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

Sustainability and Quality Management: has EFQM fostered a Sustainability Orientation that delivers to stakeholders?

Purpose

As a Quality Management (QM) framework, the European Foundation for Quality Management (EFQM) Excellence Model has stakeholder management at its core. In EFQM (2012), based on which assessments were made until 2021, “creating a sustainable future” was a fundamental principle, but how it translated to a Sustainability Orientation and delivered to stakeholders remains questionable. This study aims to investigates the Sustainability Orientation within EFQM (2012) and its associations with Results for stakeholders.

Design/methodology/approach

Longitudinal assessments of recognized-for-excellence organizations by a partner of EFQM are considered. Using factor analysis, scores on the sub-criteria that defined “creating a sustainable future” are investigated, and a Sustainability Orientation is inferred. Panel regressions and structural equation modeling assess the correlations between Sustainability Orientation and Results. A qualitative analysis follows, where sustainability reports from role-models within this population are text mined to examine whether and how they reflected the guidance in EFQM (2012) concerning “creating a sustainable future”.

Findings

Direct and indirect positive associations between the Sustainability Orientation implied by EFQM (2012) and stakeholder-performance are confirmed. Yet, inferences from text mining of reported priorities of role-models of excellence illustrate that EFQM (2012) might have driven different strategies towards sustainability.

Originality/value

Despite conceptualizations that the EFQM model embeds a Sustainability Orientation, to the best of the researchers’ knowledge, its existence and likely impact remain to be examined. By combining longitudinal statistical analysis, structural equation models and text mining, consistent insights on the link between Sustainability Orientation and organizational performance are obtained.

Forecasting the Future Excellence: 30 Years of Evaluating Service Organizations in Slovakia

The aim of this paper is to model and interpret the results obtained from the assessment of the Level of Excellence of Slovak service organizations using the criteria of the European Foundation for Quality Management (EFQM) excellence model. The Gompertz logistic function is effectively employed to fit the incremental improvement and predict the values of future Levels of Excellence. The EFQM model is usually used to improve organizational development and performance. The study focuses on the problem of the slow growth or even stagnation of Slovak service organizations towards Excellence. The questionnaire method was used to assess the Level of Excellence of the selected organizations, and the approach of measuring efficiency as a ratio of results and enablers was used to evaluate the organization’s ability to transform inputs into outputs. Data were collected from 30 service organizations over a period of 20 years. The first finding of the study is the demonstration of the applicability of the Gompertz function to model the evolution of the Level of Excellence. The accuracy of the model is very high, and this predisposes this function to be used to forecast the scores of organizations over time. Examining efficiency yielded a second finding, that organizations were failing to capitalize on the effort put into translating it into results. After the first few years of growth, efficiency stagnates and then even declines. This suggests that the application of the original EFQM excellence model has reached the end of its ability to improve the effectiveness of organizations as a whole. Individual firms may have been growing or declining, but the average service score across the country had no longer the capacity to improve anymore.

The impact of quality framework application on patients’ satisfaction

Purpose

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

Design/methodology/approach

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

Findings

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

Originality/value

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

A Health Care Value Framework for Physical Therapy Primary Health Care Organizations

BACKGROUND AND OBJECTIVE

To develop a health care value framework for physical therapy primary health care organizations including a definition.

METHOD

A scoping review was performed. First, relevant studies were identified in 4 databases (n = 74). Independent reviewers selected eligible studies. Numerical and thematic analyses were performed to draft a preliminary framework including a definition. Next, the feasibility of the framework and definition was explored by physical therapy primary health care organization experts.

RESULTS

Numerical and thematic data on health care quality and context-specific performance resulted in a health care value framework for physical therapy primary health care organizations-including a definition of health care value, namely "to continuously attain physical therapy primary health care organization-centered outcomes in coherence with patient- and stakeholder-centered outcomes, leveraged by an organization's capacity for change."

CONCLUSION

Prior literature mainly discussed health care quality and context-specific performance for primary health care organizations separately. The current study met the need for a value-based framework, feasible for physical therapy primary health care organizations, which are for a large part micro or small. It also solves the omissions of incoherent literature and existing frameworks on continuous health care quality and context-specific performance. Future research is recommended on longitudinal exploration of the HV (health care value) framework.

What is different about social enterprises’ operational practices and capabilities?

The aim of this paper is to identify the main practices and capabilities developed by social enterprises and to explore the relationship between the dual organizational identity of social enterprises and their operational capabilities. A multiple case-study research is conducted comprising five cases representative of the diversity of social enterprise models. The results suggest that the operations strategy in social enterprises is influenced by their dual organizational identity and entails some operational practices and capabilities beyond those traditionally reported in manufacturing companies. They adopt a greater diversity of practices aimed at improvement and cooperation capabilities and their specificities lead to the development of the mobilization of resources capability and the openness capability. Social enterprises with a high social identity show greater evidence of the development of these operational capabilities. This study contributes to the literature on operations strategy by identifying a set of operational practices and capabilities developed by social enterprises and exploring how they are influenced by their dual organizational identity. It responds to the claims that suggest that studying social enterprises would be a fertile ground to advance theoretical and empirical research in the field of service operations. Developing knowledge on the operations management of social enterprises provides valuable insights into improving the performance of such organizations.

How to Characterize Business Excellence and Determine the Relation between Business Excellence and Sustainability

A descriptive attribute or characteristic of an object is called dimension. In the area of Business Excellence, this concept is associated with national quality awards and Business Excellence models. The aim of the paper is to identify the Business Excellence dimensions, on the grounds of comparative analysis of selected national quality award models, including determination of relations between the Business Excellence and Sustainability. Cross-cultural comparison of Business Excellence core values in the analyzed excellence models/national quality awards will be helpful in identification of the Business Excellence dimensions. The main findings of this study are: The basis for achieving Business Excellence is to respect the core principles of TQM (Total Quality Management); Business Excellence dimensions can be identified based on core values; Business Excellence can be characterized through dimensions; there is a relationship between the Business Excellence dimensions and the Sustainability dimensions. This study is based on information that was gathered through an extensive literature review (research publications and research studies (documents) about the national quality awards and Business Excellence models using Internet and research databases (Web of Science, Scopus, EBSCO) and the authors’ own experience. Methods of analysis, comparison, selection, abstraction, induction, deduction, determination, and statistics were used. The paper is organized as follows: the methodology approach; the comparative review of the secondary data on Business Excellence core values in the analyzed models; discussion about the main findings, including the link between the Business Excellence dimensions and Sustainability dimensions.

Determining Factors That Influence Nurses' Perceptions of Quality Implementations Conducted in Hospitals in Turkey

BACKGROUND

Quality management program implementations in health services are team endeavors that involve all health service personnel. Because they are direct providers of care, nurses are best able to evaluate the influence of quality management program implementations on the health services and quality of care provided by hospitals.

PURPOSE

The aim of this study was to develop an instrument to determine how nurses perceive the implementation of quality management programs in hospitals. Furthermore, the nurses' perceptions of the influence of these implementations on the quality of patient care and their job satisfaction were examined.

METHODS

A descriptive, comparative, cross-sectional online survey was conducted using a convenience sample (N = 388) of practicing nurses working at public and university hospitals where quality management programs were implemented. Nurses' perceptions of the implementations were analyzed using confirmatory factor analysis, whereas the influence of nurses' perceptions of quality management implementations on patient care and job satisfaction was measured using structural equation modeling approaches.

RESULTS

This study revealed that the instrument is valid and reliable for the measurement of participant perceptions of quality management program implementations. Nurses' perceptions were generally negative, and they exhibited negative attitudes toward the implementation of quality management in the institutions where they work. However, the quality management program implementations had little influence on perceptions of the quality of patient care. Participant job satisfaction was lower than average, and the quality management program implementations conducted in the hospitals negatively affected job satisfaction. On the other hand, participants who worked at university hospitals perceived quality management program implementations more affirmatively; patient care quality and job satisfaction were viewed more positively as well.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Because nurses do not participate effectively in quality management program implementations, they perceive these efforts as unnecessary and the responsibility of the quality control department. It is very important to ensure that all care-service providers participate to effectively implement quality management programs in hospitals and to encourage the adoption of a culture of patient safety in all institutions.

