Provider‐perceived dimensions of total quality management in healthcare

Prioritizing enablers for service quality in healthcare sector - a DEMATEL approach

PURPOSE

The Healthcare sector is one of the important sectors of the Service Industry. It is believed that in this sector, the customer server relationship is very critical, and even the slightest gap in the people quality may have a huge impact on the delivered service quality. Some of these enablers are doctors, nursing staff and support staff. Furthermore, the nonpeople quality enablers such as diagnostic services, facilities, hygiene levels and so on are also likely to impact the delivered service quality. It was also felt that the degree of impact each enabler has on the service quality could vary. Therefore there is a need for structured and deep analysis. The paper attempts to identify, analyze and prioritize the enablers that impact the delivered service quality.

DESIGN/METHODOLOGY/APPROACH

The enablers have been identified through literature review and inputs from experts in the healthcare fraternity. The authors have explored different decision-making tools such as analytic hierarchy process (AHP), analytic network process (ANP), stepwise weight assessment ratio analysis, Hybrid Model and DEMATEL (Decision-Making Trial and Evaluation Laboratory) for the analysis of data in this paper. Based on the strengths of the approach and careful considerations by focus group discussions, DEMATEL was chosen as the best option. It is simple, unique, sparingly used in the healthcare sector, effective in prioritizing and gives meaningful insights on importance, cause and effect factors. DEMATEL approach converts the complex problem with interrelated factors into a clear structure that makes simple interrelationships among factors in the form of cause and effects digraph, and hence, the authors chose to use it. A case study in one of the hospitals has also been conducted to demonstrate the applicability of the developed index. The case study very strongly validates the developed index.

FINDINGS

This research paper has found that there are people quality enablers such as the doctor, nursing staff, support staff and nonpeople quality enablers such as facilities, diagnostic services and hygiene levels maintenance, which impact the delivered service quality. It also concludes that the delivered service quality depends not only on the quality but also on the availability of these enablers. The inputs received from the experts have been run through the DEMATEL methodology and importance computed for each. The top five priority enablers are Quality of Doctor, Availability of Doctor, Quality of Support Staff, Quality of Nursing Staff and Availability of Support Staff.

RESEARCH LIMITATIONS/IMPLICATIONS

The weights of the enablers have been obtained using the DEMATEL tool. These weights have been calculated using the inputs from 22 experts, which meets the statistical requirement (Skulmoski, 2007). However, a larger group of experts can be reached, and based on the inputs received from them, the tool can be revalidated for repeatability and reproducibility. Using Fuzzy DEMATEL can also be explored for further analysis.

PRACTICAL IMPLICATIONS

The proposed framework to assess the service quality level of a healthcare organization is based on a sound approach of DEMATEL. The service index arrived, thereafter, can be used to rate the delivered service quality by any healthcare organization. It can be used to compare the similar type of healthcare organizations across locations. This Index can facilitate improvements in the healthcare organization through internal and external benchmarking. It also helps the organization to know the gaps, understand the root cause, improve upon them and become the best in class. This Index uses the inputs from the end customers to calculate the rating, which makes it more reliable and accurate. The overall scores obtained from the Index can provide the ranking to the healthcare providing organizations and options to customers to choose from best. The service quality index can be used by an organization to continuously monitor their delivered service quality scores and improve them to become the best in class. The research paper highlights the significant role played by the people quality and its strong impact/contribution on the delivered service quality. Hence, it is believed that it will encourage the healthcare organizations to prioritize the improvement and upgrade of the people quality over the nonpeople quality aspect.

ORIGINALITY/VALUE

Putting people and nonpeople quality enablers in one single model and assigning weights to them using the DEMATEL approach is a new application in healthcare. Developing an Index to measure the delivered service quality in the healthcare sector is also different and new.

A Systematic Literature Review of Quality Management Initiatives in Dental Clinics

By considering the recently proposed definitions and metrics, oral healthcare quality management (OHQM) emerges as a distinct field in the wider healthcare area. The goal of this paper is to systematically review quality management initiatives (QMIs) implementation by dental clinics. The research methodology approach is a review of 72 sources that have been analyzed using the Context-Intervention-Mechanism-Outcome Framework (CIMO). The analysis identifies five mechanisms that explain how quality management initiatives are implemented by dental clinics. The simplest QMIs implementations are related to (1) overall quality. The next ones, in terms of complexity, are related to (2) patient satisfaction, (3) service quality, (4) internal processes improvement, and (5) business outcomes. This paper is the first attempt to provide a critical review of this topic and represents an important advancement by providing a theoretical framework that explains how quality management is implemented by practitioners in this field. The results can be used by scholars for advancing their studies related to this emerging research area and by healthcare managers in order to better implement their quality management initiatives.

Health care service quality: a journey so far

Purpose

Health care service is a widely researched area. Several established models and instruments measuring health care service quality (HCSQ) are available in the published academic literature. The objective of this article is to summarize this vast pool of available knowledge under the themes of HCSQ, its determinants and measurement strategies.

Design/methodology/approach

Sixty-three available published studies in peer reviewed journal combed in EBSCO and Google Scholar database have been examined and presented in exemplary literature review.

Findings

The findings have been segregated under the themes of HCSQ, its dimensions and determinants. It can be deduced from the findings that in spite of health care being a professional service, the user defined service quality takes center stage.

Originality/value

Rather than the seeker of care, the authors call for further research by taking a dyadic view of professional exchanges and including providers' perspectives of care in service quality evaluations as well.

Longitudinal association between adolescent negative emotions and adulthood cardiovascular disease risk: an opportunity for healthcare quality improvement

Purpose

While cardiovascular disease (CVD) is the leading cause of death globally, over 80% of the cases could be prevented through early lifestyle changes. From the perspective of quality management in healthcare, this may offer an effective prevention window if modifiable CVD risk factors are identified and treated in adolescence. The purpose of this research is to examine the negative emotions in adolescents and determine if it independently increases CVD risk later in life.

Design/methodology/approach

Longitudinal data from 12,350 participants of the Add Health study, which conducted a multi-wave survey for 14 years from adolescence (Wave 1) through adulthood (Wave 4), were used to test the research hypothesis. Four items (perception of life, self-reported depression, perceived loneliness and fearfulness) reflective of adolescent negative emotion were identified from the Wave 1 questionnaire, and factor analysis was conducted to confirm the hypothesized structure. The outcome variable, 30-year adulthood CVD risk category (high or low risk), was estimated using biomarkers, biological data and other factors collected during the 14-year follow-up in Wave 4. A logistic regression analysis was employed to assess the impact of adolescent negative emotions on adulthood CVD risk after adjusting for common risk factors such as sociodemographic characteristics, socioeconomic status and medical conditions in adolescence.

Findings

The results indicated adolescent negative emotion to be significantly associated with CVD risk category (p-value < 0.0001), even after controlling for common risk factors. A unit increase in the level of adolescent negative emotion increased the chance of being in the high CVD risk group in adulthood by 8% (odds ratio = 1.08 ± 0.03).

Practical implications

Healthcare providers and organizations could capitalize on the research findings by screening for negative emotions early in life through individual and societal interventions. The findings also provide an opportunity for implementing quality improvement initiatives to deliver robust preventive care, which, in turn, could improve the overall population health, reduce healthcare costs and improve care quality.

Originality/value

Although previous studies showed a strong link between adolescent physiological factors (e.g. obesity) and adulthood cardiovascular disease (CVD), the association between adolescent outlook/attitude (negative emotion) and CVD risk has not been examined.

Validating Service Quality (SERVQUAL) in Healthcare: Measuring Patient Satisfaction Using their Perceptions in Jordan

Patient satisfaction in the developing world has not received sufficient interest in the healthcare literature. More importantly, models predicting patient satisfaction seldom incorporates patient perspectives into their measurement providing ill-suited metrics for healthcare administrators to make decisive decisions concerning service quality improvements. The current analysis utilizes original data collected from 336 patients in Jordan. This paper tests whether service quality (SERVQUAL) is suitable to be used in the new context and concluded that SERVQUAL is reliable and valid in supplying stakeholders with reliable and valid information concerning patient satisfaction. Further, the analysis suggests a large gap between perceived and expected services performed by Jordanian hospitals signalling the need to service quality enhancement. The study calls for the adoption of agile and rapid patient screening models in emergency departments to reduce wait times and decrease the number of patients left without being seen. This study constitutes an emerging attempt at better understanding how service quality influences patient satisfaction, and more importantly, introduce affordable and cost-effective solutions capable of improving satisfaction in the short run.

Ranking model of total quality management enablers in healthcare establishments using the best-worst method

Purpose

Recent years have witnessed a significant rise in Indian healthcare establishments (HCEs) which indicate that there is a constant need to improve the healthcare quality services through the adoption and implementation of TQM enablers. The purpose of this paper is to identify such enablers and then propose a ranking model for TQM implementation in Indian HCEs for improved performance.

Design/methodology/approach

The study identifies 20 TQM enablers through comprehensive literature survey and expert’s opinion, and classifies them into five main categories. The prominence of these enablers is established using a recently developed novel multi-criteria decision making (MCDM) method, i.e. best-worst method (BWM). The importance of the various main category and sub-category enablers is decided on the basis of their weights which are determined by the BWM. In comparison to other MCDM methods, such as analytical hierarchy process, BWM requires relatively lesser comparison data and also provides consistent comparisons which results in both optimal and reliable weights of the enablers considered in this paper. Further, a sensitivity analysis is also carried out to ensure that the ranking (based on the optimal weights) of the various enablers is reliable and robust.

Findings

The results of this study reveal that out of five main category enablers, the “leadership-based enablers (E1)” and the “continuous improvement based enablers (E5)” are the most and the least important enablers, respectively. Similarly, among the 20 sub-category enablers, “quality leadership and role of physicians (E14)” and “performing regular survey of customer satisfaction and quality audit (E52)” are the most and the least dominating sub-category enablers, respectively.

Research limitations/implications

This study does not explore the interrelationship between the various TQM enablers and also does not evaluate performance of the various HCEs based on the weights of the enablers.

Practical implications

The priority of the TQM enablers determined in this paper enables decision makers to understand their influence on successful implementation of the TQM principles and policies in HCEs leading to an overall improvement in the system’s performance.

Originality/value

This study identifies the various TQM enablers in HCEs and categorizes them into five main categories and ranks them using the BWM. The findings of this research are quite useful for management of the HCEs to properly understand the relative importance of these enablers so that managers can formulate an effective and efficient strategy for their easy and smooth implementation which is necessary for continuous improvement.

Do patients really perceive better quality of service in private hospitals than public hospitals in India?

Purpose

The purpose of this paper is to compare perceived service quality of public/government and private medical college hospitals.

Design/methodology/approach

This study adopts a descriptive, cross-sectional and research design. The research sample includes 340 in patients from six medical college hospitals located in the state of Odisha, India. Primary data are collected through a structured closed ended questionnaire containing 66 items on 1–7 point Likert scale. Statistical tools like factor analysis and ANOVA are performed with the help of SPSS-17 software to analyze the collected data.

Findings

This study identifies 13 dimensions of perceived hospital service quality. The comparative study indicates better performance of public/government hospitals across the technical dimensions of perceived service quality, whereas private hospitals report better performance across majority of the functional dimensions.

Originality/value

In the Indian healthcare system, public hospitals provide low-cost healthcare targeted toward low to middle socio-economic population whereas, large corporate private hospitals provide high-cost healthcare targeted toward high-income group. So the comparison between them produces an obvious result indicating better service quality in private hospitals. Present study minimizes this gap by comparing the service quality of public and private medical college hospitals. Medical colleges ensure access to health services for a larger group of people. Thus, similarity in the segment of population receiving medical services in public and private medical colleges is higher, making the comparison of perceived service quality fairer.

Importance-performance analysis (IPA) for testing – and calibration – laboratories in India

Purpose

The purpose of this paper is to formulate the strategy for improving the laboratory practices to enhance customer satisfaction by analyzing the performance of critical factors of IS/ISO/IEC 17025 (2005) laboratory accreditation and the importance attached by the quality/technical managers in the accredited Indian testing/calibration laboratories.

