Implementing continuous quality improvement (CQI) in acute care general hospitals was investigated as an occurrence of a paradigm shift and organisational learning. Presented within a contextual framework, two case studies are reported, and are complemented by a survey of hospitals operating in Ontario, Canada. The findings support a top-down approach where the CEO exhibits transformational leadership and aligns the organisation's strategy, structure, and culture to CQI. The conflicting stakeholder goals of quality of care and cost savings are harmonized. Organisational members undergo both a cognitive and behavioural adjustment centred on teamwork, facilitated by training and education. Teamwork and involvement of physicians remain long-term challenges.
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