A two‐level EFQM self‐assessment in an Italian hospital

[Jury prize of the Austrian National Prize 2018 : 12 years European Foundation for Quality Management (EFQM) at the University Eye Clinic Graz]

Fragestellung

Kann sich ein Non-Profit-Unternehmen wie eine Universitäts-Augenklinik in Konkurrenz zu Profit-Unternehmen erfolgreich für einen Staatspreis des Bundesministeriums für Innovation und Wirtschaftsstandort in Österreich bewerben.

Material und Methode

Nach erfolgreichen Committed to Excellence (C2E) Assessments 2008/2010 wurde ein 70-seitiger Unternehmensbericht streng nach der EFQM(European Foundation for Quality Management)-Logik (bestehend aus Grundkonzepten, Kriterienmatrix und RADAR-Logik) erarbeitet. Im Assessment 2018 wurde besonderes Augenmerk auf die Entwicklung der Strategie der Universitäts-Augenklinik mit ihren beiden Anteilseignern (Shareholdern), der im Besitz des Landes Steiermark befindlichen Krankenanstalten Gesellschaft (KAGes) und der dem Bundesministerium zugehörigen Medizinischen Universität Graz, gelegt und diese mithilfe der X‑Matrix (nach Hoshin-Kanri) entwickelt und dargestellt.

Ergebnisse

Das Gesamt-Punktescore im Recognised for Excellence(R4E)-Assessment 2018 war 500 bis 550 Punkte, was die Jury zur Vergabe eines Jurypreises des Österreichischen Nationalpreises (Fokus: partizipative Führung) veranlasste. Verbesserungspotenziale waren die Ausrichtung der Kernprozesse auf die Hauptleistungsindikatoren der Universitäts-Augenklinik, die sich aus ihrer Mission, bestehend aus Patient*innen Versorgung, Forschung, Lehre, Ausbildung und Öffentlichkeitsarbeit, ergeben. Die Entwicklung der Strategie mit den Anteilseignern hat sich gegenüber dem R4E-Assessment von 2017 von einem Potenzial zu einer Stärke entwickelt.

Diskussion

Schriftliche und mündliche Rückmeldungen aus einem EFQM-Assessment sind der größte Mehrwert („value-added“) aus diversen Preisbewerbungen für eine Universitäts-Augenklinik sowie allgemein für Wirtschaftsunternehmen.

Measuring internal service quality: the case of the Greek public higher education institutions

Purpose

The purpose of this paper is to investigate the idea of internal service quality in public organizations. An attempt is made to determine the key elements that define the concept of internal service quality and to identify the factors that support the attainment of high levels of internal quality. Internal service quality refers to the quality of services offered between units and/or employees within an organization and achieving internal quality in public authorities can contribute to the sustainability of the public sector.

Design/methodology/approach

A survey was conducted among administrative staff of the publicly owned Greek Higher Education Institutions. The research instrument uses a three-level approach on internal service quality: individual, departmental and organizational. The model was tested using exploratory and confirmatory factor analysis.

Findings

Findings reveal a five-factor structure of internal service quality by adding the factors of interdepartmental quality and the human aspect of internal service provision. Analysis of the data suggests that internal service quality is dependent on the level of responsibility of the respondent’s job.

Research limitations/implications

There is evidence that the individual internal service quality factor needs to be enhanced with more items. In addition, in order to gain generalizable results, further research should be conducted in various types of public organizations.

Originality/value

This study examines a questionnaire that evaluates internal service quality and proposes a basic five-factor model for estimating this type of service quality. It also triggers the use of internal service quality theory within public sector organizations.

A Comparison of Three Models of Hospital Performance Assessment Using IPOCC Approach

Background

Hospital performance measurement is an essential component of providing feedback on the efficacy and effectiveness of service. The purpose of this study was to compare three models of performance assessment through the IPOCC approach.

Methods

This descriptive-analytical study was conducted in 2018 in Sari educational hospital. The data collection instrument was BSC, EFQM and accreditation questionnaire which was filled out through census. The validity of the BSC questionnaire and EFQM was based on expert opinion, and its reliability was found to be 0.97 and 0.92 using Cronbach's alpha coefficient. The accreditation questionnaire was developed using a checklist of the Ministry of Health. Using the expert panel, the components of the questionnaires were classified into dimensions of input, process, output, control, and context. Data analysis was done applying descriptive statistics and one way ANOVA.

