IMPLEMENTATION AND OutComes
The relationship between implementation and outcomes is largely a story involving hospital size and culture. It appears that implementing quality improvement work in larger-size hospitals with more bureaucratic cultures is a difficult task. In turn, larger-size hospitals had poorer clinical efficiency as measured by length of stay and charges for the six clinical conditions. Analysis of the individual implementation sub scales revealed that specific plans to improve quality (i.e., strategic quality planning} by those who can do something about it and providing people with the tools and authority (i.e. empowerment and training} to carry out quality improvement work appear to be most consistently associated with superior clinical efficiency.