Lessons learned from an early attempt to implement CQI principles in a regulatory system.
This article describes the Quality Assurance Project (1978-1982), which was developed as a demonstration project by a Wisconsin research team and was intended to implement and evaluate new methods for carrying out the regulatory roles of facility and resident assessment in Wisconsin nursing homes. The new method included (1) a screening process to distribute efforts between sanctioning and process improvement, (2) role changes that would move surveyors beyond problem identification toward education and consultation, and (3) a resident review process based on efforts to find systems-level problems. For the first three years of the project (reported here) certain principles were followed, many of which were similar to those of continuous quality improvement (CQI). Although this is an imperfect example of CQI implementation in a regulatory organization, it contains important lessons that may be helpful in integrating the CQI philosophy into other external review efforts.