Managerial implications of corporate board involvement and perceived market competition for quality improvement in nursing homes

This study examines the relationships among corporate board involvement, to tal quality management (TQM) adoption, perceived market competition, and th e perceived effect of quality improvement (QI) activities for a sample of n ursing homes in Pennsylvania. The findings of this study have several impli cations for healthcare managers interested in maximizing the effectiveness of QI efforts. Board involvement in quality improvement was an important predictor of QI o utcomes in the areas of finance, resident care, and human resources. Howeve r, TQM adoption had a positive effect on human resources outcomes only. The se findings suggest that board involvement in any organized form of QI may be more important than the adoption of a formal TQM program in the nursing home industry. TQM's emphasis on employee empowerment may account for its p ositive influence on human resources. Perceived competition was associated with better financial outcomes. Low-co st leadership can be a key to survival in more competitive markets, requiri ng a focus on efficiency and productivity issues in QI efforts. By focusing on process improvement, the facilities may achieve cost reductions that ca n result in an improved financial position. Facilities perceived to be in m ore competitive environments were also more likely to adopt TQM. This is co nsistent with the assertion by resource-dependence theorists that organizat ions facing competition for resources must be responsive to the needs of re source-providing constituencies.