Hospital meals are expected to support nutrition, recovery, patient wellbeing, and experiences of care, yet the work that makes them possible is often taken for granted and organised as an auxiliary service. This thesis analyses this tension through a Swedish hospital foodservicereform. The aim is to analyse how hospital foodservice wasproblematised and governed, and what this means for how meals,patients, care, and meal-related work can be understood, evaluated, and organised.
The thesis is informed by poststructural analysis of discourses, primarily Bacchi’s “What’s the problem represented to be?” approach and Poststructural Interview Analysis. Hospital foodservice is approached as a governing arrangement in which problem representations, discourses,governing technologies, and subject positions shape what becomesvisible, legitimate, and actionable.
The thesis is an embedded case study following the reform from prereform assessment through political decision-making, implementation,and evaluation. The empirical material includes patient survey data, political documents, key informant interviews, study visits, field notes, and reform documents. Three studies are included in the thesis: patient satisfaction before the reform; political problematisations underpinningthe reform; and professional boundaries in everyday meal-related work.These studies are brought together through an iterative synthesis.
High overall patient satisfaction was reported in pre-reform survey data. At the same time, the political material problematised the previous foodservice system as costly, inflexible, and insufficiently responsive topatient choice. In interview accounts, everyday meal-related work was shaped by market-oriented discourse, where meals and service were understood through efficiency and customer satisfaction, and by a discourse of enduring hospital hierarchy, where clinical authority shaped whose work and perspectives could be recognised as legitimate. The reform made patient choice, menu variety, food quality, satisfaction scores, and cost control visible as signs of success. Less visible was the everyday work required to make meals function in practice, including coordination between kitchen, wards, and service staff, and the practical and relational work of ordering, reheating, plating, serving, and meeting patients. The overall effect was selective visibility and uneven legitimacy: visible food quality was strongly legitimised, while meal-related service work remained more conditional and dependent on local negotiations.
The thesis contributes by centring governance as an analytic object in hospital foodservice research and by showing how meal-related service work can be necessary to care while remaining conditionally recognised. The central challenge is to organise responsibility, collaboration, and legitimacy in ways that make integration between meals and care possible in everyday practice
Umeå: Umeå University, 2026. , p. 133