A survey of total quality management in Iran

Adopting quality management (QM) principles in managing facilities management service delivery

Purpose

This paper aims to assess the quality management (QM) principles in facilities management (FM) service delivery for office buildings. This is to create a quality culture that will enhance the performance of FM service delivery towards meeting the users' requirements and needs.

Design/methodology/approach

This study adopts a quantitative methodology via a questionnaire survey for the data collection. In total, 24.41% of respondents from the registered FM companies in Malaysia attended the survey. SPSS 27.0 was used to interpret the collected data, which were then reviewed through descriptive and inferential analysis.

Findings

The study signifies that customer focus, leadership, improvement, evidence-based decision-making and relationship management indicate positive connections with FM service delivery in ensuring a cost-effective working process and meeting both user requirements and legal and regulatory corporate compliance. There are 18 elements of strategic, people and structural barriers that may hinder the implementation of QM in the FM service delivery. Correspondingly, the five main key enablers suggested being teamwork and participation, leadership, continuous improvement, process management and resources and competency development-based enablers.

Research limitations/implications

The study was conducted during the pandemic crisis with limited access and response from participants. However, this in-depth study was still able to synthesize the imperative QM practice in FM among FM practitioners in Malaysia.

Originality/value

This study provides insight into the implementation of QM principles to cultivate a quality culture that will enhance the performance and productivity in FM service delivery specifically for office buildings in Malaysia. Prior to this study, there was a lack of research pertaining to these two themes: QM and FM.

Statistical process control for the analysis of quality control in urodynamics: A potential new approach for quality review of urodynamics

PURPOSE

To analyze quality control in urodynamic studies, using a proportion control chart (p-chart) for statistical process control.

MATERIALS AND METHODS

This single-center study was conducted at the Urodynamic Center of West China Hospital, Sichuan University. We randomly selected 15 samples from each month in 2020, and 180 urodynamic traces were finally enrolled. We used the p-chart of statistical process control for analysis. We calculated the proportion of the incidence of a selected set of artefacts in the monthly urodynamic study process, including non-standard zero setting, no cough test, incomplete records of all measurements by urodynamicists, catheter displacement, and baseline drift. Through the specific calculation formula of statistical process control, we obtained the values of the center line, lower control limit, and upper control limit.

RESULTS

All data points of each artefact were within zone A. However, one outlier was found in the p-chart of all artefacts in October, which might have been caused by inexperienced operators.

CONCLUSIONS

Statistical process control may play an important role in the process control of urodynamic studies and guide us in identifying the cause of poor quality in process management.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors

Lean Six Sigma (LSS) has been applied in many healthcare organisations, but there has been limited research on the evolution of LSS application in healthcare. This paper aims to present the challenges, critical success factors (CSFs), readiness factors and most common tools and techniques used for LSS deployment in healthcare. A systematic literature review (SLR) was utilised to research the study objectives. Peer-reviewed literature over a 16-year period was studied to understand the deliverables of LSS. The SLR process identified relevant articles and screened a final selection for those under study. The systematic literature review helped the authors to identify the challenges and tools/techniques used for LSS in healthcare. Several CSFs and readiness factors for LSS deployment in healthcare are also presented. This work informs healthcare managers and professionals on the important factors for successful LSS deployment before embarking on the LSS journey. In addition, this work is a valuable resource for healthcare LSS practitioners and academic researchers to learn about, investigate and deploy LSS in the healthcare sector. This study is one of the most comprehensive SLRs covering the importance and specificity of understanding challenges, CSFs and organisational readiness for LSS in healthcare. This study provides knowledge of the successful deployment of LSS in healthcare.

