Developing and validating a total quality management model for healthcare organisations

Challenges of midwifery staff at Tehran hospitals: A qualitative study from the midwifery managers perspective

AIM

This study aimed to investigate the challenges faced by midwifery staff working in hospitals from midwifery manager's perspectives and provide suggestions to solve them.

DESIGN

Descriptive qualitative study.

METHODS

The study was conducted in Tehran in 2021. Data were collected using fifteen semi-structured interviews conducted with hospitals' clinical midwifery managers over 7 months. The interview data were grouped into three themes: recruitment, development, and maintenance.

RESULTS

The midwifery workforce would face significant challenges in training hospitals. Lack of suitable patterns of midwifery workforce management, the non-optimal midwives' utilization and deployment, unclear job boundaries, weak training programs for the midwives' professional development, and unpleasant working atmosphere were the main challenges. A well-defined task description for midwives to determine their position in all spheres of reproductive health service provision, create training courses based on skill gaps, and focus on improving labour relations and organizational culture are suggested.

PATIENT OR PUBLIC CONTRIBUTION

Midwifery managers were interviewed. They talked about their experience with midwifery workforce challenges.

An Empirical Study of the Contribution of Total Quality Management to Occupational Safety and Health Performance in Saudi Organizations

Working to ensure a safe and secure work environment for workers and employees has become an essential component of achieving organizational excellence in modern organizations. Occupational safety and health (OSH) programs help in attracting and retaining the workforce and human competencies, thus improving the operational and organizational performance of these organizations. Total quality management (TQM) is a management philosophy adopted by successful organizations to achieve sustainable business performance. This study aims to assess the level of implementation of total quality management and occupational safety and health in Saudi organizations and investigates the relationship between total quality management practices and occupational safety and health performance. Data were collected from a number of random organizations during the period November to December 2021. Based on a sample of 99 valid responses, empirical results were obtained through descriptive and advanced statistical analysis, indicating that TQM practices and OHS are highly implemented in Saudi organizations. The statistical results also showed that TQM practices have a significant positive impact on OSH performance in the surveyed organizations. The seven TQM fundamental pillars and the five OSH program components can be considered as essential success factors and fundamental pillars for TQM implementation in organizations and for OSH performance improvement.

Nurses' perspectives on the barriers to and facilitators of the implementation of secondary prevention for people with coronary heart disease: a qualitative descriptive study

OBJECTIVES

To identify the barriers to and facilitators of secondary prevention among people with coronary heart disease from the perspectives of nurses.

DESIGN

A qualitative descriptive design using face-to-face semistructured interviews.

SETTING

This study was conducted in China from October to November 2021.

PARTICIPANTS

Registered nurses who had experience conducting secondary prevention for coronary heart disease were purposively recruited. Twelve nurses from 10 hospitals participated in this study. The data were analysed using content analysis based on the Theoretical Domains Framework.

RESULTS

Based on the Theoretical Domains Framework, barriers to and facilitators of secondary prevention were identified within four key themes: nurse attributes (eg, knowledge and skills, motivation), patient characteristics (eg, age, education and economic conditions), the environmental context and resources (eg, organisational support, including financial support, clarity of responsibilities) and social influence (eg, economic development level, patient feedback).

CONCLUSIONS

This research highlights the importance of nurses' motivation for delivering preventive care. Organisations should provide adequate support and establish a quality management system to maintain the quality of secondary prevention.

Factor Analysis of Quality Management Systems Implementation in Healthcare: An Online Survey

This paper investigates the views of healthcare researchers and professionals on the implementation of the Quality Management System (QMS) approach using a 5-point Likert scale survey. Researchers and healthcare professionals who observed or participated in QMS implementation were surveyed. Multiple channels, including occupational societies, social networking, i.e., LinkedIn, hospital’s directories, award recipients, academic researchers, and professional connections, made it possible to reach this particular sample. Participants were surveyed using a series of questions with a total of 56 questions. The survey was administrated through the web portal of Qualtrics and then analyzed both on Qualtrics and SPSS software packages. Descriptive Statistics, Exploratory Factor Analysis (EFA), and Linear Regression were employed to draw conclusions. The final sample group consisted of 71 participants representing a range of healthcare settings. EFA was conducted, producing a model of 10 emergent factors and an outcome for total improvement. Regression modeling revealed the Critical Success Factors (CSFs) and the interaction between emergent factors. The results indicated that QMS Implementation Culture, Structure, and Managerial Training are critical to the QMS implementation success. This research helps quality professionals enhance their ability to prioritize elements affecting the successful implementation of the QMS.

