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 success es, three had outright failures, and five were in between. Adherence to a total quality management approach was not found to be associated with team suc cess. A much better predictor of success was the level of involvement and support by clinicians and managers; because that factor is largely controlled by institution al incentives, those incentives may need to be realigned before the effectiveness of a total quality management approach can be properly evaluated.