An empirical study to investigate the effects of critical factors on TQM implementation in the garment industry in Bangladesh

Purpose

The purpose of this paper is to investigate the factors that enable total quality management (TQM) implementation in the readymade garment (RMG) sector of Bangladesh. More specifically, the present study is a supplement of the previous call from research to investigate the TQM-enabling factors from a broader aspect of organizational change.

Design/methodology/approach

This study was conducted through an online survey, followed by phone calls. Data were collected using a questionnaire survey with 256 respondents of the Bangladeshi RMG sector. The TQM-enabling factors were divided into five distinct groups, based on strategic or overall changes required within an organization for TQM implementation. A theoretical research model was created to investigate the contingency of various TQM-enabling factors. Structural equation modeling (SEM) was applied to confirm the factor that enabled TQM implementation in the RMG sector of Bangladesh.

Findings

The main finding of this study shows that structural, strategic, contextual and human resource-enabling factors are significant to TQM implementation in the Bangladeshi RMG sector.

Research limitations/implications

This study has been completed in single time frame. Therefore, consideration of the time factor is completely ignored in this research. Furthermore, understanding of TQM-enabling factors in this research relied on quantitative findings only. Also, this study was limited to one industry and one geographic region. However, this study could determine whether data triangulation will provide a good perception on enabling factors and the methodology can be extended to other industries and regions.

Practical implications

This study provides a research methodology for other manufacturing industries that are planning to implement TQM in their organization. This research will contribute to the existing literature by examining the contingency of various TQM-enabling factors in the context of the Bangladeshi RMG sector, and it, therefore, provides direction to increase the success rate of TQM implementation. Furthermore, the research methodology can be used in other studies for variation of contextual variables such as size of the industry, developed or underdeveloped country and manufacturing or service industry.

Originality/value

The methodology used in this study can lead the way for other industries in the RMG sector that implements TQM in their organization. Also, this research further contributes to the existing literature by investigating the contingency of various TQM enabling factors in the context of the Bangladeshi RMG sector and developing associated strategies to raise success rate of TQM implementation.

Use of the EFQM excellence model to improve hospital pharmacy performance

BACKGROUND

Quality management systems are widely used to improve the quality and efficiency of healthcare services. However, evidence regarding the value of the European Foundation for Quality Management (EFQM) model in improving the performance of hospital departments is lacking.

OBJECTIVE

To describe the value of the EFQM model as a quality framework for improving the performance of a hospital pharmacy department (PD).

METHODS

DESIGN

A case study describing the development of the Enablers' criteria of the model and the results achieved.

SETTING

PD in a tertiary-care teaching hospital of the Madrid Public Health Service (Spain).

INTERVENTIONS

Four self-assessments were conducted using the questionnaire "Perfil" during the period 2008-2017. A quality improvement plan was developed on the basis of the results of each self-assessment. A balanced scorecard was used to track progress. Improvement in quality management was externally evaluated by the Spanish Management Excellence Club in 2010, 2013, and 2017.

MAIN OUTCOME MEASURES

Change in the scores obtained in the external assessments, the quality improvement initiatives implemented for each Enabler's criteria, and the results of key performance indicators.

RESULTS

The EFQM was a useful framework for self-assessment and a good system for identifying improvement initiatives. The model progressively improved the services provided for patients, the safety and efficiency of pharmacotherapy, productivity of the PD, and customer and staff satisfaction. The external assessment scores exceeded 300 points in 2010, 400 points in 2013, and 500 points in 2017. Scores for all of the criteria progressively improved, particularly in 'people'.

CONCLUSIONS

The EFQM was a practical tool for improvement of PD performance, especially in areas such as strategic planning, people management, and innovation. The main difficulties were the lack of decision-making capacity in relevant areas and benchmarking with other PDs.

