Connecting Sustainable Farmers to Emerging Health Care Markets

Final Report for LNC11-334

Project Type: Research and Education
Funds awarded in 2011: $162,952.00
Projected End Date: 12/31/2013
Region: North Central
State: Minnesota
Project Coordinator:
Anna Claussen
Institute for Agriculture and Trade Policy
Karen Quiroz
Institute for Agriculture and Trade Policy
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Project Information


In collaboration with three hospital systems and numerous farmers, IATP identified barriers to and opportunities for hospitals and hospital systems to become a growing market for sustainable farmers and ranchers. While significant barriers certainly do exist, we identified numerous strategies farmers and hospitals can use to increase hospital purchases of local and sustainable food, and there is evidence of strong interest on both sides. We produced educational resources for both our specific hospital partners and more broadly applicable tools that can be used by any hospital, hospital system or farmer interested in accessing this growing market.


Hospitals and hospital systems represent a sizable potential market for sustainable farmers, and interest in increasing purchases of local, sustainably produced food among hospitals and hospital systems is growing. However, limited hospital resources and the complexity of food purchase contracts and agreements at many hospitals have prevented farmers from accessing this market in any significant way to date. This project assessed the current and potential hospital food markets for North Central region sustainable farmers, and provided farmers and hospitals with tools they can use to take to increase hospital purchases of local, sustainably produced food. The 1,684 hospitals in the North Central region represent significant buying power and many of them have expressed interest in purchasing local, sustainably produced food. However, few hospitals consistently purchase such food, and the information needed to connect hospitals to farmers who produce it has been sorely lacking.

Existing hospital interest in increasing their purchases of sustainable, local food is demonstrated by steady increase in hospitals who have signed the “Healthy Food in Health Care Pledge,” a voluntary commitment which outlines steps hospitals can take to support food that is healthy for people, communities and the environment. In addition, some hospital systems are developing their own food policies or revising existing policies to address sustainability issues in addition to nutritional requirements. However, many hospitals are still in the beginning stages of initiatives to increase the sustainability of their food purchases and, despite their good intentions, have little time and resources to do the kind of analysis done through this project.

Prior to this project, most SARE-funded projects on increasing institutional purchases of sustainable food have focused on “farm to school” programs, examples of which can be found in (among other locations) Maine (1,2), New York (3), Appalachia (4), and even within the North Central region (5, 6, 7). In other cases, SARE-funded projects focused on whole food systems of which hospitals are a part, on more general “institutional purchasers,” or on more general marketing and distribution efforts that could be applied to general institutional purchasers (8, 9, 10, 11, 12, 13, 14, 15).

Importantly, prior SARE-funded projects addressing general institutional purchasers reported limited success in increasing purchases of local sustainable food at hospitals as opposed to restaurants or schools.This was often due to inadequate information to address the specific purchasing requirements of hospitals. By considering hospital purchasing exclusively, this project was able to more fully and directly address hospital-specific procurement requirements. (A 2007 SARE project out of the West Region did find some success in developing hospitals as a market, but found that success in the context of offering a farmers market on hospital grounds and delivery of community supported agriculture, or CSA, shares (16). In contrast, our project will focus on the higher volume, higher value wholesale side.)

To our knowledge, no prior SARE-funded projects focused exclusively on hospitals as a potential wholesale market for sustainable farmers. However, several important lessons have come out of projects where hospitals were directly addressed as part of larger efforts. For example, a 2006 project in Wisconsin explored expanding the restaurant and institutional market within a seven county region. Despite considerable success with restaurants, the intention of securing commitments from at least two hospitals, and initial outreach including several hospitals, the project found little success with hospitals. In their final report, the project team identified the two main barriers as 1) inconsistencies between what farmers can supply and what food service operations are accustomed to using and 2) price (in cases where the farmers’ products did meet the hospital’s requirements) (17). These types of barriers still exist, but our project will used a systems approach to encourage and support the systemic changes among hospitals that need to occur over time to contribute to lasting change that will eliminate or mitigate these barriers.

As part of a 2006 SARE project in the Northeast Region, a project team identified a hospital with interest in purchasing local food and connected this hospital with a potential farmer supplier. However, the farmer who attempted to sell to the hospital reported that a lack of communication about vendor requirements prevented the sale from actually occurring, to the disappointment of both parties (18). Our project was explicitly designed to prevent such problems through two facets: 1) we developed resources to help farmers understand the steps in the process of selling to a hospital and resources to help hospitals understand how they need to work with farmers, and 2) we helped hospitals understand how their current vendor relationships can get in the way of reaching their purchasing goals andthe steps they can take to fix this situation.

A 2000 North Central SARE project placed interns with a number of institutional food buyers to increase their purchases of local and sustainable food. The project team found some success with a number of institutions, including hospitals. However, they noted that one hospital (which had been increasing its local, sustainable purchases) suffered a major setback when the hospital outsourced its food service operation to a national vendor that was not as amenable to local, sustainable sourcing (19). Given that a majority of hospitals outsource their food service operations (and often to large vendors), addressing local and sustainable purchasing within the context of large, national vendors will be critical to truly expanding hospitals as a market in the long term. It’s important to note that food service contractors are feeling increasing pressure to provide more, local and sustainably produced food options for their institutional customers in no small part due to projects such as this one.

Work to connect hospitals and farmers has been going on outside of SARE-funded projects as well. IATP published Healthy Food, Healthy Hospitals, Healthy Communities-Stories of Health Care Leaders Bringing Fresher, Healthier Food Choices to Their Patients, Staff and Communities (20) in May 2005. At that time, there were just a few known examples of hospitals and long-term care facilities working explicitly to buy more local and sustainably produced food. Through the work of IATP and our partners in the Healthy Food in Health Care Initiative, the list of health care facilities actively engaged in these types of activities has grown exponentially over the past few years; some of this growth is highlighted in the 2008 Health Care Without Harm Menu of Change (21) report on the progress of Pledge signers.

In the early years of this work to influence health care purchasing, much of the energy has been focused on bringing hospitals on board: building relationships, making the health-based case for change, engaging with staff at individual facilities on project and pilot-type activities and supporting their efforts, sharing stories, providing hospitals with opportunities to tell their own stories as their jobs allow, and providing hospitals with tools they can use to benchmark progress toward improving the health and sustainability of their food service operations and the food they serve.

It has been gratifying to see how many hospitals are engaging in activities designed to improve the overall sustainability of their food service operations and increase patient, employee and visitor access to fresh, local and sustainably produced food. However, with few exceptions, most of the hospitals who are actively engaged have yet to move beyond the low hanging fruit and make real, lasting changes to their procurement policies and procedures. We believe it is in this next level of change—in which we help hospitals change their systems, not just find ways to act within their existing systems—where farmers will finally have access to the full extent of the potential hospital market. Our project was specifically designed to move beyond low hanging fruit and facilitate a move to the next level.

 (1) Healthy Acadia, 2008. Downeast Maine Farm to School. Northeast Region SARE Sustainable Community Innovation Project. Project reports at (accessed 10/15/10).

(2) Healthy Acadia Coalition, 2006. Farm to School in Hancock County. Northeast Region SARE Sustainable Community Innovation Project. Project reports at (accessed 10/18/10).

(3) Seeking Common Ground, 2008. Expanding connections: Marketing farm to cafeteria in the Finger Lakes Foodshed. Northeast Region SARE Sustainable Community Innovation Project. Project reports at (accessed 10/15/10).

(4) Appalachian Sustainable Agriculture Project, 2007. Appalachian Grown: Farm to School Project. South Region SARE Research and Education Project. Project reports at (accessed 10/15/10).

(5) University of Minnesota Extension, 2008. Building Minnesota’s Farm to School Policy and Infrastructure through University of Minnesota Extension and Community Partnerships. North Central Region SARE Professional Development Program Project. Project reports at (accessed 10/18/10).

(6) Michigan State University, 2006. Distribution Strategies for Developing Farm-to-School Connections. North Central Region SARE Graduate Student Project. Project reports at (accessed 10/19/10).

