Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Industrial and Systems Engineering


Mechanical, Industrial and Systems Engineering

First Advisor

Valerie Maier-Speredelozzi


Increasing medical costs have made healthcare organizations look at reducing their operating costs while meeting their demands, which made them move towards adopting systems improvement methodologies that have been successful in other business sectors, especially from manufacturing industries. The success of these improvement methodologies is contingent on employees of the organization being ready to adopt and embrace them which necessitates behavior change of employees. This study aimed to develop measures based on the Transtheoretical Model (TTM) to assess employees’attitudes and readiness to adopt improvement methodologies and the effects of employees’ demographics like supervisory level, length of service, work group and age on the adoption process. The study was conducted at the Providence VA Medical Center (PVAMC) which is trying to implement improvement methodologies. All employees were surveyed five times over a period of two and half years using TTM measures. Exploratory factor analysis indicated an 8-item single factor structure for self-efficacy and a 2-factor 16 item structure for decisional balance. An additional set of survey questions related to processes of change scale did not produce a reliable factor structure to be used for hypothesis testing. The results indicated that self-efficacy, which is the confidence to adopt improvement methodologies, did predict the stage of change with low confidence in pre-contemplation compared to maintenance. The study did not find support that decisional balance, which is the perception of pros and cons, influences the stage of change. Employees’ length of service, supervisory level and work group influenced the stage of change, and length of service and supervisory level influenced self-efficacy measure while age of employee affected self-efficacy.



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