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Effect of Monitoring and Learning on the Decoupling of TQM Practices:
The Role of Adoption Timing

Daniel Z. Levin
Rutgers University

August 2006

Working Paper


This paper adds to and refines our understanding of institutional theory, particularly the notion of decoupling. By examining adoption/implementation decoupling across multiple dimensions of a complex administrative innovation, total quality management (TQM), I am able to identify a pattern I call selective decoupling by late-adopting hospitals. Specifically, when a powerful national accreditation body started actively inspecting and evaluating one dimension of TQM (the use of quality teams and training), then subsequent adopters had less decoupling (i.e., greater implementation) for this dimension than comparable early adopters had had previously; but when inspection and evaluation were largely ceremonial, as they were during this study’s time frame for another TQM dimension (the use of quality tools), then the late-adopting hospitals exhibited more decoupling (i.e., less implementation) than had early adopters. This decoupling of tools usage by late adopters was even stronger in situations where implementation may have been particularly burdensome; i.e., in the use of advanced quality tools. These findings, supported by interview and longitudinal survey data, suggest that, when it comes to implementation after adoption, institutional forces create subtle but predictable patterns of selective decoupling. In contrast, traditional predictions from organizational learning theory did not appear to explain these results, although there was some evidence of organizational learning by industry regulators.

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