Changing clinicians' behaviors in an academic medical center: does institutional commitment to total quality management matter?
The purpose of this project was to determine whether changing clinicians' behaviors to reduce costs in a large academic medical center is facilitated by the prior existence of a total quality management program. Ten teams, made up primarily of clinicians, were charged with devising strategies for altering specific clinical behaviors to reduce costs without detriment to quality of care. Half the teams followed the center's total quality management approach. Team success was assessed by how well three key tasks were completed: problem definition, design of plan of action, and plan implementation. Two teams achieved outright successes, three had outright failures, and five were in between. Adherence to a total quality management approach was not found to be associated with team success. A much better predictor of success was the level of involvement and support by clinicians and managers; because that factor is largely controlled by institutional incentives, those incentives may need to be realigned before the effectiveness of a total quality management approach can be properly evaluated.
Wyszewianski
L
L
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA.
Kratochwill
E W
EW
D000046:Academic Medical Centers / Q000592:standards*; D001291:Attitude of Health Personnel; D003363:Cost Control; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education*; D009042:Motivation; D016134:Organizational Policy; D010348:Patient Care Team / Q000592:standards; D010934:Planning Techniques; D011340:Problem Solving; D011367:Professional Staff Committees / Q000458:organization & administration; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States