Design/methodology/approach

The perceptions of the critical factors of laboratory accreditation and the importance attached by the quality/technical managers in their organizations have been collected and analyzed to develop an importance-performance analysis (IPA) model to enhance the customer satisfaction.

Findings

Findings report that the performance of the critical factors and the importance assigned to them are not the same. There exist gaps between the performance and importance which need to be measured and analyzed by the management to strive toward continual improvement to enhance the customer satisfaction through the accredited testing and calibration services.

Research limitations/implications

This study is restricted to 54 responses out of 150 which were sent (i.e. about 36 percent response rate) to capture the perspectives of the quality/technical managers.

Practical implications

This study would enable the accredited laboratories to analyze the gap in performance and the importance assigned to critical factors through the feedback from the quality/technical managers. By analyzing the strengths and weaknesses in the accredited testing/calibration laboratories, managerial decisions and strategic plans can be proposed to gain greater insights into benchmarking improvement of the laboratory quality management system with the existing resources to strive toward customer satisfaction.

Originality/value

This paper proposes IPA as a tool to assess the gap between the importance and performance of critical factors of accredited testing and calibration laboratories in India.

Quality improvement strategies and tools: A comparative analysis between Italy and the United States

Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both countries, aims to identify commonalities and differences between the two systems and to understand which approaches are effective in improving quality of care. In both countries chief quality officers report quality improvement has become a strategic priority, clinical governance approaches, and tools-such as disease-specific quality improvement projects and clinical pathways-are commonly used, and there is widespread awareness that clinical decision making must be supported by protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide approach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for different dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not typically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization but are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the typical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical specialties than in the United States. In both countries, the results of the study show that it is not the single methodology/model that makes the difference but how the different quality improvement strategies and tools interact to each other and how they are coherently embedded with the overall organizational strategy.

Critical factors and performance indicators: accreditation of testing- and calibration-laboratories

Purpose

The purpose of this paper is to determine the critical factors (CRFs) of IS/ISO/IEC 17025:2005 laboratory accreditation and indicators of the performance (IOPs) in the testing/calibration laboratories. The impact of accreditation on the performance is analyzed using the level of presence of critical factors that can be used to benchmark the best practices in the accredited testing and calibration laboratories.

Design/methodology/approach

A questionnaire is designed on the basis of an extensive literature review on laboratory accreditation and performance. Based on the responses from pilot study, the developed instrument is tested for its unidimensionality, reliability and validity. Multiple regression analysis is carried out to analyze the impact of critical factors on the IOPs.

Findings

The findings reveal that the six distinct critical dimensions of laboratory accreditation (which are the independent variables) have a significant impact on the performance of the accredited testing/calibration laboratories. The performance is measured by the dependent variables which are the IOPs. The customer satisfaction, employee satisfaction, laboratory performance, image of the laboratory, the number of increased customers and loyalty of the existing customers are highly influenced by the accreditation which in turn improves the performance to gain the competitive advantage.

Research limitations/implications

Contribution to research is in the area of laboratory accreditation and the performance measurement by the development of a comprehensive instrument to analyze the Laboratory Quality Management System. The results are dependent on the number of respondents who are the quality/technical managers.

Practical implications

This instrument would enable the accredited laboratories to analyze their performance through the feedback from the quality/technical managers to gain credibility and to continually improve and benchmark the quality management system in alignment with the quality policies.

Originality/value

This paper proposes an instrument to measure and benchmark the performance of the accredited testing and calibration laboratories.

Equating the expected and perceived service quality

Purpose

The purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of healthcare service quality were compared by carrying out a GAP analysis to equate perceived and expected services and examined differences in the service quality.

Design/methodology/approach

The study sample comprises 310 inpatients of public and private healthcare service providers. Self-administered questionnaires were used along a five-point Likert scale and analyzed through the Statistical Package for Social Sciences. GAP analysis was used to observe the difference between expectations and perceived service quality.

