Verification of a quality management theory: using a delphi study

BACKGROUND

A model of quality management called Strategic Collaborative Quality Management (SCQM) model was developed based on the quality management literature review, the findings of a survey on quality management assessment in healthcare organisations, semi-structured interviews with healthcare stakeholders, and a Delphi study on healthcare quality management experts. The purpose of this study was to verify the SCQM model.

METHODS

The proposed model was further developed using feedback from thirty quality management experts using a Delphi method. Further, a guidebook for its implementation was prepared including a road map and performance measurement.

RESULTS

The research led to the development of a context-specific model of quality management for healthcare organisations and a series of guidelines for its implementation.

CONCLUSION

A proper model of quality management should be developed and implemented properly in healthcare organisations to achieve business excellence.

Leadership, job satisfaction and organizational commitment in healthcare sector: proposing and testing a model

Conflict of interest: none declared.

A conceptual framework for quality of care

Despite extensive research on defining and measuring health care quality, little attention has been given to different stakeholders’ perspectives of high-quality health care services. The main purpose of this study was to explore the attributes of quality healthcare in the Iranian context. Exploratory in-depth individual and focus group interviews were conducted with key healthcare stakeholders including clients, providers, managers, policy makers, payers, suppliers and accreditation panel members to identify the healthcare service quality attributes and dimensions. Data analysis was carried out by content analysis, with the constant comparative method. Over 100 attributes of quality healthcare service were elicited and grouped into five categories. The dimensions were: efficacy, effectiveness, efficiency, empathy, and environment. Consequently, a comprehensive model of service quality was developed for health care context. The findings of the current study led to a conceptual framework of healthcare quality. This model leads to a better understanding of the different aspects of quality in health care and provides a better basis for defining, measuring and controlling quality of health care services.

Occupational stress and turnover intention: implications for nursing management

BACKGROUND

The main purpose of this study was to explore the status of occupational stress among hospital nurses in Isfahan, Iran. It also aimed to examine the relationship between nurses' occupational stress and their intention to leave the hospital.

METHODS

The study employed a cross-sectional research design. A validated questionnaire was used to collect data from 296 nurses. Respondents were asked to rate the intensity of 30 common occupational stressors using a five-point scale.

RESULTS

A third of hospital nurses rated their occupational stress high. The major sources of stress were inadequate pay, inequality at work, too much work, staff shortage, lack of promotion, job insecurity and lack of management support. More than 35% of nurses stated that they are considering leaving the hospital, if they could find another job opportunity. Occupational stress was positively associated with nurses' turnover intentions.

CONCLUSION

Hospital managers should develop and apply appropriate policies and strategies to reduce occupational stress and consequently nurses' turnover intention.

Healthcare service quality: towards a broad definition

PURPOSE

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers.

DESIGN/METHODOLOGY/APPROACH

This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders.

FINDINGS

Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction.

PRACTICAL IMPLICATIONS

This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels.

ORIGINALITY/VALUE

This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Obstacles to TQM success in health care systems

PURPOSE

Many healthcare organisations have found it difficult to implement total quality management (TQM) successfully. The aim of this paper is to explore the barriers to TQM successful implementation in the healthcare sector.

DESIGN/METHODOLOGY/APPROACH

This paper reports a literature review exploring the major reasons for the failure of TQM programmes in healthcare organisations.

FINDINGS

TQM implementation and its impact depend heavily on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in healthcare organisations can be attributed to the strongly departmentalised, bureaucratic and hierarchical structure, professional autonomy, tensions between managers and professionals and the difficulties involved in evaluating healthcare processes and outcomes. Other obstacles to TQM success include lack of consistent managers' and employees' commitment to and involvement in TQM implementation, poor leadership and management, lack of a quality-oriented culture, insufficient training, and inadequate resources. The review was limited to empirical articles written in the English language during the past 30 years (1980-2010).

PRACTICAL IMPLICATIONS

The findings of this article provide policy makers and managers with a practical understanding of the factors that are likely to obstruct TQM implementation in the healthcare sector.

ORIGINALITY/VALUE

Understanding the factors that obstruct TQM implementation would enable managers to develop more effective strategies for implementing TQM successfully in healthcare organisations.

Quality of working life: an antecedent to employee turnover intention

BACKGROUND

The purpose of this study was to measure the level of quality of work life (QWL) among hospital employees in Iran. Additionally, it aimed to identify the factors that are critical to employees' QWL. It also aimed to test a theoretical model of the relationship between employees' QWL and their intention to leave the organization.

METHODS

A survey study was conducted based on a sample of 608 hospital employees using a validated questionnaire. Face, content and construct validity were conducted on the survey instrument.

RESULTS

Hospital employees reported low QWL. Employees were least satisfied with pay, benefits, job promotion, and management support. The most important predictor of QWL was management support, followed by job proud, job security and job stress. An inverse relationship was found between employees QWL and their turnover intention.

CONCLUSION

This study empirically examined the relationships between employees' QWL and their turnover intention. Managers can take appropriate actions to improve employees' QWL and subsequently reduce employees' turnover.

A study of relationship between job stress, quality of working life and turnover intention among hospital employees

Job stress is a serious threat to the quality of working life (QWL) of health-care employees and can cause hostility, aggression, absenteeism and turnover, as well as reduced productivity. In addition, job stress among employees affects the quality of health-care services. The purpose of this study was to gain a better understanding of the relationships between job stress and QWL of employees, and their impact on turnover intention at Isfahan hospitals, Iran. The study employed a cross-sectional research design. A validated questionnaire was used to collect data from hospital employees. Overall, 26% of employees graded their job stress high. The major sources of stress were inadequate pay, inequality at work, too much work, staff shortage, lack of recognition and promotion prospects, time pressure, lack of job security and lack of management support. An inverse relationship was found between job stress and QWL among hospital employees. The most important predictor of QWL was disturbance handling, followed by job proud, job security and job stress. Finally, while QWL was negatively associated with turnover intentions, job stress was positively related to employees' intention to quit. Since job stress has a strong correlation with employee QWL and turnover intention, it is very important to apply the right human resources policies to increase employees' QWL and decrease subsequent turnover. This study invites further research to explore, implement and evaluate intervention strategies for prevention of occupational stress and improvement in QWL.

A study of the relationship between job satisfaction, organizational commitment and turnover intention among hospital employees

The purpose of this descriptive, co-relational and cross-sectional study was to gain a better understanding of the relationships between job satisfaction and organizational commitment of employees, and their impact on turnover intention at Isfahan Hospitals, Isfahan, Iran, in 2005. Data were collected by the distribution of two questionnaires among 629 employees of these hospitals through a stratified random sampling method. The results of the paper indicate that hospital employees are moderately satisfied with their jobs and committed to their organization. Employees' job satisfaction and organizational commitment were closely inter-related and correlated with turnover intention (P < 0.001). The positive correlation between the two was expected, but there was also unexpected correlation with turnover intention. This may be due to external factors, such as job market conditions, which may influence perceived opportunities for career advancement elsewhere. The impact of such external factors is outside the scope of this study, but will have to be investigated in further research. As job satisfaction and organizational commitment have strong correlation with turnover, it is very important to reinforce them by applying the right human resource policies.