Applying Systems Thinking to Improve a Hospital Food Retail Environment.

Objective: To identify factors influencing the availability and sales of healthy food and drinks in a café located in a hospital setting in a rural area.

Methods: Three online and 1 in-person group model building workshops were conducted with hospital staff members to develop a causal loop diagram.

Results: Four areas in the causal loop diagram were identified, 5 teams were created to implement 15 identified action ideas, and an action registry was created to track their progress. By May 2023, 4 actions were active, 6 inactive, 4 completed, and 1 abandoned.

Conclusions And Implications: The group model building process identified factors and actions to improve the healthiness of the hospital's café and motivated staff members to act for change. However, progress was limited by staff turnover, recruitment, and inadequate participation from decision-makers. Better leadership and support by senior management can ensure that long-term objectives are achieved and healthier hospital food environments are sustained.