Advance mathematical model to study and analyse the effects of total quality management (TQM) and operational flexibility on hospital performance

Total Quality and Innovation Management in Healthcare (TQIM-H) for an Effective Innovation Development: A Conceptual Framework and Exploratory Study

To thrive, an organization must adapt to the fast and constant change in the economic environment caused by an aging society, technological changes, and the pandemic crisis. Innovation becomes important for the adaptation of industries. Healthcare is one of them. Innovation development in hospitals is effective and acceptable when its management is effective and aligns with the healthcare quality context since quality is a philosophy of work in life-related settings. To the best of our knowledge, quality management and innovation management in healthcare have never been integrated. Therefore, this research aimed to create an integrated framework of quality and innovation management in healthcare (TQIM-H). To establish the effectiveness of applying TQIM-H for the development of effective healthcare innovation, this study developed a TQIM-H conceptual framework using multiple methodologies including a literature review, multiple case studies analysis, Delphi study with healthcare experts, Technology Acceptance Model (TAM), and triangulation with an external dataset. We constructed a TQIM-H conceptual framework, consisting of seven dimensions, that can be used in developing innovation projects in hospitals and which agrees with safety and quality principles in hospitals.

Developing and training artificial neural networks using bootstrap data envelopment analysis for best performance modeling of sawmills in Ontario

Purpose

The measurement capabilities of the data envelopment analysis (DEA) models are used to train the artificial neural network (ANN) models for the best performance modeling of the sawmills in Ontario. The bootstrap DEA models measure robust technical efficiency scores and have benchmarking abilities, whereas the ANN models use abstract learning from a limited set of information and provide the predictive power.

Design/methodology/approach

The complementary modeling approaches of the DEA and the ANN provide an adaptive decision support tool for each sawmill.

Findings

The trained ANN models demonstrate promising results in predicting the relative efficiency scores and the optimal combination of the inputs and the outputs for three categories (large, medium and small) of sawmills in Ontario. The average absolute error in predicting the relative efficiency scores varies from 0.01 to 0.04, and the predicted optimal combination of the inputs (roundwood and employees) and the output (lumber) demonstrate that a large percentage of the sawmills shows less than 10% error in the prediction results.

Originality/value

The purpose of this study is to develop an integrated DEA-ANN model that can help in the continuous improvement and performance evaluations of the forest industry working under uncertain business environment.

Modelling enablers of efficiency and sustainability of healthcare: a m-TISM approach

Purpose

It would not be an exaggeration to say that healthcare is the most crucial one in today's perspective. The healthcare sector, in general, is engaged in working on various dimensions simultaneously like the safety, care, quality and cost of services, etc. Still, the desired outcomes from this sector are far away, and it becomes pertinent to address all such issues associated with healthcare on a priority basis for sustaining the outcomes in a long-term perspective. The present study aims to explore the healthcare sector and list out the directly associated enablers contributing to increasing the viability of the healthcare sector. Besides, the interrelationship among the enlisted enablers needs to be studied, which further helps in setting-out the priority to deal with individual enablers based on their impedance in the contribution towards viability increment.

Design/methodology/approach

The authors have done an extensive review to list out the enablers of the healthcare sector to perform efficiently and effectively. Further, the attempt has been made on the enablers to rank them by using the modified Total Interpretative Structure Modelling (m-TISM) approach. The validation of the study reveals the importance of enablers based on their position in the hierarchical structure. Further, the MICMAC analysis on the identified enabler is performed to categorize the identified enablers in the different clusters based on their driving power and dependence.

Findings

The research tries to envisage the importance of the healthcare sector and its contribution towards national development. The outcomes of the m-TISM model in the present study reveal the noteworthy contribution of the organizational structure in managing the healthcare facilities and represented it as the perspective of future growth. The well-designed organizational structure in the healthcare industry helps in establishing better employee–employer cooperation, workforce coordination and inter-department cooperation.

Research limitations/implications

Every research work has limitations. Likewise, the present research work also has limitations, i.e. input taken for developing the models are from very few experts that may not reflect the opinion of the whole sector.

Practical implications

The healthcare sector is the growing sector in the present-day scenario, and it is essential to keep the quality of treatment in check along with the quantity. The present study has laid down the practical foundations for improvement in the healthcare sector viability. Besides, the study emphasized on accountability of the healthcare sector officials to go with the enablers having the strong driving power for effective utilization of all the resources. This would further help them in customer (patients) satisfaction.

Originality/value

Despite an increase in demand for good quality healthcare facilities worldwide, the growth of this sector is bounded by the economic, demographic, cultural and environmental concerns, etc. The present study proposed a unique framework that provides a better understanding of the enablers. It would further help in playing a key role in increasing the viability of the healthcare sector. The hierarchy developed with the help of m-TISM and MICMAC analysis will help the viewers to recognize the important enablers based on their contribution to the viability improvement of the healthcare sector.

Proposal of a theoretical model to identify organizational decline

This study aimed to propose a conceptual model of Identification of Organizational Decline, based on two indicators: Organizational Satisfaction Indicator and Financial Indicator. For the study, we used two bibliometric reviews, which, ultimately, associated the variables of the foundations of excellence in quality with organizational decline. As a result, we observed that the topic of organizational decline in companies has factors of managerial, physical, financial, and behavioral nature, and that their performances worsen by their lack of initiative in using the three planning processes (strategic planning, budget, and control) in a structured way. Regarding companies that seek excellence in quality, these concerns become increasing demands for their managers, who must develop responsible practices and tools to achieve a good performance, bearing in mind the constant search for satisfaction and retention of customers not only for the final product, but throughout the chain process. Thus, the literature on this topic is vast, and this study is justified because it notes a strong relationship between the lack of factors of excellence in management and organizational decline.

Ranking model of total quality management enablers in healthcare establishments using the best-worst method

Purpose

Recent years have witnessed a significant rise in Indian healthcare establishments (HCEs) which indicate that there is a constant need to improve the healthcare quality services through the adoption and implementation of TQM enablers. The purpose of this paper is to identify such enablers and then propose a ranking model for TQM implementation in Indian HCEs for improved performance.

Design/methodology/approach

The study identifies 20 TQM enablers through comprehensive literature survey and expert’s opinion, and classifies them into five main categories. The prominence of these enablers is established using a recently developed novel multi-criteria decision making (MCDM) method, i.e. best-worst method (BWM). The importance of the various main category and sub-category enablers is decided on the basis of their weights which are determined by the BWM. In comparison to other MCDM methods, such as analytical hierarchy process, BWM requires relatively lesser comparison data and also provides consistent comparisons which results in both optimal and reliable weights of the enablers considered in this paper. Further, a sensitivity analysis is also carried out to ensure that the ranking (based on the optimal weights) of the various enablers is reliable and robust.

Findings

The results of this study reveal that out of five main category enablers, the “leadership-based enablers (E1)” and the “continuous improvement based enablers (E5)” are the most and the least important enablers, respectively. Similarly, among the 20 sub-category enablers, “quality leadership and role of physicians (E14)” and “performing regular survey of customer satisfaction and quality audit (E52)” are the most and the least dominating sub-category enablers, respectively.

Research limitations/implications

This study does not explore the interrelationship between the various TQM enablers and also does not evaluate performance of the various HCEs based on the weights of the enablers.

Practical implications

The priority of the TQM enablers determined in this paper enables decision makers to understand their influence on successful implementation of the TQM principles and policies in HCEs leading to an overall improvement in the system’s performance.

Originality/value

This study identifies the various TQM enablers in HCEs and categorizes them into five main categories and ranks them using the BWM. The findings of this research are quite useful for management of the HCEs to properly understand the relative importance of these enablers so that managers can formulate an effective and efficient strategy for their easy and smooth implementation which is necessary for continuous improvement.

Exploring competitive priorities in the service sector: evidence from India

Purpose

The purpose of this study is to explain the components of competitive priorities of Indian service firms, to find out the competitive priorities of different service industries in India and to find out how these competitive priorities change across low- and high-performing service firms.

Design/methodology/approach

An empirical study of 166 firms from five different service industries is undertaken in New Delhi and its surroundings.

Findings

The results reveal the presence of three competitive priorities in the services sector in India: cost, flexibility and quality/delivery, with quality/delivery being the most distinctive competitive priority. Hotel and auto-repair industries are found to be focused on controlling costs, while hospitals, banks and private colleges prioritized quality/delivery. For high-performing firms, cost is the top most competitive priority, followed by quality/delivery and flexibility, while for low-performing firms, quality/delivery remains the top most competitive priority, followed by flexibility and cost.

Originality/value

The paper enhances the understanding of competitive priorities in the Indian services sector. The identification of competitive priorities of different service industries in India and their dynamics across different industries add value to the current literature and fill an important research gap. Additionally, surveying diverse industries in this paper reveals a holistic picture of the Indian service industry and helps achieve some degree of cross-industry perspective.

The key factors of total quality management in the service sector: a cross-cultural study

Purpose

Literature refers to the key factors of total quality management (TQM) based on studies carried out in individual countries. However, few studies focus on studying the TQM factors in service companies based on multinational data. The purpose of this paper is to empirically identify the key TQM factors and their impact on internal and external customer performance measures across different countries.

Design/methodology/approach

The research questions regarding the TQM factors and their effects were examined using a sample of service organisations from three countries (131 from Greece, 70 from Mexico and 151 from Spain). TQM factors and their impact on employee and customer satisfaction were analysed separately for each country. Exploratory factor analyses, coupled with multiple linear regression analyses, were conducted.

Findings

The key TQM factors identified are common among the three participating countries and can be summarised as follows: quality practices of top management, process management, employee quality management, customer focus, and employee knowledge and education. The adoption level of these five key factors of TQM varies across service organisations in different countries. The results also confirmed that some of the TQM elements are antecedents of customer- and employee-focused performance.

Practical implications

Multinational service organisations may use such an instrument to evaluate TQM implementation among worldwide operations and then benchmark their performance. In addition, an understanding of similarities and differences among countries would help managers around the world to address difficulties of TQM implementation related to the country culture.

Originality/value

Previous studies have compared key TQM factors across different countries in manufacturing, but overall, there has been a little attempt in the literature to analyse the adoption of TQM factors among service firms, as well the relationships between quality improvement and performance across different geographical regions.

Effects of total quality management in local authorities

Purpose

The purpose of this study is to determine the main total quality management (TQM) factors adopted and the respective results achieved by local authorities – municipalities. Determining the degree to which TQM influences the respective results is also an aim of the present study.

Design/methodology/approach

A research study was designed to be carried out in Greek local authorities – municipalities, 125 of which were approached through interviews with chief executive officers (CEOs) based on a structured questionnaire. The TQM practices and results identified in the literature were used as measured variables of the questionnaire. Descriptive statistics and linear regression analyses were applied for the purpose of the study.

Findings

The TQM philosophy is not highly adopted by the Greek local authorities participating in the present study. Moreover, the Greek local authorities do not seem to derive significant TQM benefits. Finally, adopting TQM strongly and positively influences, first, operational and quality performance of the local authorities; second, citizen satisfaction and society results; and third, employee satisfaction.

Research limitations/implications

Subjective data were collected from the CEOs of a small sample of local authorities operating in a European Union country, under circumstances of financial crisis. Based on these limitations, future research studies are recommended.

Practical implications

Areas for improvement are identified for a local authority to develop a robust TQM model, approach business excellence and derive significant benefits.

Originality/value

This is the first research study in the field of TQM to be conducted at city-level administration in Greece.

Interrelationships among quality enablers, service quality, patients’ satisfaction and loyalty in hospitals

Purpose

The purpose of this paper is to clarify how enablers of quality management can secure the satisfaction and loyalty of patients through increasing service quality in hospitals.

Design/methodology/approach

The current study conducted a review of the existing literature to identify operational dimensions of the research variables. As a result of the review, 17 dimensions were identified; five European foundation for quality management enablers, five SERVQUAL service quality dimensions, four patients’ satisfaction elements and three patients’ loyalty components. To evaluate interrelationships among these 17 research dimensions, decision-making trial and evaluation laboratory technique was applied using experts’ opinions.

Findings

Several key relations were found among research dimensions. Research findings could provide a scientific insight for hospital managers to understand how they could increase the level of patients’ satisfaction and loyalty through high-quality services provided by quality management enablers.

Research limitations/implications

This study has been conducted based on the expert’s opinions from private hospitals located in Tehran and Alborz provinces, Iran. Although the results could be useful for hospital managers in different places and could provide them a valuable insight and knowledge, findings are limited to Iranian private hospitals.

Originality/value

It is taken for granted that patients’ satisfaction and loyalty could increase as a result of high-quality medical and treatment services in hospitals. On the other hand, offering excellent services meeting all the needs and expectations of customers could be consequence product of quality management enablers. Even though satisfaction and loyalty of customers, i.e. patients, is the primary target of quality management, there is little research in the literature as to how enablers of quality management can secure the satisfaction and loyalty through increasing service quality in hospitals. The gap is more critical because the specialized dimensions of four research variables have not been previously integrated into a coherent framework and interrelationships among them have not been studied and clarified in detail. The current study attempts to bridge this gap.

Best performance modeling using complementary DEA-ANN approach

Purpose

– The purpose of this paper is to design an innovative performance modeling system by jointly using data envelopment analysis (DEA) and artificial neural network (ANN). The hybrid DEA-ANN model integrates performance measurement and prediction frameworks and serves as an adaptive decision support tool in pursuit of best performance benchmarking and stepwise improvement.

Design/methodology/approach

– Advantages of combining DEA and ANN methods into an optimal performance prediction model are explored. DEA is used as a preprocessor to measure relative performance of decision-making units (DMUs) and to generate test inputs for subsequent ANN prediction modules. For this sequential process, Charnes, Cooper, and Rhodes and Banker, Chames and Cooper DEA models and back propagation neural network (BPNN) are used. The proposed methodology is empirically supported using longitudinal data of Japanese electronics manufacturing firms.

Findings

– The combined modeling approach proves effective through sequential processes by streamlining DEA analysis and BPNN predictions. The DEA model captures notable characteristics and efficiency trends of the Japanese electronics manufacturing industry and extends its utility as a preprocessor to neural network prediction modules. BPNN, in conjunction with DEA, demonstrates promising estimation capability in predicting efficiency scores and best performance benchmarks for DMUs under evaluation.

Research limitations/implications

– Integration of adaptive prediction capacity into the measurement model is a practical necessity in the benchmarking arena. The proposed framework has the potential to recalibrate benchmarks for firms through longitudinal data analysis.

Originality/value

– This research paper proposes an innovative approach of performance measurement and prediction in line with superiority-driven best performance modeling. Adaptive prediction capabilities embedded in the proposed model enhances managerial flexibilities in setting performance goals and monitoring progress during pursuit of improvement initiatives. This paper fills the research void through methodological breakthrough and the resulting model can serve as an adaptive decision support system.

Essentials of total quality management: a meta-analysis

PURPOSE

The purpose of this paper is to identify critical successful factors for Total Quality Management (TQM) implementation.

DESIGN/METHODOLOGY/APPROACH

A literature review was conducted to explore the critical successful factors for TQM implementation between 1980 and 2010.

FINDINGS

A successful TQM implementation need sufficient education and training, supportive leadership, consistent support of top management, customer focus, employee involvement, process management and continuous improvement of processes.

RESEARCH LIMITATIONS/IMPLICATIONS

The review was limited to articles written in English language during the past 30 years.

PRACTICAL IMPLICATIONS

From a practical point of view, the findings of this paper provide managers with a practical understanding of the factors that are likely to facilitate TQM implementation in organisations.

ORIGINALITY/VALUE

Understanding the factors that are likely to promote TQM implementation would enable managers to develop more effective strategies that will enhance the chances of achieving business excellence.