Assessing quality of older persons' emergency transitions between long-term and acute care settings: a proof-of-concept study

Background

Long-term care (LTC) residents frequently experience transitions in the location of more advanced care delivery, including receiving emergency department (ED) care. In this proof-of-concept study, we aimed to determine if we could identify measures in quality of care across transitions from LTC to the ED, via emergency medical services and back, by applying Institute of Medicine (IOM) Quality of Care Domains to an existing dataset.

Methods

In the Older Persons’ Transitions in Care (OPTIC) study, we collected information on residents’ transitions in two Western Canadian cities. We applied the IOM’s Quality of Care Domains to the OPTIC data to create binary measures of transition quality. We report the median (MED) per cent and IQR of measures met within each domain of quality.

Results

We tracked 637 transitions over a 12-month period, with data collected from each setting. We developed 19 safety measures, 20 measures of resident-centred care, 3 measures of timely care and 5 measures of effective care. We were unable to develop measures for equitable care at an individual transfer level. Domain scores varied across individual transitions, with the highest scores in safety (MED 79%, IQR: 63–95), efficiency (66%; IQR: 66–99), and resident-centred (45%; IQR: 25–65), followed by effectiveness (36%; IQR: 16–56), and timeliness (0%; IQR: 0–50).

Conclusions

Our results show variation in scores across the domains of quality suggesting that it is possible to track quality of transitions for individuals across all settings, and not only within settings. We recommend that future work in tracking quality of care be performed at several levels (LTC, region, health authority, province). Such tracking is necessary to evaluate and improve overall quality of care.

Leaders' attitudes towards, and commitment to quality management of training within the military

Purpose

The successful implementation of quality management in organizations is dependent on people, particularly leaders. It seems as if leaders' affective states (attitudes and commitment) in the military were connected to their capability to inspire people and a group (corps training unit) to achieve a common goal. The research reported in this article was aimed at examining officers in corps training units' attitudes towards, and commitment to quality management in training in the South African Army.

Design/methodology/approach

Focus group interviews were conducted with a sample of 49 officers on various levels (senior, junior and warrant officers) at six South African Army corps training units.

Findings

The findings indicate that the attitudes of leaders played a significant role to ensure that quality management of training is conducted effectively. Participants experienced that leaders in the South African Army were mostly responsible for the negative attitudes of officers in corps training units. Inadequate leadership support and lack of trust contributed to a lack of transparency and poor communication that resulted in poor commitment among officers at corps training units. The investigation further revealed that a positive affective state (attitudes and commitment) of leaders is essential in ensuring effective quality management of training.

Originality/value

The potential usefulness of this research may provide insight into how leaders' affective state could be improved to ensure effective quality management. This research may also be of interest to other organizations that conduct in-house training.

Impact of perceived importance of cultural readiness factors on perceived importance of Lean Six Sigma success factors for manufacturers

Purpose

This study aims at investigating the impact of the perceived importance of critical cultural readiness factors (CRFs) is on perceived importance of Lean Six Sigma (LSS) technical critical success factors (CSFs) in UK manufacturing sector.

Design/methodology/approach

A survey questionnaire through a multiple embedded case study was conducted. The study involves surveying people in the manufacturing firms followed by non-parametric Kruskal–Wallis test to study the relationships.

Findings

It was found that the people's perception towards impact of CRFs on technical CSFs of LSS projects is different depending upon each CRF, demographic factors and technical CSFs. This means that particular CRFs need to be prioritised to address LSS technical CSFs.

Research limitations/implications

The study fills the research gap in investigating the perception of people towards inter-relationship of cultural or soft CSFs of LSS and technical or hard CSFs of LSS in manufacturing firms. Nevertheless, the authors suggest further multi-case study analysis covering different manufacturing fields as future studies.

Practical implications

The study is crucial for managers financially to be ready to invest on a successful LSS project and it helps them to diagnose the cultural causes of failure in a more timely way and effectively.

Originality/value

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors and perceived importance of implementing success factors as a missing jigsaw in the current literature.

Direct and indirect impact of quality management on the integrated performance of medium-scale manufacturers

Purpose

Most studies on small and medium scale enterprises lump both small-scale and medium-scale businesses together as entirely similar phenomenon, thus creating an oversight of the degree of performance recorded by medium-scale businesses. In line with investigating medium-scale firms' performance, this study examines the role of quality management in the performance of medium-scale firms to evolve research-based recommendation for better performance.

