Modelling six sustainable development transformations in Australia and their accelerators, impediments, enablers, and interlinkages.

There is an urgent need to accelerate progress on the Sustainable Development Goals (SDGs) and recent research has identified six critical transformations. It is important to demonstrate how these transformations could be practically accelerated in a national context and what their combined effects would be. Here we bridge national systems modelling with transformation storylines to provide an analysis of a Six Transformations Pathway for Australia. We explore important policies to accelerate progress, synergies and trade-offs, and conditions that determine policy success. We find that implementing policy packages to accelerate each transformation would boost performance on the SDGs by 2030 (+23% above the baseline). Policymakers can maximize transformation synergies through investments in energy decarbonization, resilience, social protection, and sustainable food systems, while managing trade-offs for income and employment. To overcome resistance to transformations, ambitious policy action will need to be underpinned by technological, social, and political enabling conditions.

The role of policy in supporting environmentally sustainable foodservice in healthcare: lessons from exemplar hospitals.

Background: Foodservice in hospitals contributes to the environmental footprint of healthcare delivery. There is little known about the role of policy in supporting environmentally sustainable foodservices. The aim of the study was to explore policy in exemplar environmentally sustainable hospital foodservices from the perspective of hospital staff, toward what makes a policy effective, the limitations of policy, and the influential levels and types of policy. Methods: A generic qualitative inquiry approach was utilized. Staff involved in foodservices were interviewed about the role of policy during 2020-2021 from 14 hospitals across nine countries. Data were analyzed using framework and thematic analysis. Results: Policies spanned across high level policies at the level of the healthcare organization, local hospital procedures and protocols, as well as public policy from local, state/provincial and national government. Internal organizational policy was used to embed practices within the organization in the long term and help to build a shared vision and goal where public policy had lacked guidance. The creation, content and methods of communication and creating accountability made internal organizational policy successful. Public policy was most effective when it was mandatory, had clearly defined targets and funding to assist implementation. These exemplar hospitals also demonstrated attributes of policy entrepreneurs by engaging with policy makers to share their stories and lobby government for policy change. Discussion: Policy from within the healthcare organization is an important mechanism for enabling hospitals to deliver and maintain environmentally sustainable foodservice. Public policy must be designed considering the unique implementation challenges hospitals face to ensure they are successful.

Unlocking and accelerating transformations to the SDGs: a review of existing knowledge.

As we cross the 2030 deadline to achieve the Sustainable Development Goals (SDGs), there is a growing sense of urgency around the need to accelerate the necessary transformations. These encompass a broad range of systems and require fundamental changes in system goals and design. In this paper, we undertake a narrative review of the literature relating to the acceleration of transformations and offer a framework for unlocking and accelerating transformations to the SDGs. While there is no blueprint for acceleration, there is an expanding knowledge base on important dynamics, impediments and enabling conditions across diverse literatures which can help to inform strategic interventions by actors. The emerging literature on positive tipping points and deep leverage points identifies opportunities to rewire systems design so that important system feedbacks create the conditions for acceleration. Transformation takes time and actors will need to build momentum to reorient systems around new goals, informed by knowledge of common policy, technology and behavioural feedbacks that govern system dynamics. Where resistance is strong, actors can seek to augment system design in ways that weaken balancing feedbacks that stabilise existing system configurations and strengthen reinforcing feedbacks that promote emerging system configurations oriented towards the SDGs. Well-designed and sequenced interventions can promote innovation and behaviour change and build and maintain political support. This can build critical enabling conditions and push systems towards large-scale tipping points, paving the way for decisive policy action that is crucial for triggering acceleration. We conclude by highlighting gaps and priorities for further research.

Harnessing the pillars of institutions to drive environmentally sustainable hospital foodservices.

