Quality management and health: a double connection

A customer journey perspective on service delivery system design: insights from healthcare

Purpose

The purpose of this paper is to provide novel theoretical insight into service delivery system (SDS) design. To do so, this paper adopts a customer journey perspective, using it as a frame to explore dimensions of experience quality that inform design requirements.

Design/methodology/approach

This study utilises UK Patient Opinion data to analyse the stories of 200 cancer patients. Using a critical incident technique, 1,207 attributes of experience quality are generated and classified into 17 quality dimensions across five stages of the customer (patient) journey.

Findings

Analysis reveals both similarity and difference in dimensions of experience quality across the patient journey: seven dimensions are common to all five journey stages, from receiving diagnosis to end of life care; ten dimensions were found to vary, present in one or several of the stages but not in all.

Research limitations/implications

Limitations include a lack of representativity of the story sample and the impossibility to verify the factual occurrence of the stories.

Practical implications

Adopting a patient journey perspective can improve the practitioner understanding of the design requirements of SDS in healthcare. The results of the study can be applied by managers to configure SDS that achieve a higher quality of patient care throughout the patient journey.

Originality/value

This paper extends existing literature on SDS design by adopting a customer journey perspective, revealing heterogeneity in experience quality across the customer journey currently unaccounted for in SDS design frameworks. Specifically, the findings challenge homogeneity in extant SDS design frameworks, evidencing the need for multiple, stage-specific SDS design requirements.

The need for a long-term mindset when measuring the effects of lean on health-related quality management values

Purpose

The purpose of this paper is to investigate the effects a lean initiative has on the health-related quality management (QM) values, “Leadership Commitment” and “Participation of Everybody,” as well as on perceived co-worker health in the public sector.

Design/methodology/approach

A case study was carried out at a municipal division that had been working with lean for approximately 18 months. A questionnaire was used to measure the effect on health-related QM values both before and after the initial 18 month period. Documents from the intended lean implementation were studied at the starting point and after 18 months; this was followed up by examining new documents. The results from the questionnaires were analyzed using SPSS and the documents were analyzed by means of document comparisons and consensus discussion in the research group.

Findings

The effects on the health-related QM values; “Leadership Commitment” and “Participation of everybody” in this study showed that the values still permeated the organization to a relatively high extent after 18 months but that no statistical differences can be shown between the two measurement points. When measuring what effects a lean initiative has on values, a period of 18 months might be too short, if significance changes are expected. None the less, the results can be a way of monitoring the development of these softer values. Something that is equally important is to see if there have been any major changes, as a way of keeping the work with building a new culture alive and in focus. The results strengthen the assumption that a long-term mindset is needed when QM initiatives such as lean are applied within an organization especially when changes to values and workplaces are expected.

Originality/value

This study has further explored the QM in relation to lean in the respect of how the QM values “Leadership commitment” and “Participation of Everybody” are effected by a lean initiative.

Stakeholders' roles and responsibilities regarding quality of care

Purpose The purpose of this paper is to describe how different stakeholders (society, managers, employees and clients) can together ensure the quality of care. Design/methodology/approach Qualitative data were collected from four focus group interviews conducted in three countries. All interviewees were pursuing a master's degree in social and/or health care management and had begun working in their field after completing their bachelor's degree. The data were analysed using inductive content analysis. Findings The society and managers are responsible for the care system as a whole and must apply system-oriented, rather than sector-oriented, thinking. Employees are responsible for ensuring the continuity of client services in their work, and managers and employees share the responsibility of achieving the organisational goals and quality standards. The clients are responsible for acting as responsible service users and providing the required information to obtain care. Communication was strongly emphasised in the data, and it necessitates cross-professional and organisational boundaries, professional and political boundaries, as well as boundaries between the professional and the client. Research limitations/implications Since the interviewees were all pursuing a master's degree in social and/or health care management, when reflecting on their work experience, they may have also been reflecting what they had learned in university. Practical implications This study emphasises the importance of collaboration and communication between stakeholders in ensuring the quality of care. Unpredictable economies, the ageing population and the ongoing integration and reorganisation of health and social care services in Europe highlight systematic and strategic approach in quality of care. Originality/value This paper claims that communication between different care stakeholders gives a more systematic and coherent framework for the quality of care. Quality of care is a strategic choice and part of the strategic decision making at the societal, political, organisational and managerial levels.

Managing workplace health promotion in municipal organizations: The perspective of senior managers

BACKGROUND

Previous research indicates that companies manage workplace health in various ways, but more in-depth empirical knowledge of how workplace health promotion (WHP) is managed in public sector organizations is needed.

OBJECTIVE

The aim of this study was to explore how WHP is managed and incorporated into the general management system in two large Swedish municipal organizations.

METHODS

A qualitative descriptive approach was used. Fourteen senior managers were purposefully selected and interviewed using semi-structured interviews. Documents were used as supplementary data. All data were analysed using qualitative content analysis.

RESULTS

The management of WHP was described as a set of components that together contribute to the organization's capacity for WHP. The informants described WHP as dominated by fitness programmes and as following a problem-solving cycle, in which the annual employee survey emerged as an important managerial tool. Achieving feasible WHP measures and appropriate follow-ups were described as challenges. The provision of leadership competence for WHP and use of supportive resources were described as additional components.