Effect of TQM educational interventions on the management policy standard of health promoting hospitals

The purpose of this study was to manage total quality management (TQM) to increase the standard of management policy and contribute to achieve the standards for health promotion hospitals (HPHs). This was a quasi-experimental intervention study. A total of 35 managers participated in this study were selected in the census. Based on the TQM components, educational items were provided as lectures, posters and pamphlets. The TQM questionnaire and HPHs checklist used to collect data in three different periods: before the interventions, immediately after the interventions and 3 months after the interventions (follow-up). The data analysis was done by means of SPSS software (version 23). The results showed that the average difference of the components of the qualitative groups (p < 0.001), education (p = 0.004), evaluation and feedback (p < 0.001), customer-orientation (p < 0.001), suggestion system (p = 0.024), leadership commitment (p < 0.001) was significant over the three periods. Excluding the employment status before the educational intervention (p = 0.002), there was no significant relationship between the demographic characteristics and mean score of TQM (p > 0.05). Based on the findings of this study, the educational interventions had a positive effect on quality management and management policy. Therefore, educational interventions should be accompanied by changes in the culture and management policies of the hospital to meet HPH standards.

Quality management practices as a driver of employee satisfaction: exploring the mediating role of organizational image

Purpose

Total quality management (TQM) has been a universally applienod management strategy to improve organizational performance and thereby to achieve competitiveness. Compared with the scholarly and practical attention paid to identify the consequences of implementing TQM practices, little is known about how those practices enhance organizational image and employee satisfaction. This paper aims to address that research gap and is designed to empirically prove the relationship between TQM practices, organizational image and employee satisfaction.

Design/methodology/approach

A questionnaire-based survey of 285 employees including administrators, managers and heads of departments of 21 National Accreditation Board for Hospital and Healthcare providers-accredited hospitals in India was conducted. The proposed research model was tested using partial least squares based structural equation modelling.

Findings

The results revealed that TQM practices have positive direct and indirect effects on employee satisfaction, confirming the partial mediation role played by organizational image in the relationship between TQM practices and employee satisfaction.

Research limitations/implications

From the findings, leaders can understand that by implementing TQM practices, organizations can enhance image of the organization and bring high level of employee satisfaction.

Originality/value

The study tries to answer questions largely ignored in the TQM literature: the effect of TQM practices on organizational image and employee satisfaction, and the mediating role of organizational image on TQM practices and employee satisfaction.

Quality management effects on operating theater's productivity: a participatory action research

Purpose

The operating theater (OT) is resource-intensive, costly and assuring its productivity is a high priority. This study aimed to examine a quality management model's effects on a hospital's OT productivity.

Design/methodology/approach

The participatory action research approach was used for the intervention. A multidisciplinary quality improvement team was formed. The team improved OT operational processes using an eight-step quality management model. OT’s key performance indicators such as surgical cases, surgical cancellation, bill deductions, successful cardiopulmonary resuscitation, patients' complaints and employees' job satisfaction were collected before the intervention and compared with those of after intervention to determine the efficacy of the quality management model.

Findings

Applying a quality management strategy increased surgical patients' number by 14.96%, reduced surgery operations cancellation by 14.6 %, and decreased bill deduction by 44.9%. Besides, successful cardiopulmonary resuscitation increased by 21.17%, patients' complaints reduced by 61.5% and, finally, staff satisfaction increased by 15.6 %. Improved OT productivity resulted in improved financial performance. As a result, the OT revenue has risen by 68.8%.

Originality/value

This study highlights that implementing the right quality management model properly enhances hospitals' productivity. It also offers suggestions on how to implement a quality management model successfully in a hospital setting.

Identification of barriers to synergistic implementation of TQM-SCM

Purpose

The study aims at finding out major barriers for synergistic adoption of TQM-SCM in the medium- and large-scale manufacturing organizations in India. All these barriers create hurdles for the organizations as well as supply chain partners in improving their business performance. The study is a blend of theoretical and practical frameworks, which will focus on key barriers leading to interrupt the successful synergistic implementation of TQM-SCM in manufacturing organization.

Design/methodology/approach

Firstly, survey of 116 Indian organizations has been carried out to identify barriers that hinder successful implementation of TQM-SCM. Afterward, VIKOR approach was proposed to rank the major barriers of TQM-SCM implementation in Indian manufacturing organizations.

