Factors affecting human health are becoming more extensive and interconnected.1 Waste management contributes to a better economy, a better quality of life and a happier workplace by reducing or eliminating negative impacts on the environment and human health.2 From an ecological perspective, it is evident that food waste and loss (FW&L) have adverse effects not only on the environment and economy, but also on human health, overall well-being, and society.3,4 To combat this situation, it is necessary to implement governmental actions, investments in infrastructure and technology, as well as the development of human capital. The implementation of effective FW&L management systems is instrumental in achieving Target 12.3 of the United Nations Sustainable Development Goals, which aims to reduce FW&L by half.5

Within the food service supply sector, healthcare institutions such as hospitals are a significant generator of FW&L.5,6 However, many hospitals remain unaware of the amount of FW&L they produce and its associated costs.

Health systems, notably hospitals, can play a pivotal role in mitigating the environmental and social impacts of FW&L. Alongside the imperative to safeguard patient health, their commitment to sustainable procurement and food systems can also yield tangible benefits for local economies.6 Furthermore, hospitals can function as conduits for education on healthy behaviours and diets, thereby establishing themselves as pivotal entities in the promotion of social well-being. Enhancing organisational performance and corporate well-being stems from cultivating a culture committed to achieving sustainable and competitive outcomes.7,8 This approach, when applied to the context of hospitals, can contribute to the reduction of FW&L through the cultivation of an organisational culture that prioritises well-being. In essence, this entails a lifestyle that prioritises personal wellbeing and satisfaction.

Health systems can be defined as the way in which healthcare is organised and delivered to individuals within a structured framework.9 Hospitals represent a critical component within these systems, functioning as central institutions where a significant proportion of care coordination, resource allocation and service delivery occurs.10 Hospitals have been identified as key players in the reduction of the environmental and social impacts of FW&L. Despite extensive consultation of the database, the number of eligible papers was found to be minimal, ranging from 17 to 32 articles, with a total of 80 in the broader study. This indicates a lack of research on FW&L management in the healthcare sector.

These previous literature reviews offer some insights into specific aspects of FW&L in hospitals, focusing on waste measures,11 audit methodologies12 and potential solutions for food intake and waste management.13 To date, no article has been found that comprehensively describes the literature on FW&L across different hospital settings. Consequently, there is a necessity for studies that compile all localised research on FW&L in different hospitals to serve as a reference. In this regard, the present article aims to address this knowledge gap by integrating diverse aspects of the research field, which are often addressed separately, with the objective of achieving a holistic perspective of the phenomenon under study.

This paper presents a scoping review, adopting the PRISMA model (PRISMA-ScR, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review), with the intention of synthesising knowledge.14 The objective is twofold: firstly, to identify the most relevant literature on FW&L in hospitals; and secondly, to analyse their main characteristics and explore the key contributions and gaps in the research. The study sets out to address two research questions: 1) what are the main characteristics of previous literature on FW&L in hospitals?, and 2) what are the main issues and research gaps addressed on FW&L in hospitals?

To address the research questions outlined, the present study employs a scoping review methodology following the PRISMA-ScR framework developed by Tricco et al.14 in 2018 (Fig. 1). This methodological approach is particularly well-suited to synthesising existing knowledge on the topic under investigation, enabling a systematic identification of the literature's key characteristics, thematic focus, and prevailing research gaps (see Table S1 in Online Supplementary Material).

Figure 1.

PRISMA-ScR adaptation.

(0.2MB).

This paper presents the findings of a scoping review of the literature on FW&L in hospitals. Hospitals are regarded as one of the pillars of a nation's health and social care system; consequently, enhancing the quality and transparency of health management is directly associated with people's health. This underscores the significance of recent reviews that have examined the current state of FW&L in hospitals.11–13,16 During the pandemic, with restrictions highlighting the negative effects on FW&L, hospitals rose to the challenge by creating new roles, developing innovative methods for collecting FW&L data, and leveraging technology to enhance food service.28 Also, there is the potential to reduce landfill volumes by diverting biodegradable waste through-composting. This approach demonstrates the feasibility of establishing composting programmes through collaboration between hospital food systems and local gardens.24 Research by McCray et al.19 indicates that a redesign of hospital dining models is required to enhance patient satisfaction, reduce costs and positively influence the nutritional intake of clinicians. The scientific literature has recommended several solutions to this problem, including the modification of the food service system, the management of food and non-FW&L, and the adoption of multi-method management strategies. Antasouras et al.11 analysed policies and interventions, while Rinninella et al.13 focused on nutrient intake and food waste. However, these studies emphasise clinical and nutritional outcomes rather than the managerial or organisational dimensions of food waste management. This is particularly evident in the context of technological interventions for reducing food waste and the social and ethical implications of food management in hospitals. The purpose of conducting future research in this area has yet to be determined.

