Total quality leadership in the U.S. Navy: effective for health promotion activities?

Background. Although the U.S. Navy mandated Total Quality Leadership (TQL) as a management strategy throughout its medical department in the early 1990s, it was unknown to what extent it was being used for health promotion activities and, if so, how effectively. Methods. A brief mail survey of 204 Navy commands supplemented by 97 telephone interviews to TQL-for-health-promotion-using commands and nonusing controls provided worksite information on TQL implementation. Responses from a Navywide health and fitness survey provided perceptions and health behavior attitudes from the individuals at commands. Results. A total of 32% of commands surveyed had used TQL specifically for improving health- and fitness-related processes and outcomes between 1991 and 1995. Participants at commands that had used TQL for health- and fitness-related processes reported a higher importance of good health (P < 0.05) and were more certain that they would reach and or maintain their ideal weight (P < 0.05) than participants at non-TQL commands. However, there were no significant differences in perceptions of command support for health and fitness between TQL and non-TQL commands. Conclusions. Several factors and organizational arrangements that were pertinent to the development and practice of TQL in the Navy were identified. The use of TQL specifically for health promotion was not consistently related to health-related perceptions or health behavior attitudes.