Findings

Identification of barriers to synergistic implementation of TQM-SCM in the manufacturing industry of India, ranking of these barriers in terms of their severity.

Originality/value

The adoption of TQM-SCM on synergistic basis is still in its early stages in India. To the authors’ knowledge, this is the first study that is designed to prioritize barriers responsible for hindering successful synergistic implementation of (TQM-SCM) in Indian manufacturing industry. Further, the results of the study will be helpful for managers in order to prepare action plans to overcome the hurdles to TQM-SCM implementation.

Administrative challenges of clinical governance in military and university hospitals of Kerman/Iran

BACKGROUND

Over the recent years, clinical governance model has been applied to improve the quality of university and private hospitals in Iran. In addition to university hospitals, military hospitals have an effective role in the preservation and promotion of public health. The challenges of clinical governance implementation have not been investigated in such settings. Hence, the present study objective is to identify the administrative challenges of clinical governance in military and university hospitals of Kerman/Iran METHODS: This qualitative study was carried out through phenomenology in 2017. A sample of managers and experts in the implementation and execution of clinical governance was purposefully selected from three university hospitals and three military hospitals in Kerman, Iran. A total of 39 managers and experts were interviewed, and data were gathered via semistructured interviews with open questions. For data analysis, conventional content analysis method was employed.

RESULTS

In this study, five main codes and 17 subcodes were obtained. Main codes were structural challenges, educational challenges, limitations, evaluation, and human resource challenges.

CONCLUSIONS

Clinical governance is being implemented hastily with no appropriate structural, financial, and training facilities, ensuing a waste of resources, more difficult work for staff and a negative view of personnel.

Training leaders for a culture of quality and safety

PURPOSE

The purpose of this paper is to understand the degree to which a quality and safety culture exists after healthcare workers in an academic medical center complete a quality improvement and patient safety education program focused on developing leaders to change the future of healthcare quality and safety.

DESIGN/METHODOLOGY/APPROACH

The safety attitudes questionnaire (SAQ) short-form was used for measuring the culture of quality and safety among healthcare workers who were graduates of an academic medical center's healthcare quality and safety program. A 53 percent response rate from program alumni resulted in 54 usable responses.

FINDINGS

This study found that 42 (78 percent) of the respondents report that they are currently working in a healthcare quality and safety culture, with 25 (59 percent) reporting promotion into a leadership role after completion of the quality improvement education program. This compares favorably to AHRQ culture of safety survey results obtained by the same academic medical center within the year prior revealing only 63 percent of all inpatient employees surveyed reported working in a quality and safety culture.

RESEARCH LIMITATIONS/IMPLICATIONS

The study design precluded knowing to what degree a quality and safety culture, as measured by the SAQ, existed prior to attending the healthcare quality and safety program.

ORIGINALITY/VALUE

This study has practical value for other organizations considering a quality and safety education program. For organizations seeking to build capacity in quality and safety, training future leaders through a robust curriculum is essential. This may be achieved through development of an internal training program or through attending an outside organization for education.

Mediating role of quality performance on the association between organisational factors and competitive advantage

Purpose

The purpose of this paper is to provide an initial empirical insight into the mediating role of quality performance on the association between six specific organisational factors (top management support, employee involvement, employee empowerment, reward and recognition, training and customer focus) and competitive advantage.

Design/methodology/approach

A survey questionnaire was used to collect data from 179 garment organisations in a developing country, Bangladesh.

Findings

The results show that quality performance mediates the association between three specific organisational factors (top management support, employee involvement and reward and recognition) and competitive advantage. In addition, a fourth organisational factor, employee empowerment, exhibited a direct association with competitive advantage.

Originality/value

The findings provide managers of developing economies with an important insight into the critical role of quality in achieving competitive advantage. In line with the resources-based view, the findings suggest that managers should deploy their limited resources to focus on providing top management support for, encourage employee involvement in and provide adequate rewards and recognition in respect to quality initiatives.

The moderating effect of structural barriers on TQM-performance relationship in Egyptian service organizations

Purpose

This paper aims to empirically investigate how structural barriers affect the relationship between total quality management (TQM) practices implementation and organizational performance in service industries.

