Tlus paper exammes the implementation of four of the most conunon approaches
to nursmg quahty assurance m England, namely Morutor, Qualpacs, nursmg
aueiits and a patient satisfaction queshormaire entitled 'What the Pahent Thinks'
The pnmary aun of the study was to look more closely at the context, processes
and outcomes of selectmg and lmplemenhng specific quahty assurance tcx)ls
Data were analysed at three distmct levels The fmeimgs are presented around the
structure of this three-level framework and mdicate that the process of
lmplementmg a quality assurance tool is more important than the tool itself It is
suggested that a bottom-up approach to implementation, which locates
ownership and control of the quality assurance tool with practitioners, is seen to
result m more favourable staff responses and positive programme outcomes The
implementation of Qualpacs is used to illustrate some of the tensions that can
occur between the inherent prmaples of the tool and the method of
implementation In studymg the factors that might mfluence the method of
implementing a quality assurance tool, a number of orgaruzational and
managenal factors are identified