(7) Good Natured Family Farms, 2008. Bistro Kids Farm 2 School Program - Bringing Healthy, Locally Grown Food to the Next Generation. North Central Region SARE Farmer/Rancher Project. Project reports at (accessed 10/19/10).

(8) University of Wisconsin-Madison, 1999. Institutional Markets for Sustainable Agriculture Products. North Central Region SARE Research and Education Project. Project reports at (accessed 10/18/10).

(9) University of North Carolina Wilmington, 2008. Southeastern North Carolina Food Systems Project. South Region SARE Graduate Student Project. Project reports at (accessed 10/22/10).

(10) Appalachian Sustainable Agriculture Project, 2003. Appalachian Grown: Toward Regional Community-based Food Systems. South Region SARE Research and Education Project. Project reports at (accessed 10/18/10).

(11) Southern Louisa University, 2005, Expanding the Marketing Opportunities for Minority and Limited Resource Farmers in Louisiana and Mississippi. South Region SARE Research and Education Project. Project reports at (accessed 10/28/10).

(12) University of California, 2010. Developing regional distribution networks to enhance farmer prosperity: Retail value chains. West Region SARE Research and Education Project. Project information at (accessed 10/28/10).

(13) Cooperative Extension, 2007. Assessing the capacity of producers to supply institutional markets. Northeast Region SARE On Farm Research/Partnership Project. Project reports at (accessed 10/18/10).

(14) Yale Sustainable Food Project, 2007. Creating sustainable food purchasing guidelines in the Northeast. Northeast Region SARE Sustainable Community Innovation Project. Project reports at (accessed 10/18/10).

(15) Land Stewardship Project, 2002. Supporting Community with Retail and Institutional Food Service: Keeping it Safe, Legal and Local. North Central Region SARE Professional Development Program Project. Project reports at (accessed 11/1/10).

(16) PlacerGROWN, 2004. Fresh, From Our Family to Yours: Direct Marketing Education for Producers. West Region SARE Research and Education Project. Project reports at (accessed 10/25/10).

(17) REAP Food Group, 2006. Buy Fresh Buy Local: Building Marketing Opportunities for Local Foods in Restaurants and Institutional Food Services. North Central Region SARE Research and Education Project. Project reports at (accessed 10/25/10).

(18) Seeking Common Ground, 2006. Canandaigua Lake foodshed: Farm-to-cafeteria program. Northeast Region SARE Sustainable Community Innovation Project. Project reports at (accessed 10/25/10).

(19) University of Northern Iowa Center for Energy & Environmental Education, 2000. Expanding local markets through linking institutional food buyers to local farmers and processors in Northeast Iowa. North Central Region SARE Research and Education Project. Project reports at (accessed 10/25/10).

(20) Kulick, Marie, 2005. Healthy Food, Healthy Hospitals, Healthy Communities: Stories of Health Care Leaders Bringing Fresher, Healthier Food Choices to their Patients, Staff and Communities. Institute for Agriculture and Trade Policy. Available online at (accessed 11/3/10).

(21) Harvie, Jamie, 2008. Menu of Change: Healthy Food in Health Care: A 2008 Survey of Healthy Food in Health Care Pledge Hospitals. Health Care Without Harm. Available online at (accessed 11/4/10).

Project Objectives:

The long-term outcome of this project will be that hospitals and hospital systems will become a growing market for sustainable farmers and ranchers—a market that is both significant in size and straightforward for farmers and ranchers to access. (This is also means that in the long term, hospitals will be able to structure their food sourcing contracts in a way that allows them to maximize their purchases of local, sustainably produced food.)

This project contributed to this outcome in the short term by (1) increasing knowledge among hospitals and health care purchasing officials about steps they need to take to increase their purchases of local, sustainably produced food (including changes that may need to be made to purchasing contracts and agreements); and (2) increasing knowledge among farmers about how to access the hospital market and create a fair, sustainable and successful purchasing relationship.

