title: Knowledge management as a mediator for the efficacy of transformational leadership and quality management initiatives in U.S. health care.
abstract: BACKGROUND
  The health care industry has become one of the largest sectors of the U.S. economy and provides the greatest job growth of any industry. With such growth, effective leadership, knowledge management, and quality programs can ameliorate patient safety outcomes and improve organizational performance.
  
  
  OBJECTIVE
  This exploratory study examines the efficacy of transformational leadership, knowledge management, and quality initiatives, each of which has been proven effective in health care organizations. The literature has neglected the relationships among these three types of programs, although they are increasingly implemented simultaneously now. This research tests the degree to which knowledge management could act as a mediator of the effects transformational leadership and quality management have on organizational performance for hospitals.
  
  
  METHODS
  Our survey of U.S. hospitals utilizes validated scales from the literature. By calling and e-mailing quality and other department directors, the data set includes responses from all 50 states in our sample of 370 U.S. hospitals. Statistical tests confirmed acceptable regional distribution, interrater reliability, and control variable characteristics for our sample. Structural equation modeling is used to test the research hypotheses.
  
  
  RESULTS
  These preliminary results reveal that transformational leadership and quality management improve knowledge management. In addition, transformational leadership is fully mediated by knowledge responsiveness and quality management is partially mediated by knowledge responsiveness for their effects on organizational performance.
  
  
  CONCLUSIONS
  The unique contribution of this study includes the suggestion that greater transformational leadership skills are important for health care executives to motivate successful knowledge management initiatives. Secondly, continuous improvements in quality management programs have significant positive impacts on knowledge management and organizational outcomes in hospitals. Finally, successful knowledge management initiatives are more closely tied to patient and organizational outcomes through the enhancement of knowledge responsiveness than by knowledge acquisition and dissemination alone.
authors.affiliation: Department of Management, Northern Illinois University, DeKalb, IL, USA. cgowen@niu.edu
authors.forename: Charles R
authors.initials: CR
authors.lastname: Gowen
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Henagan
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: McFadden