He picked up his usual multigrain roll from Metropolitan Bakery, and filled a bowl at the salad bar, beyond which he could eye a tub of steamed hot dogs and an orange pool of molten cheese.

Lewis isn't a doctor. But you didn't need a medical degree to know which lunch was a better bet. And indeed next to the hot dogs was a pan brimming with Lewis' vision of the kind of food he's pushing to see more of in the future - herb-roasted fingerling potatoes and green and yellow squash from family farms in Fleetwood and Quarryville, Pa.

It might seem overdue and somewhat of a no-brainer to be augmenting hospital cafeteria menus (and soon patients' meals, as well) with wholesome, local produce; to cut down on the fatty, processed foods that land people in the hospital to begin with.

But it is one thing, as Lewis has learned, to preach the fresh-local gospel and another to put it into large-scale, daily practice. In fact, some hospitals have opted out, turning their cafeteria service over to the very fast-food franchises that give doctors agita. And others have dragged their feet, knowing the hassles ahead: Like a battleship, the lumbering, urban hospital kitchen wasn't built to turn on a dime.

Consider the headaches:

Coolers at Jefferson orginally designed to store compact frozen vegetables overflowed quickly with boxes of unruly Jersey cukes and peppers.

Just because eggplant is bountiful one week, you can't devote an entire menu to Moosewood eggplant dishes.

Washing out the sand from the field, peeling the potatoes, and cutting the green beans isn't exactly a walk in the park: It requires extra hands, extra space and hours.

Still, in only the second full summer of the fresh-local push, Jefferson can point to a 25 percent or more gain in locally sourced products; from 20 cases of zucchini last year, for instance, to 160 cases this year.

The effort, surprisingly, has been revenue neutral - the prep costs higher, transportation costs often lower.

And the variety has been vastly expanded: Last year the distributor didn't offer much local fare beyond squash and apples. This year, the hospital has ordered local sweet potatoes and peaches, beets and cucumbers, radishes and herbs.

It still makes up a tiny portion of the hospital's larder (less than 10 percent of the total), but staffers on the front line - staggered at the start by the sheer complexity of switching gears - are newly and outspokenly bullish.

Mary Grant, who oversees sourcing, knew attitudes were changing recently when a cook chastened her for falling back on packaged product: "Why don't we have fresh green beans?"

In fact, one particularly tasty skillet of braised summer vegetable stew - Jersey tomatoes and Japanese eggplant, fresh basil and yellow squash - never made it out of the kitchen.

The team of line cooks ate it on the spot.

The Jefferson initiative is called "Healthy Food in Healthcare." And its ambition ranges far wider, overall, than reburbishing the cafeteria menu.

On Thursdays there's a fledgling sidewalk farmers market (operated by a group called Farm to City).

Grant and her colleague Shelley Chamberlain, who supervises dining services, pushed Wawa dairies to get bovine-growth hormones out of their milk order or risk losing their contract.