It is important to acknowledge the potential of integrating the insights from management and health disciplines to enhance hospital management and align more closely with the Sustainable Development Goals relevant to the subject under investigation.

A notable increase in scientific production was observed in 2015, following the publication of the Sustainable Development Goals, and again in 2020, during the global pandemic crisis. These two significant occurrences have heightened global awareness, prompting efforts to enhance the future of our planet. The preponderance of publications is found in medical and nutrition journals, with a modest presence in social sciences. This underscores the necessity for interdisciplinary research that incorporates both fields.

The studies in Table 1 illustrate a range of approaches covering food service management, patient experiences and policy interventions. Quantitative work shows significant reductions in FW, improved nutritional intake and increased patient satisfaction through strategies such as room service models or portion control. Qualitative data reveal barriers such as regulatory constraints, poor communication and lack of awareness, underlining the need for collaborative and multi-faceted approaches. Despite regional differences, studies converge on the importance of integrated interventions, including stakeholder involvement, to improve the sustainability of hospital food systems.

The studies grouped in Table 2 provide an overview of strategies and methodologies used to address FW&L in hospitals. Qualitative studies evaluate existing waste auditing practices and explore interventions such as personalised meals or composting programs with a view to enhancing sustainability. Quantitative research highlights the environmental impact of FW, its energy potential and innovative solutions such as biofuels and insect bioconversion. The findings, when considered collectively, underscore the significance of implementing robust waste management systems, fostering collaborative community initiatives, and devising tailored strategies to address animal waste, enhance nutritional outcomes, and align hospital practices with the Sustainable Development Goals.

The studies in Table 3 set out several recommendations and actions aimed at improving FW management. The papers address a variety of topics, including the quantification of food waste, the impact of the pandemic on catering practices, and the role of effective communication and portion control in reducing waste. The main conclusions emphasise the necessity for a multifaceted approach to optimise FW management. Furthermore, the studies underscore the importance of aligning practices with evolving circumstances, indicating that food waste in hospitals can be minimised through a combination of staff training, enhanced processes and a focus on the environmental and financial benefits of waste reduction.

New multidisciplinary and supply chain approaches are required,11 with a clear identification of stages, processes and actors involved. It is imperative that health professionals, patients and catering professionals all play active roles in food measurement and control processes. A holistic analysis of food traceability, production, processing, supply, choice and waste management is imperative to effectively address the key factors. This comprehensive approach would facilitate the generation of novel food services or feeding strategies, with the dual objectives of enhancing patient intake and improving their relationship with food. These strategies would contribute to economic and social improvements in patients’ wellbeing. A comprehensive investigation into the entire chain and all stakeholders involved is imperative to address the evident practical barriers, despite the acknowledged significance of waste management.16 It is imperative to undertake a comprehensive study of the entire food chain within hospitals, with a focus on understanding demand to prevent oversupply and the utilisation of surplus ingredients in menu planning.

Further investigation is required for the retrieval and repurposing of remaining leftovers under the right conditions, as the implementation of circular strategies has the potential to contribute to the reduction of FW&L, as well as to resource efficiency. There is potential for the extension of these principles to other supply chains, such as those in the hospitality management sector, which would contribute to enhancing the quality of hospital services.

Information and communication technology has the potential to serve as an effective instrument for measurement and control. The implementation of new information systems is imperative to enhance the selection and distribution of food and preparations, as well as to facilitate connection with suppliers. A comprehensive understanding of the relationship between the technology available in hospitals, the strategies to implement it, its use by specialists, managers and patients, and the amount of waste caused, could generate new alternatives. The investigation and implementation of a range of measures and indices, utilising the information and communication technology solutions accessible to patients, doctors, nutritionists, nurses, and caterers, is recommended. Research into measurement systems alternative to weight and observation, and into the different processes of the supply chain (e.g., residues or surpluses at the preparation stage) can shed new light on the achievement of FW&L reduction. The integration of information technology in traditional hospitals is reshaping experiences and outcomes for patients, providers, and insurers. It is therefore recommended that healthcare institutions leverage this digital transformation to enhance their comprehension of FW&L and its impacts on operational efficiency and well-being.

