Quality is used to refer to an ultimate outcome as well as a predictor of an ultimate outcome. Prior to the late 1980s, the scholarly literature usually treated quality as an indicator of organizational effectiveness (Campbell, 1977; Conrad and Blackburn, 1985). In this first sense, quality referred to the rate of errors or defects in goods-producing organizations (Crosby, 1979), to institutional reputation in higher education organizations (Webster, 1981), to the presence of ambience and legitimacy in arts organizations (Tschirhart, 1993), and to reduced morbidity and mortality rates in health care organizations (Scott et al., 1978). In every case, quality was always used as a qualifier in describing some product or service—high-quality products, high-quality education, high-quality art, high-quality health care. It was only one aspect of what organizations were interested in accomplishing.

In recent years, the focus on quality has changed. More and more, quality has begun to take on the appearance of the summum bonum of organizational performance. Managers and other organization members have become converted to the pursuit of quality as the single most important organizational objective (Deming, 1986), and scholars have scrambled to catch up by substituting quality as the dependent variable of choice.

Attempts to Define Quality

Many scholarly attempts have been made to define quality in a meaningful way (Table 2-1). Garvin (1988) has identified four "eras" of quality development in the United States: (1) an inspection era, in which quality was associated with mistakes and errors detected in products or services after they were produced; (2) a statistical control era, in which defects were reduced by controlling the processes that produced the products; (3) a quality assurance era, in which techniques and philosophies encompassed total quality control and top management took responsibility for ensuring quality throughout the organization; and (4) a strategic management era, in which quality was defined from the customer's point of view and the organization's strategy became centered on quality.

Another perspective on quality development is the shift from a one-best-way approach to quality, to a contingency approach to quality, to a multiple-constituencies approach. For example, the first two eras, inspection and statistical control, represent a uniform approach, implying that it is good under every circumstance for every organization. This approach is best characterized by Shewhart's (1931) classic Economic Control of Quality of Manufactured Product, in which he outlined universal techniques as well as a philosophy that emphasized the one correct way to define and achieve quality. Deming (1986), the best-known disciple of Shewhart, perpetuated this view of quality to some extent. His famous 14 points were an effort to create organizational forms that prevented errors but did not

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