It is also important to note that culture and bed size are negatively correlated ( r = - .54; p .05), meaning that larger-size hospitals are less likely to have group/developmentally oriented cultures that emphasize teamwork, empowerment, risk-ta.king, and related attributes. Thus, the composite analysis of the relationships among bed size, culture, and QI implementation suggests that larger-size hospitals have more bureaucratic/rational cultures as opposed to group/developmental.cultures, making it more difficult to implement QI activities as reported by their employees. While size dominates the relationships with clinical efficiency when both size and QI implementation are in the same equation, the data suggest that the underlying reason for this is that larger-size hospitals have cultures less conducive to implementing quality improvement work.