R. W. Foster

Bio: R. W. Foster is an academic researcher from Northwestern University. The author has contributed to research in topics: Total quality management & Health administration. The author has an hindex of 2, co-authored 2 publications receiving 702 citations.

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

Abstract: Objective This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. Data sources and study setting Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. Study design The study involved cross-sectional examination of the named relationships. Data collection/extraction methods Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall 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 significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. Conclusions What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.

Customization or Conformity? An Institutional and Network Perspective on the Content and Consequences of TQM Adoption

Abstract: The authors thank Rakesh Khurana, Mark Shanley, and Edward Zajac for valuable comments on earlier versions of this paper. The paper has also benefited from the helpful comments of Christine Oliver and three anonymous reviewers for ASQ, as well as the editorial assistance of Linda Johanson. The following groups provided data used in this study: The AHA Hospital Research and Educational Trust, the AHA Data Survey Group, the Joint Commission on Accreditation of Health Care Organizations, and the Health Care Investment Analysts. We also thank the Baxter Foundation and the Graduate Program in Health Services Management at the Kellogg Graduate School of Management for generously funding this research. Additional support was provided by the A.C. Buehler Chair in Health Services Management at the Kellogg School. An earlier version of the paper received the 1996 West Press Best Paper Award in the Organization and Management Theory Division of the Academy of Management. This study develops a theoretical framework that integrates institutional and network perspectives on the form and consequences of administrative innovations. Hypotheses are tested with survey and archival data on the implementation of total quality management (TQM) programs and the consequences for organizational efficiency and legitimacy in a sample of over 2,700 U.S. hospitals. The results show that early adopters customize TQM practices for efficiency gains, while later adopters gain legitimacy from adopting the normative form of TQM programs. The findings suggest that institutional factors moderate the role of network membership in affecting the form of administrative innovations adopted and provide strong evidence for the importance of institutional factors in determining how innovations are defined and implemented. We discuss implications for theory and research on institutional processes and network effects and for the literatures on innovation adoption and total quality management.*

Improving the quality of health care in the United Kingdom and the United States: a framework for change.

Abstract: Fueled by public incidents and growing evidence of deficiencies in care, concern over the quality and outcomes of care has increased in both the United Kingdom and the United States. Both countries have launched a number of initiatives to deal with these issues. These initiatives are unlikely to achieve their objectives without explicit consideration of the multilevel approach to change that includes the individual, group/team, organization, and larger environment/system level. Attention must be given to issues of leadership, culture, team development, and information technology at all levels. A number of contingent factors influence these efforts in both countries, which must each balance a number of tradeoffs between centralization and decentralization in efforts to sustain the impetus for quality improvement over time. The multilevel change framework and associated properties provide a framework for assessing progress along the journey.

Planning and studying improvement in patient care : The use of theoretical perspectives

Abstract: A consistent finding in articles on quality improvement in health care is that change is difficult to achieve. According to the research literature, the majority of interventions are targeted at health care professionals. But success in achieving change may be influenced by factors other than those relating to individual professionals, and theories may help explain whether change is possible. This article argues for a more systematic use of theories in planning and evaluating quality-improvement interventions in clinical practice. It demonstrates how different theories can be used to generate testable hypotheses regarding factors that influence the implementation of change, and it shows how different theoretical assumptions lead to different quality-improvement strategies.

Total Quality Management Implementation and Competitive Advantage: The Role of Structural Control and Exploration

Abstract: The authors explored the relationship between the degree to which total quality management (TQM) practices were adopted within organizations and the corresponding competitive advantages achieved. T...

Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress.

Abstract: The literature on continuous quality improvement (CQI) has produced some evidence, based on nonrandomized studies, that its clinical application can improve outcomes of care while reducing costs. Its effectiveness is enhanced by a nucleus of physician involvement, individual practitioner feedback, and a supportive organizational culture. The few randomized studies, however, suggest no impact of CQI on clinical outcomes and no evidence to date of organization-wide improvement in clinical performance. Further, most studies address misuse issues and avoid examining overuse or underuse of services. The clinical application of CQI is more likely to have a pervasive impact when it takes place within a supportive regulatory and competitive environment, when it is aligned with financial incentives, and when it is under the direction of an organizational leadership that is committed to integrating all aspects of the work.