Using the business excellence model to develop a strategy for a healthcare organisation

Empirical classification of European Foundation for Quality Management (EFQM) model enabler sub-criteria using a quadrant matrix

Purpose

The purpose of this paper is to examine how sub-criteria of the European Foundation for Quality Management (EFQM) model is structurally connected and influence each other. This paper also tries to find the underpinning logics in the EFQM model.

Design/methodology/approach

The study uses the empirical methodology based on assessment scores of 58 different organizations to gauge the underlying structure, develop the construct and establish interlinkages among the various sub-criteria in the EFQM model. Statistical analysis is used to find the impact on results and cross influencing of criteria at the sub-criteria level. The factorial analysis is carried out using the Doe technique to create factorial plots for result categories (customer results, people results, society results and business results). The approach is to unravel (1) the role played by each sub-criterion of the model, (2) the effects of sub-criteria on the results of the EFQM model and (3) the influence of sub-criteria on the managerial aspects of the model in an organizational context.

Findings

The EFQM sub-criteria are categorised as promoters, proponents, defenders or detractors based on their impact on the results and cross-influence on each other. The study unfolded seven sub-criteria positively impacting the results and one sub-criterion negatively impacting the results if not handled properly. Out of 32 sub-criteria, nine sub-criteria are influencing more than six other sub-criteria.

Originality/value

The paper investigates, for the first time: (1) the role played by each sub-criteria of the model; (2) the relationships that are produced between these sub-criteria on the EFQM results and (3) identify how such sub-criteria would influence the managerial aspects of the model in an organizational context. This research develops underlying logics in the EFQM model using Doe factorial methods for overcoming the multi-collinearity.

Towards a further step in understanding business excellence models: a comparative approach

Purpose

A comparative analysis of the validity of business excellence models (BEMs) has rarely been empirically pursued. In addition to their similarities, BEMs exhibit differences in terms of their criteria, relations and emphasis, and some researchers have claimed that it is because these models tend to represent underlying cultural, economic, or social dynamics, as well as global best practices. Based on three such BEMs (the Malcolm Baldrige National Quality Award (MBNQA) model, the European Foundation for Quality Management (EFQM) model and the King Abdul Aziz Quality Award (KAQA) model), this paper introduces a four-phase study to analyse these models comparatively.

Design/methodology/approach

This paper: (1) conceptually delineates the distinctive natures of and differences between the three models; (2) develops a comprehensive measurement model based on the content of these models; (3) reviews the relevant literature on BEMs; (4) discusses the motivation behind this comparative approach and (5) introduces a four-phase study to comparatively analyse these models.

Findings

A comprehensive measurement model and three structural models are developed, but empirical tests have not been performed. This developed approach is introduced here as a first step in the advancement of our understanding of BEMs and their underlying theory.

Originality/value

The range of variability and complexity of BEMs—i.e. a holistic and comparative empirical view of BEMs—have not so far been fully considered, and findings in this domain tend to be inclusive, while some of the underlying relations of these models have not been investigated. This paper contributes to filling these research gaps.

The EFQM Model as a framework for total quality management in healthcare

Purpose

– To guide organizations toward total quality management (TQM), various models have been developed such as the European Foundation for Quality Management Excellence Model (EFQM Model). The purpose of this paper is to conduct a longitudinal investigation of whether the EFQM Model can serve as a framework for TQM in healthcare.

Design/methodology/approach

– Data on a national representative survey about quality management (QM) in the hospital population in the Netherlands were used to conduct this study. The survey had five measurement points between 1995 and 2011.

Findings

– The results of the study show that applying the EFQM Model in hospitals is related to improvement in organizational performance over time, a feedback loop in which hospitals use their results to further improve their organizational processes is established, and improvement is stronger when all the model’s elements are considered simultaneously.

Practical implications

– The results of the study can be applied by quality managers of healthcare institutions to achieve higher quality of care.

Originality/value

– Previous research on the relationship between the EFQM excellence model and TQM neglects two essential characteristics of the TQM philosophy, namely, the holistic perspective on QM and the presumed feedback loop of organizational performance that feeds a cycle of continuous quality improvement. The study provides new insights into the long-term benefits of applying the EFQM Model as a framework for TQM in healthcare.

Designing conceptual model of after-sales services, in companies producing the capital goods, with the idea of value co-creation

Purpose

This study aims to identify the key activities after sales and the intended criteria by the customers, considering their expected services after the product purchase process.

