Hospitals play a vital role in promoting health, yet they are significant contributors to the climate crisis. In the Netherlands, the healthcare sector is responsible for 7% of national CO₂ emissions and 13% of raw material use, figures that call for urgent change. Food systems within hospitals offer a powerful but often overlooked opportunity for impact. With nearly 40% of hospital food wasted and a heavy reliance on animal-based meals, improving sustainability here means addressing not only health, but also climate goals.

Sophia Children’s Hospital, part of Erasmus MC and the largest children’s hospital in the Netherlands, sits at the heart of this challenge. Tasked with feeding vulnerable patients under strict dietary regulations, the hospital faces a complex balancing act: how to make meals healthier and more sustainable without compromising care or comfort? Misconceptions around plant-based diets and deeply rooted food habits add further resistance to change. Still, if sustainability can succeed in a children’s hospital, where the stakes are high and the context is complicated, it sets a powerful precedent for the rest of the healthcare sector.

This project emerged from the shared ambition of a paediatrician and a sustainable design researcher, both advocating for a food system that serves the needs of patients today while protecting the well-being of future generations. While policies and research promote protein transition and food waste reduction, there remains a crucial gap between vision and implementation. That is where design can help. This project set out with a clear goal:

‘‘Designing an intervention that increases acceptance of more sustainable food choices for patients at Sophia Children’s Hospital.’’

To reach this goal, the project explored the sustainability challenges hospitals face, the nuances of children’s food experiences and the specific ambitions of Erasmus MC’s new food system, based on the pillars of health, experience and sustainability. Along the way, systemic issues emerged: the low priority for sustainability, a lack of personalisation for children’s meals, aversion to restrictions, the poor perception of hospital meals, the underutilisation of the influence of nutritional assistants and, most notably, the absence of feedback mechanisms. Without ways to listen, measure and respond to patient input, efforts to improve the food system remain disconnected from those they aim to serve.

This insight became the turning point of the project. The focus was refined to designing a structured feedback system; a foundation for continuous learning and improvement, grounded in empathy and participation.

Through stakeholder input and iterative design, the project delivered two complementary tools to bring this idea to life:
1. System Maps that identify and visualise gaps in feedback flows across the key aspects taste, meal offerings, portion size and food communication, offering a framework for data-informed decision-making.
2. The Recipe for Lasting Change Cookbook, an engaging, hands-on guide that helps to develop and implement a structured and effective feedback system in the hospital’s food operations in a way that feels doable, meaningful and even fun.

Together, these tools help turn feedback into action—not as a one-time fix, but as a continuous cycle of improvement. They provide the structure and language to support the food system’s evolution at Sophia and could serve as a model for other hospitals working toward similar goals. By focusing first on the experience—on what patients need, want and enjoy—this project lays the groundwork for sustainable change that actually sticks.