Observation. Identification. Corrective action. Sounds simple. But is it? Actually, it must be one of the most unnatural human acts ever concocted. First, direct care staff have not accepted this as being anywhere near one of their duties. When there is a QA process it is almost always a singly identified person doing an audit or an outreach of management. There seems to be disassociation between the care givers and QA implementation. Perhaps, far too many times this process is used for punitive compliance issues which then taints all future endeavors in this direction. The QA process must be integrated into every staff member’s every day practice, often the first thought should be – how can this be made better? But, to allow this culture to blossom, acceptance to receive and respond to input must permeate the psyche of all staff.