How the dining experience affects your Quality Indicator Survey

I had the opportunity at the end of September to speak at the American Dietetic Association Food & Nutrition Conference & Expo in San Diego. The topic was the new federal Quality Indicator Survey (QIS) process, which the Centers for Medicare & Medicaid are rolling out across the country. A key element of the presentation—and my message overall—was to change the negative mindset of providers and staff about being surveyed to a positive one.

The prevailing mindset is to just meet the minimum regulation standards, rather than to strive to exceed them. It is this striving to exceed a standard that creates quality—and continuous quality improvement translates to greater satisfaction for providers, staff and residents.

My goal in the session was to encourage the audience, primarily Registered Dietitians and Dietetic Technicians Registered, to lead the way in enhancing the dining experience, becoming advocates in embracing this new QIS process. In my opinion, the laboratory for QIS is the dining room. It is the place to foster hospitality and the welcome of community spirit. It is also a focal point for QIS surveyors to observe residents’ health and appearance, quality of interactions and accommodation of dietary preferences.

QIS offers the tools and structure to accomplish higher standards of service. There are forms to show the way on the website. The key components are: build better relationships among all stakeholders; define and achieve higher standards of service quality; develop sustainable systems; and educate staff on a new set of responsibilities to better run nursing home operations, seen from the residents’ perspective.

Ultimately, through this process, I believe we will better offer not just what residents want, but what they need. And what do residents need? Compassion, respect, understanding, courtesy, patience, affection, smiles, conversation. To be heard, seen and known.

What the staff need is reassurance that providers will help them develop the right skills to provide the work. They need permission to support the residents with a new mindset. Under QIS, staff will gain skills, confidence and strength in being heard, along with the residents.

And what providers need to remember is that enhancing residents’ quality of life by improving the dining experience translates ultimately to their bottom line. (Successful senior care communities nationwide consistently show that strong community creates more profitability.)

I believe I accomplished my goal in this presentation when the first audience question at the end was, “Would you put up the list again of what residents need?” Human relationships are at the core of the QIS process, and building relationship skills is the task at hand. Step one for all stakeholders is learning to listen.

Cindy Heilman MS, DTR, is CEO of Higher Standards LLC, an Oregon-based training and consulting company dedicated to improving the dining experience. Its exclusive Kind Dining training is a 9-module training series designed to improve serving staff in senior living communities. For more information, visit, or contact Heilman at

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