Design/methodology/approach

This study is a qualitative approach, and the co-creation logic and the Delphi technique were used in two rounds to design and validate the proposed model. To achieve this study’s aims, extensive literature, interviews, interaction and exploratory meetings were reviewed with manufacturers and consumers, and then the dimensions of the proposed model were regulated, corrected and validated in the two-round Delphi technique. The final model is presented after establishing the model in the test pilots and getting feedback from industry experts. To present a conceptual model, the enabler’s logic and the underlying results in the European Foundation for Quality Management (EFQM) Excellence Model were used.

Findings

The findings of this study include the identification of dimensions for the after-sales services model and the designing of a conceptual model in both sections of enablers and results. The enabler section of the proposed model includes seven dimensions, three main sectors and four support sections.

Practical implications

This model can be used to design, deploy or improve after-sales services system in manufacturing companies.

Originality/value

For the first time in an innovative procedure, the approach of value co-creation was used to design one of the organizational systems (after-sale services system). On the other hand, the conceptual pattern was proposed inspired by the EFQM Excellence Model, to create the necessary proportionality between the enabler and results sections.

Deploying business excellence – success factors for high performance

Purpose

– The purpose of this paper is to improve the understanding of how organisations successfully deploy business excellence (BE) by comparing the tools and strategies implemented by organisations at different levels of BE maturity.

Design/methodology/approach

– The study used a combination of a questionnaire, discussion groups and interviews with respondents including private sector organisations across India, Japan, Republic of China, Singapore and Thailand. These countries were selected due to them being considered as having the most advanced BE organisations in Asia by the Asian Productivity Organisation (APO) that commissioned the study. Once triangulated, the quantitative data were analysed through use of the IBM SPSS Statistical software package.

Findings

– The study has shown that on average, organisations with higher BE maturity outperform their less mature counterparts. The study also revealed that organisations with a high BE maturity were more likely to use specific tools and were more likely to use some of these tools more effectively. Finally, the study identified differences in strategic approaches to BE between organisations with high and low BE maturity.

Research limitations/implications

– Only five Asian countries were considered due to resource limitations. However, the study of 74 organisations represents one of the most comprehensive to date with 30 of these organisations being award winners.

Practical implications

– The findings offer guidance to those organisations wishing to progress from a low level of BE maturity to a more advanced level. The findings have already assisted the APO and its 20 member countries in the development and implementation of strategic interventions at a regional and national level.

Originality/value

– No other study in Asia has been conducted on such a large sample of BE-orientated organisations. The study was also unique in its focus on the tools and strategies that should be used for successful BE deployment. In addition, the study is one of only a few in Asia that has studied the results of BE on organisational performance.

An in-depth review of the internal relationships of the EFQM model

Purpose

– The European Foundation for Quality Management (EFQM) model is widely used as a management tool in companies. Consequently, it is of great importance to understand the relationships within it, and inform managers about appropriate ways to manage events in order to get the desired results in general, and for specific interest groups (stakeholders). The paper aims to discuss these issues.

Design/methodology/approach

– This paper analyzes the internal relationships of the EFQM model using empirical data from a sample of 199 Spanish companies. Four managers in each company were interviewed, to eliminate single respondent bias. Structural equation modeling is used for the analysis.

Findings

– The results obtained from the empirical analysis provide evidence of an underlying logic in the EFQM model that does not match the official model. New significant relationships between the enablers and results not considered in the official model have been found.

Research limitations/implications

– The study focusses on Spanish industrial companies with 50-500 workers and uses a cross-sectional design.

Practical implications

– Managers should look at the EFQM model as a tool for finding their own way to excellence, but it is not a precise map, because the model may have some problems of definition. Managers should introduce its elements only after deep reflection on its benefit for their company.

Originality/value

– Despite the previous research on this issue, there is still no clear consensus. Relationships that are not reflected in the theoretical model have been identified.

An EFQM excellence model for integrated healthcare governance

Purpose

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

Design/methodology/approach

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

Findings

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

Practical implications

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

Originality/value

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

[Catalonia's primary healthcare accreditation model: a valid model]

There are few experiences of accreditation models validated by primary care teams (EAP). The aim of this study was to detail the process of design, development, and subsequent validation of the consensus EAP accreditation model of Catalonia. An Operating Committee of the Health Department of Catalonia revised models proposed by the European Foundation for Quality Management, the Joint Commission International and the Institut Català de la Salut and proposed 628 essential standards to the technical group (25 experts in primary care and quality of care), to establish consensus standards. The consensus document was piloted in 30 EAP for the purpose of validating the contents, testing standards and identifying evidence. Finally, we did a survey to assess acceptance and validation of the document. The Technical Group agreed on a total of 414 essential standards. The pilot selected a total of 379. Mean compliance with the standards of the final document in the 30 EAP was 70.4%. The standards results were the worst fulfilment percentage. The survey target that 83% of the EAP found it useful and 78% found the content of the accreditation manual suitable as a tool to assess the quality of the EAP, and identify opportunities for improvement. On the downside they highlighted its complexity and laboriousness. We have a model that fits the reality of the EAP, and covers all relevant issues for the functioning of an excellent EAP. The model developed in Catalonia is a model for easy understanding.

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.

When Implementation Fails: The Case of a Nursing Guideline for Fall Prevention

BACKGROUND

Implementing guidelines can be very difficult. No magic bullet or step-by-step implementation plan is available, neither is any single implementation strategy superior. At the Academic Medical Center (AMC) in Amsterdam, a nursing guideline was developed in 1993 on prevention of patient falls. Falls decreased by 30% on six wards, yet an effort to implement the guideline into daily practice throughout the hospital failed. A renewed effort was made to implement the guideline in two wards (neurology and internal medicine) in 1999. IMPLEMENTING THE GUIDELINE: Preparations were made for implementation in the two wards. Barriers to change were identified and solutions were translated into day-to-day activities in the wards. The intervention period covered 18 months (January 2000-June 2001). A mix of implementation strategies was used, including a local consensus process, educational activities, and active support and feedback to management and staff.

RESULTS

In the internal medicine ward, the target incidence of 6% was met for four of the 18 months in the intervention period. In the neurology ward, the incidence target of 11% was met in five months.

DISCUSSION

Barriers to change and enabling factors may only become apparent during the implementation process itself. A strongly perceived need to change daily practice, a simple guideline, the hospital board's support, an understanding of local barriers, monitoring of outcomes, a locally tailored multifaceted implementation strategy, and voluntarily cooperating nurses are no guarantees for success.

A case study of a preceptorship programme in an acute NHS Trust - using the European Foundation for Quality Management tool to support clinical practice development

AIMS

To discuss the results of the evaluation, assessment and effectiveness of the trust-wide clinical practice development of a preceptorship programme for newly qualified nurses at Salford Royal Hospitals NHS Trust. To apply the European Foundation for Quality Management (EFQM) model as a tool for monitoring and assessing the performance of the programme.

BACKGROUND

Newly qualified nurses need support and preparation for their working role in their first recruitment. A preceptorship programme, developed around a quality-monitoring framework, was introduced to address this need at Salford Royal, an acute NHS Trust.

METHOD

The generic EFQM model was adapted to the specific case of the preceptorship programme. A questionnaire survey was undertaken to obtain evidence to assess how the EFQM tool was applied in the context of the preceptorship programme. Pre- and post-programme questionnaires were sent to preceptees and post-programme questionnaires to respective ward managers.

FINDINGS

Following introduction of the preceptorship programme, recruitment and retention of newly qualified nurses have increased, with preceptees self-reporting increased levels of confidence. Use of the EFQM tool has provided the information that managers and departments require. Anecdotal evidence to date suggests that barriers are being broken down. Utilization of the framework has also identified areas of practice that need to change.

CONCLUSIONS

This paper demonstrates how use of a generic tool such as EFQM can provide systematic and evaluative information for nursing.

The EFQM excellence model is useful for primary health care teams

BACKGROUND

Primary care teams are facing an increased need to develop quality programmes at local level. GPs must lead this process and promote a positive organizational culture if they want to achieve and maintain a continuous improvement of the service.

OBJECTIVE

The aim of the present study was to test the applicability and reliability of the European Foundation for Quality Management (EFQM) excellence model self-assessment questionnaire in a primary health care organization.

METHOD

A cross-sectional study was carried out of the EFQM questionnaire to compare the scores achieved by a primary health care team in Spain caring for 42 000 inhabitants using internal self-assessment with the scores achieved by professional management auditors through an external audit.

RESULTS

The scores of each criterion achieved by self-evaluation are similar to or lower than those assessed by the external evaluation. There is agreement in the areas suitable for improvement.

CONCLUSIONS

The experience proves the applicability of the EFQM excellence model for primary health care teams and its reliability, at least when the team undergoing self-assessment know they are going to be re-evaluated. There is high concordance in the identification of areas for improvement.