Prioritizing the barriers of TQM implementation from the perspective of garment sector in developing countries

Purpose

The purpose of this paper is to investigate the relative importance of different total quality management (TQM) implementation barriers in the context of Readymade Garment (RMG) industries in Bangladesh. Present study has developed a hierarchical framework of several TQM barriers to assess their importance. Expert opinions from RMG industries have been taken to evaluate the importance of one barrier over another.

Design/methodology/approach

Methodology adopted in this study to find out the rank of different TQM barriers is fuzzy analytic hierarchy process.

Findings

The study shows that, according to order, inappropriate planning of TQM implementation program, lack of financial support, lack of employee training, lack of empowerment of employees, lack of sufficient physical resources, etc. are critical barriers and hampering the successful implementation of TQM program in this sector.

Research limitations/implications

This study has both theoretical and practical implications. It has found out strong and weak contribution of different barriers during TQM implementation. Therefore, this finding will strengthen the knowledge of successful implementation of TQM and will further enrich the existing literature in the context of manufacturing industries in developing countries. Moreover, this finding will also help the decision makers in preparing an effective plan for successful implementation of TQM by utilizing limited resources.

Practical implications

Moreover, our results will aid the managers of RMG sector to find the weight of importance of different barriers. Accordingly, they will make a plan to overcome the major TQM barriers which will increase the success rate of TQM implementation. Every Successful program will bring business excellence. These findings could be a guideline for TQM implementation program in developing countries.

Originality/value

Present study possesses some significant values. First, so far our knowledge go, no other study has developed a hierarchical structure of TQM barrier on the basis of overall change needed within the organization for TQM implementation. Second, this study could be a good guideline for TQM implementation program in RMG sector in developing countries.

Wolter J. Service recovery system antecedents: a contingency theory investigation

Purpose

The purpose of this paper is to examine the influence of different antecedent factors (contingencies) on the design of a service recovery system (SRS).

Design/methodology/approach

A conceptual model was framed and a series of hypotheses generated and tested using data from 158 practicing managers using a multivariate general linear modeling technique.

Findings

The analyses indicated that firms, by and large, mainly considered environmental factors in the SRS design. Additional evidence suggests that managers do consider other contingencies but may do so in a fragmented manner. The results presented herein indicate that firms design back-office aspects of SRS in response to external factors (i.e. the environmental contingency). In contrast, the front-office components appear to have more diverse antecedents but are strongly influenced by the firm’s recovery orientation. The specific recovery practices appear to be implemented per industry standards. In sum, evidence indicates that there are diverse driving factors to total SRS design.

Research limitations/implications

Limitations are based primarily on the methodology as data were obtained from a single person who represented the entire SRS. Care was taken in the study design in order not to compromise the validity of the findings.

Practical implications

The results indicated that managers responsible for system design need to be holistic in SRS design to more tightly link decisions across multiple contingencies so as to more fully integrate total service system design. This is potentially accomplished through the inclusion of aspects of all relevant contingencies when designing recovery systems.

Originality/value

This paper’s main contribution is that it employs established theory to develop and test a model to show that firms consider multiple contingencies while designing SRS. It contributes to the emerging body of work on SRS design by providing insights that can be considered as driving forces behind the design of SRS.

Drivers and internalisation of the EFQM excellence model

Purpose

Although the European Foundation for Quality Management (EFQM) Excellence Model has been widely adopted throughout Europe, a thorough examination of the factors that contribute to the internalisation of the model (i.e. a substantive adoption) has been neglected in the literature. The purpose of this paper is to present a model that analyses the drivers of the real internalisation of the EFQM excellence model, with a focus on the role of motives for adoption, and appraisal and compensation systems.

Design/methodology/approach

An empirical study was carried out based on a sample of Spanish organisations that had been awarded EFQM recognition. Structural equation models, cluster analysis and ANOVA were used to examine the research questions.

