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Healthcare and Hospital Cafeteria Design Consultants

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Balancing Regulations, Labor, and Costs

Hospital kitchens and cafeterias represent some of the most demanding commercial cooking and dining spaces. Not only do they need to meet the needs of patients with restricted diets, but they must also be capable of efficiently providing a variety of menu items for staff and visitors. Hospital kitchens must also be capable of complying with strict hygienic standards.

Rapids Contract has addressed these demands and more in designing and installing hospital kitchens and cafeterias. While designing spaces, we balance regulations, labor and costs with the need for smooth workflow and service patterns. And, with our decades of experience and dedication to communication, we have forged relationships with contractors and fabricators to provide efficient installation and to elevate any kitchen or cafeteria into an attractive custom design.

Flexible, Labor-Saving Healthcare Kitchen Designs

Commercial healthcare dining has evolved to place an emphasis on labor-saving flexibility in the kitchen, ordering, and service areas. Rapids Contract’s designers know how to incorporate practical, functional time- and energy-savers into versatile spaces suited for room service orders, grab-and-go service, and dine-in visitors and staff.

Our CADD technology enables you to view your kitchen design in three dimensions well before the build begins. Our LEED-certified designer selects the best available on-demand technology that meets code and saves on costs. This includes eco scrappers, a green replacement for the commercial disposal, and other state-of-the-art appliances and lighting.

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Streamlined Dine-In, Room Service, and Pick Up

For today’s hospital patients and cafeteria visitors, flexibility and flow are key to fast, convenient service. Let us show you how to streamline remote ordering for hospital room service and make it easy for visitors to find and purchase a variety of hot and cold foods. In addition, we can help you select energy-efficient equipment for display and contactless pickup save money over the long run and reduce the pressure on kitchen staff.

Project Management and Communication

One of the most important considerations in selecting a hospital kitchen design firm is how they will manage your project. At Rapids Contract, our project manager will be with you throughout the entire process. He or she will be on site during construction to coordinate with the trades, from fabricators to installers, and architects to general contractors. We take relationships with you and these key partners seriously, guiding the buildout for your hospital kitchen and cafeteria to align with your specifications, timeline, and budget.

FAQs for Healthcare Cafeterias

How long does it take to install a healthcare kitchen.

The time it takes to install a healthcare cafeteria can vary widely based on several factors, including the size of the kitchen, the complexity of the design, the type of equipment being installed, local regulations and permits, the availability of contractors and skilled labor, and the efficiency of the installation process.

In general, smaller and less complex kitchens in an existing foodservice space might take a few weeks to a couple of months to install, while larger and more intricate kitchens could take several months. Here are some key factors that can influence the installation timeline:

1. Design and Planning: The design phase can significantly impact the installation time. If the kitchen’s layout and design are well-prepared in advance, it can help streamline the installation process.

2. Equipment Selection and Availability: The type of equipment needed for the kitchen can affect the timeline. If specialized or custom equipment is required, it might take longer to source and install.

3. Permits and Regulations: Obtaining necessary permits and complying with local regulations can sometimes be a time-consuming process that impacts the installation timeline.

4. Construction and Infrastructure: If any modifications or construction work is required to accommodate the kitchen, such as plumbing, electrical, or ventilation systems, this can add to the installation time.

5. Skilled Labor and Contractors: Availability of skilled contractors, electricians, plumbers, and other professionals can influence how quickly the installation can be completed.

6. Project Management: Efficient project management can help keep the installation on track and avoid delays.

7. Unforeseen Issues: Unexpected challenges or issues that arise during installation, such as equipment malfunctions or structural problems, can extend the timeline.

8. Size and Complexity: Larger kitchens with more intricate setups, multiple workstations, and specialized equipment can naturally take longer to install.

9. Coordination and Scheduling: Coordinating the various tasks involved in the installation, such as equipment delivery, construction work, and inspections, requires careful scheduling.

It’s recommended to work closely with a firm like Rapids who has solutions engineers, designers, project managers, project coordinators, and support teams experienced in commercial kitchen installations. we can provide a more accurate estimate based on the specific details of your project and help manage the process to ensure it’s completed as efficiently as possible.

How much does a healthcare kitchen cost?

The cost of setting up a healthcare cafeteria can vary widely depending on several factors, including the size of the kitchen, the type of cuisine you’ll be preparing, the quality of equipment and materials you choose, location, and local regulations. Here are some of the major cost considerations:

1. Location: The cost of commercial real estate can vary greatly based on the region, city, and neighborhood where you plan to set up your kitchen.

2. Size and Layout: The overall square footage and layout of the kitchen will impact costs. A larger kitchen will require more equipment, materials, and space planning.

3. Equipment: The cost of commercial kitchen equipment varies based on the type and brand. High-quality, specialized equipment can be more expensive. Equipment includes ovens, stoves, refrigerators, freezers, fryers, grills, ventilation systems, dishwashers, and more.

4. Ventilation and Exhaust Systems: Proper ventilation and exhaust systems are crucial for a commercial kitchen to ensure air quality and safety. These systems can be a significant cost factor.

5. Utilities and Infrastructure: Costs associated with plumbing, electrical work, and gas lines installation or modifications need to be considered.

6. Construction and Renovation: If you’re building or renovating a space to accommodate the kitchen, construction costs can vary based on the extent of the work required.

7. Permits and Regulatory Compliance: Obtaining permits and complying with health and safety regulations may incur fees.

8. Interior Design and Finishes: The quality of finishes, such as flooring, countertops, and wall coverings, can impact costs.

9. Furniture and Fixtures: If you’re setting up a restaurant or eatery within the kitchen space, the cost of furniture and fixtures for the dining area should also be considered.

10. Labor Costs: Labor costs include not only the salaries of kitchen staff but also costs for installation, construction, and any specialized services needed.

11. Contingency: It’s wise to budget for unexpected costs that may arise during the setup process.

Due to the many variables involved, it’s challenging to provide an exact figure. However, to give you a rough idea, setting up a basic small-scale commercial kitchen could start around $50,000 to $100,000. Larger, more complex kitchens with high-end equipment and finishes could cost several hundred thousand dollars or even more.

To get a more accurate estimate for your specific situation, it’s recommended to consult with our commercial kitchen design and construction professionals. We can assess your needs, provide cost breakdowns, and help you plan a budget that aligns with your goals.

What layout options are available when designing a healthcare kitchen?

When designing a healthcare cafeteria, the layout should prioritize efficiency, speed, and safety. There are several layout options to consider, each with its own advantages depending on the size of the space, the menu, and the workflow. Here are some common layout options:

1. Assembly Line or Linear Layout: This layout resembles an assembly line, with different stations for each step of the food preparation process. It’s ideal for fast food chains with a limited menu of items that can be prepared quickly. The workflow progresses in a linear fashion, from order taking to food assembly.

2. U-Shaped Layout: A U-shaped layout places the cooking equipment and prep stations along the three sides of a U shape, with the middle left open for movement. This allows cooks to access equipment and ingredients without having to cross paths frequently.

3. L-Shaped Layout: In an L-shaped layout, the kitchen equipment and workstations are arranged along two adjacent walls in an L configuration. This can be effective for smaller spaces and helps streamline the workflow between cooking and preparation areas.

4. Island Layout: An island layout positions equipment and stations in the center of the kitchen, allowing cooks to access equipment from all sides. It’s suitable for larger kitchens with ample space and can provide a more flexible workflow.

5. Zoned Layout: This layout divides the kitchen into distinct zones, each dedicated to a specific task such as cooking, preparation, dishwashing, and storage. It’s efficient for larger kitchens and helps prevent congestion by keeping different tasks separate.

6. Open Kitchen Layout: An open kitchen layout allows customers to see the food preparation process, which can add transparency and a sense of freshness. This layout requires careful organization to maintain a clean and presentable appearance.

7. Parallel Layout: In a parallel layout, equipment and stations are placed along two parallel lines. This is useful for kitchens with a linear workflow, where tasks progress from one end to the other.

8. Zone and Flow Layout: This layout combines zoned areas with a logical flow of food preparation. It ensures that tasks progress smoothly and avoids unnecessary backtracking.

9. Hybrid Layout: Depending on the specific needs of your restaurant, a combination of different layouts can be used to optimize space and workflow. For example, a U-shaped layout for cooking and an assembly line for order preparation.

Remember that the layout should be tailored to your restaurant’s unique requirements, menu items, and anticipated customer flow. It’s important to consider factors like the placement of cooking equipment, prep stations, serving areas, and storage to create a seamless and efficient kitchen environment. Consulting with Rapids’ professional kitchen designers and solutions engineers can help you make informed decisions and create a layout that maximizes productivity and safety.

Where do you get your supplies from?

You can obtain foodservice equipment and supplies from various sources, both online and offline. Here are some common options:

Online Retailers: There are numerous online retailers that specialize in selling foodservice equipment and supplies but clearly Rapids Wholesale’s Webstore is the best in the business! In fact, over 75% of the K-12 school systems in our home state utilize our website for ordering equipment and smallwares. We work neighboring state school buying groups and independent schools as well! Our team can prepare a “market basket” of items your school uses most and provide negotiated discount pricing on those items! Reach out to find out more!

Restaurant Supply Stores: These are specialized stores that offer a wide range of commercial kitchen equipment and supplies. You can find everything from cooking appliances to utensils, furniture, and cleaning supplies. Rapids currently has Restaurant Supply Store locations in St. Paul, MN and Marion, IA.

Wholesale Distributors: Some distributors cater specifically to businesses in the food industry. They often offer bulk purchasing options and may have discounts for larger orders. Rapids Account Management Team is standing by to assist.

When sourcing foodservice equipment and supplies, consider factors like price, quality, warranty, and customer reviews. Compare options from different sources to make informed decisions that align with your budget and needs. Additionally, be aware of any local regulations or codes that might affect the type of equipment you can use in your commercial kitchen.

Previous Work – University of Iowa Stead Family Children’s Hospital

When the University of Iowa Stead Family Children’s Hospital envisioned their cafe, they saw a welcoming environment that was not only easily able to handle the flow of patients and their families, but could also offer a number of meal options.

Rapids helped bring the plan to fruition using our cafeteria and kitchen design services, as well as our equipment and smallwares fulfillment program. Our dedicated team worked on both the cafeteria and the Level 12 kitchenette, ensuring both had the same high-end look and quality materials – including equipment that is all run on electric power.

LET'S FIND YOUR SOLUTION

Rapids Contract serves the United States with locations in Iowa, Minnesota, and Missouri!

Get in touch with one of our experts and let us know how we can help with any of your foodservice needs.

Talk to one of our experts right away and get immediate assistance. We are open Mon - Fri, 8am - 5pm CST.

How Hospital Food Service Can Improve Patient Experiences And Outcomes

Food is fundamental to the human experience, and that’s doubly true for the patient experience

By Michael Tolliver / Special to Healthcare Facilities Today

Hospital meatloaf and pudding jokes never seem to go away, do they? If today’s patients still expect hospital food “isn’t going to be that great,” as Press Ganey has found [1] , maybe there’s something to the staying power of hospital food jokes. Maybe they’re proof of an ever-fresh opportunity to emotionally connect with patients.  