CONCLUSIONS

The WHP management approach needs to be broadened to include work environment and organizational factors. Further integration with occupational health and safety and the general management system in the organizations is also needed.

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.

Safety improvements from health lean management implementation

Purpose

In a context where healthcare systems have to face multiple challenges, the development of a methodology that combines new managerial approaches could contribute to pursue and achieve multiple objectives. Inside the research stream that intends to combine health lean management (HLM) and clinical risk management (CRM), the purpose of this paper is to study the significant features that characterize HLM projects obtaining patient safety improvements (L&S projects).

Design/methodology/approach

The novelty of the research implies to adopt qualitative research methodology, analyzing in-depth case studies. L&S projects at different organizational levels have been selected from the same hospital. Following a research protocol, data have been collected through semi-structured interviews and they have been triangulated studying reports and archival documentation.

Findings

Comparing the three cases, it emerges that HLM can be a support for CRM since safety improvements can be achieved solving organizational issues. Analyzing the significant features of the three cases, relevant differences have been highlighted among them. At the end, first indications useful for achieving safety improvements from lean project implementation have been grasped.

Originality/value

This research provides a preliminary contribution to a new research stream that aims to develop a synergic methodology combining HLM and CRM. The first provided indications can be followed by hospital managers who wish to learn how to implement projects achieving patient safety improvements besides efficiency enhancement. After testing and exploiting the obtained results, a new methodology should be developed moving toward a safer and more sustainable healthcare system.

Developing a neuropsychological measurement to capture workplace learning

Purpose

The purpose of the paper is to examine variables to be included in a measurement instrument which measures workplace learning related to recent research into quality management and brain functioning.

Design/methodology/approach

A literature review was conducted, investigating measures of workplace learning as well as the connections between brain functioning and management. Further studies will use the brain integration scale to compare levels of brain integration with measures of workplace learning.

Findings

The variables “empathy”, “presence and communication”, “continuity”, “influence”, “development”, “work-integrated learning” and “flow” were found to be relevant from the literature review to be tested for inclusion in the measurement instrument. A measurement model with these variables included has been developed.

Research limitations/implications

This paper is conceptual in its nature. Empirical studies are needed to validate the propositions.

Practical implications

The proposed measurement instrument can be used by managers to gain insight into underlying mechanisms in the organizational culture that influence employees’ learning and potential for development. Thus, it can aid managers to achieve profound learning in their organizations, which is necessary for continuously maintaining high quality of products and services.

Social implications

For society, the implementation of the proposed measurement instrument in companies could lead to better health and higher job satisfaction among employees.

Originality/value

Traditional ways of measuring working environment are rarely connected to brain functioning of the employees. Only requiring small resources, this approach adds to an understanding of underlying mechanisms.

Work integrated learning for employee health in schools

Purpose

– The purpose of this paper is to examine relationships between quality management health dimensions, employee health, flow and work integrated learning in primary schools. Previous research has indicated relationships between quality management and health. In this study, the role that work integrated learning plays in the connection between quality and health is investigated.

Design/methodology/approach

– The study object has been a number of schools. A quantitative survey has been carried out. A random sample of 20 primary schools, of which 13 (65 per cent) agreed to participate, was selected. Questionnaires to their 301 employees were delivered and 229 (76 per cent) were returned. The reliability of the items were analysed with Cronbach’s alpha test. The statistical relationships between the items were studied with Pearson’s correlation test.

Findings

– The results show that the items are reliable. Moreover, statistical correlations between work integrated learning on the one hand and employee health, quality management health dimensions and flow on the other hand are found.

Research limitations/implications

– One limitation is that the research has only been carried out in schools and the possibilities of generalising the findings to other sectors are uncertain. Research implications are the relationships that have been identified between work integrated learning and the other factors.

Practical implications

– The knowledge that has resulted from the study should be useful for organisations in their attempts to improve the health status of the employees.

Originality/value

– The relationship between work integrated learning and employee health has not been studied in any other major study.

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.

Brain integration as a driver for quality management success

Purpose

In this paper, research leading to quality management success is examined, elaborated, and highlighted in a new profound way by focusing on the most fundamental aspect of the human dimension, the brain. The purpose is to examine the relationship between brain functioning and quality management success. In this examination, the role of core values, profound organizational learning and values of quality management are explained.

Design/methodology/approach

The paper builds on a conceptual review of research in the areas of quality management success, values of quality management, core values and neurophysiology with focus on brain integration.

Findings

The relation of core values with brain functioning is described based on previous research. A framework with logical steps from brain integration, via core values, quality management values and quality management practices to quality management success is developed.

Research limitations/implications

The paper adds to the understanding of the role brain integration has for success in quality management efforts. A limitation is that it only builds on previous research.

Practical implications

The findings provide a deeper understanding of quality management success and should thus be valuable for quality managers and leaders striving for excellence for their organisations.

Originality/value

The importance and crucial role of brain integration for quality management success has not been elaborated in the literature of quality management before.