Design/methodology/approach

Cross-sectional survey design and random sampling were employed. Analysis was based on 915 responses obtained via questionnaire copy distribution from employees within the supply chain, production, operations, and marketing/sales department of selected firms. Hypotheses testing was done using the structural equation model.

Findings

A positive significant relationship between quality management and operational performance, employee performance, and quality performance dimensions was identified. An insignificant relationship between quality management and financial and innovation performance dimensions was discovered. However, when mediated by employee focus and process management, significant relationships were observed among all performance dimensions.

Research limitations/implications

The study reveals that employee focus and process management have the greatest mediating impact on the relationship between quality management and the organisational performance of medium-scale manufacturing firms. This study charts the course for other studies to investigate the mediating role of quality management practices on the relationship between quality management and the organisational performance of medium-scale firms in other developing nations. The manufacturing sector has thirteen industries, but only six were captured in this study. This poses a limitation to the generalisation of the findings of this study. Further studies could strive for a representation of every manufacturing industry to aid generalisation purposes.

Practical implications

Managers of medium-scale manufacturing firms must understand that it might be impossible to get a one size fits all approach to improving performance dimensions. Managers are advised to choose one or two performance dimensions as the goal, then focus on achieving them. This will help clarify which path is best to get the desired results and maximise their quality management system.

Originality/value

This study examines the impact of quality management practices on an integrated performance model of medium-scale firms. The study also uniquely examines the mediating impact of exclusive quality management practices on the relationship between quality management and an integrated performance model.

Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review

The COVID-19 pandemic has strongly affected the dynamics of Emergency Departments (EDs) worldwide and has accentuated the need for tackling different operational inefficiencies that decrease the quality of care provided to infected patients. The EDs continue to struggle against this outbreak by implementing strategies maximizing their performance within an uncertain healthcare environment. The efforts, however, have remained insufficient in view of the growing number of admissions and increased severity of the coronavirus disease. Therefore, the primary aim of this paper is to review the literature on process improvement interventions focused on increasing the ED response to the current COVID-19 outbreak to delineate future research lines based on the gaps detected in the practical scenario. Therefore, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform a review containing the research papers published between December 2019 and April 2021 using ISI Web of Science, Scopus, PubMed, IEEE, Google Scholar, and Science Direct databases. The articles were further classified taking into account the research domain, primary aim, journal, and publication year. A total of 65 papers disseminated in 51 journals were concluded to satisfy the inclusion criteria. Our review found that most applications have been directed towards predicting the health outcomes in COVID-19 patients through machine learning and data analytics techniques. In the overarching pandemic, healthcare decision makers are strongly recommended to integrate artificial intelligence techniques with approaches from the operations research (OR) and quality management domains to upgrade the ED performance under social-economic restrictions.

Examining the integration of continuous improvement and strategic planning in select pharmaceutical companies in India: a case study

Purpose

The objective of the study is to examine the extent to which pharmaceutical companies in India rely on traditional planning approaches rather than the new learning approach to strategic planning. In addition to that, the study also seeks to examine the perceived ability of the pharmaceutical companies in India to integrate continuous improvement goals and product quality into the overall strategic planning and success in implementing total quality management (TQM) programs examined through three particular continuous improvement mindsets.

Design/methodology/approach

The study collected data from select pharmaceutical companies in India through survey technique using a standardized questionnaire through online mode. A descriptive statistical analysis is performed to examine the extent of integration of strategic planning and continuous improvement in the select pharmaceutical companies in India.

Findings

The results of the study indicate that pharmaceutical companies in India still rely greatly on traditional planning methods for strategic planning. However, a shift is also observed toward adoption of best practice management and modern strategic management techniques. The study also demonstrates that continuous improvement goals and strategies are included into the corporate strategic planning.

Research limitations/implications

The study employs only descriptive statistics, and no hypotheses are generated in the study because the objective is not to generalize the findings. The process of formulating quality goals and integrating them with strategy is typical to any company. Therefore, the findings cannot be generalized. The findings of the study do not given any insights into the strategic quality management process due to online mode of data collection. Also, the focus on the study is on the internal management of quality in an organization and factors in the external environment or in the value chain outside the firm, influencing strategic management of quality are beyond the scope of present study.

Practical implications

Considering the significance of quality of products, an understanding of the link between quality and strategic goals helps the managers in pharmaceutical industry to align the strategic planning goals with quality goals ensuring that the entire organization moves in same strategic direction.

Originality/value

The strong focus quality in pharmaceutical industry in India has given impetus to development of well-managed quality programs on the shop-floor to remain competitive and survive in the highly competitive global markets. However, no such study is conducted so far to understand the extent to which continuous improvement or TQM practices are integrated into strategic planning in the pharmaceutical companies in India.

Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital

Surgical intervention within 48 h of hospital admission is the gold standard procedure for the management of elderly patients with femur fractures, since the increase in preoperative waiting time is correlated with the onset of complications and longer overall length of stay (LOS) in the hospital. However, national evidence demonstrates that there is still the need to provide timely intervention for this type of patient, especially in some regions of central southern Italy. Here we discuss the introduction of a diagnostic–therapeutic assistance pathway (DTAP) to reduce the preoperative LOS for patients undergoing femur fracture surgery in a university hospital. A Lean Six Sigma methodology, based on the DMAIC cycle (Define, Measure, Analyze, Improve, Control), is implemented to evaluate the effectiveness of the DTAP. Data were retrospectively collected and analyzed from two groups of patients before and after the implementation of DTAP over a period of 10 years. The statistics of the process measured before the DTAP showed an average preoperative LOS of 5.6 days (standard deviation of 3.2), thus confirming the need for corrective actions to reduce the LOS in compliance with the national guidelines. The influence of demographic and anamnestic variables on the LOS was evaluated, and the impact of the DTAP was measured and discussed, demonstrating the effectiveness of the improvement actions implemented over the years and leading to a significant reduction in the preoperative LOS, which decreased to an average of 3.5 days (standard deviation of 3.60). The obtained reduction of 39% in the average LOS proved to be in good agreement with previously developed DTAPs for femur fracture available in the literature.

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.

Investigating the view of quality management success factors amongst future early career operations leaders

Purpose

The study aims to investigate the gap between the current vision and knowledge of future early career operations leaders (OL) and common strategic total quality management (TQM) frameworks such as Malcolm Baldrige National Quality Awards and competing value framework.

Design/methodology/approach

A survey questionnaire was developed for different groups of participants as current higher education students to identify the gap and analyse the significance of these groups on the factors in TQM framework. The Kruskal–Wallis test as the non-parametric quantitative analysis technique was adopted for this study.

Findings

A new set of TQM factors with necessity of more knowledge and understanding of future generation was identified, followed by highlighting clear differences amongst different groups of this generation in terms of their demographic measures, perceived leadership style and organisational culture.

Research limitations/implications

This research study contributed significantly to the existing study about common QM models and their integration with theories relevant to organisational culture and leadership. The data collection can be extended further in the higher education sector or beyond that.

Practical implications

A sustainable operations leadership practice needs managers and leaders with a sustainable knowledge development of quality management; and as a result of this study, the current vision of future young OL would not echo this.

Originality/value

This study has a systematic, non-parametric approach towards currently fragmented QM analysis, and is integrated with human resource and visionary elements of future young OL and universal QM models and theories.

Implications of TQM in firm’s innovation capability

Purpose

Over the last few decades, some researchers have analysed the role of total quality management (TQM) as a precursor of innovation. However, the relationship between TQM and organisational innovation remains unclear and contradictory. The purpose of this paper is to provide a framework intended to clarify the complex effect that the implementation of a TQM system has on organisational innovation, where market orientation (MO) and knowledge management (KM) play a mediator role.

Design/methodology/approach

Data in this study come from a survey of 706 Spanish CEOs. The results were analysed employing structural equation modelling to determine how TQM, MO and KM influence innovation.

Findings

The results of the empirical study show that there is a curvilinear effect between TQM and organisational innovation. Both MO and KM perspectives play a mediator role between TQM and innovation.

Practical implications

Managers should be aware that management based on TQM help organisations not only to get higher quality but also to be market oriented and better manage their knowledge; what will help them to develop innovations.

Originality/value

This research sheds light on the question of the relationship between TQM and organisational innovation that has received mixed conclusions in the literature. There is evidence in this research that the relationship between TQM and innovation responds to a curvilinear relationship, where high levels of TQM favour a more than proportionate effect on the development of innovation. It also clarifies the mechanisms by which this effect is produced, with MO and KM as mediator variables.

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.

Can Leadership Enhance Patient Satisfaction? Assessing the Role of Administrative and Medical Quality

This paper aimed to investigate the relationships between participative leadership (PL), administrative quality (AQ), medical quality (MQ), and patient satisfaction (PS) using the Malcolm Baldrige National Quality Award Healthcare Criteria (MBNQA) criteria. The study further examined the intervening influence of administrative quality and medical quality on the relationship between participative leadership and patient satisfaction. The data was obtained from 123 public sector hospitals in Pakistan. We employed confirmatory factor analysis (CFA) and structural equation modeling (SEM) techniques to test the structural model. From the study results, we found significant and positive relationships between participative, administrative quality, medical quality, and patient satisfaction. In addition, our research found administrative quality and medical quality as potential mediators on PL-PS relation. Adopting participative leadership as an exogenous factor, and both administrative and medical quality as potential mediators of patient satisfaction, provided new insights into MBNQA criteria.

