Quality award dimensions: a strategic instrument for measuring health service quality

An investigation of mediating factors for export–import business performance excellence: a systems perspective framework for Thailand

Purpose

The Baldrige criteria for assessing business performance excellence (BCPE) suggests a relationship among seven self-assessment categories. The purpose of this paper is to take an in-depth look at the BCPE by testing the causal relationship among categories grouped into four basic dimensions – driver triad, work core, outcomes, and brain centre. Identifying meaningful interrelationships for leaders helps them transform their organisations to achieve performance excellence.

Design/methodology/approach

A systems perspective supports system mapping for understanding meaningful interrelationships among dimensions and mediating factors affecting business performance excellence. A 35-item questionnaire designed to measure seven categories of the BCPE (version 2022–2023) was administered to export and import (EXIM) businesses across Thailand. Valid responses (n = 290) were analysed through SPSS and AMOS via structural equation modelling (SEM) to test the hypotheses and explore the influencing factors.

Findings

A strong systems perspective focus is essential for high organisational performance. The result reveals that all seven BCPE categories are significantly linked. In addition, mediation analysis (taking selected mediators) proved hypothesised cause-and-effect relationship as significant. The results demonstrate that the brain centre plays a crucial role in driving business success promulgating its influence within the model.

Research limitations/implications

This study provides the necessary backgrounding in systems perspectives confirming that the BCPE premises on a set of four basic dimensions: driver triad (leadership, strategy, and customers category), work core (workforce and operations category), brain centre (measurement, analysis, and knowledge management category), and outcomes (results category). These four dimensions define the essentials of an integrated management system. Further, the study shows that measurement, analysis, and knowledge management directly influenced customer focus, the highest coefficient path among the criterion in the Baldrige framework. This is the critical driver in predicting performance outcomes via meaningful feedback.

Practical implications

From a managerial point of view, the structured system management framework proposed provides a specific guide for the alignment in quality management, which can change its practice in business management and award assessment. The results evidence a significant relationship among driver triad, work core, brain centre, and outcomes to propose a form of system management. The findings help award examiners or business practitioners provide system mapping for evaluation – i.e. how well organisations meet their goals and how best to prepare feedback reports to applicants that paint meaningful pictures.

Originality/value

This study promotes a systems perspective when approaching business performance excellence, whereas other studies provide evidence to individual relationships. Moreover, the examined interrelationship among dimensions – driver triad, work core, outcomes, and brain centre – provide novel system mapping to guide managers, practitioners, or award examiners in evaluating quality management practice.

The impact of quality framework application on patients’ satisfaction

Purpose

This study aims to explore if the application of the customer results criteria contained within the King Abdullah II Award for Excellence (KAIIAE) is correlated with high levels of patient satisfaction within a large hospital based in Jordan.

Design/methodology/approach

Using a mixed methodology, supported by a pragmatist theoretical approach, a satisfaction survey was conducted with patients accessing the hospital as an in-patient across a range of specialities gathering feedback about different aspects of their care. The results were compared with a self-assessment completed by different speciality teams about the existence and maturity of customer result arrangements implemented as a result of the (KAIIAE).

Findings

The findings confirmed that quality awards such as the KAIIAE can effectively be applied in a health-care setting and can help provide a framework for improving patient experience and satisfaction. A correlation was found with those specialties that self-assessed themselves more highly in terms of these arrangements and the overall levels of patient satisfaction with that specialty, suggesting that the products of working towards the KAIIAE such as establishing effective patient experience monitoring arrangements and improved learning from complaints, has a positive impact on patient satisfaction.

Originality/value

There are limited studies which focus specifically on customer results and on the use of the KAIIAE more generally. This study therefore makes a valuable contribution in adding to the debate about the strategic value of working towards formal quality improvement models and awards in health-care settings.

Lean Six Sigma for the healthcare sector: a multiple case study analysis from the Indian context

Purpose

The purpose of this paper is to explore the voice of the customer, key performance indicators, critical to quality characteristics, critical success factors, and commonly used tools and techniques for deploying the Lean Six Sigma (LSS) strategy in Indian private hospitals, with special attention to the medical records.

Design/methodology/approach

The study utilizes the action research methodology to obtain a greater understanding of the use of LSS in the Indian healthcare sector. Multiple case studies were designed and successfully deployed to understand and ascertain challenges in LSS implementation. Five case studies were carried out in the Medical Records Departments (MRD) of four private hospitals in India.

Findings

Patients perceive that waiting in queue harms their health, which can be rectified by addressing the cycle time of the system. The research also found that effective leadership, availability of data, involvement of cross-functional team and effective communication are critical to the success of LSS projects. In addition, control charts, cause and effect diagram, 5S, gemba, two-sample t-test, standardization, waste analysis and value stream mapping are some of the common tools used to improve healthcare systems.

Research limitations/implications

The research was restricted to studying the impact of LSS on the workflow and resource consumption of the MRD in Indian allopathic hospitals only. The validity of the results can be improved by including more hospitals and more case studies from the healthcare sector in different countries.

Originality/value

The findings will enable researchers, academicians and practitioners to incorporate the results of the study in LSS implementation within the healthcare system to increase the likelihood of successful deployment. This will provide greater stimulus across other departments in the hospital sector for wider and broader application of LSS for creating and sustaining process improvements.

Analyzing perceived healthcare service quality on patient related outcomes

Purpose

Through the lens of a total quality management approach, this paper aims to examine the effects of health-care service quality on patient satisfaction, repatronage intention (RI) and positive word-of mouth (PWOM) at a public hospital specialized in women and children’s diseases. The contribution is to measure and compare patient expectations and perceptions related to the public health service quality.

Design/methodology/approach

A structured questionnaire was distributed to in-patients who stayed at a public training and research hospital for at least three days. To analyze the relationship between variables, multiple regression analysis was used. To test the difference between expected and perceived service quality, the paired-sample t-test was used.

Findings

The findings provided empirical evidence that perceived service quality significantly influenced patient satisfaction, RI and PWOM. The “responsiveness and reliability” factor was found to be the most influential on patient RI and PWOM. The “tangibility” dimension had the strongest influence on patient satisfaction.

Practical implications

The results reveal that a reliable and responsive service, empathic personnel behaviors and appropriate tangibles are the outstanding factors for high levels of patient satisfaction, RI and PWOM.

Originality/value

Although the concepts of perceived service quality, patient satisfaction, RI and PWOM are explored frequently in service literature, there are few researches that focus on specialized health services for women and children’s diseases. By evaluating the service quality, it is hoped to provide an insight to health-care managers about the service quality dimensions and their relationship with patient satisfaction, RI and PWOM, specifically based on women patients.

A multicriteria model on calculating the Sustainable Business Excellence Index of a firm with fuzzy AHP and TOPSIS

Purpose

– The purpose of this paper is to provide an integrated methodology for benchmarking the sustainability of organizations. The fuzzy analytical hierarchy process (FAHP) and technique for order of preference by similarity to ideal solution (TOPSIS) methods have been used for this purpose. The FAHP is used to determine the weights of the criteria by decision makers, and the rankings of the alternatives are determined by TOPSIS. The proposed instrument is used to calculate the Sustainable Business Excellence Index (SBEI) and its potential impact on the formulation of firm strategy. To demonstrate the applicability of the model, illustrative examples are presented.

Design/methodology/approach

– After a careful literature review, a sustainable business excellence framework is created and a fuzzy system is developed to assess firms’ sustainability. Finally, the SBEI is computed.

Findings

– The results indicate that the suggested fuzzy approach is feasible for benchmarking the sustainability of organizations. It allows the decision makers to express their opinion regarding the importance of criteria and evaluate each alternative and then have this input coordinated in a quantitative fashion.

Research limitations/implications

– Practitioners and consultants can use the instrument for conducting quality management benchmarking within and across organizations. Researchers can use the instrument in future studies for further theory development in this area.

Originality/value

– As far as the authors are aware, no previous study research has assessed the SBEI of an organization with fuzzy sets. As such, it responds to a number of contemporary challenges in the business excellence theory, most importantly the broad need to identify agile organizations.

Productivity and performance improvement in the medical records department of a hospital

Purpose

– The purpose of this paper is to illustrate how Lean Six Sigma (LSS) methodology was applied to a medical records department (MRD) of a hospital in India to reduce the Turn-Around-Time (TAT) of medical records preparation process and thus to improve the productivity and performance of the department.

Design/methodology/approach

– The research reported in this paper is based on a case study carried out using LSS approach and in improving the medical records preparation process.

Findings

– The root causes for the problem were identified and validated through data-based analysis from LSS tool box, at different stages in the project. As a result of this project, the TAT was reduced from average 19 minutes to eight minutes and the standard deviation was reduced by one-tenth, which was a remarkable achievement for department under study. This was resulted in the reduction in the work-in-process inventory of medical records from 40 units to 0 at the end of the day. Project in-turn reduced the staffing level from the earlier level of six to a current level of four.

Research limitations/implications

– The paper is based on a single case study executed in IP-MRD of a single hospital and hence there is limitation in generalizing the specific results from the study. But the approach adopted and the learning from this study can be generalized.

Originality/value

– This paper will be helpful for those professionals who are interested in implementing LSS to healthcare organization to improve the productivity and performance.

Essentials of total quality management: a meta-analysis

PURPOSE

The purpose of this paper is to identify critical successful factors for Total Quality Management (TQM) implementation.

DESIGN/METHODOLOGY/APPROACH

A literature review was conducted to explore the critical successful factors for TQM implementation between 1980 and 2010.

FINDINGS

A successful TQM implementation need sufficient education and training, supportive leadership, consistent support of top management, customer focus, employee involvement, process management and continuous improvement of processes.

RESEARCH LIMITATIONS/IMPLICATIONS

The review was limited to articles written in English language during the past 30 years.

PRACTICAL IMPLICATIONS

From a practical point of view, the findings of this paper provide managers with a practical understanding of the factors that are likely to facilitate TQM implementation in organisations.

ORIGINALITY/VALUE

Understanding the factors that are likely to promote TQM implementation would enable managers to develop more effective strategies that will enhance the chances of achieving business excellence.

Implementing quality initiatives in healthcare organizations: drivers and challenges

Purpose

– Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results.

Design/methodology/approach

– Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers.

Findings

– This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation.

Practical implications

– This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided.

Originality/value

– This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

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.

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.

A critical study of quality parameters in health care establishment: developing an integrated quality model

PURPOSE

The purpose of this article is to identify and critically analyze healthcare establishment (HCE) quality parameters described in the literature. It aims to propose an integrated quality model that includes technical quality and associated supportive quality parameters to achieve optimum patient satisfaction.

DESIGN/METHODOLOGY/APPROACH

The authors use an extensive in-depth healthcare quality literature review, discerning gaps via a critical analysis in relation to their overall impact on patient management, while identifying an integrated quality model acceptable to hospital staff.

FINDINGS

The article provides insights into contemporary HCE quality parameters by critically analyzing relevant literature. It also evolves and proposes an integrated HCE-quality model.

RESEARCH LIMITATIONS/IMPLICATIONS

Owing to HCE confidentiality, especially regarding patient data, information cannot be accessed.

PRACTICAL IMPLICATIONS

The integrated quality model parameters have practical utility for healthcare service managers. However, further studies may be required to refine and integrate newer parameters to ensure continuous quality improvement.

ORIGINALITY/VALUE

This article adds a new perspective to understanding quality parameters and suggests an integrated quality model that has practical value for maintaining HCE service quality to benefit many stakeholders.

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.

Management commitment to service quality and service recovery performance

Purpose

The purpose of this paper is to investigate a model of management commitment to service quality (MCSQ) and service recovery performance in the context of public and private hospitals in New Zealand.

Design/methodology/approach

In a cross‐sectional survey grounded in Bagozzi's reformulation of attitude theory, frontline hospital employees (FHEs) were asked about how MCSQ impacted on their service recovery performance in both the public and private sectors.

Findings

The results of the study suggest that the relationship between MCSQ and service recovery performance is mediated by organizational commitment. With the exception of the relationship between MCSQ and organizational commitment, there are no differences between FHEs in the private and public sectors.

Originality/value

Very little attention has been given to a comparative examination of those managerial practices critical for improving frontline employee service recovery efforts in a public and private healthcare context. Our research addresses this paucity.

Organisational value of healthcare quality awards in Andalusia

Purpose

The purpose of this paper is to develop and describe the symbolic value of quality awards as a key indicator of recognition that public organizations have reached in the scope of quality management and continuous improvement.

Design/methodology/approach

The paper provides a description of the evolution of the three series of healthcare quality awards that have been held to‐date in one of the biggest regions of Europe: Andalusia.

Findings

Theoretical analysis of an instrument conceived as an institutionalised way of recognizing quality assurance initiatives in the Andalusian Public Health System. At the same time, the article focuses on the importance of using a reference model to ensure that the process of assessing the projects is systematic and rigorous and therefore stands as a guarantee of transparency within a public administration.

Research limitations/implications

The ultimate outcome is dependent of the geographical context and the behaviours and perceptions of people that have participated as assessment panels.

Practical implications

The conceptual framework provides guidance on what methodology is used to assess the quality projects (process to allocate projects to assessment panels and assessment criteria required) in a complex healthcare system. It serves as a managerial framework to enhance the continuous improvement in all health‐related services.

Originality/value

The paper contributes to create a structured debate between researchers and healthcare leaders regarding the assessment criteria to evaluate healthcare quality projects.