A model to create "organizational readiness" for the successful implementation of quality management systems.

W. Edward Deming, J. M. Juran, K. Ishikawa, and P. B. Crosby have proposed systems, techniques and guidelines that have been widely accepted as "the magic solutions" for improving quality within work environments [1-4]. These approaches, along with their terminology, have become very fashionable in every work environment imaginable, including health care. The core foundation of their systems and principles is firmly contingent upon the acceptance and practice of a participatory/democratic leadership style. For the past two decades "participative management" has become a household term in most industrialized countries. However, there is evidence that even in the most enlightened cultures, the legitimate practice of participation and democratic process is often more of a myth than a reality [5]. In countries like Norway and Sweden, where attempts have been made to legalize worker participation, there is still great difficulty in achieving positive environmental conditions to support quality systems [6]. Therefore, it would seem obvious that in countries with little or no history of a democratic/ participative process, there would be even greater difficulty in successfully implementing quality management systems. Mandates, policies and legalization processes will not necessarily achieve a successful implementation process [7]. Consequently, organizations around the world, regardless of their experience in participatory leadership and democratic process, need to consider environmental preparation prior to attempting implementation of TQM or CQI systems. Organizations can avoid costly failures by attending to both individual and environmental factors well in advance of implementing TQM or CQI structures. Kurt Lewin pointed out in his change formula, B = f (I + E), that all behavior in an organization is a function of both individual and environmental factors [5]. Both individuals and organizations cling to behaviors and methodologies as a result of tradition, perceived expectations, values and beliefs. These factors are responsible for creating the existing "corporate culture" and must be challenged in order to create a receptive environment for anticipated changes. This preparation can and should be established internally prior to introducing structural changes and techniques related to TQM or CQI systems.