This week we will be discussing how organizations can improve quality. In the past, the state regulating agencies have attempted to mandate quality, but does that work?

Can you legislate quality, or is quality a part of the organizational culture? In Missouri, long term care facilities must receive a "certificate of need" before building or opening a new facility.

Many believe that this process protects poor providers by requiring those who wish to open facilities to prove that there is "need" in the area where the facility will be built or developed.

The certificates are not approved unless the other providers in the community are above 90% census levels no matter what the reputation or quality of the provider.

In my open, this antiquated process limits the free market and competition. What are your thoughts? I also believe that competition is a better way to manage quality than attempting to legislate quality.

Poor providers will not be in business if there are other options of a higher quality. Does that make sense?