Performance Measures
Given the multidimensional of organizational performance (Flood, Shortell, and Scott 1994), two sets of performance measures were used. The first involved assessment by the hospital CEOs and directors of Quality Assurance/Improvement of the QJ impact on human resources development, patient outcomes, and financial outcomes (1 = no impact to 7 =
high impact) based on factor analysis scales of multiple items asked on the National Survey of Hospital Quality Improvement efforts (Barsness, Shortell, Gillies, et al. 1993). The items were factor analyzed using principal components analysis with variant rotation (Harman 1976), and only those items with factor loading of .40 and higher yielding factors with eigenvalues above 1.0 were retained for analysis. The human resources development impact factor was composed of increased ability to recruit and retain nurses, increased physician commitment to the hospital, increased nursing staff satisfaction, improved hospital-physician relations, increased ability to recruit and retain physicians, reduced employee turnover; improved management skills and practices, and empowered front-line employees. The alpha scale reliability was .91. The patient outcome impact scale included improved patient out comes, reduced errors and inappropriate treatment, increased patient satis faction, and improved continuity of patient care. The alpha scale reliability was .80. The financial impact scale included three items: reduced costs, improved productivity/efficiency, and increa.Sed profitability. The alpha scale reliability was .78.