Our Food and Nutrition Services Management Team utilized the Total Quality Management approach to create a new menu system. The team defined quality as “meeting customer expectation 100% of the time”. The menu was identified as important because it provides the first impression of department services and as a tool for communication, education, control and marketing.A hospital wide, cross-functional team of 17 participants was formed. Baseline patient food acceptability data was collected, with 5 areas identified below the threshold. An Appropriateness of Diet Order Implementation was conducted to validate the 5 areas below the threshold. Overall score for the criteria monitored was 50%.Brainstorming exercises were utilized by the cross-functional team on the areas below the threshold: menu impression, food preferences, dietary contact, taste, food temperatures and variety. 92 ideas were generated with 51 deemed feasible. 39 ideas were implemented over the next 9 months.The Appropriateness of Diet Order Implementation Study scores rose from 50% first quarter 1994 to 89% fourth quarter 1994.Areas identified having major impact were a hostess program, new dietary uniforms, branded food items and a new room service menu. The Food and Nutrition Department was recognized in October 1994 for their efforts.