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.

Every child in the Netherlands should receive an equal opportunity to begin their life with the best possible prospects. The first 1000 days of a child’s life are of utmost importance in establishing a strong foundation for future development. Children may experience a disadvantageous beginning due to various factors such as exposure to smoking or stress (Ministerie van Volksgezondheid, 2018; Roseboom, 2018).

To offer the best start also for children, the objective of this master thesis is to develop a digital tool that leverages the potential of big data to aid in the early identification and referrals of families living in vulnerable circumstances.

The research initiative known as “Making Big Data Meaningful for a Promising Start” is funded by the Dutch research council known as Nederlandse Organisatie voor Wetenschappelijk Onderzoek (NWO), seeks to detect vulnerable situations at an earlier stage using predictive models that use existing large amounts of data (big data) to identify potential adverse outcomes for children. The prediction model has the potential to estimate the level of risk a family faces for experiencing a negative outcome in the future. In order to cater this model to the parents’ needs, various user-centred design methods were used.
The approach of this project was first to understand the context of the first 1000 days and understand who is involved, how the current risk identification and referral works, and the experiences of the parents and the healthcare professionals. Literature research and qualitative research methods such as interviews and observations provided insights into the different perspectives of parents and healthcare professionals in this specific context. This approach led to identifying several significant needs that would guide the design direction for the future conceptual tool. These needs include trust, safety and self-esteem. Parents often face fear regarding the potential outcomes linked to revealing specific information, and they may also experience emotions like shame, guilt, or self-doubt when they believe they are incapable of adequately providing for their child. This may result in parents choosing not to disclose information, which can lead to delayed identification and potential referral.

Once the underlying needs of parents were understood, the following phase involved creating together and exploring the solution space surrounding a digital tool. To achieve this, co-creation sessions were held with parents and healthcare professionals.
During the co-creation sessions, several additional requirements emerged that were deemed essential for the conceptualization of the digital tool.
Among these newly identified requirements was the consideration that if the tool incorporated a prediction model, it must not only identify risk but also offer actionable solutions and be implemented with repetitive use since circumstances can change over time.
Through understanding and aligning the needs of parents, a final digital concept Advies Op Maat was designed. The concept allows parents to fill in their information in a sandbox environment, enabling them to try the tool before committing to sending the information to the healthcare professional. Based on the information filled in, parents can receive preliminary advice and choose whether they want to continue.
By conducting moderated user testing, the experience of the digital concept was evaluated and explored. At the moment, a significant challenge in achieving trust and safety relates to the questions posed within the tool, which can be sensitive and confrontational for parents.

At the conclusion of this project, iterations were made to address and improve these specific aspects to potentially use parts of the concept in the next phases of the research project of the “Big Data and a Promising Start” initiative.