Design/methodology/approach

This research hypothesized the moderation effect of structural barriers on the relationship between TQM practices implementation and organizational performance. A questionnaire was adopted to collect data form 153 Egyptian service companies. Moderated regression analysis was used to test the study hypothesis.

Findings

The empirical analysis suggests that structural barriers partially moderate the relationship between TQM practices implementation and organizational performance. The analysis reveals that the effect of Quality Improvement, Process Improvement, External and Internal Relations and Employee Development – being as TQM dimensions – on performance is moderated by structural barriers. While the results provided insufficient evidence on the moderating effect of structural barriers on the relationship between both Performance Management – being as a TQM dimension – and performance.

Research limitations/implications

This research presents a new perspective for researches to understand the TQM–Performance relationship in the light of the contingency theory. However, the adopted sampling technique and the small sample size might limit the generalizability of the research findings.

Practical implications

This study provides useful insights for service organizations about the necessity of developing suitable structural platform for supporting their TQM efforts to boost their performance which, in turn, improves their competitiveness.

Originality/value

This research proposed and empirically validated how structural barriers play a significant role as moderators to the relationship between TQM implementation and organizational performance within service organizations context.

Resistance to change: an empirical investigation of its antecedents

Purpose

Resistance to change (RtC) is widely recognized as the main reason of failure, when it comes to change initiatives. Despite its importance, there is still a rather limited knowledge concerning the factors that trigger this behavior at the workplace. The purpose of this paper is to identify the factors affecting RtC in healthcare organizations (namely, hospitals) and specifically, in emergency departments (EDs).

Design/methodology/approach

An original conceptual framework (research model) has been developed and empirically tested using primary data collected from EDs of six Greek hospitals. In total, the actual sample incorporates the responses of 158 ED health professionals who completed a structured questionnaire.

Findings

The findings verified the initial assumption that “disposition towards change (DtC),” “anticipated impact of change (AIC)” and “attitude towards change (AtC)” mediate the impact of various personal and behavioral characteristics on “RtC.” The results suggested that “RtC” is (indirectly) influenced by four main factors (“employee-management relationship,” “personality traits,” “employee participation in the decision-making process” and “job security”).

Originality/value

This study investigates how several factors affect, both directly or indirectly, employee reactions toward “RtC.” It also examines the mediating effect of three factors (“DtC,” “AtC,” “AIC”) that capture three different dimensions of individual evaluation toward change, something that goes beyond previous work. In addition, the present study examines a wide range of antecedents of RtC, including both personality-related and job-related factors.

Assessment of TQM implementation level in Palestinian healthcare organizations

Purpose

The purpose of this paper is to assess the level of total quality management (TQM) implementation in Palestinian governmental and non-governmental hospitals using the Malcolm Baldrige National Quality Award (MBNQA) framework.

Design/methodology/approach

The study is based on collecting data using a survey questionnaire that was designed according to the MBNQA criteria. In total, 363 questionnaires from governmental and non-governmental hospitals operating in Gaza Strip were analyzed to assess the level of TQM implementation level in all hospitals (governmental and non-governmental).

Findings

The main results of this study indicate that Palestinian hospitals operating in Gaza Strip perform at a relatively acceptable level. Comparing results shows that the performance of non-governmental hospitals is better with higher degree of TQM implementation than the governmental hospitals. Detailed analysis identifies improvement opportunities-related specific aspects of the human resources focus and the performance results.

Research limitations/implications

Although this study has collected data from one Palestinian Territory, the Gaza Strip, it still identifies the critical factors and practices for TQM implementation within the Palestinian healthcare organizations to improve performance.

Practical implications

This paper suggests that business excellence models such as the MBNQA criteria can be used to assess the level of implementation of quality practices and identify the strengths and weaknesses to improve the quality of service delivery, processes, and performance of hospitals.