The intermediate outcome of this project will be that hospitals increase their purchases of sustainable, local food, and that farmers will increase their sales to hospitals. Because of the complex nature of food sourcing contracts, we anticipated that in some cases increased sales achieved in the intermediate term may be limited by these agreements. Thus, an additional important intermediate outcome will be that hospital participants will begin to take steps as necessary toward adapting their purchasing guidelines and contracts to allow for increased purchases of local, sustainable food. (This may include taking steps to adapt current contracts, but more likely will be in the form of planning how they will change the next round or renewal of the contracts.)

The audience for the project was two-fold. First, local farmers who produce food sustainably will use our information and resources to learn about and access a sizable new potential market. Second, hospitals will use our information and resources to more easily and effectively meet their internal goals for increasing the sustainability of their food purchasing.


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Materials and methods:

In this project, together with the project team and the assistance of three health system collaborators and the project advisory committee, we were able to:

  • Conduct a detailed food and beverage procurement analysis for three health systems.
  • Use the procurement data collected to extrapolate vital information about the current and potential market for local, sustainable foods in health care settings.
  • Survey a subgroup of sustainable farmers and producers in Minnesota and Wisconsin to determine their interest in and experience in selling to hospitals and gather data on products sold and form, processing, distribution, production methods, food safety, insurance carriage and more.
  • Convene an advisory committee consisting of hospital collaborator staff, a mix of Minnesota and Wisconsin sustainable farmers and producers with an interest in and/or experience in selling to hospitals, and state agriculture department representatives from Minnesota and Wisconsin.
  • Provide the participating health care collaborators with customized roadmaps designed to help them to maximize use of local, sustainably produced food; roadmaps included a detailed local, sustainable purchasing baseline, the ecological health impacts of their purchasing decisions, the health-based rationale for maximizing use of local, sustainably produced food, analysis of their potential for change and detailed recommendations for the ways they can increase their purchases from sustainable farmers and producers and manage costs.
  • Develop two reports, a tool kit and other associated resources to share the lessons learned, next steps and opportunities with hospitals and sustainable farmers in the North Central SARE region and elsewhere.

The hospital systems participating include the St. Cloud VA Medical Center in St. Cloud, Minn., Fairview Health Services headquartered in Minneapolis, Minn. and Hudson Hospitals and Clinics in Hudson, Wis. Together, these three hospital systems had $5.4 billion in combined food and beverage purchasing in 2011. Because one of the challenges of farmer sales to hospitals is the diversity of management systems and types of hospitals, it’s important to note that the three hospital systems also reflected a wide range of hospital management systems. Among these three systems were an academic institution, an independent community hospital and a federal facility. They included single-facility systems and a multi-facility system; individual hospitals with anywhere from 25 to 1,100 beds; facilities in urban, suburban and rural locations; facilities with completely self-operated food systems, others with completely contract-based food systems, and some with a combination of self-operated and contracted food service; and varied levels of existing experience with local food procurement.

The advisory committee met bi-monthly and undertook a variety of shared learning activities, often involving guest experts, to explore hospital demand for local and/or sustainable food, delivery methods and models, as well as opportunities and challenges of direct procurement with hospitals. As much as possible, the advisory committee explored actual case studies of successful and unsuccessful hospital/farmer direct procurement experiences from around the region and the country.

In 2012, the committee heard from two National VA Hospital Leaders from the east and west coast—including the creator of the VA Healthy Diet Guidelines—about their success in direct procurement;  they engaged in a discussion around the lessons learned from unsuccessful food co-ops from one of the best and last remaining co-op development specialist within USDA Rural Development; they asked thoughtful questions of an association that connects growers, processors, distributors and markets to build equity and trust in a new local food economy; and they have learned from a multi-stakeholder cooperative of producers, processors, distributors and buyers about their successful cooperation with the healthcare industry in Wisconsin from the point of view of both the Hospital’s Administrative Director of Nutrition and the Operations Manager of the Co-op. 

In 2013, the team learned about models of distribution in Wisconsin lessons from the closure of the Producer and Buyers Co-op in northwestern Wisconsin; and the operations of the Fifth Season Co-op. The committee also held “wrap up” discussions about lingering concerns, next steps and opportunities, and gave input on drafts of the final reports and tool kit. The group also had two in-person gatherings, one in May for learning and discussion, and a December 2013 final wrap-up meeting.