Results

The highest distribution of components and acquired points through the IPOCC approach were found in the BSC in the process dimension (58.8%) and control dimension (3.62 ± 0.56), in the EFQM, in the result dimension (40.2%) and structure dimension (3.25 ± 0.44), and in the accreditation, in the process dimension (64.4%) and control dimension (3.45 ± 0.72), respectively. The results of one-way ANOVA showed that there was a significant difference between different quality models (P <0.001).

Conclusion

The results of the present study showed that in evaluating the hospital through the IPOCC approach, the distribution of components was more in the dimensions of the process. Therefore, having a robust systematic approach was considered to be effective for hospitals.

Corporate social responsibility and financial profile of Spanish private hospitals

In the context of the recent economic crisis, the financial situation of the Spanish health sector has become a major concern for responsible actors from the public and private spheres, because of a decline in public spending and increased demand due to population growth and ageing. The public health system seeks collaborative synergies with the private health system to achieve better health care results, cut waiting lists and cope with financial pressure. The private health sector currently owns 452 hospitals in Spain (57% of the country's total). This paper analyses the financial statements of hospital companies in the Spanish private healthcare system, using compositional data (CoDa) methodology. It identifies a significant relationship between financial statement structure and corporate social responsibility (CSR). Relevant CSR indicators include a sustainability report according to the Global Reporting Initiative (GRI), accreditation by the Joint Commission International (JCI) and ISO 14001, 50001 and 26000 accreditations. These indicators reduce asset turnover and increase debt quality: the proportion of long-term debt within total liability. From a methodological perspective, the paper proposes the first application CoDa in statistical models to predict financial statements from non-financial variables, and the first use of CoDa in partial-least-squares structural equation models (PLS-SEM). Our methodological approach reduces the asymmetry, redundancy and outliers encountered in standard statistical models that predict financial ratios.

An EFQM excellence model for integrated healthcare governance

Purpose

– The purpose of this paper is to account for a ten-year experience with the European Foundation for Quality Management (EFQM) Excellence Model implemented in the Trento Healthcare Trust.

Design/methodology/approach

– Since 2000, the EFQM Excellence Model provided an overarching framework to streamline business process governance, to support and improve its enablers and results. From 2000 to 2009, staff performed four internal (self) and four external EFQM-based assessments that provided guidance for an integrated management system. Over the years, key controls and assurances improved service quality through business planning, learning and practice cycles.

Findings

– Rising assessment ratings and improving results characterized the journey. The average self-assessment score (on a 1,000 points scale) was 290 in 2001, which increased to 610 in 2008. Since 2006, the Trust has been Recognized for Excellence (four stars). The organization improved significantly on customer satisfaction, people results and key service delivery and outcomes.

Practical implications

– The EFQM Model can act as an effective tool to meet governance demands and promote system-level results. The approach to integrated governance discussed here may support similar change processes in comparable organizations.

Originality/value

– The paper describes a unique experience when implementing EFQM within a large Italian healthcare system, which had a broader reach and lasted longer than any experience in Italian healthcare.

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.

[Successful implementation of the EFQM management model at the Department of Ophthalmology in Graz]

BACKGROUND AND OBJECTIVE

In the context of legal requirements and scarcer resources, the implementation of a quality management (QM) model will provide a competitive advantage or a site warranty for a hospital. For 3 years, the Department of Ophthalmology in Graz has been working with the EFQM model and has now accomplished the first level quality award, namely "Committed to Excellence (C2E)". The project work towards achieving this C2E-award is described below.

STUDY DESIGN AND METHODS

EFQM stands for European Foundation for Quality Management, an organization that was founded in 1989 by the EU, together with 14 leading enterprises. In the EFQM model, the maturity of an organization in terms of quality is determined through the achievement of a number of quality awards. The C2E award is the first of these awards. At the beginning of our work for the C2E level, the strengths and weaknesses of the Department of Ophthalmology were determined by means of an EFQM questionnaire. Three improvement measures with the highest impact on the performance of the clinic were identified by the questionnaire: 1. The hospitalization of a cataract patient. 2. The lack of information between the various professional parties. 3. The lack of knowledge within the professional groups of the objectives and strategy of the Department of Ophthalmology.

