Across all the study states, TA staff tend to be experienced and highly trained. Florida's quality monitors were initially recruited from the best surveyors in the state. Washington's QANs are all masters-prepared nurses. Most of Missouri's technical assistance staff have advanced nursing degrees and many have been personally recruited by the director of the technical assistance program. It is noteworthy that, in all the study states, the technical assistance staff tend to be more experienced than most of the surveyors. This gives them the clinical knowledge they need to address the variety of topics that may be covered during a technical assistance visit.
In addition to clinical experience, the personality of technical assistance staff was considered important to the success of a quality improvement effort. Our discussants said that technical assistance staff need to be good teachers, good communicators, and good listeners. They need a personality that allows them to build trust with facilities and enables them to encourage facilities to be active participants in the technical assistance program. These "soft skills" could well be as important to technical assistance staff success as their clinical background.
States varied with respect to whether technical assistance staff had survey experience, and we could not draw any conclusions about the importance of this type of experience. On the one hand, we heard reports that it may be difficult for surveyors to change from emphasizing enforcement issues to focusing on nursing home care practices. On the other hand, experienced surveyors may have insights from their experience as to best practices observed at other facilities that they can share. Having survey experience was clearly important for technical assistance programs that have a regulatory focus.