1.
Culture Change The Role of the DON In Affecting Positive Culture Change with the Dining Experience.

2.
Pre-Culture Change <ul><li>Traditional Diet Plans </li></ul><ul><li>Split Dining Rooms: Skilled & LTC </li></ul><ul><li>Atmosphere- Dirty Cabinets, Chipped Paint, Lack of Décor, Adult Clothing Protectors </li></ul><ul><li>Meals Served on Hospital Trays </li></ul><ul><li>Meal Periods extended over 2.5 hours </li></ul><ul><li>Staff Directed Dining </li></ul><ul><li>Increased Resident Complaints </li></ul>

3.
Culture Change Physician & Staff Buy in <ul><li>NP/ MD/ Staff Education </li></ul><ul><ul><li>Liberalized Diets </li></ul></ul><ul><ul><li>Letter from Nutrition Alliance, LLC </li></ul></ul><ul><ul><li>In-Service for Staff </li></ul></ul><ul><ul><li>F-Tag Focus Audit </li></ul></ul><ul><ul><li>Staff Driven vs. Resident Centered Education </li></ul></ul><ul><li>Resident Education </li></ul><ul><ul><li>Letters to All Residents </li></ul></ul><ul><ul><li>Resident Council Education </li></ul></ul>

4.
Culture Change Overcoming Obstacles <ul><li>Liberalizing the Diets- Kitchen, Nursing, Physicians </li></ul><ul><li>Staff Schedule vs. Meal Times </li></ul><ul><ul><li>Traditional Shifts changed to 6a-2p-10p </li></ul></ul><ul><ul><li>11a-7p C.N.A flexed for transitional census </li></ul></ul><ul><li>Split Dining Room </li></ul><ul><ul><li>Combined two DR ’s </li></ul></ul><ul><ul><li>Removed Big Screen TV into smaller room </li></ul></ul><ul><ul><li>Created lounge in place of ‘Skilled DR” </li></ul></ul><ul><li>Lack of Ambience/ Décor </li></ul><ul><ul><li>Paint/ Wall Decorations/ Linens </li></ul></ul><ul><li>Tasks vs. Relationships </li></ul>

5.
Culture Change Overcoming Obstacles <ul><li>Modified Fine Family Dining </li></ul><ul><ul><li>Table Settings Pre-Meal </li></ul></ul><ul><ul><li>First Course prior to meal service </li></ul></ul><ul><ul><ul><li>Hot/ Cold Cereal & Beverages- Breakfast </li></ul></ul></ul><ul><ul><ul><li>Soup & Beverages- Lunch & Dinner </li></ul></ul></ul><ul><li>Atmosphere </li></ul><ul><ul><li>Adult Clothing Protectors  Linen Lobster Napkins </li></ul></ul><ul><ul><li>Placemats Breakfast/ Lunch  Linen table clothes for dinner </li></ul></ul><ul><ul><li>Lazy Susan ’s & Bud vases added to tables </li></ul></ul><ul><ul><li>Reserved Seating vs. traditional seating arrangements </li></ul></ul><ul><ul><li>Music at meal times </li></ul></ul><ul><ul><li>Dining Room chairs vs. Wheelchair seating </li></ul></ul><ul><ul><li>Bread baskets on tables </li></ul></ul><ul><ul><li>Staff-Staff Socializing  Resident-Resident/Staff Socializing </li></ul></ul>

6.
Culture Change Overcoming Obstacles <ul><li>Additional Obstacles </li></ul><ul><ul><li>Specialized textures, SNP, supplements </li></ul></ul><ul><ul><li>Losing Linens </li></ul></ul><ul><ul><li>Food Service </li></ul></ul><ul><ul><ul><li>Traditional Food line in Kitchen  DR Serving Line </li></ul></ul></ul><ul><ul><ul><li>Traditional Hospital Trays  Restaurant Style Service </li></ul></ul></ul><ul><ul><ul><li>Portion Control </li></ul></ul></ul><ul><ul><ul><li>Survey Readiness </li></ul></ul></ul>

7.
Beyond Culture Change Resident Centered Dining <ul><li>Room Service Menu </li></ul><ul><li>Omelet Station Sundays </li></ul><ul><li>Wednesday Salad Bars </li></ul><ul><li>Evening Wine & Cheese Socials </li></ul><ul><li>Musicians During Meals </li></ul><ul><li>Information Station </li></ul><ul><li>Open Café Style Between meals </li></ul><ul><li>Resident Food Committee </li></ul><ul><li>Continuous Quality Improvement </li></ul><ul><li>Guest Services Book </li></ul>