Originality/value

Despite the widespread use of TQM in the developed countries, little attention has been placed to implement and assess the quality initiatives by organizations in the developing countries and even fewer in low-income Arab countries (Aamer et al., 2017; Øvretveit and Al Serouri, 2006). In addition, a very few number of studies in reference to the assessment of TQM implementation in the Palestinian context, in general, and in healthcare organizations, in particular, highlight the need for this study. To move the field in that direction, the goal of this research was to assess the level of TQM implementation in the healthcare organizations (mainly hospitals) in Gaza Strip (one of the least fortunate areas of the Palestinian-occupied territories) where no prior similar research studies could be found. Therefore, this study contributes to filling this gap in the literature by providing empirical assessment of TQM level of implementation in Gaza Strip hospitals.

Recent Iranian Health System Reform: An Operational Perspective to Improve Health Services Quality

The operational management of healthcare services is expected to directly touch patient experiences. Iranian Ministry of Health and Medical Education (MoHME) for the first time, as such, has sought to improve the operational management of healthcare delivery within a reform agenda by setting benchmarks for ‘number of visit per hour’ and waiting time in outpatient clinics of about 700 affiliated hospitals. As a new initiative, it has faced with mixed reactions and various doubts have been cast on its successful implementation. This manuscript aims to shed some light on the operational challenges of the initiative and the requirements of its successful implementation.

Success rate evaluation of clinical governance implementation in teaching hospitals in Kerman (Iran) based on nine steps of Karsh's model

Background

One of the ways to improve the quality of services in the health system is through clinical governance. This method aims to create a framework for clinical services providers to be accountable in return for continuing improvement of quality and maintaining standards of services.

Objective

To evaluate the success rate of clinical governance implementation in Kerman teaching hospitals based on 9 steps of Karsh’s Model.

Methods

This cross-sectional study was conducted in 2015 on 94 people including chief executive officers (CEOs), nursing managers, clinical governance managers and experts, head nurses and nurses. The required data were collected through a researcher-made questionnaire containing 38 questions with three-point Likert Scale (good, moderate, and weak). The Karsh’s Model consists of nine steps including top management commitment to change, accountability for change, creating a structured approach for change, training, pilot implementation, communication, feedback, simulation, and end-user participation. Data analysis using descriptive statistics and Mann-Whitney-Wilcoxon test was done by SPSS software version 16.

Results

About 81.9 % of respondents were female and 74.5 have a Bachelor of Nursing (BN) degree. In general, the status of clinical governance implementation in studied hospitals based on 9 steps of the model was 44 % (moderate). A significant relationship was observed among accountability and organizational position (p=0.0012) and field of study (p=0.000). Also, there were significant relationships between structure-based approach and organizational position (p=0.007), communication and demographic characteristics (p=0.000), and end-user participation with organizational position (p=0.03).

Conclusion

Clinical governance should be implemented by correct needs assessment and participation of all stakeholders, to ensure its enforcement in practice, and to enhance the quality of services.

A qualitative study on the implementation of quality systems in Australian hospitals

Public hospitals are required to have quality systems in place to meet accreditation standards, achieve government performance expectations and continually improve care. However, previous study suggests that there has been limited success in the implementation of effective quality systems. Using document review, self-evaluation and qualitative data from interviews and focus groups of 270 board members, managers and staff we explored the implementation of quality systems in eight Australian public hospitals. Using normalisation process theory, we found that the hospitals took a technical, top-down approach to quality system implementation and did not provide staff with opportunities for socialization of the technology that enabled them to normalise the quality work. 'Quality' was consistently described as an 'extra' set of tasks to do, rather than a means to creating sustained, safe, quality care. Despite enormous goodwill and positive intent, a lack of understanding of how to effect change in the complexity of hospitals has led the boards and senior managers in our sample to execute a technical, top-down approach based on compliance and reactive risk.

TQM implementation for the healthcare sector

Purpose

The purpose of this paper is to enlarge the debate on total quality management (TQM) implementation in the healthcare sector and to evaluate how and whether leadership can affect TQM implementation.