On the other hand, hospitals have a lot to prioritize when it comes to the patient experience, so why should food take so much focus? HCAHPS may not ask directly about food, but studies show food service quality contributes to overall satisfaction of a hospital stay, not to mention patient recovery. [2]

That interdependence of food service and patient experience makes sense. Food doesn’t poke or prod a patient. It offers a comforting choice. A menu is much easier to understand than treatment options, and ordering food is the chance to make a positive decision for yourself. 

Delivering on that promise of a positive outcome is the goal of great food service. Food is fundamental to the human experience, and that’s doubly true for the patient experience, since nutrition is key to patient health. Almost half of all deaths attributed to heart disease, stroke, and Type 2 diabetes are linked to poor diet. [3]  

So how are hospitals helping patients learn about long-term nutritional health? How are they making the most of that opportunity to connect with patients through food? And how are they making sure it benefits the bottom line and sticks with patients, improving outcomes? Here’s a specially prepared selection of choice strategies, so let’s dig in.  

Stealth health 

The general trend toward health-conscious consumption does put pressure on menu creation, but for many patients (along with their stressed family and friends), healthy options can’t compete with the desire for comfort food. Giving people what they want is usually a hallmark of great service, but hospitals have a clear interest in reducing the risk of readmission, and that means meeting nutritional standards that contribute to recovery.

But as parents and nurses know, providing healthy food doesn’t guarantee it’ll be eaten. More than half of patients leave half or more of their meals uneaten, according to a 2019 study. The same study also noted that diminished nutritional intake delayed recovery and increased risk of complications. [4]

People want French fries. Instead of taking choices away and increasing the chance that patients order something they don’t really want (and don’t end up eating), the “stealth health” strategy make fries, burgers, and comfort food like mac and cheese healthier. A lot of hospitals no longer deep fry, for instance, but the most successful “stealth health” strategies focus on the positive. An enhanced flavor model makes palatable options healthier, and healthy options more palatable. 

The key to a successfully implemented enhanced flavor profile is finding ways to efficiently produce on demand at scale. Prioritizing healthy food and patient choice means being smart about costs. With nutritional needs in hand and creative chefs on board, menu plans need to take sourcing and logistics into account. Great food service teams apply clear metrics and analytics to find the efficiency and cost savings needed to keep quality food affordable.

Choosy patients choose information

There’s also expectation management for dietary restrictions, and the importance of having information at hand for patients and guests who want to make more informed choices. Informative labels are just the first step. Information technology is the next one. Access to menus online helps everyone compare choices for themselves. The best systems prioritize user access to up-to-date menu information, and speed the user experience with tools that sort for vegetarian, diabetic, or other key factors and restrictions (such as salt and fat content, or allergens).

Many hospitals are finding the personal touch does wonders. When a dietitian sits with a patient and talks through their needs and wants, that’s both a service win and a healthcare win. Low salt and less grease may taste different, but with an enhanced flavor profile, change doesn’t have to be bad. Setting expectations helps patients focus on the positive, instead of what’s missing. Following up the in-person attention with in-room touch menus or online access enables choice and showcases the quality menu planners work so hard to provide.

Here’s where quality food really shines. What the dietitian helps patients learn, the food helps them accept, with tasty options and great service. 

Room service Is the way

Anyone can order almost anything from a smartphone. Patients of every age bracket want to order what they want when they want it, and hospital food is no exception. Instead of sending up trays of unordered food that staff will have to throw away later, a room service model gives patients choice. 

The benefits of the room service model are clear. Less than half as much wasted food (29% waste with a traditional model against 12% for the room service model) means patients are getting significantly better nutrition. Moving Press Ganey scores from 64 th  to 95 th  for “quality of food” is also a pretty powerful indicator of the impact on patient experience. [5]  

If “hotel-style” room service sounds like it’s more expensive to run, think about this: the benefits in the study above also came with a 15% decrease in patient meal costs. The increased costs of room service turn out to be mainly start-up costs in equipment, software and training. [6]

Once those initial costs are dealt with (or, perhaps better for the hospital, avoided by bringing on a service partner with technical scope and labor expertise already in place), food costs can be reduced by room service models by reducing stock and inventory and eliminating overproduction. [7]

Retail, retail, retail

If the patients are getting room service, how does the retail cafeteria impact the patient experience? Family members eat there. Nurses and staff eat there. Improved employee engagement scores are a clear chance to increase your HCAHPS top box scores: 85% of engaged hospital employees demonstrate a genuinely caring attitude with patients as opposed to only 38% of disengaged employees. [8]  But when the cafeteria is terrible, people will say so, out loud, a lot. That impression sticks in the mind of patients and can color lots of other judgements. And let’s be honest, family members often fill out surveys for patients. If they had a bad experience in the retail area, they might overlook how great the room service was for the patient.  

Rising food costs and budget cuts may be squeezing the bottom line, but the retail portion of hospital food service is a chance to put all that meal planning, logistics, and service to work increasing retail revenues. On-demand dishes and healthier options, alongside amenities like coffee kiosks and food carts, keep everyone satisfied. 

Retail is the chance to capitalize more on all the logistics work you’re doing to locally source ingredients, cook from fresh, and enhance flavors for patients. Now you can replace that tired cafeteria experience, and deliver that café, bistro, or restaurant feel that draws people in and delivers.

In some locations, a hospital can become a true dining destination for the greater community. Especially if the community lacks healthier, affordable options, hospital dining can be a boon to seniors and other community members looking to improve eating habits. Hospitals can increase their draw by promoting their tasty, healthy menu for community groups. 

Hospitals with great retail programs can often offer nutritious food to at-risk groups at prices lower than local restaurants, without having to subsidize meals. Outreach programs like this both serve the community and create efficiency by generating revenue when staff may normally be underutilized.

The real trend is production management

There’s lots of trends to spot. Authentic foods from across the cultural spectrum, celebrity chef recipes, even setting up gardens on-site to grow their own produce – there are a lot of great ideas out there. They all come with their own stumbling blocks and start-up costs. Making sure that innovative, expanded menu options work for your hospital and your patients takes production expertise. Great ideas must be adapted for the healthcare environment and made efficient with flexible, intelligent production management. 

For instance, farmer’s markets and local sourcing still have to meet regulations and strict processes, like chain of custody (recording who has what to help ensure quality control). And when a menu relies on a certain ingredient, great production teams know how to adapt or shift menu strategies when it’s not available. Keeping taste and quality high while working with the reality on the ground efficiently puts the patient experience first.

And for dessert…

Hating hospital food may be as American as apple pie, but savvy hospital directors know that lower expectation is an opportunity to exceed it. Where hospitals used to subsidize food, including huge discounts for employees to eat there, rising costs of food and food preparation have put that model to bed. When it comes to the bottom line, everything can look like a cost center, but food service done well can be a revenue generator.

Driving patient satisfaction and reducing readmissions are a tall order for any department. The right menu, the right food sourcing, the right service model, every element takes planning, resources, and commitment to implement efficiently. The right partner is ready to dump legacy caterer worries and woes and bring innovation and excitement to the table.

Michael V. Tolliver is Vice President Healthcare Operations at  ABM . 

October 5, 2020

Topic Area: Food Service

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Good Taste: Designing Healthcare Dining Spaces

As competition surges among healthcare providers, delivering positive experiences for patients is inspiring projects that breathe new life into care spaces. But simultaneously, organizations are turning their attention to areas of the hospital that likewise improve staff and family satisfaction, and few spaces hold the potential to achieve this that the cafeteria does.

“The dining room in the hospital may not be a great source of revenue, but it does serve as an integral cog in the overall well-being and quality of the hospital services,” explains Yi Belanger, designer at Add Inc. , which is now with Stantec (Miami). “Patient and family member satisfaction ratings greatly rely on the overall experience of their hospital stay, and oftentimes, it means the hospital’s overall accommodations and service, including their dining space.”

On the flip side, hospitals with outdated dining facilities may suffer from perception coloring reality, leading patients and families to erroneously believe that the hospital itself is outdated.

A vast departure from the traditional single cafeteria line with limited food options and hours of operation, today’s hospital dining areas are designed as comfortable, hospitality-inspired spaces customized for the user experience. Embraced by staff and patient families, these spaces are viewed as a welcome amenity, particularly for those spending extended periods of time in the hospital.

Efficiency and flow To start, hospitals across the country are attempting to rectify the long-standing inefficiencies in cafeteria flow and service. Traditionally set up based on a lengthy serving line, entry and exit points were often unclear, and wandering patrons commonly threw a wrench in circulation.

To ensure a new space achieves optimal flow and space efficiencies, both in the serving/dining zones and back-of-house areas, Belanger says her team typically interviews the administrative, clinical, and kitchen staff to develop an understanding of workflow patterns in existing dining areas. Based on those conversations, the optimal amount of seating and square footage needed for circulation, serving, and egress emerges.

Another noted trend is breaking up the traditional food service line into multiple stations with varied food offerings: for example, a salad bar, prepackaged to-go meals, sandwich station, and condiment stands. “Signage can be used to effectively guide visitors, but the design team must create a flow that allows guests to visualize the menu offerings, traverse to the desired offering stations, and pay and exit from a controlled space in a minimal time frame. The design must also maximize the number of transactions within a specified time frame,” says David N. Moon, principal of Moon Mayoras Architects (San Diego).

Strategic seating When it comes to seating arrangements, the key is variety, incorporating options like a bar with stools, larger tables, smaller booths, and outdoor seating, if possible. “I like to create zones in these spaces for serving, dining, lounging, and personal space,” Belanger says. “These spaces can be equipped with movable furniture and modular systems that can be transformed for different functions during work hours and afterwards.”

Cindy Elkin, interior designer at RLF (Orlando), says that seating should support a variety of dining experiences and levels of social interaction. “To distinguish between these areas, we establish a flow of spaces and look at how we can manipulate the ceiling planes, wall boundaries, and seating heights to create spaces that are immediately identifiable as more intimate quiet areas or on-demand, energizing spaces,” she says.

For example, Kalloor recommends half-height walls to partition off small groupings of tables so that the numerous dining seats can be zoned into small compartments. These walls can also double as a barrier to shield these more private seating areas from traffic flow. “Patterned or colorful acrylic panels can also be used to serve as a vertical screen that helps to divide and organize space without the visual weight of a full wall,” she says.

To customize the space to specific user groups, Belanger recommends booth seating for the comfort and privacy of families, and unfixed tables and chairs in small and large clusters to support staff. Although preferences will vary from hospital to hospital, institutions generally require separate dining areas for doctors to support events like staff presentations, physician case studies, and educational programs often occurring during lunchtime. Some institutions may also require private areas for VIPs, such as hospital benefactors, foreign dignitaries, or celebrities.

Mastering materials As for how healthcare dining areas are being reimagined from an interiors perspective, the options for finishes are endless. “Dining spaces within a healthcare setting are the one place where designers can take more design risks,” says Margi Kaminski, senior associate vice president at RTKL (Chicago).

The materials palette can be much broader than that generally used in other healthcare spaces and may include accents such as high-gloss wall tiles in bold colors or patterned resin panels and textured glass. Kaminski also considers furnishings like sculptured chairs or decorative lighting for dining projects.

