Table 2. Illustrative Quotes From Food Service Directors (N = 8), Study of Best Practices for Implementing and Sustaining Healthy Food Service Guidelines, 2017.

Best Practices	Illustrative Quotesa
Theme: Demand for and sales of healthy foods and beverages
Evaluate new dishes with staff and customers to see which are received well.	P05: “I think we've had the most amount of success when we built up some excitement around taste-testing. Our dietitians get involved in soliciting and providing information and showing the consumers that many of the healthy items can be tasty and satisfying.”
Use point of sale (POS) and nutrition analysis software to identify and prioritize popular recipes that meet healthy food guidelines.	P04: “We use what we call CBORDb and all of our recipes are put in there and that’s how we do the nutrition analysis to make sure that meals meet the criteria that we set for sodium and calories and saturated fats.” P06: “We have a POS system that we track sales through to look at our top-selling items. We can run many different reports to see what’s selling or what’s not selling.”
Anticipate dropping popular comfort foods by preparing customers in advance.	P07: “We removed the deep fryers, and prior to that there were quite a few items that were deep fried. We started this and communicated the changes a month in advance to the launch . . . Fried chicken was a very popular item, but we replaced it with baked chicken made with a pecan crust and we let the dining guests taste it . . . ”
Avoid setting healthy foods apart as something different; rather, attempt to improve the healthfulness of most dishes served at the cafeteria.	P07: “Our goal was not to say ‘healthy’ or ‘unhealthy’, but to make the entire menu healthier, and by posting nutritional information, people could make a choice . . . They call this approach ‘stealth health’, or the idea that you avoid labeling foods ‘healthy’ because if a food is labeled ‘healthy’, people will not want to eat it.”
To increase customer volume, roll out and launch new menus that feature tastier, healthy menu options.	P07: “. . . by creating a healthier menu, we actually created an entirely new market. We brought them in, we brought all the regular dining guests in and for the last 4 years we have consistently increased sales.”
Offset higher food costs for new healthier menu items by adjusting the price point of other popular food offerings to ensure overall profitability.	P03: “You know, it’s about a balance. I put in a healthy item and maybe instead of my 45% food cost that I want to have on it, its 55%. Then I offset that with something else being a little more costly and a little lower food cost and hopefully it’s something that’s less healthy.”
Realign employee and customer discounts to favor healthy menu options.	P04: “We decided to give consumers the choice and so we went from a system of a 20% discount for all food to a 25% discount for healthy food.”
Theme: Production and supply of healthy foods and beverages
Regularly emphasize and share the goals of the healthy food program with staff, emphasizing the benefits of a healthier diet.	P03: “I think it’s another good reason to share what all the goals are and to make sure that the food service staff understands that it’s what the [healthy food service guideline program] is trying to get us to do.”
Instill pride in the production of better tasting, healthier foods, thereby enhancing staff productivity and retention.	P03: “Once you have people trained and once people buy into the program, [they] take pride in the fact that when I make my soup, we boil vegetables for a vegetable broth, we use all fresh ingredients that we chop up ourselves . . . People [food service staff] bought into that and became more productive because they liked what they were doing.”
Conduct taste tests with frontline staff so they buy in to healthy options and will then market them to consumers.	P07: “We got buy-in for our [implementation] changes from not only the employees, but our customers and our dining guests.”
Develop recipes that balance the cost of ingredients, but overall provide a healthy, delicious alternative.	P08: “Salmon is very expensive to sell and we could not sell it without losing money. So, to provide a healthier option, we chose to take the salmon filets and use them to make salmon croquettes. By adding some filler to the cooked salmon, we were able to bring the price point down, extending the salmon while keeping a great tasting, healthy product.”
Absorb losses associated with more expensive, healthier foods by offsetting higher costs with increases in the price of other popular dishes on the cafeteria’s larger menu.	P03: “We use an all-natural antibiotic-free chicken that is never frozen, and it’s a fabulous product. It costs more than any other chicken out there almost, but it’s what we chose quality-wise as what our facility wanted to do.”
Serve smaller portions of those foods that are more expensive to make.	P06: “For example, for national nutrition month this March, we did new parfaits. We were selling a 9-ounce parfait cup with pudding and cookies for $1.75. For March, we pulled all those items and we replaced them with a 7-ounce smaller portioned parfait that had whole grains, quinoa, fresh berries, and Greek yogurt and priced it at $2.50. We really didn't think that people would buy them, but they're the hottest seller right now.”
Introduce innovative training options that maximize the reach and impact of trainers.	P06: “So we have a demo kitchen that can tape-record live training sessions . . . producing training videos . . . that are accessible to all of our frontline food service employees.”
Adopt innovative technologies and obtain kitchen equipment to enhance labor efficiency and productivity.	P01: “We have some really nice Bain-maries and Planchas and other great equipment that we can use to decrease the oil and still make foods taste good.”
Work with your GPO to negotiate prices and secure reasonably priced ingredients for healthy foods.	P07: “ [Respondent’s GPO] is the one that negotiates the pricelist. I sat on the [respondent’s GPO] food service committee for 4 years . . . We actually had monthly meetings as far as negotiating contracts and what the needs were of the operations that were part of [respondent’s GPO].”
When managing multiple sites or facilities, use POS systems to determine top-sellers and to simplify inventory management.	P06: “One of the things we’ve done . . . is look at all of the salad dressings we have and ask, “Why do we need 17 different salad dressings?” We identified 7 salad dressings that are approved to use in the retail operation and the manager can scale up or down based on the size of the operation. We were able to really consolidate our inventory and our purchasing and save money that way.”
Identify and work with small, local vendors to achieve healthy food goals.	P07: “We sat down with our vendors and said we needed them to make a recipe that cuts sodium content in 10 breads in half. They did it. Within 3 weeks we had a new recipe and we had healthier items.”
Set up healthy stations to ensure portion control and distinguish healthy food choices.	P08: “For the salad bar, we have red, yellow, and green handled tongs and scoops. So instead of having little print cards out on the salad bar, we just had one sign in front of the salad bar and then we have the color coded handles there.”
Adopt behavioral design strategies to encourage healthy food selection and sales.	P01: “[W]e have a red/yellow/green for sugar-sweetened beverages so we give them a green for your waters and unsweetened teas, and then red is for the high sugar items, and then yellow is for, like, so it has a little bit of sugar but not to the degree that regular soda would have in it.”

Abbreviation: GPO, group purchasing organization.

^a Eight food service directors participated in our interviews. P0x numbers identify each respondent (Table 1).

^b CBORD is a diet/menu analysis system.