D is just weird. Low variability in organizational structure? That sounds like a recipe for stagnation. Quality improvement is all about adapting to change!
I think A and C are also important factors to consider. Teams need to be empowered to make decisions, and getting buy-in from all levels is crucial for a successful program.
The correct answer is B. Informal leaders can be influential in implementing a quality improvement program. Formal structures are great, but you can't ignore the power of informal networks.
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