The Implementation of TQM in the Qatari Healthcare Sector TQM ...

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The Implementation of TQM in the The Implementation of TQM in the Qatari Healthcare SectorQatari Healthcare Sector

Banan Mukhalalati, BSc (Pharmacy), MBAAssistant Dean,

Faculty and student Affairs,College of Pharmacy,

Qatar University

In partial fulfillment for MBA Degree

TQM Background

• The main objective of TQM is to "Do the right things, right the first time, every time".

• TQM is now becoming recognized and applicable in service organizations.

• The progress of the service management literature is much more strict as they utilize academic pathways that broaden the understanding of the TQM.

• Expectations of healthcare services are growing and those delivering care no longer control determination of what is excellent care, To be "good enough", healthcare should meet values anticipated by customers and skilled professionals. -Grol, 2002

• There were no efforts to decrease the dissimilarity in patient care, such as critical pathways. A solution will take place when people who practice the process suggest modifications. This includes the doctors, nurses and other professional. - Huq ,1996

BM, Faculty Research Seminar, CoP, QU 10/11/2009

TQM Definition

TQM as an approach: TQM is a way of managing to improve the effectiveness, flexibility, competitive advantage of a business and remove waste. The techniques of TQM can be applied throughout a company by that employees from different departments, with different priorities and abilities, communicate with and help each other.


TQM DefinitionIn definitions of TQM, two substantial aspects can be identified: the “hard” side and the “soft” side. The “hard” (or technical) side refers to management tools and practices, while the “soft” (or “philosophical”) is associated with management concepts and principles. The “hard” aspects of TQM consist of clear and well-documented methods while the “soft” aspects compose its whole theory, combining its background and philosophical elements.

Vouzas and Psychogios ,2007


STEPS OF TQM IMPLEMENTATION

• A certain level of stress is desirable to initiate TQM; people need to feel a need for a change.

• A crisis, if it is not too disabling, can also help create a sense of urgency which can mobilize people to act; In the case of TQM, this may be a threat, or demands from consumers or other stakeholders for improved quality of service..

• After the crisis, a leader may make a strategic decision by articulating a new vision of the future, a plan to implement TQM may be such a strategic decision.

• Finally, mechanisms or structures are needed to enable the change to occur and become institutionalized (Hashmi, 2007).

Hashmi, K. (2007), Introduction and implementation of TQM, http://www.isixsigma.com/library/content/c031008a.asp


RELATED RESEARCH

• Huq (2005) argued that a TQM system requires a new administrative point of view in which the company is viewed as an open system where management roles are highlighted, strategic leadership is supported, and focus on external and internal customers is commanded.

• Joyce et al. (2006) proposed that to maintain a “quality” healthcare provider, it is necessary to engineer the quality as early as possible – successfully at the specification and creation of the electronic businesses proposal stage.

• Sommer and Merritt (1994), in a pre-post-test study at a large rehabilitation hospital, showed major progress in work attitudes (job happiness, organizational loyalty, teamwork atmosphere, competitiveness) for TQM after the first year of involvement.

• Vretveit (2001) found that some countries are conducting programs that consist of quality strategies, quality accreditation, evaluation and appraisal procedures. However, Little research is available to show the evidence about their efficacy.


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Culture Change – Qatari Culture

• The failure to address the culture of an organization is the reason for many initiatives to have limited success or to fail. Understanding the culture and using this to map the steps needed to accomplish a change is an important part of the TQM journey.

• The culture in any organization is formed by the beliefs, behaviors, norms, values, and the “climate.” A culture change, from one accepting defects to one of doing the right thing first time, every time, needs two key elements: commitment from the leaders and involvement of all the members.

• Al-khalifa and Aspinwall (2001) concluded that Qatari companies would find difficulties in implementing TQM because they are dominated by a hierarchical culture. Most Organizations have a mix of two cultural type, which does not match the cultural profile of TQM. This assessment highlights where changes are needed to support a total quality approach.


The Concept of Continuous Improvement by TQM

• Continuous improvement must deal not only with improving outcomes, but more significantly with improving capabilities to produce better results.

