Imagine being able to build a completely green restaurant from scratch with a decent budget and endless creative freedom. That's the dream executive chef Justin Johnson was presented with when the 90-bed Watertown Regional Medical Center in Watertown, Wis., decided to completely overhaul its 40-year-old cafeteria and kitchen.

Watertown’s restaurant and room service operation feed up to 400 people a day, including patients, visitors and hospital staff from this location and others in the area network.Harvest Market, the from-scratch restaurant that opened in November of last year, takes the farm-to-table concept literally by using an 11,000-square-foot full-scale farm to supply a large share of the restaurant's fresh produce. With a list of other sustainable initiatives such as energy-saving equipment and design elements made from renewable materials, the full-scale restaurant and room service kitchen demonstrate how green and sustainable design can intersect with healthy eating, fresh food and nutrition. The restaurant and room service operation feed up to 400 people a day, including patients, visitors and hospital staff from this location and others in the area network.

"While conceiving this project and figuring out our brand, we found ourselves pushing the envelope more and more," says Johnson, who notes the project spanned a year and a half from concept development to construction and opening.

"Why can't we grow our own food and source everything locally and have a menu that changes every day as opposed to what you see in many institutional foodservice operations?" Johnson posed this question to himself and the development team, which included marketing professionals, hospital maintenance and construction crews and dieticians. The team was also lucky to have a gardener and others with green thumbs on staff.

Prior to opening the new restaurant, the hospital operated a standard institutional cafeteria with a tray line, steam tables and nothing special when it came to the food, Johnson says. Rather than trained cooks or chefs, the cafeteria employed healthcare associates who simply reheated already prepared foods. Now, the open-action, servery-style restaurant prepares everything from scratch, even breaking down whole animals from a nearby farmer. Full-time prep cooks work in an entirely separate HAACP-certified prep kitchen off the back loading dock. In fact, having a chef not only run the kitchen but also play an integral part in the remodel and daily operations is an emerging trend in healthcare foodservice that Johnson could see increasing as this segment continues to compete against traditional restaurants.

"The hospital wanted to put more of a focus on the dining and patient experience with a focus on health care, not sick care, as well as offer the highest level of customer service it could," says Johnson.

In addition to showcasing many sustainable initiatives and features, the hospital takes a proactive approach to health, focusing on fresh, nutritious, wholesome food, healthy eating and wellness as preventative measures that will limit diseases in the long run. Obesity rates in Dodge and Jefferson counties, where the hospital network is situated, are some of the highest in the country, according to Johnson. For many restaurants and foodservice operations, sustainability is an afterthought, if it's a thought at all. Sourcing local produce and creating a clean, energy-efficient environment naturally work into Watertown Medical Center's dual philosophy of both sustainability and health, says Johnson.

Sustainable Menu Development

Watertown’s menu leverages seasonal ingredients sourced from local providers. Making menu items to order helps keep food waste at a minimum. "In most healthcare settings you're locked into a cycle menu and can't change it very much," says Johnson. "We've built Harvest to be flexible so we can change the menu items as much as we want and always use what's fresh and in season. Great ingredients just taste better."

Sourcing seasonally and directly from its own farm as well as from other local producers also has implications for sustainability. Designing a menu around what's harvested from the farm and readily available naturally cuts down on waste and prevents not only overpurchasing but also overproducing food. Rather than staying at the mercy of a large broadline distributor, the restaurant works with a smaller, more regional distributor willing to pick up extra produce and humanely raised meats and eggs from Wisconsin farmers as a supplement to the citrus fruits, cooking oils, sustainable seafood and other ingredients the hospital must source from outside the state.

Cooking everything from scratch — from sauces and soups to pastries, baked goods, salad dressings and other staples — also helps the restaurant use everything on hand and get a better handle on its inventory as well as offer a better dining experience and cater to those with special diets and allergies. Culinary staff cook everything to order, which means very little goes to waste.

Johnson admits that regularly changing the menu can pose a challenge for any operator, large or small, so the restaurant features a set menu with favorites while showcasing a rotating list of specials making use of seasonal, local food.

Building the Farm

"We knew that we at least wanted some herb pots outside the kitchen and talked about sourcing from local farms since we are in a rural setting, but we took the discussion one step further by cutting out the middleman and growing food ourselves," says Johnson.

The restaurant development team carved out nearly an acre of land behind the hospital's main parking lot for Harvest Market's farm. Last summer, a test of the growing capabilities showed the team was able to cultivate 45 different crops, including various types of tomatoes, several varieties of lettuces, kale, Swiss chard, green beans, snap peas, cucumbers, lemon cucumbers, asparagus, garlic, red okra, carrots, onions, leeks and an array of herbs. In fact, the farm proved to be so fertile that it supplied 90 percent of the produce used by the kitchen in the months leading up to the remodel.

"We are very self-sufficient and only go to our wholesaler for things like lemons, limes and orchard fruit when it comes to produce," says Johnson, who notes that Harvest Market earned a coveted nomination from the National Restaurant Association's operator innovation awards last year as a result of its farm and other sustainable endeavors.

While the hospital's landscaping crew helps with the watering, weeding and planting, farm management remains a collaborative effort of the 30-member kitchen staff, including cooks, prep cooks and dishwashers, as well as other hospital support staff. "A couple days a week on harvest days we all go down and pick the crops together, so it's really become a community effort," says Johnson, noting the origin of the restaurant's name. "This year we will be working on developing a more efficient schedule for planting and harvesting. By staggering the planting we will be able to ensure a more consistent, steady supply of produce rather than having everything be ready to harvest at the same time."

Farm Food Safety

Many large healthcare foodservice operators have strict restrictions about sourcing from local farms because of food safety and HACCP requirements. "The reason we're able to grow our own food is because we don't operate under any kind of contract foodservice management," says Johnson. "If we don't have green beans, we won't place green beans on the menu. In contrast, a lot of times in institutional menu cycles, if Tuesday's menu has green beans, you have to buy them from somewhere."

Still, food safety and HACCP planning play an even more important role in Harvest Market's operation because the restaurant grows its own food. While the restaurant development team had the farm soil tested and followed other agricultural protocol, it took a special focus on clean, safe handling and processing of the harvested and other locally sourced food by building a separate, HACCP-certified prep kitchen off the loading dock.

"We have a tractor that drops all of the fresh produce off at the dock and then the produce goes straight into this 'slop kitchen' through a three-step vegetable washing and drying process," Johnson says. Lettuces are washed and dried and carrots are peeled before making their way upstairs to the main kitchen for prep and cooking. "Since we see deliveries almost every day, we have to keep a very tight schedule, and we have two full-time prep cooks on hand."

The prep kitchen also features a refrigerated butcher room where Johnson and prep cooks break down whole chickens, fish and meat. All of the meat is cut, cleaned, sealed and secured in this room before entering the main kitchen. A sous-vide machine helps vacuum-seal and preserve the shelf life for some of the meat, Johnson explains, noting that the kitchen team is developing its own HACCP plan for this process.

Food Preservation and Waste Management

Naturally, in an operation of this kind, food preservation remains a growing area of interest for Harvest Market. Vacuum sealing, pickling, fermenting and canning help preserve large batches of produce for longer-term storage through colder months while cutting down on waste. By growing, processing and preserving its own food, Harvest Market has seen a 30 percent reduction in food costs.

Johnson says the restaurant uses much of the same equipment a home cook would use for canning, but he wouldn't be surprised to see more manufacturers developing commercial-grade canning and preservation equipment as this trend continues to take off.

Staff place scraps from the prep kitchen in bins strategically located throughout the space and then compost the waste on-site to use as fertilizer in the restaurant's garden. Harvest Market uses a simple, manually operated composting cylinder that someone must regularly turn, but Johnson could see the need to invest in larger-scale equipment coming soon.

Sustainable Design and Resource Conservation

A total gut job of the interior foodservice space presented the opportunity to purchase all-new, more energy-efficient equipment and systems. The hospital purchased $600,000 worth of equipment, including many Energy Star-rated pieces such as chargrills, flattops, refrigeration units and convection ovens. Other new equipment items purchased for the remodeled operation include a combi oven, immersion circulator and even dough sheeting and bakery equipment for from-scratch baked goods prepared by the restaurant's full-time pastry chef. Key investments also include a state-of-the-art demand-controlled ventilation system to cut down on HVAC energy use as well as energy-efficient and 90 percent natural lighting, low-flow toilets and faucets and submetering to monitor water use. The restaurant also switched its takeout containers and other disposables to compostable brands and replaced bottled water purchases with a new filtering system.

Other sustainable design features include recycled carpet and flooring made from recycled tires, tables made from repurposed barn wood, and low-emitting materials and finishes.

"For us, energy and water management was nonnegotiable," Johnson says. "If you have the means to buy energy-efficient equipment and design your space to save resources, we believe you should. Our organization as a whole wanted to set an example. We're not necessarily trying to do any of these things out of a self-important mission. It's just what's right. If the technology and best practices are there, why not use it?"