In early 2014, we released three key outputs from this project: a report detailing the outcomes of the project aimed at hospitals, a similar report aimed at farmers, and a tool kit with resources that both farmers and hospitals can use to implement the suggestions detailed in the reports. We also held two webinars to share the results of the project, one focused on the hospital perspective and one on the farmer perspective.



Research results and discussion:
(The following is a summary of the results of our project. For a complete discussion and detailed data analysis, please see the two “Connecting Sustainable Farmers to Hospitals” reports.)

There is ample evidence that hospitals throughout the north central region—Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin—are interested in buying food and beverages produced by sustainable farmers/producers. Seventy percent of respondents to the Institute for Agri­culture and Trade Policy (IATP) 2012 Sustainable Agricul­ture Research and Education (SARE) project Health Care Collaborator Food Service Survey believe that the purchase and use of sustainable foods is in line with the mission of their hospital.

However, whether purchasing through their existing supply chain partners or directly from producers, hospitals face several key challenges in sourcing local, sustainably grown foods. Today, it is still much easier to purchase most hospital food through a prime vendor rather than deal with the limited availability of local, sustainable prod­ucts via current suppliers; accomodate the higher prices for sustainably grown foods; and justify the demands on staff time to research and resolve these issues.

In time and with persistence, all of these challenges are surmountable to some degree and can certainly make a significant difference in the livelihoods of north central region sustainable farmers/producers.

The long-term potential market is significant. In the near-term however, the potential market is much smaller. How much smaller depends on many of the factors/issues, but especially the following:

  • Whether a hospital has made and strictly adheres to a percentage-based purchasing commitment that limits or discourages non-prime vendor purchases.
  • Whether a hospital uses a food service contractor who prohibits direct purchase of products from farms or has onerous requirements for becoming an approved vendor that effectively bar most interested sustain­able farmers/producers from selling to a hospital with contractor-managed food service.
  • The percentage of a hospital’s food and beverage budget that is spent on highly processed and pre-made convenience items and beverages such as coffee, tea, juice, soda, etc.

Despite all this and given the current average annual sales of many of the farmers/producers interested in selling to the hospitals in their community, this information should not prevent interested sustainable farmers/producers from working to access this market. Instead, these farmers/producers are encouraged to take several steps to increase their potential to make sales to hospitals in the near-term, including but not limited to:

  • Targeting potential hospital customers based on their size and the farm/operation’s size/current production capacity—keeping in mind that about 50 percent of north central region hospitals are in rural areas and most of those hospitals have 25 staffed beds or less and even lower numbers of actual patients throughout the year.
  • Being proactive about addressing potential food safety concerns: Knowing the local, state, and federal rules and regulations for sales in-state and across state lines and going beyond regulatory require­ments, as feasible, to increase hospital confidence in products, e.g., developing an on-farm food safety plan or, if selling fresh produce, completing a USDA Good Agricultural Practices (GAPs) training program and maintaining a copy of the certificate of completion.
  • Being proactive in education and marketing to hospitals: Assuring that the farm/operation website and other marketing resources include informa­tion on steps taken to address food safety, such as training, food safety plans, how and where food items are processed, e.g., state-inspected plant, USDA-inspected plant, licensed commercial kitchen; include information on any products the farm/opera­tion is particularly interested in selling to hospitals and who they should contact to set up a meeting and/or farm tour; highlighting low-prep and food-prep neutral items that can be more easily incorporated into hospital food service and keep their need for additional labor, equipment, etc.

Leading hospitals have shown that it is possible over time, and with a conscious effort, to have 50 percent or more of their annual food and beverage purchases produced by sustainable farmers. Ideally, most of these purchases would be made from sustainable farmers/producers located in the hospital’s community.

In the near-term, to maximize procurement of food produced by sustainable farmers, hospitals are encouraged to:

  • Set a goal of 15 percent sustainable, and once reached, set a new goal. This is the baseline percentage outlined in Green Guide for Health Care (GGHC) Food Service Credit 3 and IATP SARE project health care collaborators see this as doable within three years. Subsequent GGHC goals include 25 and 50 percent.
  • Support sustainable farmers/producers via current supply chain partners by purchasing food and beverage items that are most easily identifiable as produced by sustainable farmers/producers from existing supply chain partners, e.g., USDA Organic products and fluid milk and yogurt produced without use of rBGH/rBST.
  • Establish a purchasing relationship with at least one sustainable farmer/producer, producer group or food hub in their community.

