Aspects of the QA Plan requirement were seen as having a positive impact on quality of care, and one HFAM representative believed that - though it's too soon to tell if the Medical Director requirements will have an affect on quality--this requirement has the potential to have a positive effect. Those who believed that quality of care were positively influenced by the QA requirement made the following observations:
- since the requirement calls for more management to be involved in daily operations, there should be a positive impact on resident outcomes (OHCQ staff);
- improved or increased interactions between nurses and nursing assistants and between nursing assistants and residents should result in better resident outcomes (OHCQ staff);
- the requirement for a social worker to attend the QA meetings improves quality of care and quality of life for residents (from a facility social worker); and
- the second survey and QA Plan "couldn't but help" quality of care for residents (Lifespan).
HFAM stated that the regulations may have merely "fine-tuned" programs already in place intended to enhance quality.
Providers believe that the focus on quality improvement and QIs, combined with the Second Survey, has actually worked to improve quality.
A potential negative impact on resident quality of life was cited by the Ombudsmen as being attributable to the QA requirements. Some facilities have reportedly initiated "Grand body rounds" or "full body checks" in response to need for QA and daily monitoring. This process involves a team (of three staff) rounding on all patients and inspecting their skin (at times including genitalia). The Ombudsmen consider this a violation of patient rights and of privacy, and believe that facilities have begun the practice in response to the QA requirements.
While perceived to have a positive effect, the true effectiveness of the Maryland quality improvement initiatives has not yet been measured. The next phase, per the state, is to evaluate the effectiveness of the programs. According to OHCQ, the eventual evaluation will look at complaint rates, correlations between deficiency citations and areas targeted for facility quality improvement, and facility satisfaction with the Second Survey.