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Table 2 Healthy ONES changes after implementation of the Institute for Healthcare Improvements(IHI) rapid improvement process

From: The healthy options for nutrition environments in schools (Healthy ONES) group randomized trial: using implementation models to change nutrition policy and environments in low income schools

Target Environment Target Strategy
Goal: Eliminate unhealthy foods and beverages on campus.
Classroom ·Treasure chests filled with nonfood rewards for 4th and 5th grades
·Unhealthy snacks brought from home discouraged by teachers
·Healthy food/beverages and nonfood items for classroom celebrations
·Nutrition Services catered meals for classroom parties
Before/After School ·Created healthier menu for after school snack
·Changed PTA fundraising to include nonfood events i.e. Jog-A-Thons
·Traditional carnival activities became healthy i.e. cake walk to prize walk
·Removed unhealthy foods from PTA sponsored event menus i.e. nachos, candy
·Added fruits, vegetables and complete meal options to PTA event menus
·Partnered PTA with Nutrition Services to cater healthy foods for events
Recess ·Implemented daily fruit at recess program
·Staff proactively discouraging students from consuming unhealthy snacks during recess
·“Healthy & Unhealthy” snack poster displayed for ease of snack coaching at recess
Cafeteria (school meals) ·Cafeteria monitors proactively discouraging unhealthy food/beverages from home
  ·“Healthy & Unhealthy” snack poster displayed for ease of snack coaching at lunch
  ·Removed perceived unhealthy items from menu i.e., nachos, cinnamon bun, chocolate milk
  ·Exclusive use of nonfood rewards by custodian and cafeteria staff for student helpers
  ·Added healthier, in-house prepared entrées to menus
Goal: Develop nutrition services as main source for healthful eating (HE).
Classroom ·Catered healthy meals for classroom celebrations
·Include nonfood item as part of meal for extra celebration
Before/After School ·Created healthier menu for after school snacks
·Catered healthy menu items for after school events and celebration
·Supported student chef clubs/student cooking classes
Recess ·Provide cut fresh fruit at recess
Cafeteria (school meals) ·Increased student ability to consume fresh fruits and vegetables
  ·Advertising/marketing of approved healthy snack and beverages only
  ·Student taste tests of new menu items
  ·Free meal for staff who eat school lunches with students
  ·Encouraged parents to try meals to demonstrate they were healthful and flavorful
Goal: School staff modeling healthful eating (HE)
Classroom ·Teachers promoting HE messages in classroom
·Teachers proactively discouraging students from bringing unhealthy snacks to school
·Teachers informing parents of school healthy celebration and snack policy
Before/After School ·Staff not consuming unhealthy food and beverages in front of students
·Staff participating in parent nutrition meetings
·Staff participating in student chef clubs/cooking classes
Recess ·Staff provided with thermal mugs to conceal caffeinated beverage consumption
·Staff participates with students in the fruit at recess program
Cafeteria (school meals) ·Staff choosing to eat the school lunch
  ·Staff encouraging their students to eat/try fruits and vegetables
  ·Staff supporting nutrition services changes by encouraging children to eat school meals