Design/methodology/approach

This paper is based on findings from a literature review of TQM and leadership. The authors analysed these findings to categorise causes of a lack of leadership in TQM programme implementations.

Findings

The authors propose three categories of causes of a lack of leadership in TQM programme implementation. The first cause is well-known: a lack of senior managers’ involvement and commitment. The second category is the “combined leadership” that occurs in large healthcare organisations; and the third category is the influence of an external “political leadership” on public healthcare.

Research limitations/implications

This paper presents researchers with three categories of causes of failure of leadership in TQM implementation that can be investigated. It also encourages reflections from practitioners concerning TQM leadership in the healthcare sector.

Practical implications

The authors request that practitioners reflect on ways to create or sustain a “monolithic” leadership, especially in large organisations, to ensure a common vision, values and attitude for unitary TQM governance.

Originality/value

In an original way, this paper analyses and proposes three categories of causes linked to a lack of TQM leadership in the healthcare sector.

TQM and organizational performance using the balanced scorecard approach

Purpose

The purpose of this paper is to examine the relationship between the implementation of total quality management (TQM) and organizational performance, using the balanced scorecard (BSC) approach.

Design/methodology/approach

In order to investigate the relationship between TQM and BSC, a questionnaire was developed and distributed to 30 largest pharmaceutical distribution companies in Iran. Structural equation modeling was used to evaluate the measurement model and to test the research hypotheses using the data from 933 completed questionnaires.

Findings

The results supported the research model and revealed that TQM implementation can positively and significantly influence the BSC and its four perspectives.

Practical implications

Considering the strong association between TQM and all four perspectives of organizational performance (BSC), managers should strongly leverage the implementation of TQM practices in order to reach their strategic objectives.

Originality/value

This study is the first empirical study conducted on the association of TQM and BSC in the pharmaceutical industry. The findings of this study provide strong evidence supporting the implementation of TQM in the pharmaceutical context.

PATIENTS' SATISFACTION WITH HEALTH SERVICES AT THE NATIONAL INSTITUTE OF PUBLIC HEALTH OF KOSOVA

Aim:

Purpose of the research is to assess patient satisfaction with the quality of health services provided in National Institute of Public Health of Kosova.

Methods:

Study was observational and cross-sectional. Interviews were conducted with 625 clients of IPH. Inclusion criteria for enrollment in the study were patients above 18 years old, with verbally informed consent.

Results:

In our study, access to IPH, efficacy, patient-provider interpersonal communication, and explanations regarding procedures, readiness to answer to patients need and physical settings and appearance are valued satisfactorily whereas cleanliness was rated with minimal grades. Evaluated 12 quality components, were scored with average mark 3.6.

Conclusions:

SWOT analysis, and fishbone diagram should be used on regular bases and a new position for a manager for administrative issues, is opened, complaints box and list of rights and responsibilities of patients were dislocated in a more visible place, and internal staff turnover, is introduced.

Nursing experiences of clinical governance implementation: a qualitative study

Purpose

– Clinical governance (CG) was used as a driver to improve safety and quality of healthcare. CG implementing is a change in health system and all the stakeholders must be participating. The purpose of this paper is to study nurses’ experience about CG movement in Tabriz hospitals.

Design/methodology/approach

– A qualitative study using Focus Group Discussions (FGD) was done. Purposeful Sampling was used to select the objectives including 65 participants. Actually seven FGD’s were held. Content analysis was used to extract the meaningful themes.

Findings

– It is revealed that nurses are the focal point in CG implementation in hospitals. Low commitment of managers and lack of physicians’ contribution was experienced by nurses. However, personnel education and development and patient safety have got more attention. Blame culture and increased work stress was reported as challenges.

Originality/value

– CG as a change in healthcare system, especially in low- and middle-income countries, is faced by several challenges and its implementation would have different experiences. Nursing staff, the major group in hospitals, would be having interesting experiences through CG. Their practical opinions could guide the policy makers to employ proper plans to effectively implement CG. Considering the result of this study in practice would lead to improve CG implementation.