The digital transformation of health systems and hospitals necessitates a collaborative approach to information exchange that requires further development.36 In this regard, the present guidelines are proposed as a contribution to future research. The subsequent lines of enquiry delineate a triad of pivotal actions: cooperation, communication and coordination. The present paper addresses these concepts in the ‘circular triple C’ model. Cooperation is imperative across three vital tiers: practical, academic and institutions-academia. Building on this paper, it is suggested that researchers consider taking an interdisciplinary approach and exploring the effects of collaboration in a cross-cutting way, considering the different pathologies and/or geographical locations of hospitals.

This approach could facilitate the identification of interventions that are more broadly applicable and those that necessitate a more precise focus. The effective communication among these three levels is paramount to facilitate cooperation, as they must exchange precise information to collectively pursue objectives aimed at enhancing citizens’ well-being.37,38 However, it is not solely adequate communication that is required; seamless coordination of plans and actions across these three levels is equally vital.

In addition, it has been determined that the option to reuse resources is limited. Consequently, the implementation of a circular model within the hospital value chain is proposed. Whilst acknowledging the potential complexity of circular practices due to the stringent sanitary conditions that pertain within hospital environments, it is asserted that these practices could yield substantial benefits, including enhanced well-being for patients and personnel.

However, it should be noted that the choice of search engines is a key limitation. A broadened search may yield articles related to other pertinent domains, such as supply chains or the circular economy. In addition, a comprehensive review of academic articles, professional studies and case studies on the implementation of new FW&L reduction strategies is recommended to achieve a more thorough assessment of their effectiveness.

This paper signifies a pivotal moment in the scientific literature, providing a framework to guide future research endeavours into the impact of FW&L in healthcare facilities. In this regard, the proposed model is expected to yield practical, academic, and societal implications. Adopting a systems thinking methodology, as emphasised by McCoy and Allotey,10 this approach acknowledges the dynamic and interconnected nature of health systems. The integration of insights from both management and health disciplines fosters an interdisciplinary approach to addressing FW&L in hospitals, aligning with Sustainable Development Goals and offering valuable contributions to hospital management.

The proposed approach is predicated on the notion that the reduction of all general hospital waste will not only diminish its environmental and economic impact but is also imperative for the provision of diets with adequate nutritional values in hospitals to minimise the incidence of infections among patients.33,39

The present research offers practical, academic and social contributions by highlighting the need to increase scientific production, promote interdisciplinary and hospital collaboration, implement public policies and advance Sustainable Development Goals 12 to improve health, reduce waste and costs, and protect the environment.

The impact of FW&L management on the well-being of patients and healthcare workers is a potential area for future research. It is important to note that food is not only a basic need, but also a factor that contributes to the improvement of the happiness of people.40 In the context of hospitals, enhancing the atmosphere to promote happiness can significantly contribute to patients’ recovery and subsequent discharge to their families. Finally, there is a need for capacity building and policy development to improve waste and loss management practices.41

The review data has been extracted from the Web of Sciences and Scopus databases and could be requested from the contact author.

María Errea.

The corresponding author, on behalf of the other authors guarantee the accuracy, transparency and honesty of the data and information contained in the study, that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described.

M. Torrejón-Ramos, M.S. Medina-Salgado and M. Ortiz-de-Urbina-Criado were involved in the conception and design, and analyzed and interpreted the data. M.S. Medina-Salgado and M. Ortiz-de-Urbina-Criado revised it critically for intellectual content. All authors participated in drafting of the paper, and have approved the submitted version (and any substantially modified version that involves the author's contribution to the study). All authors agree both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

This paper has been supported by the PID2021-124641NB-I00 Project from the Ministry of Science and Innovation (Spain), the high-performance research group “Openinnova” (number 381, Rey Juan Carlos University), and the high-performance research group on Circularity, Sustainability, Innovation, and Talent “CIRSIT” (Number 521, Rey Juan Carlos University).

None.