8.
Culture Change Achieved <ul><li>Decreased Resident Complaints </li></ul><ul><li>Decreased Weight loss in building </li></ul><ul><li>No increase in insulin/antihypertensive use </li></ul><ul><li>Increased wound healing </li></ul><ul><li>Decreased infection control rate </li></ul><ul><li>Increased Family Satisfaction </li></ul><ul><li>Continuous Survey Readiness </li></ul>

9.
Rich Amenities Menu <ul><li>Hours 5:00 A.M. – 5 P.M. </li></ul><ul><li>Residents Name_______________ Room #___________ </li></ul><ul><li>Date__________ Delivery Time: _______AM _______PM </li></ul><ul><li>Assorted Trays and Snacks </li></ul><ul><li>• Assorted Cheese and Crackers (Dairy) </li></ul><ul><li>• Assorted Cheese, Fruit and Crackers (Dairy) </li></ul><ul><li>• Assorted Fresh Fruits (Dairy or Meat) </li></ul><ul><li>• Assorted Canned Fruits (Dairy or Meat) </li></ul><ul><li>• Fresh Vegetables (Dairy or Meat) </li></ul><ul><li>Assortment of Cut Fresh Vegetables with Ranch Dip. Tray to include arrots, Celery, Broccoli and Cauliflower but is subject to change. Can be used for a meat meal without ranch dip. </li></ul><ul><li>• Smoked Salmon with Cream Cheese and Mini Bagel (Dairy) </li></ul><ul><li>Assorted Sandwiches </li></ul><ul><li>With all sandwiches please specify what type of bread or rolls you want </li></ul><ul><li>• Peanut Butter and Jelly (Dairy or Meat) </li></ul><ul><li>• Egg Salad (Dairy or Meat) </li></ul><ul><li>• Tuna Salad (Dairy or Meat) </li></ul><ul><li>• Roasted Turkey (Meat) </li></ul><ul><li>• Salami (Meat) </li></ul><ul><li>• Bologna (Meat) </li></ul><ul><li>• Pastrami (Meat) </li></ul><ul><li>• Roast Beef (Meat) </li></ul>

10.
Rich Amenities Menu <ul><li>Assorted Salads </li></ul><ul><li>Different dressings can be substituted to suit taste, dietary restrictions and meal periods </li></ul><ul><li>Caesar Salad (Dairy) </li></ul><ul><li>Chopped Romaine, Croutons and Parmesan </li></ul><ul><li>Baby Spinach Salad (Dairy) </li></ul><ul><li>Italian Dressing, Roasted Peppers, Hard Boiled Eggs and Croutons </li></ul><ul><li>Chef Salad (Dairy) </li></ul><ul><li>Field Greens Topped with Swiss and American Cheeses, Hard Boiled Eggs, Grape </li></ul><ul><li>Tomatoes, Avocado and Croutons </li></ul><ul><li>Italian, Ranch or Blue cheese Dressings </li></ul><ul><li>Chef Salad (Meat) </li></ul><ul><li>Field Greens Topped with Turkey, Roast Beef, Salami, Black Olives, Red Onions, Roasted Peppers, Pepperoncini, Croutons and Italian Dressing </li></ul>

11.
Rich Amenities Menu <ul><li>Assorted Desserts, Pastries and Other Treats </li></ul><ul><li>There are also sugar and dairy free choices available. Please make sure to speak with the kitchen to see what is available. The following selections will be available on a daily basis. </li></ul><ul><li>A variety of fresh pastries is available on a daily basis please check with the kitchen to see what is available </li></ul><ul><li>Yogurt, Berry and Granola Parfait (Dairy) </li></ul><ul><li>Fresh Baked Muffins (Flavors vary daily, please check with kitchen) (Dairy) </li></ul><ul><li>Fresh Baked Fruit or Cheese Danish (Dairy) </li></ul><ul><li>Croissants (Dairy) </li></ul><ul><li>Bagels and Cream Cheese (Dairy) </li></ul><ul><li>Individual Cupcakes with Icing (Dairy) </li></ul><ul><li>Big Cookies (Flavors vary daily, please check with kitchen) (Dairy) </li></ul>

12.
Culture Change <ul><li>“ Culture does not change because we desire to change it. Culture changes when the organization is transformed; the culture reflects the realities of people working together every day.&quot; ~ Frances Hesselbein The Key to Cultural Transformation, Leader to Leader (Spring 1999) </li></ul>

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Rich Dining Room

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Rich Dining Room

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Rich Dining Room

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Rich Dining Room