THE CULTURE HYPOTHESIS
Culture is defined as the values, beliefs, and norms of an organization that shape its behavior. It is commonly believed that successful implementation of CQl/TQM requires a significant commitment to a culture emphasizing empowerment, autonomy, and risk taking. Existing research suggests that such cultures are associated with higher-performing intensive care units with regard to efficiency of utilization and perceived outcomes of cases. Based on the underlying values of organizational members,and Kimberly (1984) defined four cultural types: a group culture based on norms and values associated with affiliation, teamwork, and participation; a developmental culture based on risk-taking innovation and change; a hierarchical culture reflecting the values and norms associated with bureaucracy; and a rational culture emphasizing efficiency and achievemenl Given the emphasis of QJ efforts on empowering individuals to make decisions and on promoting communication across departments
and functions, it is felt that cultures emphasizing group and developmental components will be more conducive to implementing QJ efforts. Thus, the second hypothesis: