IMPLEMENTATION APPROACH
The approach used to implement quality improvement was measured by asking senior executives, quality improvement council members, and quality assurance committee members to respond to a series of questions involving their hospital's approach to implementation in regard to their approach to change, administrative orientation, employee involvement, department involvement, and physician involvement. These dimensions were measured on ordinal scales from I (defender-like) to 7 (prospector-like) with respondents circling a separate number if the approach of the hospital was best described as opportunistic. Since opportunists are by definition unpredictable, they were randomly assigned an ordinal value ranging from defender at the low end of the seven-point scale to prospector at the high end of the scale. Replies were received from an average of approximately 50 respondents per hospital, a response rate of 76 percent. In the present study, the overall average of the six scales is used as the measure of implementation approach.