Quality management through a national quality award framework: The experience of a hospital in Brazil

Does healthcare service quality affect outbound medical tourists’ satisfaction and loyalty? Experience from a developing country

Purpose

Poor quality of services in the health-care sector of the developing countries like Bangladesh forces affluent patients to seek advanced medical treatment from abroad. The purpose of this study is to explore the outbound medical tourists’ satisfaction and loyalty on the basis of the quality of the health-care service provided by foreign medical institutions.

Design/methodology/approach

The medical tourists from Bangladesh who have got medical services from Indian medical institutions were taken as a sample by applying a purposive sampling technique. For the measurement of outbound medical tourists’ satisfaction, the dimensions of the HEALTHQUAL model were adopted. A self-administrated questionnaire was the major tool for collecting data from the respondents. Using partial least square-structural equation model multivariate statistical technique and with the aid of SmartPLS software, primary data collected from 218 final respondents were analyzed.

Findings

The findings of this study reveal that four dimensions of the HEALTHQUAL model, namely, empathy, tangibility, efficiency, and safety have a significant positive impact on building medical tourists’ overall satisfaction, and then the overall satisfaction also has a positive level of significance on building loyalty towards foreign medical service providers.

Practical implications

The findings of this study can be a helpful instrument for the developing countries to rethink and reshuffle their own existing health-care system for providing quality medical services and at the same time, the medical tourists importing countries to sharpen their existing service quality as well as to attract more medical tourists in the future.

Originality/value

A handful of research has been carried out, especially focused on health-care service quality measurement and the relationship of health-care service quality with satisfaction and loyalty from the perspective of developing countries outbound medical tourists. Thus, this research work will give a flavor to think of health-care service quality in a different dimension.

Key determinants of quality in the pharmaceutical supply chain

Purpose

Empirical studies on the supply chain quality management (SCQM) of the pharmaceutical sector are scarce and scattered. This paper investigates a set of key quality determinants in the pharmaceutical sector to offer a holistic quality control framework for its supply chain (SC).

Design/methodology/approach

A mixed-method design was used. A focused group discussion with seven pharmaceutical SC managers summarized the narratives of the SCQM in this sector and helped to develop a questionnaire. The survey data were collected from the managers of 299 pharmaceutical firms.

Findings

The statistical results show the key determinants are leadership (LS), customer focus (CF), process integration and management (PIM), supplier relations (SR), quality practice (QP), human resource practices (HRP) and safety (SF). Unlike many other sectors, in the pharmaceutical SC, logistics and inventory costs have been proved to be not as important as other measures in the eyes of the SC managers and as part of SCQM performance measures, which can be a result of the priority systems influenced by the World Health Organization standards.

Originality/value

The study is distinctive in its scope as is carried out in a developing country with focus on concept of SCQM with reference to pharmaceutical SC. It shows great potential for further studies and improvements in logistics and warehousing in this sector, for the interest of the pharmaceutical SC managers and regulators who aim to ensure safety and quality in the health-care sector.

Assessment of TQM implementation level in Palestinian healthcare organizations

Purpose

The purpose of this paper is to assess the level of total quality management (TQM) implementation in Palestinian governmental and non-governmental hospitals using the Malcolm Baldrige National Quality Award (MBNQA) framework.

Design/methodology/approach

The study is based on collecting data using a survey questionnaire that was designed according to the MBNQA criteria. In total, 363 questionnaires from governmental and non-governmental hospitals operating in Gaza Strip were analyzed to assess the level of TQM implementation level in all hospitals (governmental and non-governmental).

Findings

The main results of this study indicate that Palestinian hospitals operating in Gaza Strip perform at a relatively acceptable level. Comparing results shows that the performance of non-governmental hospitals is better with higher degree of TQM implementation than the governmental hospitals. Detailed analysis identifies improvement opportunities-related specific aspects of the human resources focus and the performance results.

Research limitations/implications

Although this study has collected data from one Palestinian Territory, the Gaza Strip, it still identifies the critical factors and practices for TQM implementation within the Palestinian healthcare organizations to improve performance.

Practical implications

This paper suggests that business excellence models such as the MBNQA criteria can be used to assess the level of implementation of quality practices and identify the strengths and weaknesses to improve the quality of service delivery, processes, and performance of hospitals.

