| According to TQM causal logic, the success of intermediate quality outcomes is critical to ultimate organizational success, such as external customer satisfaction. TQM is widely used in government settings, but little is known empirically about whether it works. This study contributes to empirical knowledge about the effects of TQM by examining its implementation in the Health Care Financing Administration (HCFA). The research analyzes the relationships between TQM interventions and five intermediate outcomes (dependent variables): job satisfaction, teamwork, trust, customer awareness (the extent to which employees regard others as customers), and customer feedback (the extent to which work units obtain and act on feedback from internal or external customers). The ten independent variables were: managerial commitment, empowerment, participatory management communication, coaching, discipline, participation on a quality council, participation on a quality improvement team, problem solving training, and TQM skills training. Nineteen background variables (exogenous factors and demographic) were controlled for.;Both quantitative and qualitative analyses were conducted in three major phases of research: (1) A written survey was administered to a stratified random sample of 721 managers and non-managers in four study bureaus (the response rate was 79 percent); (2) semi-structured interviews were conducted with four Bureau Directors and 24 randomly selected non-managers and managers to elicit qualitative information concerning environmental/contextual factors that might affect variables measured; (3) The nature and type of TQM implementation elements were documented and described in detail using agency documents (meeting minutes, memos, charters, etc.), the 28 semi-structured interviews, and additional interviews with various agency officials.;Multiple regression results showed that managerial commitment, empowerment, participatory management, and communication strongly and positively affected job satisfaction, teamwork, and trust. Empowerment, participatory management, and coaching most consistently affected customer awareness. TQM-type skills training only emerged as a predictor of customer feedback.;The implications are that organizations implementing TQM should ensure strong managerial commitment to the effort. Organizations should ensure that employees are empowered to make decisions on their own and that they are highly involved in decision making. This research indicates that implementing TQM structures and training alone will not affect intermediate outcomes deemed critical to ultimate TQM success. |
