The present study addresses this gap by systematically examining quality improvement efforts in 61 hospitals. Using a variance theory perspective the research focuses on factors influencing the implementation of quality improvement activities and the perceived impact on human resources development, patient care outcomes, and financial outcomes. In addition, for a subset of 38 hospitals the relationships between CQI involvement, the degree of quality improvement implementation, and implementation approach (i.e., prospector, analyzer, defender, etc.} with length of stay and charges for acute myocardial infarction (AMI}, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF}, pneumonia, total hip replacement, and stroke are examined. The following sections describe the study's framework and hypotheses, methods, results, and implications.