Findings

Internal motives concerning the creation of a participative style are the main driver of internalisation. Moreover, having an appraisal system-oriented towards the development of employees helps the substantive adoption of the EFQM model. These findings reinforce the importance of the soft elements of the EFQM model.

Originality/value

This study enhances evidence about the motives for adoption and their influence on the internalisation of the EFQM model. It analyses internalisation in a novel context, EFQM recognised organisations, and contributes to the debate about the efficacy of the EFQM model to performance improvement, by unveiling the factors that could foster the internalisation of the model within the organisational routines.

EFQM model’s application in the context of higher education

Purpose

The European Foundation for Quality Management (EFQM) excellence model has been widely used by higher education institutions (HEIs). However, knowledge about the state of the art concerning its application in the context of HEIs is still reduced. The purpose of this paper is to provide groundwork able to boost coordinated research efforts toward the development of the knowledge body in the field.

Design/methodology/approach

This research is based on a systematic literature review (SLR) of 25 papers identified in the ISI Web of Knowledge and SCOPUS databases, and considered relevant for analysis.

Findings

The paper provides a broad overview of the main issues explored so far in literature: potential benefits, potential barriers and critical success factors. By highlighting the main shortcomings of current research and the corresponding opportunities for additional research directions, the authors hope to boost further research efforts in the field.

Originality/value

To the authors’ knowledge, this is the first SLR in the field.

A customer journey perspective on service delivery system design: insights from healthcare

Purpose

The purpose of this paper is to provide novel theoretical insight into service delivery system (SDS) design. To do so, this paper adopts a customer journey perspective, using it as a frame to explore dimensions of experience quality that inform design requirements.

Design/methodology/approach

This study utilises UK Patient Opinion data to analyse the stories of 200 cancer patients. Using a critical incident technique, 1,207 attributes of experience quality are generated and classified into 17 quality dimensions across five stages of the customer (patient) journey.

Findings

Analysis reveals both similarity and difference in dimensions of experience quality across the patient journey: seven dimensions are common to all five journey stages, from receiving diagnosis to end of life care; ten dimensions were found to vary, present in one or several of the stages but not in all.

Research limitations/implications

Limitations include a lack of representativity of the story sample and the impossibility to verify the factual occurrence of the stories.

Practical implications

Adopting a patient journey perspective can improve the practitioner understanding of the design requirements of SDS in healthcare. The results of the study can be applied by managers to configure SDS that achieve a higher quality of patient care throughout the patient journey.

Originality/value

This paper extends existing literature on SDS design by adopting a customer journey perspective, revealing heterogeneity in experience quality across the customer journey currently unaccounted for in SDS design frameworks. Specifically, the findings challenge homogeneity in extant SDS design frameworks, evidencing the need for multiple, stage-specific SDS design requirements.

Economic crisis and business excellence: a comparative multi case study assessment

Purpose

The purpose of this paper is to investigate the impact that crisis had on quality management and basic business processes using INSEAD’s industrial excellence framework (IEF) towards large Greek industrial units. This study proposes a modified version of the IEF which can help firms to operate through a turbulent environment.

Design/methodology/approach

Data that were collected during the current financial crisis were compared with a matched sample of business units surveyed a decade earlier. The variables that were used to measure performance were grouped into two categories, quality management and process improvement.

Findings

Through the examination of these cases, the authors identify the characteristics that empowered those BUs so as to remain alive during the turbulence. According to the results, the survivors train their staff systematically, have closer relationships with their suppliers, assess their processes and follow up with action plans. Findings also suggest cultural differences between survivors vs non-survivors. Survivors display a cultural profile typical to adhocracy since they describe themselves as more flexible and externally focused instead of being stable and internally focused. These findings are discussed and avenues for future research are presented.

Practical implications

The results of the study can be applied by quality managers of industrial organizations to achieve higher performance and overcome a turbulence of the external environment.

Originality/value

Previous research on the business excellence frameworks neglects the essential issue of sustainability and how an organization can survive a crisis. The study provides new insights into the long-term benefits of applying an excellence framework.

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.