Developing and validating a total quality management model for healthcare organisations

Purpose

– The purpose of this paper is to develop a total quality management (TQM) model for healthcare organisations and validate it using a sample of Iranian healthcare organisations.

Design/methodology/approach

– A validated questionnaire was used to collect data from all healthcare organisations that implemented TQM in Isfahan province, Iran.

Findings

– Using the proposed model, TQM implementation was measured in healthcare organisations. The level of TQM success in Isfahan healthcare organisations was medium. The highest score was achieved in the dimension of “customer management”, followed by “leadership” and “employee management”. Employee management, information management, customer management, process management and leadership had the most positive effect on TQM success. Using a series of quality management techniques had “synergistic” effect on TQM success.

Practical implications

– Top management support, effective management of human resources, full involvement of the entire workforce including physicians, education and training, team working, continuous improvement, a corporate quality culture, customer focus and using a combination of management techniques under a quality management system are necessary for TQM successful implementation.

Originality/value

– A healthcare context-specific model of TQM was developed and tested and suggestions were provided for its successful implementation.

Identification and prioritization of barriers to total quality management implementation in service industry

Purpose

– Despite the potential benefits of total quality management (TQM) articulated by quality experts and practitioners, these benefits are not easy to achieve in practice. Many service industries have found difficult to implement TQM successfully. The present study investigates and categorizes the barriers to a successful implementation of TQM program in the service industry. The purpose of this paper is to understand TQM barriers and prioritize their relative importance by ranking them in the service industry.

Design/methodology/approach

– Based on previously published literature on TQM barriers in service industry and after discussions with quality experts, this study utilizes a set of 12 barriers to TQM as identified by the authors of TQM barriers to accomplish the objectives of the present study. The 12 barriers were divided into three categories. These barriers were prioritized and ranked using an analytic hierarchy process (AHP) approach, a multi-criteria decision-making process.

Findings

– In this research, the category “managerial issues” was found to be the most important, followed by “people-oriented issues” and “organizational issues” based on their priority weights. The results have also highlighted that the barrier “lack of communication” was the most significant among all the other barriers. It was followed by “lack of top-management commitment,” “employee’s resistance to change,” and “lack of coordination between departments.” The least significant barrier was “high turnover at management level.”

Practical implications

– The study ranks the barriers, from the most important to the least important, which will allow managers and practitioners in the service industry to decide which barriers they need to pay attention to and work on for a successful implementation of TQM.

Originality/value

– The strength of this study is the development of a comprehensive model for the investigation and prioritization of barriers that the service industry experiences when implementing a TQM program. Presenting TQM barriers in the form of AHP-based model and categorizing barriers is a new effort in the area of TQM.

Gotzamani K, L. Psomas E. The impact of employees’ attributes on the quality of food products

Purpose

– The purpose of this paper is to analyse the importance of specific, quality-related employees’ attributes to the enhancement of product quality in food companies. The main goal is to examine the synergistic relationships between specific employees’ attributes, which have been related in literature to ISO 9000 successful implementation, to continuous improvement, operational performance and product quality.

Design/methodology/approach

– The analysis includes an initial exploratory factor analysis, followed by confirmatory factor analysis and structural equation modelling, in order to investigate the relations between the constructs of the proposed model.

Findings

– The findings reveal that although the examined quality-related “employees’ attributes” do not directly contribute to “product quality”, they influence both “continuous improvement” and “operational performance” of food firms. The results also confirm the impact of both “continuous improvement” and “operational performance” on “product quality” and also that “continuous improvement” helps explain “operational performance”.

Research limitations/implications

– The domain in which the model has been validated, the restricted use of moderators in the model and lack of empirical validation of the model in non-food sector companies, based on various respondents from each company, are a number of limitations associated with this study which suggest future research proposals.

Practical implications

– The findings of this study can motivate managers of food companies to focus on certain quality-related employees’ attributes in order to boost continuous improvement of ISO 9001 systems and operational performance of their companies, leading to product quality enhancement.