Findings

A cross-sectional study revealed significant quality gaps between the expected and perceived services of public and private healthcare service providers; conversely patients’ expectations are not fully met in both types of hospitals. Private hospitals surpassed in terms of overall perceived service quality from their counterparts. Perceived services were found better in terms of physician medical services in public sector hospitals, while rooms and housekeeping services were found better in terms of private sector hospitals.

Practical implications

The result can be used by both public and private healthcare service providers to restructure their quality management practices which could only be possible through effective management commitment, regular patients’ feedback and translucent complaint procedures.

Originality/value

The study conceptualizes the expected and perceived hospital service quality dimensions as an eight-dimensional framework. A comparison between public and private sector hospitals is made to get a better understanding about the differences in the perceived healthcare services among two sectors. Consequences of the study will aid hospital managers and policy makers to get a fuller picture of healthcare services in order to contrive enhancement practices.

How patients think about social responsibility of public hospitals in China?

BACKGROUND

Hospital social responsibility is receiving increasing attention, especially in China where major changes to the healthcare system have taken place. This study examines how patients viewed hospital social responsibility in China and explore the factors that influenced patients' perception of hospital social responsibility.

METHODS

A cross-sectional survey was conducted, using a structured questionnaire, on a sample of 5385 patients from 48 public hospitals in three regions of China: Shanghai, Hainan, and Shaanxi. A multilevel regression model was employed to examine factors influencing patients' assessments of hospital social responsibility. Intra-class correlation coefficients (ICCs) were calculated to estimate the proportion of variance in the dependent variables determined at the hospital level.

RESULTS

The scores for service quality, appropriateness, accessibility and professional ethics were positively associated with patients' assessments of hospital social responsibility. Older outpatients tended to give lower assessments, while inpatients in larger hospitals scored higher. After adjusted for the independent variables, the ICC rose from 0.182 to 0.313 for inpatients and from 0.162 to 0.263 for outpatients. The variance at the patient level was reduced by 51.5 and 48.6 %, respectively, for inpatients and outpatients. And the variance at the hospital level was reduced by 16.7 % for both groups.

CONCLUSIONS

Some hospital and patient characteristics and their perceptions of service quality, appropriateness, accessibility and professional ethics were associated with their assessments of public hospital social responsibility. The differences were mainly determined at the patient level. More attention to law-abiding behaviors, cost-effective health services, and charitable works could improve perceptions of hospitals' adherence to social responsibility.

Measuring patients’ healthcare service quality perceptions, satisfaction, and loyalty in public and private sector hospitals in Pakistan

Purpose

This study aims to explore the relationship between healthcare perceived service quality (HCSQ) and patient loyalty. Mediating role of patient satisfaction is also assessed between HCSQ and patient loyalty.

Design/methodology/approach

A sample of 600 was gathered using stratified random sampling technique from inpatients of public and private sector hospitals of Pakistan through self-administered questionnaire, and was analyzed through regression analysis.

Findings

Findings indicate that healthcare perceived service quality has a significant positive effect on patients’ loyalty. Patient satisfaction also mediates the relationship between HCSQ and patient loyalty. Findings state that there is a significant difference between HCSQ which is perceived by the patients of both public and private sector hospitals. Differences suggest that the patients of private sector hospitals were found more satisfied than their counterparts.

Practical implications

The results indicate that hospital managers should have knowledge about the perceptions and satisfaction of patients as it leads to a step towards introducing reforms in the quality of healthcare sector.

Originality/value

No such particular research in literature has been made earlier in Pakistan’s context which has assessed the perceptions of patients in terms of HCSQ dimensions as being addressed in this study. Thus, this study endeavors to fill that gap in terms of measuring healthcare services provided by both public and private sector hospitals. Outcomes of this study will enable hospitals’ managers to get a better understanding towards stronger as well as weaker aspects of service quality, and will help in observing factors which contribute towards patients’ satisfaction and patient loyalty in building long term relationships between hospital and patients.

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.

An empirical investigation to determine patient satisfaction factors at tertiary care hospitals in India

Purpose

– The purpose of this study is to investigate and test a six-factor model that explains considerable variation in patient satisfaction with tertiary care hospitals in India.