However, because dining spaces are housed within a high-use setting, designers must be “extra clever and creative in our material selections,” says Belanger, with furnishings and finishes specified that are durable and easily cleaned. “You want to create a space that performs like a high school cafeteria but looks more like a restaurant,” says Chris Youssef, an associate at Perkins Eastman (New York), “so mosaic tiles, glass, and wood laminates are the go-to materials that will give warmth, durability, and a higher-end look.”

Meanwhile, Belanger likes to introduce a lot of soft fabrics ingrained with stain-resistant properties and that fight wear and tear. Elkin adds visual interest to seating areas through texture, using rough and smooth surfaces to provide a backdrop while still maintaining cleanability and durability.

Kalloor turns to natural materials—in moderation—to finish a space. “While many natural materials may not be suitable for healthcare dining environments due to durability or sterility, when used selectively, they can add a lot of impact.” For instance, ceilings are a good place to incorporate the richness and beauty of wood, while natural stone tiles or glass mosaics can be integrated into the design in small doses and still deliver high design impact.

Another strategy, Kalloor says, is to use synthetic materials that mimic natural materials, colors, and patterns. “Examples include resilient flooring with a natural stone or wood look, engineered surface materials such as quartz or solid surface with visuals that imitate natural stone, and protective wall panels that are treated with a top layer that has an organic texture or wood panel appearance,” she says.

For flooring, Elkin recommends a balance of hard and soft flooring surfaces to create boundaries between different seating clusters and service areas. For example, hard-surface flooring, such as porcelain tiles, are typically installed in high-traffic circulation zones and at food service transition areas. Hard-surface flooring with minimal seams also minimizes crevices that may harbor dirt and germs. Poured composite floors like terrazzo o ffer can high-end visual appeal and come in a large variety of colors, visual textures, and custom patterns.

Up above An inherent piece of any dining space is all of the equipment required to operate, but one design trick is to shift attention elsewhere—specifically, up. “Designers use ceiling treatments as an opportunity to create interest and draw the eye up and away from the equipment in the serving areas and away from the cluster of chairs and tables in the dining room,” Kaminski says.

Kalloor adds that thoughtful ceiling design comes with even more benefits: “Ceiling treatments allow a large space to be visually compartmentalized into zones, they contribute the most to the acoustical quality within the space, and they tend be the only plane in the room that does not contain a lot of visual clutter.”

Belanger prefers gypsum ceilings in smaller dining and lounge spaces to create an upscale look, but in most applications specifies a smooth-finished acoustic ceiling tile. In place of standard 2-by-2-inch tiles, Kaminski recommends large-format, 48- by-48-inch options to create a more modern look. Barbara Bouza, managing director and principal at Gensler (Los Angeles), adds that high-performance mineral fiber and fiberglass materials will meet washability, noise level, anti-mold, and antibacterial requirements.

Let light in Lighting is another area where designers can boost the aesthetics of healthcare dining spaces. Whether it’s recessed down lights, decorative pendants, wall washers, rope lights, or indirect accent lights, there are plenty of options to help set the desired tone. For example, Kaminski says, “Mini-pendants over serving areas add a bit of fun, whereas clusters of drum fixtures in the dining area draw the eye upward to create a focal point above the sea of tables and chairs.”

Another trend Belanger sees is hospitals embracing LED lighting. “They understand that the initial cost is higher, but they save on the lifecycle cost almost immediately by reducing the frequency of maintenance calls to replace these fixtures,” she says. “I always like to give them direct/indirect LED fixtures with no more than 3500K for their general light over the food service and back-of-house areas,” she continues. Essentially, 3500K lighting provides a soft, warm light, whereas 4000K or higher takes on a more clinical/institutional look. With the softer light, a more restaurant-like environment is created.

“In the dining areas, I use recessed LED ‘high hats’ controlled by dimmers for different functions, ambience, and mood. LED decorative sconces and/or pendants make a world of difference in creating drama and appeal in a healthcare dining space. It also takes away the institutional look and makes the space feel like a restaurant,” she adds.

Of course, daylighting is also a desirable feature, driven by both newer energy code requirements and user preferences. “Allowing for daylight is key as this space is primarily used by hospital staff who are working in windowless spaces for much of the day,” Kalloor says. “If possible, the dining room should be designed along at least one exterior wall within the facility so that windows can stream light into the space.” Kalloor also recommends clerestory windows and skylights, in addition to conducting sunlight studies to optimize glazing placement and minimize glare.

Take out Moving forward, designers can anticipate that hospitals will continue prioritizing their dining areas, particularly given the elevated role that patient families are now playing in the healthcare process.

“With shortages in healthcare staff, specifically nursing, the family plays an important role in the caregiving experience and spends more time than ever in the hospital environment,” Bouza says. “These spaces offer visitors a welcome environment more conducive to working, having coffee, or even a small family meeting. A great dining space makes good business sense.”

Barbara Horwitz-Bennett is a contributing editor for Healthcare Design . She can be reached at [email protected] .

SIDEBAR : Back-of-house basics

Offering a take-away list of back-of-house best practices, food service consultant Richard Dieli of Dieli Murawka Howe (San Diego), suggests the following:

•             Provide kitchen and ancillary spaces space for movement and storage of carts and mobile equipment in a safe and sanitary location.

•             Provide more refrigeration than one thinks will be needed.

•             Create a flow within the kitchen spaces that minimizes employee and mobile equipment cross traffic.

•             Create a flow that allows easy access to refrigeration and storage for employees from all production areas.

•             Install hand sinks in all production areas to promote food safety and reinforce a safe and sanitary work environment.

•             Stay focused on utility costs. Utility and water usage are both deleterious to the environment and have a negative impact on the hospital’s bottom line.

•             Optimize natural light. A pleasant work environment makes a healthier and happy employee, which in turn, will positively affect production.

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Step-by-Step Guide to Crafting a Business Plan for a Hospital

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Welcome to our blog post on how to write a business plan for a hospital! In today's rapidly growing healthcare industry, starting a hospital that focuses on providing quality, personalized medical services is a promising venture. According to recent statistics, the global healthcare market is projected to reach a value of $12.3 trillion by 2026, with a compound annual growth rate of 6.7%. This presents a great opportunity for entrepreneurs looking to make a difference in the lives of patients and contribute to the advancement of healthcare technology.

Before diving into the details of writing a business plan for your hospital, it's crucial to identify the market need and demand for this type of healthcare facility. Conducting a thorough market research will help you understand the current trends and assess the potential demand for specialized medical services. By analyzing competition and industry trends, you can gain insights into successful strategies and differentiate your hospital from others.

Developing a solid financial plan is essential for securing funding and partnerships. It involves outlining the hospital's projected revenue, expenses, and investment requirements. By preparing a comprehensive financial plan, you can demonstrate the viability and profitability of your venture to potential investors or lenders.

Defining the hospital's vision, mission, and values sets the foundation for its overall purpose. This helps in establishing a clear direction and guiding the decision-making process. Creating an organizational structure and identifying key roles ensures smooth operations and effective management of resources.

Formulating a comprehensive marketing strategy is crucial for attracting patients and building strong referral networks. It involves defining your target audience, identifying the best channels to reach them, and creating compelling messaging that highlights the unique benefits of your hospital.

Lastly, assessing the legal and regulatory requirements is vital to ensure compliance with healthcare laws and regulations. This includes obtaining the necessary licenses, permits, and certifications to operate your hospital.

By following these nine steps, you will be well-equipped to write a comprehensive business plan for your hospital. Stay tuned for our upcoming blog posts, where we will dive deeper into each step to provide you with practical insights and actionable tips.

Identify The Market Need And Demand

One of the first and most crucial steps in writing a business plan for a hospital is to identify the market need and demand for the services you intend to provide. Understanding the needs and preferences of potential patients is essential for developing a successful hospital that can effectively meet their healthcare requirements.

To gather this important information, conducting a thorough market research is key. This research should focus on the local healthcare landscape, demographics, and the specific services and medical treatments currently available in the area. By analyzing this data, you can identify any gaps or unmet needs in the market that your hospital can fulfill.

During the market research process, it is also important to evaluate the demographic trends and population dynamics in the area. Understanding factors such as age distribution, income levels, and prevalent medical conditions can help you tailor your services to the specific needs of the target population.

By thoroughly understanding the market need and demand for your hospital's services, you can develop a business plan that is aligned with the needs of the community you aim to serve. This will help ensure the success and sustainability of your hospital in the long run.

Conducting a Thorough Market Research

Conducting thorough market research is an essential step in developing a business plan for a hospital. This research will help you gain a clear understanding of the market need and demand, enabling you to make informed decisions about your hospital's offerings and target audience.

When conducting market research for a hospital, consider the following:

• Identify your target market: Determine the specific demographic and geographic characteristics of the population you intend to serve. This will help you tailor your services and marketing efforts accordingly.
• Analyze market trends: Stay updated with the latest trends in the healthcare industry. Identify emerging technologies, treatments, and practices that can distinguish your hospital from the competition.
• Assess competition: Study your competitors' offerings, pricing strategies, and marketing tactics. This will allow you to identify gaps in the market and position your hospital uniquely.
• Explore patient preferences: Understand what patients value when it comes to healthcare services. Conduct surveys or interviews to gather insights on their preferences, expectations, and experiences with existing healthcare providers.
• Evaluate regulatory factors: Familiarize yourself with the legal and regulatory requirements applicable to hospitals in your region. This includes licensing, documentation, and compliance with healthcare regulations.

Tips for Conducting Market Research for a Hospital

• Utilize online resources: Make use of online databases, industry reports, and market research tools to gather data on healthcare trends, market size, and consumer behavior.
• Engage with industry experts: Seek guidance from healthcare professionals, consultants, and experts who have in-depth knowledge of the industry. Their insights can provide valuable guidance during the research process.
• Consider qualitative and quantitative research: Combine qualitative methods like interviews and focus groups with quantitative techniques such as surveys and data analysis. This will provide a comprehensive understanding of your target market.
• Continuously update your research: Regularly review and update your market research to stay on top of industry developments and changing market dynamics. This will help you adapt your business plan accordingly.

By conducting thorough market research, you will be equipped with the necessary information to develop a business plan that aligns with the needs and expectations of your target market. This research will serve as a foundation for making informed decisions and ultimately contributing to the success of your hospital.

Analyze Competition And Industry Trends

One crucial step in developing a successful business plan for a hospital is to thoroughly analyze the competition and industry trends. This analysis provides valuable insights into the current market and helps identify opportunities and potential challenges that the hospital may face. Below are some important points to consider during this analysis:

Identify competitors: Begin by identifying existing hospitals and medical facilities that may be direct competitors. Research their offerings, facility size, capacity, and reputation within the community. Understanding their strengths and weaknesses will help you position your hospital effectively.

Study industry trends: Stay up-to-date with the latest trends in the healthcare industry. Identify key innovations, advancements in medical technology, and emerging treatments or services that could impact the hospital's success. This will help you adapt and stand out in a rapidly evolving industry.

Analyze market demand: Evaluate the current and projected demand for healthcare services in the target area. Consider factors such as population growth, demographic trends, and the prevalence of specific medical conditions. Understanding market demand will help in planning the hospital's service offerings and staffing requirements.

Evaluate competitive advantages: Identify what sets your hospital apart from the competition. This could include specialized services, unique treatment approaches, advanced technology, or a focus on personalized patient care. Highlighting these competitive advantages in your business plan will attract potential patients and investors.

• Use online resources, industry publications, and professional networks to gather information on competitors and industry trends.
• Engage with healthcare professionals, potential patients, and community members to gain insights into their expectations and preferences.
• Consider conducting surveys or focus groups to gather more specific feedback and opinions on the market and competition.
• Regularly revisit and update the analysis of competition and industry trends to stay ahead of the curve and maintain a competitive edge.

Develop A Solid Financial Plan

A solid financial plan is crucial for the success of any business, including a hospital. It provides a roadmap for achieving financial stability and sustainability. Here are some important steps to take when developing a solid financial plan for a hospital:

• Estimate costs and revenue: Start by estimating the costs involved in setting up and running the hospital. This includes expenses such as equipment, facility construction or lease, staff salaries, operational costs, and marketing expenses. Additionally, analyze the expected revenue sources, such as patient fees, insurance reimbursements, and potential partnerships or collaborations.
• Financial projections: Utilize the market research and competition analysis to make informed financial projections. This will include forecasting the number of patients, expected reimbursement rates, and expected revenue growth over a specific period of time. Be sure to consider factors such as seasonality, demand fluctuations, and potential economic changes.
• Budget allocation: Once you have estimated costs and revenue and made financial projections, prioritize how you will allocate your budget. Consider allocating resources for essential needs such as medical equipment, technology, employee training, marketing, and community outreach programs. Create a detailed budget plan that includes both recurrent and capital expenses.

Tips for developing a solid financial plan:

• Consult with financial advisors or experts in the healthcare industry to ensure accuracy and validity of financial projections.
• Consider different funding sources, such as private investors, loans, grants, or public funding programs specifically targeting healthcare projects.
• Account for contingency funds to handle unexpected expenses or emergencies.
• Regularly revisit and update your financial plan to reflect changing market conditions, trends, and regulatory requirements.

Developing a solid financial plan requires a thorough understanding of the healthcare industry, market dynamics, and financial management principles. It's essential to invest time and effort into this step to lay a strong foundation for the hospital's financial success.

Secure Funding and Partnerships

Once you have developed a solid financial plan, the next crucial step in starting a hospital is securing funding and building partnerships. This stage is vitally important as it determines the financial stability and sustainability of your hospital.

1. Identify potential funding sources: Start by exploring various funding options available to you. This may include approaching investors, applying for grants and loans, or seeking partnerships with other organizations. Assess the pros and cons of each option to determine the best fit for your hospital.

• Prepare a comprehensive business plan and financial projections to convince potential investors or lenders of your hospital's viability.
• Consider partnering with organizations that share a similar mission and vision to leverage their expertise, resources, and infrastructure.

2. Craft a compelling funding proposal: Develop a persuasive funding proposal that clearly outlines your hospital's mission, goals, financial needs, and potential benefits for investors or partners. Emphasize the unique value proposition and the impact your hospital can make in the healthcare industry.

3. Build strategic partnerships: Collaborate with other healthcare organizations, research institutions, or technology companies to access resources, expertise, and specialized services. Look for complementary strengths that align with your hospital's vision and objectives.

• Network within the healthcare industry to build connections and explore potential partnership opportunities.
• Consider joining professional associations or attending industry conferences to connect with potential partners.

4. Establish trust and credibility: Demonstrate your hospital's potential by showcasing the qualifications and expertise of your team, highlighting successful case studies, or sharing testimonials from satisfied patients or partners. Establishing credibility is crucial to attract investments and create fruitful partnerships.

5. Think beyond financial support: While securing funding is a primary concern, also consider the value that partners can bring beyond monetary contributions. Look for partners who can offer strategic guidance, business acumen, or access to a broader network of healthcare professionals and resources.

6. Seek legal and financial advice: Consult legal and financial experts to ensure that your funding and partnership agreements are robust and legally sound. They can assist in negotiating favorable terms and protecting your hospital's interests.

By carefully navigating the funding and partnership landscape, you can secure the necessary resources and allies to propel your hospital towards success. Remember, building strong partnerships is not just about financial support but also finding collaborative opportunities that align with your hospital's vision and values.

Define The Hospital's Vision, Mission, And Values

Defining the vision, mission, and values of your hospital is crucial for establishing its identity and guiding its direction. These elements serve as the foundation for your organization and shape its culture, goals, and strategies.

When crafting the vision statement , consider the long-term aspirations and purpose of your hospital. It should succinctly describe the desired future state and the impact you aim to make in the community. This statement should inspire and motivate both your staff and patients.

The mission statement clarifies the fundamental purpose and reason for the existence of your hospital. It outlines the primary services you will provide and the target population you aim to serve. This statement should be concise and clearly communicate the value you intend to deliver.

The values of your hospital outline the guiding principles and beliefs that underpin your organization's culture and conduct. These principles should align with the overall mission and vision. They provide a framework for decision-making, as well as help ensure consistency in providing patient care.

Tips for Defining Your Hospital's Vision, Mission, and Values:

• Involve key stakeholders, including staff, patients, and community members, in the process to gain diverse perspectives and foster a sense of ownership.
• Keep your statements concise and easily understandable to ensure clarity and coherence.
• Ensure that your vision, mission, and values are in line with the market need identified and the unique value proposition of your hospital.
• Regularly revisit and refine your vision, mission, and values to adapt to changes in the healthcare landscape and the evolving needs of your patients.

By clearly defining your hospital's vision, mission, and values, you establish a strong foundation that guides decision-making, fosters a sense of purpose among your staff, and communicates the unique value your hospital brings to the community.

Outline The Organizational Structure And Key Roles

In order to effectively run a hospital, it is crucial to clearly outline the organizational structure and identify the key roles within the healthcare facility. This will help ensure smooth operations, effective communication, and proper allocation of responsibilities. Here are some important steps to consider when outlining the organizational structure and key roles:

• Identify the leadership positions: Start by identifying the key leadership positions that will oversee the hospital's operations. This typically includes roles such as Chief Executive Officer (CEO), Chief Medical Officer (CMO), and Chief Nursing Officer (CNO).
• Define the departments: Next, outline the various departments within the hospital, such as administration, nursing, finance, human resources, and medical services. Each department should have a designated leader responsible for managing day-to-day operations and ensuring departmental goals are met.
• Establish reporting lines: Clearly define the reporting lines within the organizational structure to ensure efficient communication and decision-making processes. Indicate who reports to whom, and establish a hierarchical structure that promotes accountability and clarity.
• Identify key roles: Determine the key roles within each department and specify the responsibilities and qualifications for each position. This may include physicians, nurses, therapists, administrative staff, and other healthcare professionals required to deliver quality care.
• Promote teamwork and collaboration: Emphasize the importance of teamwork and collaboration among different departments and roles within the hospital. Encourage regular meetings, cross-functional projects, and open communication channels to foster a culture of cooperation and interdisciplinary care.
• Delegate authority: Delegate authority and empower individuals within their respective roles to make decisions and take ownership of their responsibilities. This encourages autonomy and accountability, and enables efficient problem-solving and decision-making processes.
• Consider developing an organizational chart to visually represent the hierarchical structure and reporting lines within the hospital.
• Regularly review and update the organizational structure to ensure it aligns with the evolving needs of the hospital and changing healthcare landscape.
• Communicate the organizational structure and key roles to all employees to ensure clarity and understanding of their responsibilities and reporting lines.

By carefully outlining the organizational structure and key roles, a hospital can establish a strong foundation for effective management, collaboration, and seamless delivery of quality healthcare services.

Formulate A Comprehensive Marketing Strategy

A comprehensive marketing strategy is essential for successfully promoting and positioning your hospital in the healthcare industry. It involves identifying your target audience, creating effective messaging, choosing the right marketing channels, and continuously evaluating and adapting your strategies to ensure maximum reach and impact.

When formulating your marketing strategy, keep the following key aspects in mind:

Tips for Formulating A Comprehensive Marketing Strategy:

• Identify your target audience: Determine the demographics and characteristics of the patients you want to attract. This enables you to tailor your marketing efforts towards their specific needs and preferences.
• Create compelling messaging: Develop a clear and persuasive message that highlights the unique value proposition of your hospital. Emphasize the personalized care, cutting-edge technology, and evidence-based treatment you offer.
• Choose the right marketing channels: Utilize a mix of traditional and digital marketing channels to reach your target audience effectively. Consider strategies such as search engine optimization (SEO), social media marketing, email campaigns, and referral programs.
• Build strong relationships: Cultivate relationships with referring physicians, healthcare professionals, and community organizations. Establish partnerships to increase referrals and enhance your reputation within the healthcare community.
• Monitor and evaluate: Regularly measure the effectiveness of your marketing efforts by tracking key performance indicators (KPIs). Analyze data, gather feedback, and adapt your strategies accordingly to ensure maximum impact and return on investment.

A comprehensive marketing strategy plays a vital role in attracting patients, establishing your hospital's brand, and maintaining a competitive edge in the healthcare industry. By understanding your target audience, crafting compelling messaging, choosing the right channels, and continuously evaluating your strategies, you can position your hospital as a trusted provider of high-quality and personalized medical services.

Assess Legal And Regulatory Requirements

Ensuring compliance with legal and regulatory requirements is crucial when setting up a hospital. This step involves researching, understanding, and meeting the various laws and regulations that govern the healthcare industry.

• Obtain necessary licenses and permits: Familiarize yourself with the licensing requirements specific to hospitals in your jurisdiction. Determine the necessary permits and certifications required to operate legally.
• Comply with healthcare regulations: Understand and comply with regulations related to patient privacy, data protection, health and safety standards, and medical waste management. Implement appropriate policies and protocols to ensure compliance.
• Stay updated with healthcare laws: Keep abreast of any changes or updates in healthcare laws and regulations that may have an impact on your hospital. This includes staying informed about reimbursement policies, billing regulations, and insurance requirements.
• Secure professional licenses and certifications: Ensure all healthcare professionals working at the hospital possess valid licenses and certifications. Perform necessary background checks and verification procedures to maintain quality and patient safety standards.
• Implement proper documentation and record-keeping practices: Establish systems for accurate and organized documentation to comply with medical record-keeping requirements. Adhere to guidelines for the storage, retention, and disposal of medical records.
• Seek legal counsel: Consult with healthcare attorneys or legal experts with experience in the healthcare industry to navigate the complex legal landscape.
• Stay updated with changes: Regularly review and update your knowledge on relevant laws and regulations to ensure ongoing compliance.
• Establish a compliance team: Assign responsibilities to a dedicated compliance team or officer to monitor and enforce adherence to legal and regulatory requirements.

In conclusion, developing a business plan for a hospital requires careful consideration and thorough research. By following the nine steps outlined in this checklist, you can ensure that your hospital is well-prepared to meet the market demand, provide high-quality care, and comply with legal and regulatory requirements. By focusing on personalized medical services, leveraging cutting-edge technology, and adopting a multidisciplinary approach to treatment, your hospital can strive towards providing the best possible outcomes for patients.

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Hospital Canteen SOP Template

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Hospital canteens play a vital role in providing nutritious meals to patients, staff, and visitors. But ensuring food safety and maintaining high standards can be a challenge. That's where ClickUp's Hospital Canteen SOP Template comes in!

With this template, you can streamline your Standard Operating Procedures (SOPs) for the hospital canteen, ensuring that your team:

• Follows strict hygiene and safety protocols to prevent foodborne illnesses
• Maintains proper food storage, handling, and preparation techniques
• Adheres to dietary restrictions and special meal requirements
• Monitors and maintains equipment and facilities for optimal performance

Whether you're managing a small hospital canteen or a large-scale operation, this template will help you maintain the highest standards of food safety and quality. Get started today and ensure a healthy dining experience for all!

Benefits of Hospital Canteen SOP Template

When it comes to running a hospital canteen smoothly and efficiently, having a standard operating procedure (SOP) template is a game-changer. Here are some of the benefits of using the Hospital Canteen SOP Template:

• Ensures consistent food quality and safety standards
• Streamlines daily operations and reduces errors
• Provides clear guidelines for staff on food preparation, handling, and storage
• Improves customer satisfaction by maintaining high service standards
• Helps with training new employees and maintaining a well-trained team
• Enhances overall efficiency and productivity in the canteen

Main Elements of Hospital Canteen SOP Template

ClickUp's Hospital Canteen SOP Template is designed to help you create and maintain standard operating procedures for your hospital canteen operations.

This Doc template contains all the necessary sections and content to guide you in creating a comprehensive SOP. It also includes ClickUp features such as:

• Custom Statuses: Create tasks with custom statuses to track the progress of each step in your SOP, such as "To Do," "In Progress," and "Completed."
• Custom Fields: Categorize and add attributes to your tasks to provide additional information and manage your canteen operations effectively.
• Custom Views: Utilize different views, such as List, Board, or Calendar, to visualize and manage your SOP tasks in a way that suits your workflow.
• Project Management: Enhance your SOP creation process with ClickUp's features like Tags, Dependencies, Priorities, and Integrations with other tools.

How to Use SOP for Hospital Canteen

Running a hospital canteen requires careful planning and adherence to standard operating procedures (SOPs). Here are four steps to effectively use the Hospital Canteen SOP Template in ClickUp:

1. Familiarize yourself with the template

Before diving into the SOP template, take some time to familiarize yourself with its structure and content. Understand the purpose and scope of the SOP, as well as the specific guidelines and procedures outlined within it. This will help you navigate the template more efficiently and ensure that you're following the correct protocols.

Use the Docs feature in ClickUp to access and read through the Hospital Canteen SOP Template.

2. Customize the template to your hospital's needs

Every hospital has unique requirements and regulations when it comes to running a canteen. Take the time to tailor the SOP template to fit your hospital's specific needs. This may involve adding or removing certain sections, updating procedures to align with your hospital's policies, or incorporating any additional guidelines or regulations that are relevant to your canteen operations.

Utilize the custom fields feature in ClickUp to make necessary modifications and personalize the Hospital Canteen SOP Template.

3. Train your canteen staff

Once you have finalized the customized SOP template, it's crucial to train your canteen staff on its contents and expectations. Schedule a training session to go over each section of the SOP, explaining the procedures, guidelines, and best practices outlined in the document. Ensure that your staff understands their roles and responsibilities, as well as the importance of adhering to the SOP for maintaining a safe and efficient canteen environment.

Create tasks in ClickUp to assign training sessions and track the progress of each staff member.

4. Regularly review and update the SOP

SOPs are not set in stone and should be reviewed and updated periodically to reflect any changes in regulations, hospital policies, or best practices. Schedule regular reviews of the Hospital Canteen SOP to ensure it remains up-to-date and relevant. Encourage feedback from your canteen staff and consider their suggestions for improvement. By continuously evaluating and updating the SOP, you can ensure that your canteen operations stay in compliance and consistently meet the highest standards.

Set recurring tasks in ClickUp to remind yourself to review and update the Hospital Canteen SOP on a regular basis.

Get Started with ClickUp's Hospital Canteen SOP Template

Hospital canteen managers can use this Hospital Canteen SOP Template to streamline operations and ensure a smooth running canteen for staff and patients.

First, hit “Add Template” to sign up for ClickUp and add the template to your Workspace. Make sure you designate which Space or location in your Workspace you’d like this template applied.

Next, invite relevant members or guests to your Workspace to start collaborating.

Now you can take advantage of the full potential of this template to manage your canteen:

• Create Docs to outline the Standard Operating Procedures (SOPs) for each area of the canteen, such as food preparation, cleaning, and cashier duties
• Assign tasks to team members to ensure everyone is aware of their responsibilities
• Utilize Checklists for daily opening and closing procedures to maintain cleanliness and hygiene
• Attach relevant documents such as menus, ingredient lists, and special dietary requirements for easy reference
• Set up recurring tasks to schedule regular equipment maintenance and cleaning
• Use the Gantt chart view to create a timeline for menu planning and ordering supplies
• Collaborate using Comments for seamless communication and feedback on menu ideas and customer preferences

Related Templates

• Applied Energy Management SOP Template
• Safety in Pharmaceutical Industry SOP Template
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Availability of Healthy Food and Beverages in Hospital Outlets and Interventions in the UK and USA to Improve the Hospital Food Environment: A Systematic Narrative Literature Review

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The aims of this systematic review are to determine the availability of healthy food and beverages in hospitals and identify interventions that positively influence the hospital food environment, thereby improving the dietary intake of employees and visitors. Embase, Medline, APA PsycInfo, Scopus, Google Scholar and Google were used to identify publications. Publications relating to the wider hospital food environment in the UK and USA were considered eligible, while those regarding food available to in-patients were excluded. Eligible publications ( n = 40) were explored using a narrative synthesis. Risk of bias and research quality were assessed using the Quality Criteria Checklist for Primary Research. Although limited by the heterogeneity of study designs, this review concludes that the overall quality of hospital food environments varies. Educational, labelling, financial and choice architecture interventions were shown to improve the hospital food environment and/or dietary intake of consumers. Implementing pre-existing initiatives improved food environments, but multi-component interventions had some undesirable effects, such as reduced fruit and vegetable intake.

1. Introduction

Overweight and obesity are extremely prevalent across the UK and USA. In 2018, it was estimated that 67% of men and 60% of women in the UK had overweight or obesity [ 1 ], along with 71.6% of American adults in 2015/2016 [ 2 ]. A high body mass index (BMI) is linked to a range of non-communicable diseases, such as hypertension, type 2 diabetes and coronary heart disease [ 3 ], which has led to a significant number of hospital admissions associated with weight-related disorders. Between 2014 and 2015, it was estimated that the economic cost of overweight and obesity-related health complications to the National Health Service (NHS) was GBP 6.1 billion [ 4 ], while the healthcare cost of obesity in America was approximately USD 149.4 billion [ 5 ].

In addition to the high prevalence of obesity and overweight in the general population, healthcare employees demonstrate similar weight-management issues. One study carried out by Kyle et al. (2017) used data from the 2008–2012 Health Survey for England and found that 25.1% of the nurses surveyed had a BMI of 30 kg/m 2 or higher, classifying them as ‘obese’. Furthermore, 32% of unregistered care workers, 26% of non-health-related NHS employees and 12% of other healthcare professionals also had a BMI of 30 kg/m 2 or higher. These values are similar among American hospital staff members, with 27% of American nurses estimated to be obese [ 6 ].

A key cause of obesity is eating an excess of unhealthy foods. In the UK, the Office for Health Improvement and Disparities advises infrequent consumption of foods high in fat, salt and sugar [ 7 ]. American guidelines reflect the same general recommendations; according to the 2015–2020 Dietary Guidelines for Americans, a healthy diet should involve the restriction of saturated and trans fats, added sugars and salt [ 8 ]. Therefore, unhealthy foods can be defined as products that are high in these substances.

The range of healthy or unhealthy food and beverages available, food marketing techniques and the cost of food items in a specified setting can be referred to as the food environment [ 9 ]; this has a significant impact on the nutritional quality of food consumed by the general public. Studies have shown that there is an association between easier access to fast food and greater BMI and odds of obesity [ 10 ], suggesting that the food environment has a strong influence on weight status.

The general public has an expectation of hospitals and other healthcare environments to promote healthy behaviours, with 97% of participants in one survey indicating that hospitals should act as positive role models for healthy lifestyle behaviours [ 11 ]. Despite this, unhealthy foods are often found in hospital food outlets.

The aim of this review is to explore the extent to which healthy food and drink options are available to employees and visitors in hospital food environments and to determine which interventions are effective in reducing the purchase and consumption of unhealthy foods and beverages. This research may identify interventions that can improve the health and wellbeing of hospital employees and visitors, potentially leading to policy change to ensure healthy food is predominant in the wider hospital food environment.

2. Materials and Methods

The protocol associated with this systematic review was registered with PROSPERO, an international database of prospectively registered systematic reviews (reference number CRD42021223249). An amendment was made on 12 August 2021, detailing the repetition of database searching and a revised quality assessment method.

To find literature relevant to the current hospital food environment and interventions to improve the nutritional quality of food available to employees and visitors, a systematic search was carried out using five electronic databases: Embase, Medline, APA PsycInfo (all accessed via Ovid), Scopus and Google Scholar. Google was also utilised to ascertain suitable grey literature. Initial searches were carried out on 23 October 2020 and repeated on 21 July 2021 to detect new publications.

Suitable keyword search terms were identified; controlled search terms included “hospital”, “convenience food”, “healthy diet”, “automatic food dispensers” and “nutritional value”. Key words were amended slightly for each database; full search terms are listed in Appendix A .

Eligibility criteria were established to aid the selection of relevant publications. Some criteria were used to narrow the scope of the research to facilitate a detailed review of source material within the timeframe available. Two researchers carried out independent eligibility screening using Rayyan [ 12 ], and disputes were resolved via discussion with a third researcher.

Publications were included in the present review if they related to the wider hospital food environment (i.e., food outlets accessible to hospital employees and/or visitors) in the UK or the USA. No restrictions were placed on publication dates. Publications were excluded if they focused on food available only to patients in hospital wards. Additional exclusion criteria included studies with no full-text sources available, studies written in a language other than English and studies which involved systematic reviews or meta-analyses.

Search results were imported to Endnote [ 13 ]; duplicates were removed before the sample was exported to Rayyan [ 12 ]. Studies were initially screened based on the adherence of their titles and abstracts to the eligibility criteria. Included studies were further refined by screening full texts and removing ineligible records.

Several key pieces of data were extracted from each study in a standardised template by one researcher. Extracted information included author names, year of publication, country, study design, aim, duration, intervention/observation methods, outcome measures and results. A quality assessment and risk of bias analysis was also carried out on each source by one researcher using the Quality Criteria Checklist for Primary Research from the Academy of Nutrition and Dietetics [ 14 ]. See Appendix B , Table A1 for the full data extraction table.

The key outcomes of interest were the nutritional quality of food and beverages currently available to employees and visitors in hospitals as well as interventions aiming to improve the nutritional quality of products, awareness of nutritional values, dietary intake or overall health of hospital employees and visitors. Summary measures for these outcomes varied greatly between eligible publications. Due to the heterogeneity of summary measures and study designs, a quantitative synthesis or meta-analysis was not possible; consequently, a narrative synthesis was undertaken.

Studies were initially grouped into categories based on study type (i.e., observations and interventions). Interventions were allocated to sub-categories to allow for a well-structured narrative synthesis. Sub-categories included educational, labelling, financial, choice architecture, pre-existing guideline implementation and multi-component interventions.

Of the 806 search results initially identified from databases and search engines, 40 studies met the eligibility criteria. The most common reason for exclusion was the irrelevance of study outcomes to the research question. This was often due to a focus on patient meals rather than the food available to hospital employees and visitors. A PRISMA flow diagram [ 15 ] displays the inclusion and exclusion process ( Figure 1 ).

PRISMA 2009 flow diagram [ 15 ], detailing the number of studies included and excluded at each stage of the screening process.

3.1. Participant Characteristics

Fifteen publications reported the number of hospital employees, students or visitors involved in observations or interventions [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], while twelve reported the number of food outlets [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] and ten reported the number of healthcare facilities involved [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Three studies recorded the number of food outlets and survey respondents [ 53 , 54 , 55 ]. In total, the eligible publications reported the involvement of 18,171 participants, 139 food outlets and 529 hospitals and healthcare facilities.

3.2. Countries

In the UK, 5 interventions [ 31 , 34 , 38 , 39 , 40 ], 7 observations [ 17 , 23 , 35 , 37 , 44 , 45 , 51 ] and 1 mixed methods design [ 41 ] were reported; in the USA, 14 interventions [ 16 , 20 , 24 , 25 , 28 , 29 , 30 , 33 , 36 , 42 , 43 , 48 , 53 , 54 , 55 ], 10 observations [ 18 , 19 , 21 , 27 , 32 , 46 , 47 , 49 , 50 , 52 ] and 2 mixed methods studies [ 22 , 26 ] were reported.

3.3. Study Design

Observational studies ( n = 17) employed a range of techniques, such as interviews, focus groups and cohort studies. Of the intervention studies ( n = 20), 8 utilised a randomised controlled trial design [ 16 , 28 , 29 , 31 , 33 , 34 , 38 , 53 ], and 12 utilised quasi-experimental methods [ 20 , 24 , 25 , 30 , 36 , 39 , 40 , 42 , 43 , 48 , 54 , 55 ]; additionally, 3 studies employed mixed methods [ 22 , 26 , 41 ], incorporating a range of techniques, such as conducting interviews and collecting sales figures. The full data extraction can be seen in Table A1 . According to the Quality Criteria Checklist for Primary Research, 11 of the eligible publications met high quality and risk of bias standards [ 16 , 18 , 26 , 27 , 28 , 29 , 31 , 38 , 48 , 49 , 53 ], while 29 were considered neither particularly strong nor particularly weak ( Table A1 ) [ 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 50 , 51 , 52 , 54 , 55 ].

3.4. Observations

Five observational studies explored hospital food outlet adherence to pre-existing standards and guidelines [ 32 , 35 , 37 , 46 , 51 ]. Sustain (2017) found variation in the hospital food environments between 30 hospitals, with around 50% complying with standards listed in the NHS contract. Healthy options were also found to be more prevalent than unhealthy options in vending machines [ 51 ]. Similarly, James et al. (2017) investigated 30 food outlets across two NHS hospitals and their adherence to The National Institute for Health and Care Excellence (NICE) Quality Standard 94. Quality Standard 94 includes three quality statements relating to the availability of healthy options in vending machines (statement 1), nutritional information on menus (statement 2) and prominent display of healthy options (statement 3). Adherence to statements 1 and 2 was poor; only 10% of food products and 53% of drinks available in vending machines were classified as healthy and nutritional information was not available on menus at either hospital. Adherence to statement 3 was mixed, as both healthy and unhealthy options were displayed prominently in food outlets [ 35 ].

In 19 facilities across California, Lawrence et al. (2009) found that 81% of food in vending machines did not adhere to the California state nutrition standards for schools. Carbonated drinks were the most common beverages in vending machines, with advertisements for these beverages being prevalent. At the time of the study, 60% of facilities had already adopted or were beginning to implement nutritional standards for vending machines [ 46 ].

Mohinra et al. (2021) investigated the food environment in a dental hospital and found that beverages met Commissioning for Quality and Innovation (CQUIN) targets for sugar content; however, foods high in fat, salt and sugar were displayed in prominent locations, and unhealthy options were more affordable than healthy options [ 37 ].

Derrick et al. (2015) assessed the nutritional quality of cafeteria meals in relation to LiVe Well Plate guideline adherence. On average, food outlets that adhered to the LiVe Well Plate guideline had significantly higher nutrition composite scores than those which did not, particularly for point-of-purchase options, suggesting healthier food environments [ 32 ].

The diverse nutritional quality of cafeteria meals was also reported by Jaworowska et al. (2018). Variation was identified between different meals in the same outlet and between the same meals at different facilities; the majority of meals were high in saturated fat, while 69% of meat-based dishes and 43% of vegetarian dishes were high in salt content [ 44 ].

Findings were similar within paediatric hospitals or clinics. Across 14 facilities, Lesser et al. (2012) reported that most food outlets offered healthy options and half displayed nutritional information at the point of purchase. However, the majority had high-calorie options positioned close to point-of-purchase and promoting unhealthy options on signs was more common than promoting healthy options. Furthermore, half of the cafeterias had no healthy hot meals [ 47 ]. In vending machines accessible to children, Kibblewhite et al. (2010) found that none of the food-based or mixed food and drink vending machines contained 50% or more healthy food options. Meanwhile, 13% of drinks machines in paediatric clinics and 9% of drinks machines in other areas of the hospital contained 50% or more healthy options. Advertisements for brands associated with unhealthy products were also commonly found on vending machines [ 45 ].

Parental visitors to a paediatric hospital were broadly dissatisfied with the food environment. Food options were considered restrictive, and concerns were raised regarding the quality, freshness and positioning of products. Participants also felt that food available in the hospital food environment contradicted healthy eating messaging on signage [ 23 ].

Interviews, focus groups and surveys were also carried out with hospital employees and non-parental visitors. Bak et al. (2020) reported that nursing students believed that few healthy food options were available in hospitals. The students indicated that subsidising healthy foods could improve the hospital food environment and positively influence eating behaviours among nurses [ 17 ]. Barriers and facilitators to healthy eating were identified via interviews with 17 food service managers, carried out by Lederer et al. (2014). Only four of the respondents reported that their cafeteria followed nutrition standards set by the hospital ( n = 3) or by the American Heart Association and the Academy of Nutrition and Dietetics ( n = 1). The majority of respondents said that consumer-related factors, such as customer satisfaction and demand, were barriers to healthy food implementation [ 21 ]. Consumer satisfaction was also cited as a potential barrier by food service managers in a study by Jilcott Pitts et al. (2016). Other challenges included profit implications and training costs, while potential facilitators of healthy eating included altered positioning of healthy and unhealthy options and signage promoting healthy options [ 19 ]. Furthermore, Liebert et al. (2013) also highlighted profits and resources as potential barriers to implementing nutrition interventions. Despite this, over 80% of respondents were concerned about eating well and stated that they would be more likely to do so if healthy options were cheaper than unhealthy options. Additionally, 73% were in favour of the taxation and subsidisation of products based on nutritional content [ 22 ].

The impact of hospital location or average visitor socioeconomic status on the hospital food environment was also explored. Winston et al. (2013) found no significant relationship between the socioeconomic status of the local area and the nutrition composite score of the hospital [ 52 ]. In contrast, a study by Goldstein et al. (2014) found that physicians seeing mostly patients of higher socioeconomic status were more likely to report high levels of nutritional support compared to those seeing patients of lower socioeconomic status [ 18 ].

3.5. Interventions

Hospital food environment interventions can be grouped into several categories. Studies incorporating interventions from three or more categories are classified as “multi-component”; these studies are grouped and explored separately under the “Multi-Component Interventions” subheading.

3.5.1. Educational

Educational interventions aim to increase consumer knowledge of the nutritional guidelines or the nutritional content of foods. Of the seven educational interventions, four utilised signage or flyers to increase awareness of the nutritional content of products.

Allan and Powel (2020) assessed the impact of point-of-purchase signage on the nutritional quality of purchases and found that signage reduced the calorie content of purchases, reduced sugar content in some circumstances and had no impact on fat content [ 31 ]. Webb et al. (2011) also introduced nutritional labelling on posters or nutritional labelling on posters and a point-of-purchase menu board. More consumers noticed the nutritional information when posters and menu boards were used, compared to only posters. Nutritional labelling on posters and menu boards was also associated with the increased purchase of lower-calorie snacks and side dishes but made no significant difference in the nutritional content of entrée purchases [ 55 ].

When combining signage with traffic light labelling, Sonnenberg et al. (2013) found that nutritional content, taste and price became more important to consumers, while convenience became less important. Participants who were influenced by nutritional information bought more healthy products than those who were not [ 25 ]. Block et al. (2010) introduced signage and flyers about the health implications of regular soft-drink consumption, along with taxation. Education alone had no significant effect on sugar-sweetened soft drink sales. However, education enhanced the effects of taxation, reducing soft drink sales by 10% compared to price increases alone [ 53 ].

Two studies used digital methods to deliver nutritional information [ 16 , 28 ]. Abel et al. (2015) sent texts or emails to participants regarding calorie reference values. Participants who received the information were twice as likely to know reference values compared to a control group, but this did not appear to alter calorie consumption or portion sizes [ 16 ]. Thorndike et al. (2021) used emails (and letters) to provide feedback on food choices. The number of healthy purchases increased while the number of unhealthy purchases decreased. These effects remained significant at a 24-month follow-up, but there was no significant change in weight status [ 28 ].

Another study by Thorndike et al. (2016) used social norm feedback in combination with financial incentives. Social norm feedback alone led to a 1.8% increase in healthy purchases, but this was not statistically significant. Combining social norm feedback with a financial incentive resulted in a 2.2% increase in healthy purchases, and employees rated healthiest at baseline were influenced most greatly by the interventions [ 29 ].

3.5.2. Labelling

Six studies explored the effects of labelling [ 25 , 27 , 30 , 33 , 42 , 54 ]. Elbel et al. (2013) added ‘less healthy’ labels to some items, and this increased purchase of healthier options by 7% [ 33 ]. Sato et al. (2013) added calorie, fat and sodium content information to packaging. A non-significant increase in healthier options sold was observed, along with a significant decrease in the total number of meals sold per day. Despite this, 71% of customers who noticed the intervention reacted positively to it, and 50% claimed that the labels influenced them to purchase a healthier option [ 54 ].

The most common form of labelling was traffic light labelling. Sonnenberg et al. (2013) investigated the impacts of traffic light labelling and nutritional signage on customer food-related attitudes. The intervention increased the importance of health and nutrition to participants, and more participants claimed to use nutritional information when making food choices during the intervention compared to pre-intervention. More healthy options were purchased by those who were influenced by the labels than those who were not [ 25 ].

Traffic light labelling reduced the number of unhealthy purchases in three studies. Whitt et al. (2018) assessed the impact of traffic light labelling on food choices compared to cartoon labelling. Traffic light labelling decreased unhealthy food purchases by 7% from baseline, while cartoon labelling increased the number of unhealthy purchases by 1% from baseline and by 5% from the washout period [ 42 ]. In two studies, Thorndike et al. (2014, 2019) found that traffic light labelling decreased the proportion of red-labelled products purchased [ 30 ], which resulted in fewer calories purchased and potential employee weight loss [ 27 ].

3.5.3. Financial

The effects of financial interventions were primarily investigated via taxation and subsidisation of products. Elbel et al. (2013) found that taxing unhealthy products increased the proportion of healthy purchases by 11.5% from baseline and that this was associated with fewer unhealthy purchases and an increased proportion of healthy beverage purchases [ 33 ]. Similarly, Block et al. (2010) found that increasing the prices of sugar-sweetened soft drinks decreased sales by 26% [ 53 ]. Patsch et al. (2016) utilised taxation and subsidisation and found significant increases in the proportion of healthy alternatives sold along with decreases in the number of traditional, less healthy products sold [ 24 ].

In addition to feedback-based interventions, Thorndike et al. (2016) offered financial incentives for healthy purchases. Feedback plus a financial incentive led to a 2.2% increase in healthy purchases, compared to a 1.8% increase for feedback alone and a 0.1% increase for the control group [ 29 ]. In a second study by Thorndike et al. (2021), the intervention increased the purchase of healthy products by 7.3% and decreased the purchase of unhealthy options by 3.9%. This effect did not lead to significant weight loss in the intervention group [ 28 ].

3.5.4. Choice Architecture

Choice architecture was implemented in several ways; the most prevalent method was altering the proportion of healthy and unhealthy products available to purchase. Three studies focused on products available in vending machines. Griffiths et al. (2020), Grivois-Shah et al. (2018) and Pechey et al. (2019) found an increase in the number of healthy products purchased [ 43 ], a decrease in the amount of calories purchased [ 34 , 38 ] and mixed results regarding the financial impact of the intervention [ 34 , 43 ]. Simpson et al. (2018) conducted a similar study in a hospital shop but found no significant difference in the relative proportion of healthy options sold between pre- and post-intervention sales data [ 40 ].

Thorndike et al. (2014) took a different approach and utilised choice architecture by making healthy options more visible. The impact of choice architecture itself is unknown, as it was only assessed in combination with traffic light labelling. Nevertheless, the overall intervention decreased the proportion of unhealthy product sales by 3% and increased the proportion of healthy product sales by 5% after two years [ 30 ].

Public Health England, as previously known (2018), investigated the impact of altering product positioning in vending machines; this is explored in more depth in the ‘Implementing Standards and Guidelines’ section [ 39 ].

3.5.5. Implementing Standards and Guidelines

Three studies assessed the impacts of supporting the implementation of pre-existing standards for hospital food outlets [ 39 , 41 , 48 ]. Moran et al. (2016) encouraged the implementation of the Healthy Hospitals Food Initiative and improved adherence to the programme. The nutritional quality of the hospital food environment also improved [ 48 ].

Stead et al. (2020) focused on the implementation of Healthcare Retail Standards in hospital shops. Compliance with these standards had no effect on the number of fruit products available but decreased the number of chocolate-based options and the number of promotions for these products. The standards also reduced meal-deal sales [ 41 ].

Public Health England (2018) altered the content of vending machines in line with Government Buying Standards for Food and Catering. In drinks machines, these changes decreased calorie and sugar content of purchases and increased proportion of ‘diet’ beverages sold. In food machines, sales of crisps decreased while sales of confectionary and dried fruit and nut products increased [ 39 ].

3.5.6. Multi-Component Interventions

Stites et al. (2015) carried out a study involving choice architecture, financial incentives and educational components. Hospital employees were taught mindfulness techniques, encouraged to pre-order meals and, for part of the intervention, provided with vouchers for the cafeteria. This intervention resulted in lower calorie and fat purchases compared to a control group, with and without the vouchers. Despite the dietary changes, weight loss was not significant among the intervention group [ 26 ].

LaCaille et al. (2016) incorporated signage, traffic light labelling and choice architecture into a nutrition intervention, alongside encouraging physical activity participation. The control group experienced a greater average reduction in waist circumference than the intervention group after six months (but not after 12 months). As well as this, the intervention group experienced a significant decrease in fruit, vegetable and fibre intake over the course of the study. Consumption of foods high in sugar and fat also decreased [ 20 ].

Mazza et al. (2017) also reported mixed results. Financial interventions and traffic light labelling were combined with health and social norm messaging and choice architecture. Financial interventions and traffic light labelling increased healthy beverage purchases by 2.9%. The addition of health and social norm messaging and grouping items into nutritional categories further increased healthy beverage purchases. Healthy crisp sales increased by 5.4% when traffic light labelling was introduced and by 6% when health messaging was implemented. However, healthy crisp sales decreased by 5.9% when the price of water was reduced, suggesting that this financial intervention nullified the beneficial effects of traffic light labelling [ 36 ].

4. Discussion

The observational studies carried out across the UK and USA suggest that the quality of the wider food environment is diverse. Compliance with pre-existing standards and guidelines is varied [ 32 , 35 , 37 , 46 , 51 ] and the nutritional quality of cafeteria meals differs between meals and facilities [ 44 , 47 ]. A lack of healthy food options was reported in vending machines, while the availability of healthy beverage options was slightly greater [ 45 ]. Hospital visitors and employees reported concerns regarding the quality, freshness and positioning of healthy and unhealthy options [ 23 ] and believed there was a lack of healthy options available [ 17 ]. Barriers to the implementation of healthy eating initiatives were also identified, including customer satisfaction [ 19 , 21 ] and profit implications [ 19 , 22 ], although participants were in favour of a financial intervention to encourage healthy food and beverage choices [ 22 ]. Findings relating to the impact of socioeconomic status on the hospital food environment are inconsistent [ 18 , 52 ].

Utilising signage and flyers is associated with the reduced calorie content of purchases [ 31 ], and displaying nutritional information on menu boards and posters increases the purchase of low-calorie options compared with using posters alone [ 55 ]. Digital methods of communicating nutritional information can increase knowledge of reference values [ 16 ] and increase purchase frequency of healthy options whilst decreasing purchase frequency of unhealthy options [ 28 ], but effects on calorie consumption are contested [ 16 , 28 ] and these interventions have no significant impact on weight-related outcomes [ 28 ]. Moreover, educational interventions can be successfully incorporated with traffic light labelling [ 25 ] and financial interventions [ 29 , 53 ].

Adding simple labels to products, marking them as ‘less healthy’ or giving some nutritional information, is associated with an increase in the number of healthy purchases [ 33 ] but also with decreased total purchases per day [ 54 ]. Nevertheless, labelling interventions are viewed positively by consumers [ 54 ]. Traffic light labelling has been shown to increase the importance of nutrition to participants [ 25 ], increase the number of healthy purchases [ 25 ], reduce the number of unhealthy purchases [ 30 , 42 ] and reduce the calorie content of purchases [ 27 ]. It was predicted that this could lead to consumer weight loss, provided that no other lifestyle alterations occurred [ 27 ].

Taxation on unhealthy products or subsidisation of healthy products was found to be associated with an increased proportion of healthy purchases [ 24 , 33 ] and a decreased number of sugar-sweetened soft drink purchases [ 53 ]. Financial incentives were also found to effectively increase healthy purchases and decrease unhealthy purchases [ 28 , 29 ], but no impact on weight-related outcomes was identified [ 28 ].

Altering the proportion of healthy options available to purchase from vending machines was found to increase healthy purchases [ 43 ] and decrease the calorific content of purchases [ 34 , 38 ]. This type of intervention may have undesirable financial outcomes for food outlets, but this remains unclear [ 34 , 43 ].

One study found no change in the proportion of healthy options sold before and after a choice architecture intervention in a hospital shop [ 40 ]. However, another study reported that displaying healthy options more prominently reduced unhealthy purchases and increased healthy purchases when combined with traffic light labelling [ 30 ]. Choice architecture interventions also increased ‘diet’ beverage sales and reduced the total sugar content of purchases [ 39 ].

Encouraging implementation of pre-existing standards and guidelines is associated with an overall improvement in the hospital food environment [ 48 ] and decreased availability of unhealthy products [ 41 ]. In beverage vending machines, implementing governmental standards increased the proportion of ‘diet’ beverage sales and reduced the sugar and calorie content of purchases [ 39 ]. However, adherence to these standards has also been shown to reduce sales of meal deals [ 41 ] and increase sales of confectionary [ 39 ].

Multi-component interventions have been carried out with a range of study designs. These interventions have been shown to reduce calorie and fat content of purchases [ 26 ], reduce consumption of foods high in sugar and fat [ 20 ], increase healthy beverage purchases [ 36 ] and increase the purchase of healthy snack options [ 36 ]. However, certain multi-component interventions have also resulted in decreased fruit, vegetable and fibre intake [ 20 ] and decreased sales of healthy snack options [ 36 ]. These interventions were not associated with significant weight loss [ 20 , 26 ].

This review has several strengths. Study screening was independently conducted by two researchers, and the process was blinded to reduce the impact of researcher bias. Additionally, conducting a narrative synthesis allowed the integration of material that would have been incomparable using quantitative synthesis. Therefore, the heterogeneous data have been compiled into a useful summary to inform further research. However, the heterogeneity of study designs and outcome measures restricts the use of quantitative synthesis and meta-analysis to summarise findings. Additionally, many studies involve multiple interventions, making it difficult to determine the impact of each intervention on outcomes. This limits the strength of recommendations.

Another limitation of this review is our pragmatic decision to restrict the search to studies carried out in the UK and USA. This decision was taken because the number of studies carried out in the UK and USA allowed for an in-depth analysis of all relevant literature within the available time frame. It should be noted that the exclusion of studies from other countries limits the wider generalisability of findings.

Furthermore, some studies took place several years ago, meaning that information about the ‘current hospital food environment’ may no longer be valid. One observation found that 60% of facilities were beginning to adopt vending machine nutrition standards in 2009 [ 46 ], so vending machine nutritional quality could have since changed. Nevertheless, poor nutritional quality in vending machines was reported in 2017 [ 35 ], indicating that concerns about healthy vending machine options may remain relevant.

The majority of interventions discussed in this review can be used to improve nutrition awareness, eating behaviour or the overall hospital food environment. Studies that surveyed hospital employees or visitors on their acceptance of these interventions reported that over 70% of responses were positive [ 22 , 54 ].

Some studies show that combining multiple interventions can improve the nutritional quality of food purchases. However, multi-component interventions may have the potential to lead to detrimental impacts, such as reduced fruit and vegetable consumption and reduced sales of healthy snacks [ 20 , 36 ]. Consequently, more robust study designs are required to identify the most effective intervention combinations in multi-component studies.

Further interventions are needed in the UK to investigate the most effective methods of improving the nutritional quality of employee and visitor diets. Research into the associations between food environment and food intake in a variety of settings, other than hospitals, would also be valuable. Moreover, some interventions included in this review would benefit from being replicated to generate an evidence base with consistent outcome measures. This would produce more homogenous data, facilitating quantitative synthesis and meta-analysis. A more precise estimated effect size would be generated, thereby strengthening practice and policy recommendations.

Timely implementation of public health interventions, such as altering food environments and encouraging healthier diets, is especially pertinent in the wake of the COVID-19 pandemic. Dietary patterns high in fat, salt and sugar contribute to the prevalence of obesity and type II diabetes, which increase the risk of severe COVID-19 outcomes [ 56 ]. By altering the hospital food environment, healthy food and beverages could be made the easiest option to purchase, thereby improving dietary quality and potentially reducing the risk of ill-health among hospital employees and visitors. Food environment interventions could also reduce the discrepancy between health messaging and poor hospital food environments, ensuring that hospitals act as positive role models for healthy lifestyle behaviours.

5. Conclusions

In conclusion, the quality of the hospital food environment varies within and between facilities. Hospital visitors and employees are generally receptive to food environment interventions and a variety of designs can be used to improve the hospital food environment and increase the proportion of healthy purchases. However, multi-component interventions can have neutral or detrimental effects on participant eating behaviours depending on the design. Therefore, further research that also encompasses studies beyond the UK and USA is required to determine the most effective combinations within multi-component interventions.

Acknowledgments

Guidance on database searching was provided by Aimee Cook, a Medical Sciences Librarian at Newcastle University Library.

Appendix A.1. Scopus Search Criteria

Hospital AND (food OR nutrition*) AND (“convenience food” OR “fast food” OR “healthy food” OR snack OR fat OR salt OR sugar OR calorie OR beverage) AND (catering OR outlet OR vending AND machine OR cafe* OR restaurant OR canteen OR “hospital shop” OR “hospital store” OR “gift shop”) AND (policy OR “food preference” OR “consumer attitudes” OR choice OR decision OR “health promotion” OR diet OR healthy OR options) AND (LIMIT-TO (AFFILCOUNTRY, “United States”) OR LIMIT-TO (AFFILCOUNTRY, “United Kingdom”)) AND (LIMIT-TO (LANGUAGE, “English”)).

Appendix A.2. Embase, Medline and APA PsycInfo Controlled Vocabulary Search

Hospital AND (Food OR Food product OR Convenience food OR Packaged food OR Fat OR Dietary fat OR Fat intake OR Dietary fat OR Sodium chloride OR Salt intake OR Dietary salt OR Sugar OR Dietary sugar OR Sugar intake OR Beverage OR Sugar-sweetened beverage OR Calorie) AND (Catering service OR Food outlet OR Food service OR Vending machine OR Automatic food dispensers OR Commercial food OR Cafeteria OR Cafeteria diet OR Restaurant OR Canteen OR Shop OR Store OR Retail OR Commerce) AND (Nutrition policy OR Healthcare policy OR Government policy making OR Public health OR Healthcare planning OR Health policy OR Nutrition OR Nutritional value OR Nutritive value OR Food preference OR Feeding behaviour OR Consumer attitudes OR Consumer satisfaction OR Eating behaviour OR Choice OR Decision making OR Health promotion OR Food availability OR Diet OR Healthy diet OR Food options).

Full data extraction for n = 40 studies, including quality assessment and risk of bias analysis, carried out using the Quality Criteria Checklist for Primary Research [ 14 ].

+: The report has met targets for quality (such as generalisability, inclusion and exclusion and data collection and analysis) and risk of bias. ∅: Report quality is neither particularly strong nor particularly weak. --: Targets for quality and bias have not been met.

Author Contributions

Author contributions to this review are as follows: Conceptualisation, L.M., S.S. and S.R.; methodology, L.M., S.S. and S.R.; validation, L.M., S.S. and S.R.; investigation, S.R.; resources, S.R.; data curation, S.R. and L.M.; writing—original draft preparation, S.R.; writing—review and editing, S.R., L.M. and S.S; visualisation, S.R.; supervision, L.M. and S.S.; project administration, L.M. and S.S.; funding acquisition, L.M. and S.S. All authors have read and agreed to the published version of the manuscript.

This research received no external funding. We are grateful to Newcastle University for supporting this work.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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-->   UUEE MOSCOW SHEREMETYEVO X V2 DEMO is a new scenery of UUEE Sheremetyevo airport in Moscow, Russia, fully compatible with FSX/FSX:SE/P3Dv1/P3Dv2/P3Dv3/P3Dv4. This product is a fully functional DEMO version of the commercial payware product. Most objects are modelled as in the full version but covered with low resolution textures, non-animated jetways and generally much less details. Using this free demo ensures no problems with online (VATSIM, IVAO, multiplayer etc.) flying in case some users use the payware scenery and some don't. Sheremetyevo International Airport (SVO/UUEE) is an international airport located in Khimki, Moscow Oblast.Sheremetyevo serves as the main hub for Russian flag carrier Aeroflot and its branch Rossiya Airlines, Nordwind Airlines or Ural Airlines. The product is equipped with an automatic installer, which means that the scenery will be automatically added to the Flight Simulator Scenery Library. Please uninstall all previous versions of this airport you may have installed before. Please also make sure that no duplicated AFCAD files are installed. Enjoy your virtual flying with Drzewiecki Design! AVSIM Library System Version 2.00 -- 2004-May-01 © 2001-2024 AVSIM Online All Rights Reserved 313 COMMENTS PDF A Business Model Plan for Providing Food for Hospital Patients 3. The Delivery Network: At initial stages, small delivery network with around 4 backup. Rather than increasing the men, we would like to invest more on proper food temperature control mechanism. using the latest version of vehicles gives good fuel economy, thus saving. 4. Sterilized packaging: The packaging. Hospitals take a fresh look on cafeteria design Hospitals take a fresh look on cafeteria design 8 Ways to Improve Hospital Foodservice for Patients 8 Ways to Improve Hospital Foodservice for Patients Healthcare / Hospital Cafeteria Design LET'S FIND YOUR SOLUTION. Rapids Contract serves the United States with locations in Iowa, Minnesota, and Missouri! SUBMIT INQUIRY. TALK TO AN EXPERT | 866-875-4241. Rapids Contract offers comprehensive design for healthcare and hospital cafeterias, kitchens, serving lines, and other food service areas. How Hospital Food Service Can Improve Patient Experiences And Outcomes It offers a comforting choice. A menu is much easier to understand than treatment options, and ordering food is the chance to make a positive decision for yourself. Delivering on that promise of a positive outcome is the goal of great food service. Food is fundamental to the human experience, and that's doubly true for the patient experience ... Canteen-Proposal Canteen-proposal - Datta Tiffins - Free download as Word Doc (.doc), PDF File (.pdf), Text File (.txt) or read online for free. The document is a proposal from Datta Tiffins to provide canteen services at M.M. Joshi Eye Hospital. It outlines Datta Tiffins' commitment to providing hygienic and healthy food options. It details the services offered such as meals, snacks and beverages. 7 Ways to Increase Sales in Your Hospital Cafeteria 7 Ways to Increase Sales in Your Hospital Cafeteria Good Taste: Designing Healthcare Dining Spaces Good Taste: Designing Healthcare Dining Spaces Hospital Kitchen Design For Optimal Foodservice Modern hospital kitchen design chooses to emphasize wellness, hope, and fresh, local ingredients. Steam trays and cafeteria-style dining are things of the past. Appliances like microgreen growers allow kitchens to have access to fresh greens year-round, regardless of the climate or season. Since hospital kitchens serve the local community as ... Room Service Food Delivery Models for Hospital In-Patients: A Review of Context and Policy Issues. Hospital food services play a critical role in the management of all hospitalized patients. Optimal nutritional intake is considered crucial for both patient health and patient satisfaction with their hospital experience. 1, 2 Inadequate food intake throughout the course of admission may result in nutritional status deterioration, 3 which is associated with prolonged ... (PDF) Quality and standards of hospital food service; a critical Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and ... How to Write a Business Plan for a Hospital: Proven Steps 2. Craft a compelling funding proposal: Develop a persuasive funding proposal that clearly outlines your hospital's mission, goals, financial needs, and potential benefits for investors or partners. Emphasize the unique value proposition and the impact your hospital can make in the healthcare industry. 3. Hospital Canteen SOP Template That's where ClickUp's Hospital Canteen SOP Template comes in! With this template, you can streamline your Standard Operating Procedures (SOPs) for the hospital canteen, ensuring that your team: Follows strict hygiene and safety protocols to prevent foodborne illnesses. Maintains proper food storage, handling, and preparation techniques. How to Write an Effective Business Plan in Medicine How to Write an Effective Business Plan in Medicine Healthcare Serving our Healthcare Providers. We service America's hospital systems, doctor offices, and healthcare facilities. For these teams and visitors, taking care of the patient is their top priority. Often, they keep going and forget to grab a bite to eat. By partnering with us, we'll help make it easy for these caregivers to take a break and ... What are the main points of the design plan of the hospital canteen 3. Standards for kitchen design of hospital canteens Hospital canteens have very strict requirements on the place, because the hospital is a very clean place with higher sanitation standards than other places. 1. Do not choose areas prone to pollution in dry terrain, water supply and drainage conditions and power supply areas. Availability of Healthy Food and Beverages in Hospital Outlets and 1. Introduction. Overweight and obesity are extremely prevalent across the UK and USA. In 2018, it was estimated that 67% of men and 60% of women in the UK had overweight or obesity [], along with 71.6% of American adults in 2015/2016 [].A high body mass index (BMI) is linked to a range of non-communicable diseases, such as hypertension, type 2 diabetes and coronary heart disease [], which has ... Canteen Proposal Canteen Proposal | PDF | Cafeteria | Tableware Business-Plan-For Canteen Inside Campus Business-Plan-For Canteen Inside Campus - Free download as Word Doc (.doc), PDF File (.pdf), Text File (.txt) or read online for free. This document outlines a business plan for a startup called Food Arcade, which will be an arcade-themed food establishment. The summary includes: 1) Food Arcade aims to be a unique dining experience that combines video games and classic arcade games with ... Dolgoprudny Map Dolgoprudny is a town in Moscow Oblast, Russia, located about 20 kilometers north of Moscow city center. The town's name is derived from Russian "Долгий пруд" —a long and narrow pond situated in the northeastern part of the town. Photo: Георгий Долгопский, CC BY-SA 4.0. Ukraine is facing shortages in its brave fight ... Dolgoprudny, Moscow Oblast, Russia Dolgoprudny Geographical coordinates: Latitude: 55.9333, Longitude: 37.5 55° 55′ 60″ North, 37° 30′ 0″ East Dolgoprudny Area: 2,070 hectares 20.70 km² (7.99 sq mi): Dolgoprudny Altitude: 183 m (600 ft) Dolgoprudny Climate: Humid continental climate (Köppen climate classification: Dfb) Contacts Contacts Warehouse and Оffice. Industrial Park Sheremetyevo. 141400, Moscow Oblast, Khimki city, Klyazma area, 1g. Phone: +7 (495) 6519231 Fax: +7 (495) 6519232 AVSIM Library Sheremetyevo International Airport (SVO/UUEE) is an international airport located in Khimki, Moscow Oblast.Sheremetyevo serves as the main hub for Russian flag carrier Aeroflot and its branch Rossiya Airlines, Nordwind Airlines or Ural Airlines. The product is equipped with an automatic installer, which means that the scenery will be ... assignment essay homework paper phd report resume review speech thesis