Quality management in Irish health care

ISO 9001 and the public service: an investigation of the effect of the QMS on the quality of public service organizations

Purpose

The purpose of this paper is to identify the influence exerted by a quality management system (QMS) under ISO 9001: 2015 on the quality of public services organizations in Mexico.

Design/methodology/approach

The methodological design was quantitative, explanatory, observational and transversal, for which a sample of 461 public servants from the state of Guanajuato, Mexico was obtained. To test the hypotheses, a structural equation model (SEM) was developed through the statistical software Amos v.21. For the analysis of the data, software SPSS v.21 was used. Regarding the goodness and adjustment indices of the SEM (χ2 = 720.09, df = 320, CFI = 0.933, TLI = 0.926 and RMSEA = 0.05) which, therefore, proved to be acceptable.

Findings

According to the results obtained through the SEM model, the QMS under ISO 9001: 2015 is positively and significantly influenced tangible aspects (β1 = 0.79, p < 0.01), reliability (β2 = 0.90, p < 0.01), related to response quality (β3 = 0.93, p < 0.01), guarantees (β4 = 0.91, p < 0.01) and empathy (β5 = 0.88, p < 0.01) of the quality related to public services in Mexico. The study’s key contribution is that it discovered that implementing a QMS in accordance with the ISO 9001: 2015 standard has an impact on the quality of public services, with the most influential quality of response. Similarly, the assurance and dependability of service quality turned out to be important in providing public service quality.

Research limitations/implications

In this paper, the QMS was only evaluated as a variable that intervenes in the process of obtaining quality in public service under the ISO 9001 standard in its 2015 version. In this regard, the results’ trustworthiness is limited to the extent that the findings may be generalized in the state of Guanajuato, Mexico’s public service. As a result, the scientific community is left primarily focused on service quality to promote new future research.

Practical implications

The ISO 9001: 2015 standard’s QMS is one of the tools for success in both the commercial and government sectors. However, there are practical limitations, which focus on the time during which managers exercise their vision in the public sector: first, the dynamics that managers play in public policy; second, the length of time they have served in public office; and third, the interest of directors of public institutions to improve the quality of service provided by the government. Other practical consequences concern organizational culture and identity, public servant commitment, senior management or secretaries of government, as well as work and training.

Originality/value

The findings of this paper are important and valuable because they foster knowledge generation in the public sector through the ISO 9000 quality area. A model that permits the adoption and implementation of a QMS based on the ISO 9001: 2015 standard in public organizations that seek to provide quality in their services offered to the user is also presented to the literature. Similarly, the paper is important because there is currently insufficient research focusing on the variables examined in the context of public service in Mexico.

Comeback workout: QM practices and the health and fitness industry

Purpose

The purpose of this paper is to provide a theoretical model for the relationship between quality management (QM) practices and the health and fitness industry through two competencies, including relational competence (RC) and technical competence (TC).

Design/methodology/approach

Drawing from the resource-based view and the relational competence theory, this paper seeks a further understanding of the conceptual link between QM practices and the health and fitness industry.

Findings

This paper proposes that RC and TC will positively mediate the relationship between QM practices and customers’ behavioral intentions to use the health and fitness service.

Research limitations/implications

This paper provides an integrated perspective to the health and fitness industry. More specifically, this paper suggests that QM practices can be applicable to customers’ behavioral intentions to use the health and fitness service. This paper also provides a solid conceptual foundation through which managers in the health and fitness industry put more effort in developing the relationship with customers. An empirical investigation might be needed for future study.

Practical implications

This paper suggests that managers and employees in the health and fitness industry need to provide a sustained and consistent effort into maintaining the interaction with customers. This paper also suggests that the use of QM practices can be related to customer perception (e.g. boosting behavioral intentions toward service providers) and can provide sustainable competitive advantage in the health and fitness industry.

Originality/value

This paper extends current understanding of QM practices and the health and fitness industry by providing a conceptual framework regarding how QM practices are related to the health and fitness industry through RC and TC.

Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae- A scoping review

Quality circles or peer review groups, and similar structured small groups of 6–12 health care professionals meet regularly across Europe to reflect on and improve their standard practice. There is debate over their effectiveness in primary health care, especially over their potential to change practitioners’ behaviour. Despite their popularity, we could not identify broad surveys of the literature on quality circles in a primary care context. Our scoping review was intended to identify possible definitions of quality circles, their origins, and reported effectiveness in primary health care, and to identify gaps in our knowledge. We searched appropriate databases and included any relevant paper on quality circles published until December 2017. We then compared information we found in the articles to that we found in books and on websites. Our search returned 7824 citations, from which we identified 82 background papers and 58 papers about quality circles. We found that they originated in manufacturing industry and that many countries adopted them for primary health care to continuously improve medical education, professional development, and quality of care. Quality circles are not standardized and their techniques are complex. We identified 19 papers that described individual studies, one paper that summarized 3 studies, and 1 systematic review that suggested that quality circles can effectively change behaviour, though effect sizes varied, depending on topic and context. Studies also suggested participation may affirm self-esteem and increase professional confidence. Because reports of the effect of quality circles on behaviour are variable, we recommend theory-driven research approaches to analyse and improve the effectiveness of this complex intervention.

Interrelationships among quality enablers, service quality, patients’ satisfaction and loyalty in hospitals

Purpose

The purpose of this paper is to clarify how enablers of quality management can secure the satisfaction and loyalty of patients through increasing service quality in hospitals.

Design/methodology/approach

The current study conducted a review of the existing literature to identify operational dimensions of the research variables. As a result of the review, 17 dimensions were identified; five European foundation for quality management enablers, five SERVQUAL service quality dimensions, four patients’ satisfaction elements and three patients’ loyalty components. To evaluate interrelationships among these 17 research dimensions, decision-making trial and evaluation laboratory technique was applied using experts’ opinions.

Findings

Several key relations were found among research dimensions. Research findings could provide a scientific insight for hospital managers to understand how they could increase the level of patients’ satisfaction and loyalty through high-quality services provided by quality management enablers.

Research limitations/implications

This study has been conducted based on the expert’s opinions from private hospitals located in Tehran and Alborz provinces, Iran. Although the results could be useful for hospital managers in different places and could provide them a valuable insight and knowledge, findings are limited to Iranian private hospitals.

Originality/value

It is taken for granted that patients’ satisfaction and loyalty could increase as a result of high-quality medical and treatment services in hospitals. On the other hand, offering excellent services meeting all the needs and expectations of customers could be consequence product of quality management enablers. Even though satisfaction and loyalty of customers, i.e. patients, is the primary target of quality management, there is little research in the literature as to how enablers of quality management can secure the satisfaction and loyalty through increasing service quality in hospitals. The gap is more critical because the specialized dimensions of four research variables have not been previously integrated into a coherent framework and interrelationships among them have not been studied and clarified in detail. The current study attempts to bridge this gap.

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

Purpose

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

Design/methodology/approach

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

Findings

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

Practical implications

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

Originality/value

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

'It sounds like a great idea but…': a qualitative study of GPs' attitudes towards the development of a national diabetes register

OBJECTIVE

The aim of this study was to investigate the attitudes of general practitioners (GPs) to the development of a national diabetes register as a way of improving the quality of care.

DESIGN

Qualitative study using semistructured interviews.

SETTING

General practice, Ireland.

PARTICIPANTS

Purposive sample of 29 GPs and two practice nurses. Participants' practices varied by (a) location (rural/urban), (b) size (single-handed/group practice) and (c) extent of computerisation.

METHODS

The semistructured topic guide focused on experiences of change in the health system at a local and national level and attitudes towards the development of a national diabetes register. Analysis was conducted using the Framework approach.

RESULTS

Participants were sceptical about the development of a national diabetes register. The main advantage was 'knowing the numbers' for epidemiological and policy purposes. However, participants questioned the benefits for their practice and patients. There were concerns that it would drain resources from other priorities and distract from patient management. These attitudes were strongly influenced by previous experience of change in the health system. Participants felt that remuneration would be necessary to ensure full engagement, reflecting wider frustrations with payment structures for general practice. There was a sense of wariness towards health service administration which was not specific to diabetes care but which coloured some participants' attitudes towards a national register. In contrast, participants referred to positive experiences of change at a local level, facilitated by a 'practice ethos' and professional leadership.