RESULTS

These areas requiring improvement were targeted, addressed and improved in a 6-months project work, structured by the EFQM model. The project work as a whole, the results obtained and the corresponding written documentation were evaluated positively in a 1-day assessment by Quality Austria.

DISCUSSION

The EFQM model is a challenging quality management model. After the necessary training of project members or under the supervision of experienced quality managers, the EFQM model may be successfully applied to patient care, teaching and research in a department of ophthalmology.

Evaluation of physical activity programmes for the elderly - exploring the lessons from other sectors and examining the general characteristics of the programmes

BACKGROUND

In Portugal, there are several physical activity (PA) programmes for elderly people developed by the local government. The importance of these programmes has been increasing since the evidence has shown that this type of health promotion interventions may reduce the deleterious effects of the ageing process. However, no study has already identified the general characteristics of these programmes nor if they use any scheme to assess the quality of the service provided. A widely-used scheme is the EFQM Excellence Model, which will be in the core of our present work. Thus, the main aims of this preliminary study were 1) to identify the general characteristics of the PA programmes developed by the Portuguese Local Public Administration 2) to determine the extent of implementation of quality initiatives in these programmes.

METHODS

Data were collected by an on-line questionnaire sent to all Continental Municipalities (n = 278). Categorical data were expressed as absolute counts and percentages. Continuous data were expressed as the mean and SD. An open-ended question was analysed using qualitative content analysis with QSR NVivo software. Associations between categorical variables were tested by the use of contingency tables and the calculation of chi-square tests. Significance level was set at p ≤ 0.05.

RESULTS

Results showed: i) a total of 125 PA programmes were identified in the 18 districts of the Portugal mainland; ii) the main goal of the majority (95.2%) was the participants' health promotion; iii) different characteristics of the programmes were found according to different regions of the country; iv) certain characteristics of the programmes were associated to the existence of other features; v) only one PA programme developed quality initiatives.

CONCLUSIONS

In conclusion, although there are many PA programmes for elderly people spread throughout the country, aiming at improving the health of participants, the overwhelming majority does not adopt quality control initiatives. Considering that the quality of a service increases customer satisfaction, the continuous quality improvement of the PA programmes for elderly people should therefore be implemented since they can be useful and critical for elderly satisfaction and adherence.

Culture and quality care perceptions in a Pakistani hospital

PURPOSE

Organizational culture is a determinant for quality improvement. This paper aims to assess organizational culture in a hospital setting, understand its relationship with perceptions about quality of care and identify areas for improvement.

DESIGN/METHODOLOGY/APPROACH

The paper is based on a cross-sectional survey in a large clinical department that used two validated questionnaires. The first contained 20 items addressing perceptions of cultural typology (64 respondents). The second one assessed staff views on quality improvement implementation (48 faculty) in three domains: leadership, information and analysis and human resource utilization (employee satisfaction).

FINDINGS

All four cultural types received scoring, from a mean of 17.5 (group), 13.7 (developmental), 31.2 (rational) to 37.2 (hierarchical). The latter was the dominant cultural type. Group (participatory) and developmental (open) culture types had significant positive correlation with optimistic perceptions about leadership (r = 0.48 and 0.55 respectively, p < 0.00). Hierarchical (bureaucratic) culture was significantly negatively correlated with domains; leadership (r = -0.61,p < 0.00), information and analysis (-0.50, p < 0.00) and employee satisfaction (r = -0.55, p < 0.00). Responses reveal a need for leadership to better utilize suggestions for improving quality of care, strengthening the process of information analysis and encouraging reward and recognition for employees.

RESEARCH LIMITATIONS/IMPLICATIONS

It is likely that, by adopting a participatory and open culture, staff views about organizational leadership will improve and employee satisfaction will be enhanced. This finding has implications for quality care implementation in other hospital settings.

ORIGINALITY/VALUE

The paper bridges an important gap in the literature by addressing the relationship between culture and quality care perceptions in a Pakistani hospital. As such a new and informative perspective is added.