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At dawn, at the loading dock behind the kitchen at St. Joseph Mercy Hospital of Ann Arbor, Michigan, small lift loaders and handcarts trundle boxes from food trucks to storage rooms.  The perishables go straight to immense walk-in refrigerators packed with processed produce-buckets of cubed melons, bags of pre-washed lettuce, packages of onions diced by the quarter-, half-, and three-quarter inch.

That St. Joe’s executive chef can peel open a three-pound bag of diced onions and dump it into the steel cauldron he calls a soup pot is an efficiency triumph of no small consequence. Preparing the soup du jour from whole ingredients-all sixty-five gallons of it-would take hours of chopping.

When you’re making soup for 600, changing your grocery list can quickly get complicated. Hospitals like St. Joe’s are emerging as the next frontier of the local food movement, but they are struggling to navigate the tensions between their new food goals and their reliance on standardized, low-cost products delivered dependably day in and day out. The question is, Can the local food movement scale up to meet institutional demand without losing sight of its original values?

Last fall, as part of the hospital’s sustainable food efforts, St. Joe’s loading dock had a new visitor. Farmer Richard Andres arrived from just down the road with 200 pounds of his green beans-local, organic, and grown by a family farmer. They were a point of pride for the hospital’s good food advocates, including CEO Rob Casalou and chief clinical dietitian Lisa McDowell. Like Farm to School initiatives, which are flourishing with support from Michelle Obama’s anti-obesity campaign, St. Joe’s sees enthusiasm for fresh local produce as a way to encourage healthier eating while supporting local farm economies.

In the kitchen, however, Andres’s superbly fresh beans meant eight hours of washing, snipping and slicing. Even St. Joe’s food purchasing coordinator sidled out from behind her computer to help get the job done. “Nobody understands how long it takes to prepare certain things,” says Executive Chef Ryan Kendall. “If it’s from a major food distributor, it comes in ready to rock and roll.”