Data Collection/Extraction Methods. Reliable and valid scales for the organi7.8. tional culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care.
Principal Findings. A participative, Oexible, risk-taking organi7.ational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation.