successful implementations by providing structured approaches, including feedback systems, and by contributing to the recognition of improvement initiatives, according to experiences shared during interviews.