THE IMPLEMENTATION APPROACH HYPOTHESIS
Implementation approach was based on the original Miles and Snow (1978} typology classifying organizations as defenders, analyzers, prospectors, and reactors based on a largely ordinal scale subsequently described
A defender approach involves fine-tuning the organization's existing
quality assurance/improvement approaches. In the defender approach, physicians play fairly traditional quality assurance roles focusing primarily on external accreditation requirements.
An analyst approach to implementing quality improvement follows a relatively ordered sequence of steps from top management training to lower level employee training in which only a few highly focused QJ projects would be undertaken at one time and carefully evaluated before further activities were initiated. The prospector approach emphasizes seizing opportunities as they arise but within an overall planned framework of implementation. In the prospector approach, physicians are trained and involved in the processes as needs arise ("just-in-time"} training, so that the training becomes immediately useful.
In a reactor or opportunistic approach, quality improvement techniques and approaches may be used to address problems, but they are not part of an overall plan. Physicians operate within largely traditional roles, primarily reacting to immediate quality problems with little generalization of learning to other situations. Overall, given the requirements of quality improvement (e.g., process focus, teams, empowerment, and customer focus}, we believe that approaches that are more like those of the analyzer or prospector will be associated with a greater degree of implementation than those of the defender or reactor/opportunistic and, hence, the third hypothesis outlined below: