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An institutional perspective on quality initiatives: evidence beyond manufacturing

Organisational quality improvement techniques have been gaining acceptance in industry over the last few decades, although the extent of their utilisation is highly variable. Most of the evidence of their potential has been within the manufacturing sector, and it is unclear whether they have scope or value outside of manufacturing. We examine two quality improvement initiatives, Lean and Six Sigma, to assess adoption from an institutional theory perspective in the healthcare industry. Findings from our survey of 118 organisations suggest that these quality initiatives have higher levels of rhetoric than actual results. From an institutional theory perspective, results suggest that early adopters of these quality techniques will have a different focus or emphasis than late adopters, and that the focus changes overtime from clinical projects to administrative projects. Implications suggest a need for greater emphasis on change management to mitigate the perceived internal sources of resistance.