Originality/value

Despite the widespread use of TQM in the developed countries, little attention has been placed to implement and assess the quality initiatives by organizations in the developing countries and even fewer in low-income Arab countries (Aamer et al., 2017; Øvretveit and Al Serouri, 2006). In addition, a very few number of studies in reference to the assessment of TQM implementation in the Palestinian context, in general, and in healthcare organizations, in particular, highlight the need for this study. To move the field in that direction, the goal of this research was to assess the level of TQM implementation in the healthcare organizations (mainly hospitals) in Gaza Strip (one of the least fortunate areas of the Palestinian-occupied territories) where no prior similar research studies could be found. Therefore, this study contributes to filling this gap in the literature by providing empirical assessment of TQM level of implementation in Gaza Strip hospitals.

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.

Developing and validating a total quality management model for healthcare organisations

Purpose

– The purpose of this paper is to develop a total quality management (TQM) model for healthcare organisations and validate it using a sample of Iranian healthcare organisations.

Design/methodology/approach

– A validated questionnaire was used to collect data from all healthcare organisations that implemented TQM in Isfahan province, Iran.

Findings

– Using the proposed model, TQM implementation was measured in healthcare organisations. The level of TQM success in Isfahan healthcare organisations was medium. The highest score was achieved in the dimension of “customer management”, followed by “leadership” and “employee management”. Employee management, information management, customer management, process management and leadership had the most positive effect on TQM success. Using a series of quality management techniques had “synergistic” effect on TQM success.

Practical implications

– Top management support, effective management of human resources, full involvement of the entire workforce including physicians, education and training, team working, continuous improvement, a corporate quality culture, customer focus and using a combination of management techniques under a quality management system are necessary for TQM successful implementation.

Originality/value

– A healthcare context-specific model of TQM was developed and tested and suggestions were provided for its successful implementation.

The critical managerial capabilities of medical and nursing managers in an Israeli hospital

Purpose

– The purpose of this paper is to determine the managerial capabilities that are required of medical and nursing managers, in a Christian-affiliated hospital in Israel, in order to promote the job satisfaction of their subordinates.

Design/methodology/approach

– Data were gathered via questionnaires, administered to 107 doctors and nurses of a small Christian-affiliated hospital in Israel, regarding the job satisfaction of the respondents, and their evaluation of the managerial capabilities of their medical and nursing superiors. Correlations and regressions were carried out on the data.

Findings

– Overall managerial capabilities of medical and nursing managers were shown to be significantly related to how their subordinates felt about their teams and about their work. The results suggest differences between nurses and doctors. When analyzed for the two dimensions of managerial capabilities and the two dimensions of job satisfaction, the results were significant for the nurses, but not significant for the doctors. When tested for Christians vs non-Christians, the results for the nurses were the same as in the sample as a whole; whereas for the doctors, there were differences between the two religious groups.

Research limitations/implications

– The sample is small and culturally specific, thus limiting the generalization potential of this study.

Practical implications

– Findings of this research may have practical implications regarding hospitals’ recruitment, promotion, instruction and follow-up policies.

Originality/value

– This study sheds light on the issue of hospital management and leadership within a specific cultural-religious setting, which has not been previously investigated.

Receiving a national quality award three times

Purpose

– In recent decades, a framework for management performance has proven to be an important management practice for achieving organisational performance excellence. In this sense, the purpose of this paper is to analyse how a specific company manages to achieve performance excellence through the attainment of the Brazilian National Quality Award.

Design/methodology/approach

– The study adopts a case-based approach using a single unit of analysis that might be considered a revealing case. The company studied is one of the largest companies in the information and financial analysis sector in Latin America and is part of a major worldwide corporation. Semi-structured interviews with senior managers and document analysis were used for data collection, with content and inductive analysis performed a posteriori.

Findings

– The main results outline the approach adopted by the company for each performance excellence award criterion and highlight some of the relevant organisational practices, especially those related to the nature of the company’s businesses. The findings show that the top management has been an essential driving force in transforming the managers at all levels into agents of improvement at the studied company. Additional key points are the deployment of the company’s “shared values” throughout the company and the implementation of a medium- and long-term comprehensive strategic plan focused on the award criteria. The company’s strategic system has been a driving force of its success.

Research limitations/implications

– For a more extensive empirical validation, further replications using other samples are needed to ensure the external validity of these findings.

Originality/value

– This paper is one of the few published studies discussing business excellence in emerging economies, which is not observed very often in developing markets. In addition, the paper focuses on promoting a culture of quality, a less common phenomenon in the economies of developing countries than in those of developed nations. Finally, this paper may be useful for practitioners and academics interested in the subject of quality and performance excellence.