LEADERSHIP FOR QUALITY IMPROVEMENT IN HEALTH-CARE - EMPIRICAL-EVIDENCE ON HOSPITAL BOARDS, MANAGERS, AND PHYSICIANS

This article explores factors promoting leadership from the top for ho spital quality improvement (CQI/TQM). From literature on governance, q ualify improvement, and organization theory, working hypotheses were d eveloped about the effects of physician and management involvement in governance on CQI/TQM adoption, board leadership for quality, and top management leadership for quality. Hypotheses were tested using a samp le of 2,030 hospitals obtained by merging two national mailed surveys. Probit and logistic regression showed physician involvement in govern ance played a significant role in CQI/TQM adoption and board activity in quality improvement. Formal management involvement in governance de monstrated little effect on CQI/TQM adoption, board leadership for qua lity, or top management leadership for quality. Informal management in volvement in governance, as reflected in opportunities to influence bo ard composition, had negative effects on board and top management lead ership for quality. Top management leadership for quality increased bo ard leadership for quality. Implications are discussed.