It is unfortunate that so many residents of nursing homes are denied this proverbial spice of life. Institutional foods traditionally consist of unappealing meat, watered-down sauces, and uncreative staples. The residents at our facility were no exception-they complained about many aspects of the dining experience. The food was boring and tasteless, they said, and was frequently served at less than the ideal temperature. Residents voiced their dissatisfaction at the resident council meetings, and these same sentiments were echoed in the resident satisfaction questionnaire. Figure 1 shows just how severe that dissatisfaction was.
Once the satisfaction questionnaire clearly quantified a myriad of food service problems, our Performance Improvement Committee met to address the issues. Our program, "Creating a Five-Star Dining Experience," began in October 2002. The program continues to evolve, but it was basically in shape by January 2003.
Our Performance Improvement Committee met and established a focus committee, which would meet weekly to conceive, develop, and implement changes designed to meet the food service objectives. The focus committee consisted of the Food Service Supervisor, Director of Nursing, Administrator, and Director of Therapeutic Recreation. The focus committee was determined to bring the variety and subtlety of food to our residents, leading toward a time when meals would be more than a temporary diversion in the day, but instead an adventure to the far corners of the palate.
We admitted that our previous menu was dull and dreary. Bringing "ambrosia and nectar" to our table would not only make mealtime a delight, but cast upon our institutional walls a glowing sense of comfort and harmony.
The focus committee quantified our objectives as follows:
- At least 95% of the residents will be extremely satisfied with the taste of the food.
- At least 90% of the residents will be extremely satisfied with the variety of food offered.
- At least 95% of the residents will be extremely satisfied with the food temperature.
- At least 95% of the residents will be extremely satisfied with the overall dining experience.
The focus committee established four basic interventions:
1. Waiter/waitress: At your service. The focus committee determined that the reason the food was served at less than ideal temperature was the lack of expedience with which the food was served. The hot food arrived in the dining rooms hot, and the cold food was cold, but the untimely distribution of the food trays resulted in most food being lukewarm. The focus committee determined that if additional workers besides CNAs and nurses distributed trays, the trays could be delivered to the residents in a matter of minutes. The Administrator met with all staff (exclud- ing housekeeping and maintenance) and discussed the new plan and each person's involvement. It was decided that no one would take lunch during resident mealtimes. Rather, every clerk, social worker, medical records employee, business office staffer, secretary, and all other ancillary personnel would be assigned to one of two dining rooms. Every day they would report to the assigned dining room five minutes before the scheduled meal. Dining room captains and cocaptains were selected from management employees; they would coordinate the extra staff in an orderly and efficient manner.
As the food carts rolled into the main dining rooms, the captains would have the "waitstaff" line up. In a methodical manner, a captain would take a tray from the food cart and give it to the first waitstaff person in the line. He or she would deliver the tray and return to the line for another tray. In this manner, all 60 trays were served within 10 minutes. The hot food was hot and the cold food was cold. After 15 minutes, total, of service, the employees (now no longer serving as waitstaff) would return to their respective jobs, although the nurses and nursing assistants who routinely stayed with the residents and assisted them with eating would continue to do so.