CONCLUSIONS

This study highlights the growing sense of scepticism and inertia towards change within the health system. This inertia stems from previous experience and the competing demands of maintaining versus improving care in a system with dwindling resources.

ISO 9001 certification for hospitals in Bulgaria: does it help service?

The aim of our study is to review the published literature on establishment and implementation of ISO 9001 QMS in European hospitals, to study the availability of International Organization for Standardization (ISO) quality management systems (QMS) in Bulgarian hospitals and to outline the main advantages of ISO implementation in the hospitals in Bulgaria. The information on availability of ISO QMS in the hospitals in Bulgaria was gathered via Bulgarian certification register, the registries of various quality associations, websites of hospitals and certification companies presented in Bulgaria. A total number of 312 hospitals in Bulgaria were screened for the availability of QMS certified against the ISO 9001 requirements. The experience of European hospitals that implemented QMS is positive and the used approaches to improve the processes and the demonstrated effects from ISO implementation are analysed by the researchers. Unlike other European Union member states, the establishment of quality management systems in Bulgaria is not compulsory. However, our study revealed that 14.42% of the hospitals in Bulgaria have implemented and have certified quality systems against the requirements of ISO 9001. Our study confirmed that a quality management system using the ISO 9001 standard is useful for the hospitals as it can help to increase the operational efficiencies, to reduce errors, improve patient safety and produce a more preventive approach instead of a reactive environment.

Strategic collaborative quality management and employee job satisfaction

BACKGROUND

This study aimed to examine Strategic Collaborative Quality Management (SCQM) impact on employee job satisfaction.

METHODS

The study presents a case study over six years following the implementation of the SCQM programme in a public hospital. A validated questionnaire was used to measure employees' job satisfaction. The impact of the intervention was measured by comparing the pre-intervention and post-intervention measures in the hospital.

RESULTS

The hospital reported a significant improvement in some dimensions of job satisfaction like management and supervision, organisational policies, task requirement, and working conditions.

CONCLUSION

This paper provides detailed information on how a quality management model implementation affects employees. A well developed, well introduced and institutionalised quality management model can improve employees' job satisfaction. However, the success of quality management needs top management commitment and stability.

Exploring why quality circles work in primary health care: a realist review protocol

BACKGROUND

Quality circles (QCs) are commonly used in primary health care in Europe to consider and improve standard practice over time. They represent a complex social intervention that occurs within the fast-changing system of primary health care. Numerous controlled trials, reviews, and studies have shown small but unpredictable positive effect sizes on behavior change. Although QCs seem to be effective, stakeholders have difficulty understanding how the results are achieved and in generalizing the results with confidence. They also lack understanding of the active components of QCs which result in changes in the behavior of health care professionals. This protocol for a realist synthesis will examine how configurations of components and the contextual features of QCs influence their performance.

METHODS/DESIGN

Stakeholder interviews and a scoping search revealed the processes of QCs and helped to describe their core components and underlying theories. After clarifying their historical and geographical distribution, a purposive and systematic search was developed to identify relevant papers to answer the research questions, which are: understanding why, how, and when QCs work, over what time frame, and in what circumstances. After selecting and abstracting appropriate data, configurations of contexts and mechanisms which influence the outcome of QCs within each study will be identified. Studies will be grouped by similar propositional statements in order to identify patterns and validation from stakeholders sought. Finally, theories will be explored in order to explain these patterns and to help stakeholders maintain and improve QC performance.

DISCUSSION

Analyzing context-mechanism-outcome (CMO) patterns will reveal how QCs work and how contextual factors interact to influence their outcome. The aim is to investigate unique configurations that enable them to improve the performance of health care professionals. Using a standardized reporting system, this realist review will allow the research questions to be answered to the satisfaction of key stakeholders and enable on-going critical examination and dissemination of the findings.

STUDY REGISTRATION

PROSPERO registration number: CRD42013004826.

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.

