Table 3.

Cross-cutting facilitators in conducting CQI for health promotion within retail food environments in hospitals as identified by Nutrition & Food Services .

	Inside out model	Theme	Context	Quote
Facilitators	Policy and environments supportive of health	Healthy Eating Policy	Nutrient Criteria guide what foods to sell more of and less of—supposed to help classify foods. Staff to support policy and interventions	‘We need to be grounded in a nutrient criteria that helps us define what’s healthy and unhealthy …. but to me, it’s such a small piece of the policy’. (Participant #3, administration)
	Communities that recognize health problems	People are busy and don’t have a lot of time; people want a choice	Interventions that allow staff to avoid grocery stores avoid long lineups for lunch	‘Increasing our access to a very busy healthcare system so that our caregivers and visitors have time to actually eat and nourish themselves’. (Participant #2, administration)
	Organizations that monitor and promote policies	HEPSC	Group of interdisciplinary members who provide strategic direction for the Healthy Eating Policy.	‘The steering committee is such an important aspect of you know the policy implementation. So, one of the guiding principles in my mind of any steering committee, but definitely the one that promotes the healthy eating environment, is to have interdisciplinary membership’. (Participant #2, administration)
	Interpersonal connections that foster collective action	Local knowledge	Engagement with customers provided a lot of information to tweak interventions. People with the greatest access to customers are the point-of-sale staff.	‘So maybe didn’t have a whole picture of the why but maybe it was just more of an ask, but I think you have to be sensitive I think of the needs of the site’. (Participant P#8, administration)
		Low-risk trials	Small trials allowed participants to prove themselves and gain the trust of managers and other staff	‘… when we talk about how do you make a change or have you ever done something without any data if we didn’t do that original study it would have been very difficult for us to say let’s take a huge chance and just do this everywhere. Like you have to prove to yourself that it’s worthwhile doing first and then that’s those little studies’. (Participant #3, manager)
		Longstanding partnerships with researchers	Involvement of researchers allows for longitudinal study and application to grants, funding and future research opportunities.	‘to work with universities and to have the research we really want to have data like daily data at our fingertips’ (Participant #2, administration)
	Fair and equal resources distributed across individuals	Champions and leaders	Participants mentioned specific people when discussing interventions. There are people they go to for resources and information about interventions.	I: ‘How do you decide what products to put at eye level and which to put on bottom shelves like how does that work?’ P: ‘Sometimes it comes through [name] I guess through like a provincial group so she provides I know when I started we did a lot of work around pricing and placement and she’s provided a lot of guidance for us’. (Participant #8, administration)