title: Continuous quality improvement as an innovation: which nursing facilities adopt it?
abstract: OBJECTIVE
  We identify environmental and organizational predictors that best discriminate between formal continuous quality improvement (CQI) adopters and nonadopters in nursing homes (NHs) and create a diagnostic profile for facility administrators and policy makers to promote CQI.
  
  
  METHODS
  We performed a cross-sectional survey of licensed NH administrators in New Jersey in 1999, using The Nursing Care Quality Improvement Survey ( Zinn, Weech, & Brannon, 1998) and The New Jersey NH Profiles Chart. We also performed a discriminant analysis. Of 350 NHs, 46% returned completed questionnaires.
  
  
  RESULTS
  Using variance innovation, resource dependence, and institutional perspectives for our framework, we found that new requirements, environmental competition, organizational time and structural facilitators, and manager training made statistically significant contributions to discriminating between formal CQI adopters and nonadopters.
  
  
  CONCLUSIONS
  Regardless of size, NHs adopt formal CQI to meet external expectations of new regulations and accreditation criteria. CQI adoption is facilitated by information systems, flexible use of personnel, and team supports, as well as CQI training for managers. This profile of adopters can guide administrators and policy makers in promoting CQI for NHs, and it can help NHs already interested in CQI focus internal resources on key facilitators.
authors.affiliation: APN-Rutgers, The State University of New Jersey, Institute for Health, Health Care Policy, and Aging Research, 30 College Avenue, New Brunswick, NJ 08901-1293, USA. Jlucas@ihhcpar.rutgers.edu
authors.forename: Judith A
authors.initials: JA
authors.lastname: Lucas
authors.forename: Tamara
authors.initials: T
authors.lastname: Avi-Itzhak
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Robinson
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Morris
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Koren
authors.forename: Susan C
authors.initials: SC
authors.lastname: Reinhard
mesh_terms: D004059:Diffusion of Innovation; D009735:Nursing Homes / Q000592:standards*; D011050:Policy Making; D017749:Total Quality Management; D014481:United States