Background: The cultural-cognitive, normative and regulative pillars of institutions influence the ability of hospitals to change how they function at an organizational and operational level. As more hospitals and their foodservices instigate changes to address their environmental footprint and impact on food systems, they move through the "sustainability phase model" from no response through to high level action and leadership. The aim of this study was to describe and compare the pillars of institutions between hospitals in different stages of achieving environmentally sustainable foodservices (business-as-usual vs. exemplar hospitals). Methods: For this qualitative inquiry study, interviews were conducted with 33 hospital staff from 3 business-as-usual hospitals in Melbourne, Australia and 21 hospital staff from 14 exemplar hospitals across 9 countries. Participants were asked questions about their perspectives on environmental sustainability in foodservices and the barriers, enablers and drivers they experienced. Each data set was analyzed thematically and then compared. Findings: There was a clear and distinct difference in responses and behaviors within each pillar between the exemplar and business-as-usual hospitals. The cultural-cognitive pillar identified a similarity in personal belief in the importance of addressing environmental impacts of foodservices, but difference in how staff saw and acted on their responsibility to drive change. The normative pillar uncovered a supportive culture that encouraged change in exemplar hospitals whilst business-as-usual hospital staff felt disheartened by the difficult processes and lack of support. The regulative pillar reflected business-as-usual hospital staff feeling restricted by government policy vs. exemplar hospital participants who were motivated to internalize government policy in different ways and work with other hospitals to advocate for better policy. Interpretation: These findings highlight strategies related to each of the three pillars of institutions that can be used to drive effective, sustainable long term change within hospitals. This includes staff education and training, revisiting hospital culture and values around environmental sustainability, embedding sustainable foodservices in internal policies, and a comprehensive government policy approach to sustainable healthcare.

The Drivers of Environmentally Sustainable Hospital Foodservices.

Background: Hospital foodservices have the potential to positively contribute to the local food system and planetary healthcare. Understanding the factors contributing to the success of "exemplar hospitals" with environmentally sustainable foodservices gives an opportunity to reimagine foodservices and guide strategic planning. The aim of this study was to identify the drivers of sustainable hospital foodservices. Methods: For this qualitative multiple case study, purposive sampling was used to identify exemplar hospitals internationally. Semi-structured interviews were conducted with staff with extensive knowledge of their foodservices to explore the drivers of sustainable practices. Relevant documents provided background on the case. These documents and interview data were analyzed using the framework and thematic analysis. Findings: There were 21 participants from 14 hospitals recruited across nine countries. Sustainable foodservice practices included local and organic food procurement, gardens onsite, vegetarian menus, re-serving unopened portion-controlled items, traditional foods, and food waste composting. Four themes were identified: initiating drivers, supporting enablers, challenges, and influence. Initiating drivers that "sparked" sustainable practices included the values of individuals or the hospital (e.g., community, environmental, or religious values), logical solutions to a problem, or government requirements. Enablers that facilitated success included motivated individuals, dedicated personnel, supportive leadership, internal protocols, and perceived benefits. External enablers included being part of member organizations, government requirements, and learning from other hospitals. Exemplar hospitals had broader influence, including educating the hospital community, supporting other hospitals, and influencing government policies/targets. Common challenges were staff resistance and inadequate policy directive. Interpretation: These findings examine the successful international cases of sustainable hospital foodservices to provide a global overview to assist with strategic planning both within hospitals and within governing bodies.

Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review.

BACKGROUND: Hospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal). OBJECTIVE: To systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice. METHODS: Eight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively. RESULTS: From 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients' intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this. CONCLUSION: The literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.

Judgment under uncertainty; a probabilistic evaluation framework for decision-making about sanitation systems in low-income countries.

This paper introduces the probabilistic evaluation framework, to enable transparent and objective decision-making in technology selection for sanitation solutions in low-income countries. The probabilistic framework recognizes the often poor quality of the available data for evaluations. Within this framework, the evaluations will be done based on the probabilities that the expected outcomes occur in practice, considering the uncertainties in evaluation parameters. Consequently, the outcome of evaluations will not be single point estimates; but there exists a range of possible outcomes. A first trial application of this framework for evaluation of sanitation options in the Nyalenda settlement in Kisumu, Kenya, showed how the range of values that an evaluation parameter may obtain in practice would influence the evaluation outcomes. In addition, as the probabilistic evaluation requires various site-specific data, sensitivity analysis was performed to determine the influence of each data set quality on the evaluation outcomes. Based on that, data collection activities could be (re)directed, in a trade-off between the required investments in those activities and the resolution of the decisions that are to be made.