Quality management vision of future early career operations managers

Purpose

The purpose of this paper is to investigate the gap between the current vision and knowledge of future early career operations managers (OM) and a common strategic total quality management (TQM) framework.

Design/methodology/approach

A survey questionnaire and a non-parametric test for different groups of participants were adopted to identify the gap and analyse the significance of these groups on the factors in the TQM framework.

Findings

A new set of TQM factors with the necessity of more knowledge and understanding of future generation were identified, followed by the identification of clear differences amongst different groups of this generation.

Practical implications

A sustainable OM practice needs managers and leaders with a sustainable knowledge development of quality management (QM); and as the result of this study, the current vision of future young OM would not echo this.

Originality/value

This study has a systematic, non-parametric approach towards currently fragmented QM analysis, and is integrated with human resource and visionary elements of future young OM and universal QM models and theories.

Enabling continuous learning and quality improvement in health care

Purpose The purpose of this paper is to examine how the design and implementation of learning models for performance management can foster continuous learning and quality improvement within a publicly funded, multi-site community hospital organization. Design/methodology/approach Niagara Health's patient flow performance management system, a learning model, was studied over a 20-month period. A descriptive case study design guided the analysis of qualitative observational data and its synthesis with organizational learning theory literature. Emerging from this analysis were four propositions to inform the implementation of learning models and future research. Findings This performance management system was observed to enable: ongoing performance-related knowledge exchange by creating opportunities for routine social interaction; collective recognition and understanding of practice and performance patterns; relationship building, learning for improvement, and "higher order" learning through dialogue facilitated using humble inquiry; and, alignment of quality improvement efforts to organizational strategic objectives through a multi-level feedback/feed-forward communication structure. Research limitations/implications The single organization and descriptive study design may limit the generalizability of the findings and introduce confirmation bias. Future research should more comprehensively evaluate the impact of learning models on organizational learning processes and performance outcomes. Practical implications This study offers novel insight which may inform the design and implementation of learning models for performance management within and beyond the study site. Originality/value Few studies have examined the mechanics of performance management systems in relation to organizational learning theory and research. Broader adoption of learning models may be key to the development of continuously learning and improving health systems.

Waiting too long: bottlenecks and improvements – a case study of a surgery department

Purpose

The purpose of this paper is to promote a business process approach for developing and improving the efficiency of hospital service quality in order to reduce clinical risks and increase patients satisfaction. The problems healthcare facilities face are how to reduce waste and risk and improve quality. The adoption of a process-focused organization could reduce organizational errors which have a negative influence on performance.

Design/methodology/approach

The research is based on a case study methodology, analyzing a specific real-life case. It is shown a practical example in the surgery department of an Italian hospital, identifying, analyzing and managing critical situations, in terms of improvement. To this end, national and international contributions, public documents, institutional websites, conference papers, books, workshops and hospital websites have been analyzed. Moreover, other data were collected through questionnaires.

Findings

Results show how a comprehensive view of the processes may lead to improvement in operations by identifying different risks and bottlenecks, suggesting the rapid implementation of corrective policies and improvements, in terms of overall efficiency.

Practical implications

By implementing innovative organizational processes to identify and reduce bottleneck a healthcare system could achieve a competitive advantage.

Originality/value

Within the Italian healthcare system, limited attention has been paid to the design of healthcare facilities. Flexible solutions are necessary for lean management. The originality of this work lies in the analysis applied to a complex organization, through which hidden critical situations have been identified, and solutions to improve and provide better healthcare management have been suggested.

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.

Improving service quality in healthcare organisations through geomarketing statistical tools

Purpose

The purpose of this paper is to demonstrate how geomarketing statical tools (notably, gravitational models) can support healthcare organisations to improve the quality of their services.

Design/methodology/approach

Geomarketing tools were applied to the analysis of data (91,478 observations) concerning the performance of nuclear magnetic resonance.

Findings

Geomarketing models can support and enhance the planning of service provisions of healthcare organisations. Drawing the planning actions on the patient needs and actual behaviours allow the healthcare organisations to obtain better market performance.

Practical implications

The results support the health service planning activities related to covering the so-called “offer gaps”.

Originality/value

This is the first study to apply geomarketing to improve the quality of healthcare services.