A new market for growers

Rockville Market Farm workers transplanting butternut squash plants in the spring. The Vermont farm sells 50 to 100 pounds of butternut squash per week to Fletcher Allen Health Care hospital in Burlington, Vt.

While the hospital is not one of the farm’s major accounts—Rozendaal sells the majority of his squash grown on 15 acres to restaurants, whole food stores and co-ops (he also grows 10 acres of mixed vegetables)—it is an important one. “Hospitals are a prestigious account,” said Rozendaal. “It adds credibility to a farm, and it has helped to secure other accounts.”

Fletcher Allen Health Care is part of a growing movement in the U.S. hospital industry to purchase more locally grown foods. The hospital not only purchases locally grown squash from Rozendaal, but it purchases other local fruits and vegetables from a variety of local farms, plus local, hormone-free milk. Most of the local products are purchased through small vendors, local distributors (such as Black River Produce) or directly from farmers. A small amount of local foods are also purchased through the hospital’s contracted supplier, U.S. Foodservice.

This kind of marriage between local growers and community hospitals is a natural outgrowth of the heightened concern about healthy eating and the advantages of buying fresh, locally grown foods. It also adds an important, and consistent, market for growers.

“This movement came out of the farm-to-school programs. Hospitals were the next most natural fit for good food, considering that many hospitals, ironically, have fast-food outlets and unhealthy food options,” said Moira Beery.

Beery is the farm-to-institution manager for the Center for Food & Justice, a division of the Urban & Environmental Policy Institute at Occidental College in Los Angeles, Calif., which is spearheading a national farm-to-hospital movement, along with other organizations such as the Community Food Security Coalition and Healthy Food in Healthcare, among others.

“Hospitals have a health mission, but in the hospital’s cafeterias and kitchens that mission seems to have been overlooked,” Beery said. With the nation facing an obesity and diet-related illness epidemic, many hospitals are searching for ways to improve the quality of hospital food—long plagued with the reputation for being unappetizing and highly processed. By partnering with local farms, community hospitals are able to purchase locally grown products, such as fruits, vegetables, meat and dairy products, for inpatient and cafeteria use; hospitals are also hosting farmers’ markets or CSA programs on hospital campuses.

The farm-to-hospital effort—now in its third year—boasts one of the largest nonprofit HMOs (which also operatesseveral hospitals), Kaiser Permanente, as a major supporter. A number of hospitals throughout the country are also exploring farm-to-hospital programs. In Billings, Mont., Billings Deaconess Clinic now purchases locally raised turkeys. Sutter Maternity and Surgery Center in Santa Cruz, Calif., buys almost 20 percent of its produce from trainee farmers working the Agriculture and Land-Based Training Association farm in nearby Salinas, Calif. At Duke University in Durham, N.C., there is a weekly farmers’ market between the clinic and the hospital that sells fruits, vegetables and healthy lunches. Ten Kaiser Permanente hospitals in California now have regular farmers’ markets.


Hospitals in the United States bought $3.3 billion worth of food in 2004, according to a report on the topic written by Beery and her colleague Mark Vallianatos. Cumulatively, these expenditures rank the industry as the nation’s third largest institutional purchaser of food items behind K-12 schools and colleges/universities.

However, the market remains untapped for reasons that have to do with the hospitals and the farmers themselves.

Rockville Market Farm’s butternut squash, peeled and ready to be
delivered to the hospital.

Some of the obstacles from the hospitals’ point of view have to do with the lack of knowledge about the availability of fresh, local food. Another barrier is the extra time it takes to purchase produce from a local farmer, says Diane Imrie, director of nutrition services for Fletcher Allen Health Care. “One person handles most of the ordering—with more farmers onboard, it gets to be tricky,” she said.

The ability of a hospital to participate in a farm-to-hospital buying program depends entirely on the individual hospital. “There definitely needs to be an openness and a flexibility in the [food purchasing] budget,” said Beery. In some areas of the country, where the local food movement is well developed, such as in northern California, hospitals are open to the idea.

