Snacking made simple? Exploring the policy and organizational practices of continuous quality improvement for health promotion in healthcare

Abstract

The goal of this dissertation is to advance the understanding of healthcare continuous quality improvement (CQI) practices for health promotion at policy and organizational levels. This qualitative study (phenomenology) explored the experiences of Nutrition and Food Services practitioners at Nova Scotia Health. Healthy eating policies contain benchmarks that guide implementation and CQI but focus on nutritional benchmarks and, to a lesser extent, promotions and fundraising. Practitioners’ perspectives on CQI include broad perspectives for health promotion, however, monitoring was lacking for food environment benchmarks. Participants employed PDSA cycles to demonstrate the potential benefits of health promotion and prove themselves to others, identifying facilitators (e.g., policy), and barriers to CQI (e.g., nutrient criteria). Leadership prioritized the availability of healthy foods, while staff incorporated local knowledge from informal and formal networks. In conclusion, policies guide benchmark monitoring and investments in data collection that can reinforce healthcare as a health-promoting setting, and sub-setting (retail).