State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Aspects of Washington's Quality Improvement Program that Work Well


The QAN program is based on the concept that survey agency staff members can establish supportive, professional relationships with nursing facility leaders so that facility staff can be kept informed about potential compliance issues that are observed. Feedback from the Washington providers with whom we spoke suggests that the state has been effective in achieving this goal. Nearly all of those with whom we spoke were very positive about the work that QANs do as QANs (i.e., as opposed to their role as surveyors). Furthermore, virtually all of those with whom we spoke--state personnel, providers and consumer representatives--reported that one of the best things about the QAN program was its close ties to the Survey. Virtually all thought that the state's providing additional help to facilities regarding expected performance (i.e., as would be assessed in a survey) was important and helpful (although some thought that some other things might be more important to quality). Program features that contributed to this, including such things as the protocols and the information provided by QANs, were reported to be aspects of the program that work well.

Positive features cited by providers included these comments:

  • "When the QANs actually do come around as QANs they can tell you the perfect correction for a problem…they can tell you what the survey is focusing on."

  • "Its their experience that is helpful."

  • "They have the ability to assess and then interpret the assessment; they get this from their experience.

  • "Some of the QANs have been just outstanding…one we had was very prompt in answering questions."

  • "The accessibility of the QANs is the strength of the program…the facility can call them with questions."

  • "On the whole I like it; they can come in with an objective eye."

  • "The QANS and the surveyors talk, so if you know your QAN and have a good relationship, she can influence the surveyors."

  • "It's a lot better than the police [i.e., the surveyors] coming in once a year."

The Ombudsmen with whom we spoke emphasized some similar positive features noting, "The emphasis is on best practices rather than failed practices [as with the survey]," "It has the potential to develop a working relationship with the facility so that they will call the QAN when the need help; when it works, what makes it work is the relationship." Both the Ombudsman and state program managers reported that it was important that the program is in every facility. One Ombudsman contrasted this program feature with the QIO model saying, "With the QIO, a facility has to volunteer for help. Our experience is that poorer facilities are very fearful of people from the outside. Thus with the QIO model, the rich get richer and the poor get poorer."

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