State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Impact of Washington's Quality Improvement Programs on Quality of Care/Quality of Life


No formal evaluation of the effect of the QAN program has been made to date. Program managers noted that it is very difficult to tell what influences quality given the numerous factors involved. One manager reported, "In regions with more limited QAN presence we get more complaints." From that and other evidence she had concluded, "Yes, I know that [the QAN program] is positively affecting outcomes and quality."

QAN nurses with whom we spoke were also generally quite positive about the effect of the program on quality. Most cited particular examples of positive changes related to the QAN program. For example, one nurse said, "Yes, I do believe it has an impact. I recently had a facility that had a bad reputation and lots of problems. Initially I was giving them [poor marks on the protocols]. Then we recently did a survey and it came out very well." But these nurses also noted the complexity of quality improvement. Several spoke about the difficulty and seeming futility of working with some facilities where, it was said, "The Administrator and Director of Nursing just can't get it together." In some cases the nurses said, the only thing that turns a facility around is when more and/or different staff are hired. The QAN nurses pointed out that the nursing shortage and current nursing training have a great deal to do with facility quality, regardless of the best efforts of the QAN program.

Providers and ombudsmen with whom we held discussions similarly noted ways in which they thought the QAN program positively affected quality, but also stressed the importance of other factors such as resources. For example, one provider said, "It can definitely have a positive effect on quality of life. For example, some residents won't tell nursing facility staff things they will tell a QAN or another independent person coming in." Another said, "There is potential with the program to correct problems; a good QAN can help facilities prioritize quality problems and can help new Directors of Nursing and facility staff to improve quality." An Ombudsman echoed the theme of early correcting of problems noting, "I think [the QAN program] does have a positive effect because it is taking care of problems at an early stage."

In general, most of those interviewed saw the clearest link between the QAN program and quality to be through the survey. That is, they viewed good performance on the survey as indicating better quality; to the extent that the QAN program helped facilities perform better on the survey--and many that we interviewed said that this happened--the QAN program could be said to positively affect quality.

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