ASSESSING THE IMPACT OF CONTINUOUS-QUALITY-IMPROVEMENT TOTAL-QUALITY-MANAGEMENT - CONCEPT VERSUS IMPLEMENTATION

Objective. This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sam ple of up to 61 U.S. hospitals. Data Sources and Study Setting. Primar y data were collected from 61 U.S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality impro vement/total quality management (CQI/TQM), organizational culture, imp lementation approaches, and degree of quality improvement implementati on based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measur es of clinical efficiency (i.e., charges and length of stay) for six c linical conditions. Study Design. The study involved cross-sectional e xamination of the named relationships. Data Collection/Extraction Meth ods. Reliable and valid scales for the organizational culture and qual ity improvement implementation measures were developed based on respon ses from over 7,000 individuals across the 61 hospitals with an overal l completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. Principal Findings . A participative, flexible, risk-taking organizational culture was si gnificantly related to quality improvement implementation. Quality imp rovement implementation, in turn, was positively associated with great er perceived patient outcomes and human resource development. Larger-s ize hospitals experienced lower clinical efficiency with regard to hig her charges and higher length of stay, due in part to having more bure aucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. Conclusions. What really matters is whethe r or not a hospital has a culture that supports quality improvement wo rk and an approach that encourages flexible implementation. Larger-siz e hospitals face more difficult challenges in this regard.