Pursuant to Fourth Substitute House Bill 1103 (Chapter 134, Laws of 2008) Due to the length of this report we have divided it into the following three sections: Section 1: Health Systems Quality Assurance Division – implementation of HB 1103 (2008) and Secretary's Recommendations (PDF: 1,023 KB) Section 2: Washington State Medical Quality Assurance Commission – Efficient, Transparent, Responsive: A Safer Patient, a Respected Profession, a Modern Medical Board – 4SHB 1103 Pilot Project Report (PDF: 15,733 KB) Section 3: Washington State Nursing Care Quality Assurance Commission – 1103 Report, Comparison of Performance Outcomes (PDF: 3,119 KB)