How may it be improved? The votes... The dialogue... -By participation by all levels of staff. -Our QA program is definitely effective. We are in Massachusetts and we had 1 deficiency last year and 4 this year. Not one had to do with quality of care it was all paper related. We are improving it every day as we involve front line staff right down to the housekeepers and laundry personnel to assist with decisions on a day to day operation along with the residents who can participate in QA as it is their home. -Still too much paper compliance and not enough REAL change. -Provide more innovative and fresh/new activity every now and then. What do you think?