Document Type


Lead Author Type

MBI Masters Student


Guenter Tusch

Embargo Period



Since the 1980s there has been an explosion in the use of formalized methodologies for increasing quality and efficiency. Methods outlined by philosophies such as TQM, Six Sigma, Lean, and ISO 9001 have yielded great returns in the manufacturing environment. These techniques have proven successful in reducing costs, increasing production, and improving quality in both manufacturing and service environments. After several generations of exposure to similar yet distinct philosophies of quality management, several hybrid methodologies have arisen to leverage the strength of two or more systems simultaneously (Dahlgaard and Dahlgaard-Park, 2006; Karthi et al., 2011).

Since health care has become an area of continued attention in the pursuit of reducing government waste, it is a natural candidate for the application of the systematic and data driven techniques defined by TQM, Six Sigma, Lean, and ISO 9001 philosophies. The nature of healthcare as a service necessary for wellbeing, the presence of 3rd party payers, and the non-employee relationship between hospitals and healthcare providers contribute to presenting unique challenges when implementing quality improvement initiatives. This paper performs a literature review of the relationship between quality management practices and their effects on quality outcomes focusing on the unique challenges to implementing quality improvement initiatives in a healthcare setting. An approach is suggested using elements of TQM to create a standardized management structure and organizational focus (Irani et al., 2004; Taveira et al., 2003), lean to identify waste, six sigma to reduce redundancy and monitor processes so that small tests of change can be effectively monitored via the Plan Do Check Act (PDCA) cycle, and ISO 9001 to ensure that monitored processes are documented and enforced.

Previous studies have shown Baldrige Award (for Performance Excellence) winning hospitals to have better patient safety records than similar hospitals that have not won the Baldrige Award (Denney et al., 2009; Foster, 2011). We continue this investigation by comparing patient safety in hospitals that choose DNV accreditation to hospitals that choose another accrediting body. The DNV hospital accreditation organization “seamlessly introduces ISO 9001 quality methods into the hospital setting.” If the assumption is made that hospitals focused on standardization and process oriented quality improvement initiatives would choose the accreditation agency most closely aligned with its quality improvement philosophy, then DNV accredited hospitals would represent a more process-oriented population than their peers. This paper investigates whether a hospital’s investment in a formalized methodology of quality improvement translates into better performance on select AHRQ and SCIP measures of patient safety, patient satisfaction via the HCAPS survey, readmission rates for select conditions, and hospital acquired conditions by comparing DNV accredited to non-DNV accredited hospitals. I found significance in 6 of 61 metrics available in the data.