Focus on quality in healthcare in Ireland

PURPOSE

The purpose of this paper is to summarise the recent debates and issues on the healthcare system in Ireland, which have come to the fore through media exposure. The implications for these debates on quality are suggested and questions are raised to stimulate further debate.

DESIGN/METHODOLOGY/APPROACH

Recent reports and media opinion articles are reviewed in the light of the health reform programme and the increased prosperity due to the Celtic Tiger era in Ireland.

FINDINGS

The Health Service in Ireland is not what it should be. Progress has been made but resistance at all levels is significant due to the mistrust and miscommunication between the managerial and clinical personnel which have built up during the past number of years. The trust of the public is at an all-time low. However, once patients are within the system they are satisfied with their care.

ORIGINALITY/VALUE

This is a discussion paper which raises more questions than answers and is timely with the focus on quality in healthcare, particularly now as Ireland prepares for a general election for a new government with healthcare a priority issue.

Public Health Nurses and the delivery of quality nursing care in the community

AIM

The aim of the study was to explore factors which impact on quality nursing care in the community from the Public Health Nurse's (PHN) perspective.

BACKGROUND

Public Health Nursing has significantly evolved over the past few years with the delivery of quality nursing being a focus point. This study explores factors that impact upon the delivery of quality care in Public Health Nursing in Ireland. The findings provide an opportunity for an additional perspective to be included in the existing international findings and act as a starting point from which further research can be built.

METHOD

A qualitative method using semi-structured interviews were conducted. Interviews were taped and content analysed.

FINDINGS

Four main categories emefrged from the data, namely role change, components of quality nursing care, barriers to quality nursing care and the factors that facilitate the delivery of quality nursing care in the community. PHNs strive for evidence-based practice; they acknowledged their inability to achieve this and referred to factors that inhibited them from reaching their goal.

CONCLUSION

Enhanced education for PHNs will equip them in the delivery of a quality service and have a positive impact on patient care. Better communication is required between PHNs, line managers and the multidisciplinary team. The delivery of community services need to be reviewed and developed further in accordance with the health strategy policy.

RELEVANCE TO CLINICAL PRACTICE

This study has identified the evolution in clinical practice associated with the changing role and scope of Public Health Nursing. Clinical practice has evolved over time to incorporate societal change, technological advances and the delivery of an evidence-based service responsive to identified need. This study identified the presence of an increase in the specialist clinical work being undertaken as a result of new technological advances entering the community working environment.

Involving service users in defining and evaluating the service quality of a disability service

PURPOSE

This study proposes to examine how a particular service quality model, the P-C-P attributes model, can be used to develop a measurement tool for a disability organisation, which involves service users in defining and determining service quality.

DESIGN/METHODOLOGY/APPROACH

The evaluation focused on a physical disability service within the voluntary sector in Ireland. To identify the service quality dimensions, which were important, a series of focus groups were completed with service personnel and service users. A questionnaire was then developed from the information identified relating to a number of service quality dimensions.

FINDINGS

The results illustrated an overall high level of satisfaction with the service. There were a number of service dimensions identified in each of the attribute groupings, which could be improved. Respondents also made a number of recommendations for improvement.

RESEARCH LIMITATIONS/IMPLICATIONS

The study identified limitations to the model relating to whether the actual experiences of service users are captured.

ORIGINALITY/VALUE

This paper outlines from a consumer perspective the service attributes that provide satisfaction with service delivery but also highlighted areas where improvement was necessary and that the P-C-P model is a suitable framework for use.

A systems-based methodology for structural analysis of health care operations

This paper introduces a systems-based methodology for conducting analysis of organizational structure for health care operations. Increasingly, health care organizations must operate in turbulent environments characterized by rapid change, high levels of uncertainty, and increasing levels of complexity. A fundamental issue for effective-performance in these environments is the development and maintenance of organizational structures that simultaneously provide both operational stability and agile response to environmental turbulence. Drawing from systems science, a systems-based methodology for structural analysis of healthcare operations is developed. This methodology identifies operational deficiencies stemming from inadequate organizational structure and suggests focal areas for structural modification. The results from an application of the methodology in a health care organization are examined. Implications and limitations for use of the methodology by health care professionals are provided.