Farm-to-hospital programs and public health: Leveraging local food for organizational and behavioral change

Farm-to-hospital (FTH) programs have emerged over the last decade as an approach for hospitals to leverage their buying power and growing influence in the food system to support healthier eating hab­its, as well as stimulate local economic develop­ment and community wealth building, often within a broader set of policy, systems, and environmental (PSE) interventions. While FTH programs have increased in prominence over the last decade, sev­eral challenges prevent widespread adoption. These include distributor contracts that limit outside pur­chases, logistical challenges receiving products from local vendors, and a lack of buy-in from key decision-makers. These challenges frequently reflect foodservice operations organized to maxim­ize revenue, which lends itself to an approach that sources cheap and unhealthy food products. In this paper, we present findings from a case study of two hospitals part of the University of Wisconsin Health system in their efforts to develop a farm-to-hospital program from 2008 to 2017. Specifically, we study the organizational strategies used by the We Are Health Committee (WAHC) and its infor­mal predecessors to create the conditions to facili­tate and encourage local food procurement. We find that stakeholders reorganized their foodservice operations around the value of supporting public health, leveraging their clinics’ mission as a public health institution. This resulted in the creation of new organizational structures and roles, including merging their nutritional and foodservice depart­ments, creating the infrastructure for institution-wide change. Local food procurement was per­ceived as a means to develop nutritional interven­tions targeting the availability of healthier food items without creating the perception of paternal­ism among visitors. Finally, as stakeholders observed the local economic impact of their pur­chasing decisions, the values of their foodservice evolved to explicitly include supporting local eco­nomic development, resulting in an evolution of their relationship with their broadline distributor to facilitate increased local food purchases.