Exploring the Practices of Healthcare Practitioners During the Implementation of a Healthy Eating Policy

Health promotion policy is an effective way to improve population health and reduce the burden of chronic disease, yet how implementation of health promotion at policy levels occurs within healthcare remains unclear. Healthcare organizations, on the one hand, aim to improve population health and 'upstream' health determinants through the Quintuple Aim, but, on the other, are complex and dynamic organizations, with a particular emphasis on downstream clinical care services. Many types of practitioners interpret health promotion policies within the healthcare setting and must implement them in their everyday work: policy implementation as an everyday occurrence. Healthy eating policies focused on creating supportive food environments (e.g., cafeterias, cafes) are being adopted by healthcare organizations as a way to improve diets and reduce the burden of chronic disease. An examination of healthy eating policy implementation is essential to better understand how health promotion is integrated into healthcare organizations. This qualitative phenomenological study uses organizational social theory on street-level bureaucrats to interpret the implementation of a healthy eating policy within healthcare food retail services and the relationships between street-level bureaucrats. We conducted 12 in-depth policy key informant interviews and analysed findings using directed content analysis. The findings showed a shift in priorities from leadership to allocate resources for health promotion tasks to make food more accessible and available to staff. Participants considered context as they implemented the policy using local knowledge arising from informal and formal networks and identified other opportunities to influence healthy eating. Studying the actions of healthcare practitioners in everyday policymaking provides essential context and insight into how policy implementation unfolds. Although standards for health promotion are lacking, practitioners can engage in quality improvement initiatives to challenge the status quo and improve food environments.