Introduction: Replacing dietary animal protein with plant protein reduces greenhouse gas emissions and improves human health. Hospital foodservices can support change, but require buy‐in and collaboration between people across the system.Methods: A qualitative descriptive study aimed to explore hospital patient menu content expert perspectives regarding increasing the proportion of plant to animal protein in hospital patient menus and outline actions required to do this. Semi‐structured interviews were completed with hospital or foodservice contractor employees and data were analysed using a general inductive approach.Results: Twenty‐five of the 35 content experts interviewed supported increasing the proportion of plant to animal protein foods. All voiced concerns, including patients not eating meals, jeopardising protein intake and increasing malnutrition rates, and the prohibitive cost of plant‐based protein foods. Participants described steps to change patient menus, including a cyclical design process. This entailed consultation with stakeholders, setting a target, choosing a strategy, developing a menu and recipes, finding food product, planning the system and operations, and checking it works. Most felt the best ways to increase the proportion of plant to animal protein were to swap ingredients in familiar recipes or replace entire menu items (n = 21), add plant‐based options to the menu (n = 25), and move the position of plant‐based meals on the menu (n = 22).Conclusion: This study conceptualised a process for increasing the proportion of plant to animal protein in hospital patient menus for use by hospitals or policymakers. Future studies should test these suggested menu changes, assessing impacts on greenhouse gas emissions, plate waste, malnutrition indicators, cost and patient satisfaction.

Moving towards healthy sustainable diets which replace a proportion of animal with plant-based protein requires effective population-based strategies. A variety of strategies in food service settings can support this. This systematic review aimed to evaluate the effectiveness of strategies to decrease animal protein and/or increase plant protein in foodservice settings. Outcomes included uptake (primary outcome), satisfaction, financial, environmental, and dietary intake (secondary outcomes). Both quantitative and qualitative outcomes were included. Seven databases were searched to identify peer-reviewed studies conducted in commercial and institutional foodservices using any strategy to decrease beef, lamb, pork, poultry, eggs, fish or seafood and/or increase legumes/pulses, legume/pulse-based meat substitutes or nuts. Titles/abstracts then full texts were screened independently by two authors. Quality appraisal was completed using the Mixed Methods Appraisal Tool. From 20,002 records identified, 38 studies from 29 manuscripts met the eligibility criteria, of which 16% were high quality. Almost half the manuscripts were published in the last two years. Most took place in institutional settings (n = 30) and all were in Europe or the United States. Strategies included forced restriction (n = 4), menu re-design (n = 6), recipe re-design (n = 6), service re-design (n = 4), menu labelling (n = 7), prompt at point of sale (n = 7) and multi-pronged strategies (n = 4). Menu labelling and re-designing menus, recipes, and service increased uptake of target foods in most studies with the largest consistent changes with menu re-design. Most recipe and service re-design strategies had a positive or neutral effect on satisfaction. Few studies explored financial, dietary or environmental outcomes. Future meat reduction initiatives should focus on menu and recipe re-design as these do not appear to negatively impact consumer satisfaction. More studies are needed to evaluate financial, environmental, and dietary outcomes.