Experimenting at the frontiers of food and health: the Nourish journey so far

By: Beth Hunter

A little over a year ago, 25 Nourish Innovators from Canadian health care organizations from coast to coast to coast, gathered near a frozen lake in the Laurentians, kicking off our collective journey to change the role of food in health care. The Innovators are dieticians, food service managers, procurement directors, community food managers and others who make decisions about food every day in hospitals, long term care centres and community health centres across Canada. It has been a year of growth and change for Nourish with our Innovators and partners filled with joys and trials, experiments and detours, roadblocks and progress. We take a moment here to look both back over the past year and ahead to the next.

The Nourish Innovators have been actively engaging in the work of bringing food to a more central place in health care in exciting and diverse ways: growing fields of maize, planting gardens and setting up beehives; changing procurement policies and working closely with distributors and food service companies; developing new purchasing relationships with local farmers, fishers and First Nations entrepreneurs; aligning food service more closely with the needs of patients and residents; forging ties with government, and more.

The conversations are not always easy:  the role of their institutions in moving indigenous reconciliation forward; the apparent tension between comfort food and healthy food; the contradictions between local and sustainable menu choices.

One of the most generative activities we undertook this year was launching five collaborative projects being led by Nourish Innovators, to address some of the key barriers and to activate points of leverage in both food and health systems. The project development process was a dynamic, iterative one; an experiment in remote, virtual collaboration. It started with Innovators generating fourteen project ideas, of which seven were developed and five pitched. All of the innovators, plus Nourish, advisors and mentors provided feedback which  led to a refinement of project ideas and a joint agreement for allocation of $100,000 of available funding between the five projects.

Several of the collaborative projects are focused on informing and empowering decision-makers at healthcare facilities around specific issues:

Difficult conversations and clearer actions

The first year of Nourish has mainly focused on developing and stewarding the Innovator leadership program. Building demand (the biggest green circle in the change strategy diagram) by supporting these changemakers is of central importance. This happens through workshops, webinars, coaching, peer-learning groups, many conversations and meetings. The conversations are not always easy:  the role of their institutions in moving indigenous reconciliation forward; the apparent tension between comfort food and healthy food; the contradictions between local and sustainable menu choices. But our conversations deepen our understanding and lead to stronger, richer action.

Growing supply is the focus of many of the collaborative projects to find tools and strategies to increase the amount of local, sustainable, delicious, and traditional foods. This builds on earlier institutional food work of Food Secure Canada and McConnell which culminated in the Purchasing Power report and we are continuing to explore how to work effectively with large broadline distributors as well as local food hubs, farmers and fishers. For example, Nourish Innovators and team presented at Sysco’s 2017 Healthcare and Hospitality Education Days this year in Vancouver, Halifax and Montreal about the many opportunities for innovation, from room service to local food procurement and more.

As we head into year two of Nourish, we are increasingly developing our work to influence  public policy, knowing how essential it is to achieving systems change. Our multi-stakeholder Wasan retreat in September 2017 was an opportunity to map out the complex system of food and healthcare issues, as well as brainstorm and prototype possible solutions to advance recognition of the role food plays in health and healing. One group prototyped a convening on food in health care for provincial government officials across Canada, which is now being planned for September 2018.

Another group did a deep dive into strategies to strengthen local food procurement through the Local Food Act in Ontario, which has helped to inform the work of the Food for Health Policy collaborative project. This work was given a boost this month (March 2018), with the Ontario Minister of Agriculture’s announcement that they are activating the process to set goals and targets for public sector organizations to use more locally grown and produced food. We also have some exciting opportunities with the new Canada Food Guide where we expect to work with Health Canada and many other partners through its development and promotion over the coming years.

Encircling the three pillars of demand, supply and policy is the orange changing the narrative band. We know that none of the changes we seek will stick unless they’re embedded in daily practices and culture, and that we need research and evaluation to inform and validate what we do. Last year, the Foundation supported HealthcareCAN to develop an Issue Brief on  The Role of Food in Hospitals; this year we’re looking to deepen our research with a proposal to host a CIHR Health System Impact Fellow. Using a developmental evaluation approach, we’ve been trying to track the desired and unexpected changes we’re making while staying humble, keeping an eye not only on our successes, but the failures and learnings for Nourish as a whole.

Deep partnerships and systems leadership

We know that systems change only happens with partnerships that are deep and wide. One learning from this year is the importance of personal relationships as the bedrock of partnership —  progress moves at the speed of trust! We’ve been deepening our existing partnerships and developing new ones  including with the Canadian Malnutrition Task Force and Dietitians of Canada. We are exploring how to best engage other important stakeholders including patients, physicians and nurses.

As we look at all the changes happening at different levels of the food and healthcare systems, and also at the places where change meets resistance, we are struck by the need for systems leadership. One of our Nourish partners, the Academy for Systems Change, exists to grow ‘awareness-based systemic change’ and has been a source of inspiration and information for Nourish, notably through our advisor and Academy co-founder Hal Hamilton and my own Fellowship there over the past three years.  In a Stanford Social Innovation article on The Dawn of Systems Leadership, Hal, Peter Senge and John Kania identify three core capacities of systems leaders: fostering collective leadership, fostering reflection and generative conversations, and shifting from reactive problem solving to co-creating the future.  We are working to find and strengthen these capacities in ourselves, the Nourish Innovators, and our partners.

In a few weeks, Nourish Innovators will head to the west coast for our second in-person retreat to connect and share learnings. We are looking forward to deepening our relationships and bringing new Innovators into the fold, while looking for the ways to connect our work with partners and others not present who share our belief that food is fundamental to health and healing.