• A fundamental principle of TQM is that mistakes may be made by people, but most of them are caused, or at least permitted, by faulty systems and processes. This means that the root cause of such mistakes can be identified, eliminated, and prevented by changing the process. (Hashmi, 2007),


RESEARCH PROBLEM AND OBJECTIVES

The review of literatures revealed that no previous study has investigated the impact of TQM implementation on the performance of healthcare organizations in the Arab countries e.g. Qatar, considering different views of private and public hospitals and different managerial levels.

This research aims to examine the implementation of TQM in the healthcare sector in Qatar in attempts to:

• Present an overview of the TQM initiatives in the Qatari healthcare sector.• Identify the level of understanding and knowledge about TQM in the Qatari healthcare sector. • Identify the critical success factors of TQM implementation in the Qatari healthcare sector.


CONTRIBUTION TO CURRENT KNOWLEDGE

• A pioneer contribution of this study is comparing between managerial levels and between the private and the public sectors. Furthermore, the result of this study are related to result of previous studies to evaluate their consistency and interactive support.

• This study provides important ideas to academicians and practitioners about the critical success factors of TQM implementation such as providing relevant training for senior management/staff and involving suppliers in improvement activities.

• This study covers the key aspects that embody the state-of-the-art TQM implementation in the Qatari health care sector, i.e. initiative efforts, the level of understanding, and the critical success factors


RESEARCH METHODOLOGY

Survey instrument:Self administered questioners; information about the respondent, information about the hospital, TQM initiatives, assessment of the level of understanding of TQM, the critical success factors of TQM, Likert scale.

The Sample:200 managers within the private and public hospitals

The response rate:42.00%(84/200); satisfactory for subsequent analysis. (64%)respondents from the public hospitals and (36%)from the private hospitals.


RESEARCH METHODOLOGYReliability and validity testing of the instrument:Utilizing the Cronbach's alpha test, all values indicate that the study's instruments are reliable. The questionnaire was pre-tested to ensure that the wording appropriateness and it was validated by six managers.

To ensure that responses were representing the larger population, a non-response bias test was used to compare the early and late respondents. 2 tests showed no significant difference at the 5% significance level, so a non-response bias is not a concern.


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DEMOGRAPHICS OF THE RESPONDENTS TO THE SURVEY






NUMBER NUMBER OF EMPLOYEES WORKING OF EMPLOYEES WORKING UNDER THE RESPONDENTUNDER THE RESPONDENT


YEARS YEARS OF ESTABLISHMENT OF THE OF ESTABLISHMENT OF THE RESPONDENT’S DEPARTMENTRESPONDENT’S DEPARTMENT


TQM INITIATIVES• A. Setting up a quality department• B. Applying statistical process control • C. Development of a quality system• D. Employee involvement to improve quality• E. Establishing measures of quality progress• F. Developing strategies for total quality• G. Business process improvement• H. Supplier involvement program• I. Customer satisfaction initiatives• J. Cultural change program


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• A. TQM is a philosophy and practice to ensure effective and efficient use of all resources

• B. TQM aims to make customers the focus of a business

• C. Teamwork and participation are important for achieving a continuous improvement culture

• D. TQM helps ensure problems are prevented through effective management decisions•• E. Customers drive the improvement efforts in all affected business processes

• F. Business performance management must be given the same priority as financial measures)

• G. Training and education are vital elements when adopting TQM

• H. Quality systems standards such as ISO 9000 will not on their own ensure high-quality

• I. Statistical techniques are important to ensure consistency of products and process quality

• J. Quality improvement can only be conducted when proper policies are in place

• K. Supplier involvement is vital in supporting quality improvement

• L. Management leadership, commitment and support determine the success of new change•• M. An improvement work environment is created through management-worker partnership

• N. Initiatives such as Kaizan, suggestion schemes, quality circles, etc. will motivate employees

TQM KNOWELEDGE AND UNDERSTANDING LEVEL


TQM CRITICAL SUCCESS FACTORS• A. It is necessary to engineer in quality as early as possible – preferably at the foundation of

businesses plan stage.

• B. Organizational structure adjustment supports the success of TQM.

• C. Leadership and support from top management.

• D. Conducting continuous improvement.

• E. Selective application of tools and techniques.

• F. Involving suppliers in improvement activities.

• G. Adopting a quality assurance system and or accreditation.• H Sufficient financial resources• I Providing relevant training for senior management/staff level.

• J. Providing effective and appropriate training for employees.

• K. Favorable work environment and culture.


Main Findings TQM initiatives• The development of a quality system is the most adopted initiative effort

in all the hospitals. This finding is consistent with the study of Growl, Baker and Moss (2002), who concluded that expectations of healthcare services are growing. To be considered "good enough," care should meet values anticipated by customers and skilled professionals; this agreement in values is facilitated by establishing a quality system.

• The least adopted TQM initiative is the application of statistical process control, and that can be explained by lack of knowledge of respondents about the exact control methods used by the Quality Improvement departments or because some hospitals lack the financial resources and expertise to implement those statistical process control methods.

Grol, R. Baker, B. and Moss, F., (2002) ‘’ Quality improvement research: understanding the science of change in health care‘’, Qual Saf Health Care, Vol. 11, pp.110-111

Kohli, R., Kerns, B. and Forgionne, G.A. (1995) ‘’ The application of TQM in a hospital’s casualty and pathology departments‘’, International Journal of Quality & Reliability Management, Vol. 12, No. 9, pp. 57-75.


Main FindingsTQM Understanding and Knowledge

• Training, education , teamwork and participation are important for achieving a continuous improvement culture and are vital elements when adopting TQM. This finding is supported by Fung’s (1998) article that showed that the learning team approach assists to accomplish an educational organization and attain TQM.

• There is some uncertainty as to the level of understanding of whether suppliers’ involvement in supporting quality improvement has a vital role in implementing TQM system. This is inconsistent with Parish’s (1997) argument that the implementation of Service Level Agreements (SLAs): informal contracts arranged between supplier and users, offer a contribution to an organization’s success in TQM implementation

Fung, M. (1998) ‘’ A learning team approach for service organizations to achieve TQM and beat the competition‘’, Managing Service Quality, Vol. 8, No 5, pp. 367-374.

Sommer, S.M. and Merritt, D. (1994) ‘’ The Impact of a TQM Intervention on Workplace Attitudes in a Health-care Organization‘’ , Journal of Organizational Change Management, Vol. 7, No. 2, pp. 53-62.

Parish, R. (1997) ‘’ Service level agreements as a contributor to TQM goals‘’, Logistics Information Management, Vol. 10, No.6, pp. 284-288.


Main FindingsCritical success factors of TQM implementation

• Providing appropriate training for employees, as well as leadership and support from top management are considered the most important success factors by most respondents. This finding is consistent with the findings of Rad (2005) concerning the key success factors for implementing TQM in the Isfahan state, Iran.

• Involving suppliers in improvement activities was shown to be the least important success factor, This finding is inconsistent with the finding of Rad(2005) concerning the key success factors for implementing TQM in Isfahan state, Iran that identified that focus on suppliers and partners is one of the key success factor.

Rad, A. ( 2005), ‘’ A survey of total quality management in Iran Barriers to successful implementation in health care organizations‘’ , Leadership in Health Services, Vol. 18, No. 3, pp. 12-34.

Ennis, K. and Harrington, D. (1999) ‘’ Factors to consider in the implementation of quality within Irish healthcare‘’, Managing Service Quality, Vol. 9, No. 5, pp. 320-326


COMPARISON BETWEEN DIFFERENT MANAGERIAL LEVELS

TQM INITIATIVE EFFORTS• The study reveals that there is a significant difference among

different level managers concerning the development of a quality system and customer satisfaction as initiative efforts.

• This suggests the need for better communication between all level managers in order to achieve a quality improvement environment and aTQM system that needs the full integration between each stakeholder of the organization. This suggestion is supported by Huq’s (2005) research that argued that changing to a TQM idea requires a new administration view, a change in the organization structure to eliminate the barriers, and an improved communication through information systems.


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COMPARISON BETWEEN DIFFERENT MANAGERIAL LEVEL VIEWS

THE LEVEL OF UNDERSTANDING AND KNOWLEDGE OF TQM

• Management and leadership commitment and support determine the success of change

• Hashmi’s (2007) study stressed that TQM is now a broad management tool, as applicable in service organizations. There are a number of evolutionary thread that are the basis for TQM, which include commitment by senior management as well as line management ownership

• Vouzas and Psychogios (2007) argued that in definitions of TQM, two aspects can be identified: the “hard” side and the “soft” side. The “hard” (or technical) side refers to management tools, techniques and practices, while the “soft” (or “philosophical”) is associated with management concepts and principles that are well-documented in forms that may be policies and guidelines.


COMPARISON BETWEEN DIFFERENT MANAGERIAL LEVEL VIEWS

Critical Success FactorsThis study indicates the agreement of different level managers for considering all the studied factors as critical success factors for TQM implementation. This shows that the management had provided an empowering environment and allowed all level managers to be knowledgeable and involved in TQM efforts.


Comparison Between the Public and Private Sector Views

• In terms of TQM initiatives, there is a difference between the private and public health sectors in applying statistical process control, developing strategies for total quality and focusing on business process improvement as initiatives for TQM implementation.

• Private and public hospitals have agreed on most of the surveyed factors to be critical for success, except organizational structure adjustment requirement, selective application of tools and techniques and providing effective and appropriate training for employees. Conversely, earlier studies highlighted the successful impact of organizational structure adjustment prior to implementing TQM, as well as appropriate training for employees, especially if the latter is accompanied by giving the trained employees the authority and accountability to apply what they learnt.


Managerial Implications• A significant implication of the current study is that the health

organizations in Qatar can use the TQM philosophy as a strategic competitive weapon rather than a temporary solution for the patient satisfaction problem.

• Another implication of this study is that it draws attention to enhancing the public hospitals’ understanding of the impact of the organizational structure adjustment, as well as the importance of satisfying all internal and external stakeholders upon the introduction of TQM strategy.

• Private health care organizations in Qatar should understand that there is a difference between ISO certification and TQM strategy, where the former is prerequisite for the last.


Managerial Implications• Managers as well as quality policy makers should pay more attention to

the vital role of suppliers in the TQM implementation and success stages.• Non-implementer of the TQM philosophy should learn from the

experience of TQM implementers; the expected challenges and pitfalls.• The results of the study are consistent with the literature in that training

and educational culture enhancement, as well as teamwork and participation from all workers, provides a new motivation for the workers to have a stronger feeling of ownership toward their organizations, and this is facilitated by implementing a TQM system.

• Finally, the research contends that TQM implementation may seem to be an easy task, but this is a very deceiving thought. The problem is not only how to implement the program, but how to make it work effectively and efficiently.


Recommendations for Future Research

• Comparative studies with other less-developed countries to observe the similarities and dissimilarities concerning TQM implementation.

• Real case studies are needed to study TQM implementation processes

• Empirical research should be conducted to evaluate the understanding and the critical success factors based on customers’ point of view.


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Recommendations for Future Research

• Further research is required to highlight the connection between suppliers and healthcare organizations, so that the suppliers’ vital role in TQM implementation can be made evident.

• Further studies need to be undertaken concerning the detailed impact of organizational culture and structure, top management support and employee training and involvement on TQM implementation.


LAST BUT NOT LEAST

Finally, we hope that this study will open new dimensions for other researchers in this field, contributing to the knowledge and enhancing the implementation of innovative tools and philosophies for the better development of reform efforts at the current booming stage of Qatar.


ACKNOWLEDGMENTS

• All praise be to Allah for making it possible for me to seek knowledge, to learn, and to present this humble effort of mine.

• I am thankful to my research supervisor, Dr. Salaheldin Ismail, for his guidance, detailed feedback, and for being ever available.

• I would like to extend my thanks to Qatar University, CBE under the leadership of the Dean Dr. Al- Nejdawy and all the faculty who taught me.

• I would like to thank HMC Managing Director, Dr. Hanan Al-Kawari, for facilitating my research and for providing me with guidance of my career.

• My utmost gratitude is to my parents whose upbringing, faith in me, and love have been my compass in aiming for higher academic degree.

• I am grateful to my children Muaz, Hanaa, and Lujayn whose smiles and excitement have made it easy for me in times of stress and difficulty.

• My heartfelt unconditional forever indebtedness is due to my husband, Mazen, whose encouragement and support have been key to my success.


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