Design/methodology/approach

– The data of this study were collected through a systematic randomly distributed questionnaire. A pre-tested and contextually prepared structured questionnaire was used to gather 436 responses from selected tertiary care hospitals located in Hyderabad. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha are used to measure the internal consistency of the scale using the computer software SPSS 20.0.

Findings

– The findings of this study highlight six distinct dimensions of patient satisfaction and the relationships among them. Positive and significant relationships among the dimensions and patient satisfaction have been found.

Research limitations/implications

– One limitation to this study was the inclusion of the selected tertiary care hospitals in Hyderabad city and responses are collected from inpatients who were admitted in the surgical departments of these hospitals.

Practical implications

– This instrument would enable patients to provide feedback to hospitals regarding the quality of health care received by them. Hospitals could use this feedback to analyze their performance, satisfaction and benchmark their performance against competitive hospitals. This study has directs implications for health care service providers to provide quality of services to patients, to maintain high level of patient’s satisfaction and re-intentions.

Originality/value

– Few studies identified and examined the factors that influence patient’s perceived satisfaction. This study adds value by investigating what factors influences patient satisfaction among selected tertiary care hospitals located in Hyderabad.

Developing a HospiSE scale for hospital service excellence

Purpose

– This empirical survey research aims to identify the dimensions of service excellence culture for hospitals. Ultimately, a measurement tool was developed for hospital service excellence (i.e. HospiSE scale).

Design/methodology/approach

– The survey research involved qualitative and quantitative approaches in the scale development process. The structured questionnaire was carefully designed after literature review and focus groups discussions. The respondents were employees from the public and private hospitals in Malaysia. A total of 1,558 usable questionnaires were used for the quantitative analysis. The HospiSE scale was empirically tested for reliability and validity through exploratory and confirmatory factor analyses.

Findings

– This measurement-oriented research had identified three dimensions of service excellence culture for hospitals, namely: employee orientation, patient orientation and competitor orientation. The multi-dimensional measure consists of 21 items.

Research limitations/implications

– Longitudinal research is required to provide evidence of the causal effects of HospiSE on employee satisfaction and loyalty. The HospiSE scale also requires further verification and refinement.

Practical implications

– The parsimonious scale can serve as a strategic and practical measure to evaluate and manage service excellence culture at hospitals. Reliable and valid information can be obtained for fast and cost-effective diagnosis of the service culture for continuous improvement.

Social implications

– The new scale is expected to be an important diagnostic to understand and measure service excellence culture at hospitals. The patients and society at large will benefit from the improved hospital service management.

Originality/value

– The multi-item measurement tool is new and it can provide insights into service management, resource allocation and human resource management for excellent hospital service. The measurement development process is contextualized for the hospital services.

The impact of total quality service (TQS) on healthcare and patient satisfaction: an empirical study of Turkish private and public hospitals

This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient-perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals.

A comparative study of total quality management of health care system in India and Iran

Background

Total quality management (TQM) has a great potential to address quality problems in a wide range of industries and improve the organizational performance. The growing need to take initiatives by hospitals in countries like India and Iran to improve the service quality and reduce wastage of resources has inspired the authors to develop a survey instrument to measure health care quality and performance in the two countries.

Methods

Based on the Baldrige health care criteria for performance excellence 2009-2010 and the guidelines proposed by the American Hospitals Association for hospitals in pursuit of excellence, compared health care services in three countries. The data are collected from the capital cities and their nearby places in India and Iran. Using ANOVAs, three groups in quality planning and performance have been compared.

Result

Results showed there is significantly difference between groups and in no case the hospitals from India and Iran are found scoring close to the benchmarks. The average scores of Indian and Iranian hospitals on different constructs of the IHCQPM model are compared with the major results achieved by the recipients of the MBNQ award.

Conclusion

In no case the hospitals from India and Iran are found scoring close to the benchmarks (Baldrige health care criteria for performance excellence 2009-2010 and the guidelines proposed by the American Hospitals Association for hospitals). These results suggested to health care services more attempt to achieve high quality in management and performance.