By National Center for Chronic Disease Prevention and Health Promotion

Division of Nutrition, Physical Activity, and Obesity

The Centers For Disease Control and Prevention (CDC)

A Step By  Step Approach To Implementing Policy and Environment Changes.

Improvements in hospital food and beverage policy and environments can be made by using a planned series of measures, including engaging stakeholders, forming a team, assessing current policies and conditions, assessing needs and identifying goals, developing an implementation and maintenance plan, and then evaluating the effects of those changes. This section outlines this series of steps designed to help implement change. These steps are similar to those proposed in other The Centers for Disease Control and Prevention (CDC) documents and are best incrementally. For example, begin by engaging stakeholders and partners before forming a team or conducting initial assessments.

Step 1. Engage Stakeholders and Partners

Engaging stakeholders in improving environments is a critical first step. These stakeholders may include, but are not limited to, the following:

  1. Hospital leadership team and executives.
  2. Human resources.
  3. Food and nutrition services personnel.
  4. Clinical staff.
  5. Support services staff (e.g., clerical, environmental, engineering) representatives.
  6. Community coalitions are working on nutrition, wellness, or obesity.
  7. Food, beverage, and vending purchasers or contractors.

Stakeholders provide critical input into the development of your program and efforts to promote healthier choices. They are also essential to (a) leverage resources for future change, and (b) disseminate and share with other groups who can promote your e orts. Stakeholders play a significant role in the evaluation of your work. By engaging interested parties and finding partners across a spectrum of settings and experiences, you can begin the process of policy and environmental change.

Step 2. Form A Team

The team members should share information among one another, and report developments to their parent organizations. Team members also serve other important roles. For example, champions can gather support from staff; human resources, or executive leaders who can leverage their organizational resources to implement change; and members who have the capacity can help in disseminating information.


Step 3. Conduct A Policy and Environment Assessment.

To understand what healthy options are available in your hospital’s food, beverage, and physical activity environments, you will need to conduct an environmental assessment.  When deciding which conditions to assess, it may be important to consider which venues have the most impact on employee or visitor health. Once your team has conducted an environmental assessment, you will need to review the results to identify where improvements can be made. You can then review your hospital’s food, beverage, and physical activity policies. It will assist in determining where policies have been adequately implemented and how changes may be able to improve healthier food, beverage, and physical activity environments and options.


Step 4. Assess Needs, and Identify Goals.

Once you have documented the policies and environments in your hospital, you can use that information to complete a needs assessment. Each hospital will be unique in its spectrum of opportunities and barriers to changing the food, beverage, and physical activity environments. The members of the team formed in Step 2 can use information gathered from the policy and environment scans as part of a needs assessment.

Assessing the immediate requirements of the hospital staff is important. Identifying what the staff would like to see improved, and implementing those changes first, may build rapport with staff and result in sustained buy-in for future e orts to be achieved. A well-conducted needs assessment can lay the groundwork for an efficient environment change e ort and identification of goals for immediate action. Also, you should gather the input of hospital visitors and nearby community members because they often play important roles in supporting the hospital’s e orts to promote health. Anonymous surveys can collect input from these groups. After gathering information from staff, visitors, and the hospital community as a whole, the team and key stakeholders can identify goals they would like to achieve in the future.


Step 5. Develop Implementation and Maintenance Plans.

The implementation plan should identify specific activities that your team needs to accomplish to meet your stated goals. These activities should align with the short, intermediate, and long-term outcomes that you have chosen to your team. For each of these activities, you should determine the following: a timeline, the accountable person or group for that activity identified, a list of partners, a measure that will help determine whether you are making progress toward your goal, and action steps, including resource identification, that need to be taken to fulfill the activity. Suggestions for developing implementation plans and templates are available online. This process will help you and your team develop a logic model, which, in conjunction with your implementation plan, will allow you to track and monitor progress, implementation fidelity, and the accomplishment of outcomes.


Step 6. Evaluation

  1. Engage your team in designing the assessment of your e ort to improve the hospital’s food, beverage, and physical activity environments.
  2. Describe the effort to improve the hospital food, beverage, and physical activity environments in enough detail that anyone can understand your specific goals and strategies.
  3. Focus the evaluation by using the following important considerations with your team, stakeholders, and partners: what is the purpose of the assessment?; what are the evaluation questions?; how do the assessment issues related to the program outcomes?
  4. Identifying and using several different sources of information will provide the most accurate view of the project’s success and shortcomings.
  5. Analyze the data and evidence you have gathered.
  6. Efforts must be made so that.
  7. The evaluation findings are disseminated effectively to all intended audiences.

oleh. dr Maria Ulfa.,MMR