An institutional perspective on quality initiatives: evidence beyond manufacturing

Organisational quality improvement techniques have been gaining acceptance in industry over the last few decades, although the extent of their utilisation is highly variable. Most of the evidence of their potential has been within the manufacturing sector, and it is unclear whether they have scope or value outside of manufacturing. We examine two quality improvement initiatives, Lean and Six Sigma, to assess adoption from an institutional theory perspective in the healthcare industry. Findings from our survey of 118 organisations suggest that these quality initiatives have higher levels of rhetoric than actual results. From an institutional theory perspective, results suggest that early adopters of these quality techniques will have a different focus or emphasis than late adopters, and that the focus changes overtime from clinical projects to administrative projects. Implications suggest a need for greater emphasis on change management to mitigate the perceived internal sources of resistance.

[1]  J. Hackman,et al.  Total Quality Management: Empirical, Conceptual, and Practical Issues , 1995 .

[2]  John W. Meyer,et al.  Institutionalized Organizations: Formal Structure as Myth and Ceremony , 1977, American Journal of Sociology.

[3]  Mark J. Zbaracki.  The Rhetoric and Reality of Total Quality Management , 1998 .

[4]  Heather A. Haveman.  Follow the leader: Mimetic isomorphism and entry into new markets , 1993 .

[5]  W. Powell,et al.  The iron cage revisited institutional isomorphism and collective rationality in organizational fields , 1983 .

[6]  S. Shortell,et al.  Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. , 1998, The Milbank quarterly.

[7]  Martin D. Carrigan,et al.  Six Sigma in Health Care Management and Strategy , 2006, The health care manager.

[8]  David J. Lemak,et al.  Total quality management and sustainable competitive advantage , 2000 .

[9]  Pamela S. Tolbert,et al.  Institutional Sources of Change in the Formal Structure of Organizations: The Diffusion of Civil Service Reform, 1880-1935 , 1983 .

[10]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[11]  Mark C. Suchman.  Managing Legitimacy: Strategic and Institutional Approaches , 1995 .

[12]  P. Tsasis,et al.  Organizational change through Lean Thinking , 2008, Health services management research.

[13]  W. Scott.  The Adolescence of Institutional Theory. , 1987 .

[14]  Ken Black,et al.  Six Sigma arises from the ashes of TQM with a twist. , 2006, International journal of health care quality assurance incorporating Leadership in health services.

[15]  Gerald Zeitz,et al.  Distinguishing Adoption and Entrenchment of Management Practices: A Framework for Analysis , 1999 .

[16]  Kee-hung Lai,et al.  An operational and institutional perspective on total quality management , 2007 .

[17]  Roger G. Schroeder,et al.  Six sigma: A goal-theoretic perspective , 2003 .

[18]  William Martin.  Special report: quality of care survey. Quality models: selecting the best model to deliver results. , 2007, Physician executive.

[19]  James D. Westphal,et al.  Customization or Conformity? An Institutional and Network Perspective on the Content and Consequences of TQM Adoption , 1997 .