Over the long-term, all north central region hospitals are encouraged to:

  • Increase the types and amounts of products purchased directly from sustainable farmers/producers.
  • Increase procurement flexibility by reducing percentage based commitments to purchase from mainline distributors.
  • As opportunities arise, participate in the development/expansion of alternative food distribution models, such as regional food hubs.
  • Avoid contractual food service management arrangements that prevent purchase of food directly from sustainable farmers.
  • In addition, north central region VA hospitals/medical centers are encouraged to implement the VA-specific recommendations outlined in the Next Steps and Opportunities section of this report.


Research conclusions:

Within the timeframe of this grant, we were able to see fulfillment of the short-term indicators for this project: (1) increasing knowledge among hospitals and health care purchasing officials about steps they need to take to increase their purchases of local, sustainably produced food and (2) increasing knowledge among farmers about how to access the hospital market and create a fair, sustainable and successful purchasing relationship.

 This increased knowledge is evidenced by participation data, participant feedback and staff observations, including:

-  More than 300 people attended educational webinars on Farm to Hospital (December 18 and 19, 2013). We were impressed by the quality of the discussion in the question and answer period, which indicated strong interest and engagement with the information provided.

-  The roadmaps for procurement developed for the three participating hospitals were very well received and have already proven to be extremely useful in advancing farm to hospital efforts. In follow-up conversations a few months after the project, we saw some early indications that the roadmaps are having the desired effect. One hospital had started a healthy food taskforce, which even received funding for its work. They attributed their successful internal advocacy, in part, to the roadmap’s systematic approach and practicality. At the time of this conversation, the hospital had started negotiating sales with a local Hmong farmers’ cooperative and had agreed to pilot a CSA collaboration at three of their sites. At a second hospital, the Advisory Committee member had made a presentation to their hospital directors that was well received; again, they cited the roadmap as helping them “make the case” for local procurement. A third hospital is already procuring local meats, fruits and vegetables; and they are also exploring additional procurement from a local dairy farm.

- The Advisory Committee of 15 farmers and hospital staff was selected, in part, to bring together people with local procurement experience and newer advocates. We expected that newer advocates would learn from more experienced people in the group, however, we learned that none had participated in a group involving both producers and buyers in such a systematic analysis of the issues in hospital procurement. Thus, producers gained more insights into hospital procurement issues, and hospital staff had a chance to ask producers questions about the dynamics of farming that they would not have if they only met in a business setting. 

Economic Analysis

As part of the development of this project, we conducted research into the spending patterns of participating hospitals and the purchasing levels by hospitals in the region. In 2011, SARE project health care collaborators—Fairview Health Services, Hudson Hospital & Clinics, and Nutrition and Food Services (NFS), and the patient side at the VA Medical Center in St. Cloud, Minnesota spent $6.7 million dollars on food and beverages. The purchases included approximately 800,000 pounds of whole and fresh pre-processed produce, 481,000 pounds of fresh and frozen beef, pork and poultry, 64,000 pounds of cheese, 54,000 pounds of yogurt, 51,000 pounds of cottage cheese, butter, sour cream and cream cheese, 104,000 pounds of liquid eggs, 192,000 shell eggs, and 91,000 gallons of fluid milk. These eight facilities spent similar amounts in 2012.

Veterans Health Administration (VHA) Healthy Diet Guidelines support VA hospital/medical center purchase of sustainable food and beverages, and federal procurement guidelines generally encourage support of small businesses, including farms. The 37 VA hospitals/medical centers in the north central region alone spend an estimated $29.4 million or more each year on food and beverages.

In addition, 136 north central region hospitals have demon­strated their interest in supporting sustainable farmers/producers by signing the Healthy Food in Health Care (HFHC) Pledge and/or taking the Healthier Hospitals Initiative (HHI) Healthier Food Challenge. Combined, these hospitals spent an estimated $74.8 to $220.6 million on food and beverages in 2012, and averaged between $106.3 and $146.5 million, depending on whether staffed beds or average daily census is used.

Together, the 1,493 registered community hospitals, including HFHC Pledge signers and HHI Healthier Food Challenge participants, and VA hospitals/medical centers in the north central U.S. spend an estimated $718 million to 1.3 billion each year on food and beverages.

Farmer Adoption

While these publications are still new, we are pleased to report that these reports have received more than 5,000 views (farmer-focus report: 2,733 and hospital focused report: 2,585). While we cannot identify individual viewers, we believe that a significant number were farmers including the 104 people who signed up for the farmer-focused webinar in December. 

Participation Summary

Educational & Outreach Activities

Participation Summary:

Education/outreach description:

We produced two reports: Connecting Sustainable Farmers to Hospitals: Farmer Focused Report and Connecting Sustainable Farmers to Hospitals: Hospital Focused Report. In these documents, we synthesized information about healthcare food procurement, describing the various dynamics and business drivers that are unique to this sector. We also provided two case studies of successful collaboration between sustainable farmers and hospitals as well as detailed procurement information and estimates of market potential in the region.

Based on this information, and our work with the Advisory Committee, we were able to develop practical resources and meaningful recommendations for both healthcare food directors and farmers. This information was presented in 12 toolkits attached to the reports. These include:

1. Using Written Protocols to Guide Direct Procurement of Food From Sustainable Farmers, Producers
2. Food- and Beverage-Related Eco-labels/Label Claims
3. Financial Strategies for Incorporating Sustainable Food into a Hospital’s Budget
4. The Health-Based Rationale for Hospital Purchase of Sustainable Food
5. Local, Sustainable Products Carried by Distributors Serving Minnesota and Western Wisconsin
6. Iowa, Minnesota and   Western Wisconsin Sustainable Farmers, Producers Interested in Selling to Hospitals
7. Online Resources for Hospitals Interested in Connecting to Sustainable Farmers, Producers Farm to Hospital
8. Online Resources for Sustainable Farmers, Producers Interested in Selling to Hospitals
9. Seasonal Availability of Produce and Other Foods Produced in Minnesota and Wisconsin
10. Sustainable Food Procurement: Working with Current Supply Chain Partners
11. Ten Steps to Creating Mutually Beneficial Relationships with Local, Sustainable Farmers, Producers
12. Hospital Food Purchasing: A Primer for North Central Region Sustainable Farmers/Producers

We also produced the previously mentioned roadmaps for the three participating hospitals. These reports included a detailed local, sustainable purchasing baseline; the ecological health impacts of their purchasing decisions; the health-based rationale for maximizing use of local, sustainably produced food; analysis of each hospital’s potential for change; and detailed recommendations for the ways the hospital can increase their purchases from sustainable farmers and producers while managing costs. In addition we included seven appendices that explained issues such as eco-labels/label claims; review of each hospitals local purchases for the prior year; listing of local products available through distributors; list of local producers interested in selling to hospitals; and a chart of seasonal availability of local foods.

Project Outcomes


Areas needing additional study

Further clarity is needed around the term sustainable. Use of third-party certifications and USDA and U.S. Food and Drug Administration (FDA)-approved label claims to identify sustainably-produced food is simple, and leaves little room for misapplication. However, solely applying a mileage-based criterion can, and will often, have unintended consequences—purchasers giving an preference to highly processed food items that are manufactured within the mileage radius or conventionally raised food items, such as turkey, chicken, eggs, beef , cheese, fluid milk, and pork, processed and sold by large, often multi-national, food companies headquartered within the mileage range.

Hospitals need more information on product availability via farmers and producers. Many hospitals focus on buying produce from area farms, and either forget or do not seem to know that many other types of products are available. Knowledge is also very limited in regards to the types of produce items that can be available long past harvest, such as crops that store well for long periods. There is also a bit of a misperception about volume availability and the amount of time it takes to scale-up production in response to buyer interest.






Information Products

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Agriculture or SARE.