Management Systems, Patient Quality Improvement, Resource Availability, and Substance Abuse Treatment Quality


Address correspondence to Dail Fields, Ph.D., School of Global Leadership & Entrepreneurship, Regent University, Virginia Beach, VA 23464; e-mail:



To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment.

Data Sources/Study Setting

Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS).

Study Design

The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance.

Data Collection

Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007–2008.

Principal Findings

Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient.


Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present.