“That said, I have seen a real shift in awareness all around the country in just the past six months,” said Beery.

On the other side of the fence, a major obstacle to selling to hospitals has to do with the farmers themselves; they don’t understand how to get their foot in the door.

One approach may be for farmers to band together with other growers to approach a hospital as a cooperative or group. “Hospitals are used to buying large amounts of food that is delivered on a consistent basis. Farmers may be better received if the volume is higher, and the hospitals can draw from a multitude of farms,” said Beery.

Even if there is a connection between the hospital and the farmer, there are also huge barriers of transportation issues, storage and quantity, which often hinders any successful business relationship. “But these links can be made if both the hospital and the farmers are committed,” noted Beery.

Take the success of the farm-to-school programs around the country, which had the same logistic issues, but have been overcome in many areas of the country, and have had a positive impact on health promotion and consumption of fruits and vegetables by schoolchildren.

The time it takes to make contact with a community hospital is well worth the effort, said Rozendaal. “The hospital [nutrition staff] came out to our farm to see what we were all about. This has helped our relationship a lot. They saw we were a sanitary, clean, well-run farm,” he said. “It has been a good account for us.”

The author is a freelance writer from Keene, N.H.

Tips on Approaching Hospitals

The Healthy Food in Healthcare organization offers some practical tips on how growers can approach hospitals to sell produce.

1. Product consistency and communication

Have a clear idea of what you are capable of providing for your clients. Larger institutions are typically used to relying on large, dependable food service providers, and may have limited resources and staff available to place and receive orders. Be clear about the products and quantities you estimate will be available and when; and, if possible, provide hospital food service staff with a seasonality chart so they can better plan their menus. To increase variety and fill production gaps, consider working with other growers. If product volumes will be short, abundant or cosmetically damaged, let clients know as far in advance as possible. Making the effort to personalize your service will demonstrate your concern and care for client service and also give food service staff time to adjust menus as needed.

2. Delivery

Delivery details are a vital part of establishing a new purchasing arrangement with a hospital. Few hospitals have the capacity to pick up product from a farm or farmers’ market, and most hospitals are wary of receiving deliveries from multiple trucks. Delivery systems that coordinate product pickup and delivery from several farms to a local hospital can be helpful in reducing the administrative work for the hospital. Find out what channels the hospital currently uses to purchase its food products (such as a distributor) and explore the possibility of working through these channels. Contact local agriculture organizations to determine if there is a local farmer cooperative or other farmer infrastructure for marketing your products to local institutions.

3. Pricing

When determining product prices, try to maintain consistent prices throughout the season, barring any natural disasters or large market fluctuations. Do your best to project a price that reflects costs of production and profitability, but allow space for discounts due to volumes or other such negotiations. When invoicing institutions, make invoices clear, concise and readable, and try to maintain the same billing layout throughout your wholesale relationship. Most institutions are generally reliable, though payment can be slow in coming. Keep in mind that institutions typically pay below retail prices and may take up to one to three months to pay for goods received. Many institutions will require growers to hold at least $1 million of general liability insurance. Working through an existing distributor, farmer cooperative or other marketing network may allow you to circumvent this issue.

4. Regulations and food safety

Hospitals are beholden to certain regulations regarding food preparation, handling and processing due to the nature of their work. Growers should be mindful of HACCP (Hazard Analysis and Critical Control Points; to learn more visit: www.cfsan.fda.gov/~lrd/haccp.html), JCAHO (Joint Commission on Accreditation of Healthcare Organizations), and other health care-related food regulations. In order to address some food safety concerns, growers might consider documenting their farm’s policies and practices concerning the following:

  • Field harvesting
  • Washing/packing line
  • Loading, storage and transportation
  • Water usage
  • Worker health and hygiene

This information was excerpted with permission from Healthy Food in Health Care: A Menu of Options (www.HealthyFoodinHealthCare.org).