Access Type

Open Access Dissertation

Date of Award


Degree Type


Degree Name



Political Science

First Advisor

Richard C. Elling


In recent years, there has been significant interest in the application of total quality management/continuous quality improvement (TQM/CQI) within health care organizations. The health care industry, in its quest to improve outcomes with fewer resources, began to look at CQI/TQM as a possible solution. To date, the most comprehensive and enthusiastic response to efforts to improve quality while containing or lowering costs is reflected in hospitals' commitment to continuous quality improvement/total quality management (CQI/TQM). The health care industry, particularly hospitals, has embraced the concepts of CQI/TQM with the belief that adoption will lead to an improvement in both the quality and efficiency of health service delivery (Shortell, 1995). The purpose of this study is to assess CQI/TQM program elements, activities and barriers and to evaluate perceptions of CQI/TQM program success in Michigan hospitals. The study focuses on answering the following central questions: What do Michigan CQI programs look like? To what extent do Michigan programs match model programs? What are the perceived outcomes of CQI? and, What leads to a successful CQI program? The hospitals included in this study were selected from a list of Michigan hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). As of June 2001 there were 152 JCAHO accredited hospitals in Michigan. A 50% random sample of these hospitals was taken. The first wave of surveys were sent in June and August 2001. Surveys were sent directly to the individual who was in charge of the hospital's CQI program. The results of this study make it clear that CQI program elements/activities are extremely important to a hospital's CQI program. In addition, the results of the study suggest that greater focus of CQI program elements/activities might increase enthusiasm toward CQI. Finally, Michigan hospitals need to commit to breaking down barriers to CQI---most importantly lack of management support. While Michigan hospitals appear to have made a good start with their programs, perceived outcomes, levels of enthusiasm or commitment toward are nowhere near what they could be. What remains to be seen is how Michigan hospitals will meet this challenge.