Originality/value

– This study finds particular relevance in emphasizing that although specific quality-related employees’ attributes, as these are detected in literature, have a significant contribution towards continuous improvement and operational performance, they are not the only critical factor leading to product quality. More complex relationships need to be considered by integrating other constructs as major antecedents of food product quality.

Why TQM programmes fail? A pathology approach

Purpose

– Implementing total quality management (TQM) is not without difficulties and achieving its promised benefits is not easy. The purpose of this paper is to identify the barriers to TQM successful implementation.

Design/methodology/approach

– A literature review has been done to explore the major reasons for the failure of TQM programmes.

Findings

– An examination of 54 TQM empirical studies identified 54 obstacles to successful TQM implementation. There are both theoretical and practical difficulties in applying TQM in organisations. An ineffective TQM package, inappropriate TQM implementation methods and an inappropriate environment for implementing TQM are the main reasons for TQM failure. The most frequently mentioned reasons for TQM implementation failures include insufficient education and training, lack of employees’ involvement, lack of top management support, inadequate resources, deficient leadership, lack of a quality-oriented culture, poor communication, lack of a plan for change and employee resistance to the change programme.

Research limitations/implications

– The review was limited to articles written in English language during the past 30 years (1980-2010).

Practical implications

– TQM does deliver better performance when an appropriate model of TQM is appropriately implemented in a supportive environment. The findings of this paper provide managers with a practical understanding of the factors that are likely to obstruct TQM implementation. Managers should overcome these barriers to achieve the TQM benefits.

Originality/value

– Understanding the factors that are likely to obstruct TQM implementation will help organisations in planning better TQM models.

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.

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.

Clinical governance implementation in a selected teaching emergency department: a systems approach

BACKGROUND

Clinical governance (CG) is among the different frameworks proposed to improve the quality of healthcare. Iran, like many other countries, has put healthcare quality improvement in its top health policy priorities. In November 2009, implementation of CG became a task for all hospitals across the country. However, it has been a challenge to clarify the notion of CG and the way to implement it in Iran. The purpose of this action research study is to understand how CG can be defined and implemented in a selected teaching emergency department (ED).

METHODS/DESIGN

We will use Soft Systems Methodology for both designing the study and inquiring into its content. As we considered a complex problem situation regarding the quality of care in the selected ED, we initially conceptualized CG as a cyclic set of purposeful activities designed to explore the situation and find relevant changes to improve the quality of care. Then, implementation of CG will conceptually be to carry out that set of purposeful activities. The activities will be about: understanding the situation and finding out relevant issues concerning the quality of care; exploring different stakeholders' views and ideas about the situation and how it can be improved; and defining actions to improve the quality of care through structured debates and development of accommodations among stakeholders. We will flexibly use qualitative methods of data collection and analysis in the course of the study. To ensure the study rigor, we will use different strategies.

DISCUSSION

Successful implementation of CG, like other quality improvement frameworks, requires special consideration of underlying complexities. We believe that addressing the complex situation and reflections on involvement in this action research will make it possible to understand the concept of CG and its implementation in the selected setting. By describing the context and executed flexible methods of implementation, the results of this study would contribute to the development of implementation science and be employed by boards and executives governing other clinical settings to facilitate CG implementation.

Best practices of total quality management implementation in health care settings

Due to the growing prominence of total quality management (TQM) in health care, the present study was conducted to identify the set of TQM practices for its successful implementation in healthcare institutions through a systematic review of literature. A research strategy was performed on the selected papers published between 1995 and 2009. An appropriate database was chosen and 15 peer-reviewed research papers were identified through a screening process and were finally reviewed for this study. Eight supporting TQM practices, such as top-management commitment, teamwork and participation, process management, customer focus and satisfaction, resource management, organization behavior and culture, continuous improvement, and training and education were identified as best practices for TQM implementation in any health care setting. The article concludes with a set of recommendations for the future researchers to discuss, develop, and work upon in order to achieve better precision and generalizations.

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals

BACKGROUND

The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective.

METHODS

A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence).

RESULTS

Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management.

CONCLUSION

QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size - the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals.