Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals

Factor Analysis of Quality Management Systems Implementation in Healthcare: An Online Survey

This paper investigates the views of healthcare researchers and professionals on the implementation of the Quality Management System (QMS) approach using a 5-point Likert scale survey. Researchers and healthcare professionals who observed or participated in QMS implementation were surveyed. Multiple channels, including occupational societies, social networking, i.e., LinkedIn, hospital’s directories, award recipients, academic researchers, and professional connections, made it possible to reach this particular sample. Participants were surveyed using a series of questions with a total of 56 questions. The survey was administrated through the web portal of Qualtrics and then analyzed both on Qualtrics and SPSS software packages. Descriptive Statistics, Exploratory Factor Analysis (EFA), and Linear Regression were employed to draw conclusions. The final sample group consisted of 71 participants representing a range of healthcare settings. EFA was conducted, producing a model of 10 emergent factors and an outcome for total improvement. Regression modeling revealed the Critical Success Factors (CSFs) and the interaction between emergent factors. The results indicated that QMS Implementation Culture, Structure, and Managerial Training are critical to the QMS implementation success. This research helps quality professionals enhance their ability to prioritize elements affecting the successful implementation of the QMS.

What hospitals need to know about guidelines-A mixed-method analysis of guideline implementation in Dutch hospitals

RATIONALE, AIMS AND OBJECTIVES

This study provides insight into how Dutch hospitals ensure that guidelines are used in practice and identifies what key messages other hospitals can learn from existing practices. We examine current practices in handling compliance and, therefore, focus on hospitals that reported that they do not experience problems in the implementation of guidelines.

METHOD

A survey of Dutch hospital boards and 9 semistructured interviews were conducted with a purposive sample of 3 hospitals. Interviews were held with 3 representatives of each hospital, specifically, with a member of the board of directors, a member of the executive medical staff, and the manager of the quality and safety department.

RESULTS

Hospitals find guidelines necessary and useful. Hospitals have the power to improve implementation if boards of directors and medical staff are committed, intrinsically motivated, cooperate with each other, and use guidelines pragmatically. Even then, they prioritize guidelines, as resources are scarce. Despite their good work, all hospitals in this study appeared to struggle to adhere to guidelines.

CONCLUSIONS

If hospitals experience problems with guideline implementation, they tend to focus more on external expectations, leading to defensive behaviour. Hospitals that do not experience implementation problems focus more on integrating guidelines into their own policies.

Quality Management Systems Implementation Compared With Organizational Maturity in Hospital

BACKGROUND

A quality management system can provide a framework for continuous improvement in order to increase the probability of customers and other stakeholders' satisfaction. The test maturity model helps organizations to assess the degree of maturity in implementing effective and sustained quality management systems; plan based on the current realities of the organization and prioritize their improvement programs.

OBJECTIVES

We aim to investigate and compare the level of organizational maturity in hospitals with the status of quality management systems implementation.

MATERIALS & METHODS

This analytical cross sectional study was conducted among hospital administrators and quality experts working in hospitals with over 200 beds located in Tehran. In the first step, 32 hospitals were selected and then 96 employees working in the selected hospitals were studied. The data were gathered using the implementation checklist of quality management systems and the organization maturity questionnaire derived from ISO 10014. The content validity was calculated using Lawshe method and the reliability was estimated using test - retest method and calculation of Cronbach's alpha coefficient. The descriptive and inferential statistics were used to analyze the data using SPSS 18 software.

RESULTS

According to the table, the mean score of organizational maturity among hospitals in the first stage of quality management systems implementation was equal to those in the third stage and hypothesis was rejected (p-value = 0.093). In general, there is no significant difference in the organizational maturity between the first and third level hospitals (in terms of implementation of quality management systems).

CONCLUSIONS

Overall, the findings of the study show that there is no significant difference in the organizational maturity between the hospitals in different levels of the quality management systems implementation and in fact, the maturity of the organizations cannot be attributed to the implementation of such systems. As a result, hospitals should make changes in the quantity and quality of quality management systems in an effort to increase organizational maturity, whereby they improve the hospital efficiency and productivity.

Essentials of total quality management: a meta-analysis

PURPOSE

The purpose of this paper is to identify critical successful factors for Total Quality Management (TQM) implementation.

DESIGN/METHODOLOGY/APPROACH

A literature review was conducted to explore the critical successful factors for TQM implementation between 1980 and 2010.

FINDINGS

A successful TQM implementation need sufficient education and training, supportive leadership, consistent support of top management, customer focus, employee involvement, process management and continuous improvement of processes.

RESEARCH LIMITATIONS/IMPLICATIONS

The review was limited to articles written in English language during the past 30 years.

PRACTICAL IMPLICATIONS

From a practical point of view, the findings of this paper provide managers with a practical understanding of the factors that are likely to facilitate TQM implementation in organisations.

ORIGINALITY/VALUE

Understanding the factors that are likely to promote TQM implementation would enable managers to develop more effective strategies that will enhance the chances of achieving business excellence.

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.

Why TQM does not work in Iranian healthcare organisations

Purpose

– Despite the potential benefits of total quality management (TQM), many healthcare organisations encountered difficulties in its implementation. The purpose of this paper is to explore the barriers to successful implementation of TQM in healthcare organisations of Iran.

Design/methodology/approach

– This study involved a mixed research design. In-depth interviews were conducted with TQM practitioners to explore TQM implementation obstacles in Iranian healthcare organisations. In addition, this study involved survey-based research on the obstacles associated with successful TQM transformation.

Findings

– TQM implementation and its impact depend on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in Iranian healthcare organisations can be attributed to the non-holistic approach adopted in its implementation, inadequate knowledge of managers’ about TQM implementation, frequent top management turnover, poor planning, vague and short-termed improvement goals, lack of consistent managers’ and employees’ commitment to and involvement in TQM implementation, lack of a corporate quality culture, lack of team orientation, lack of continuous education and training and lack of customer focus. Human resource problems, cultural and strategic problems were the most important obstacles to TQM successful implementation, respectively.

Practical implications

– Understanding the factors that are likely to obstruct TQM implementation would enable managers to develop more viable strategies for achieving business excellence.

Originality/value

– Understanding the factors that are likely to obstruct TQM implementation will help organisations in planning better TQM models.

ISO 9001 in health service sector: a review and future research proposal

Purpose

– This paper aims to describe the state-of-the-art in ISO 9001 research in healthcare service sector and propose the future research agenda.

Design/methodology/approach

– A comprehensive literature review of the ISO 9001 studies in healthcare service sector was carried out.

Findings

– The effectiveness of ISO 9001 implementation in healthcare service sector is still not clear. Previous researches show common stages for implementing ISO 9001 in a healthcare service organization. However, there is no previous research that reveals the content of the system implemented. In addition, there is no previous research that reveals the interpretation of ISO 9001 based on the practice of ISO 9001 implementation in an organization. Based on the review, eight future research agendas were proposed.

Originality/value

– The paper is believed to be the first to discuss the state-of-the-art of ISO 9001 researches in healthcare service sector.

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.

Role of a quality management system in improving patient safety - laboratory aspects

OBJECTIVES

The aim of this study is to describe how implementation of a quality management system (QMS) based on ISO 15189 enhances patient safety.

DESIGN AND METHODS

A literature review showed that several European hospitals implemented a QMS based on ISO 9001 and assessed the impact on patient safety. An Internet search showed that problems affecting patient safety have occurred in a number of laboratories across Canada. The requirements of a QMS based on ISO 15189 are outlined, and the impact of the implementation of each requirement on patient safety is summarized. The Quality Management Program - Laboratory Services in Ontario is briefly described, and the experience of Ontario laboratories with Ontario Laboratory Accreditation, based on ISO 15189, is outlined.

RESULTS

Several hospitals that implemented ISO 9001 reported either a positive impact or no impact on patient safety. Patient safety problems in Canadian laboratories are described. Implementation of each requirement of the QMS can be seen to have a positive effect on patient safety. Average laboratory conformance on Ontario Laboratory Accreditation is very high, and laboratories must address and resolve any nonconformities. Other standards, practices, and quality requirements may also contribute to patient safety.

CONCLUSION

Implementation of a QMS based on ISO 15189 provides a solid foundation for quality in the laboratory and enhances patient safety. It helps to prevent patient safety issues; when such issues do occur, effective processes are in place for investigation and resolution. Patient safety problems in Canadian laboratories might have been prevented had effective QMSs been in place. Ontario Laboratory Accreditation has had a positive impact on quality in Ontario laboratories.

Longitudinal analysis on the development of hospital quality management systems in the Netherlands

OBJECTIVE

Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a multi-layered organizational development programme based on quality improvement collaboratives. The objective is to answer the question as to whether these changes were accompanied by a further development of hospital quality management systems and to what extent did the development within the multi-layered programme hospitals differ from that in other hospitals.

DESIGN

Longitudinal data were collected in 1995, 2000, 2005 and 2007 using a validated questionnaire. Descriptive analyses and multi-level modelling were applied to test whether: (1) quality management system development stages in hospitals differ over time, (2) development stages and trends differ between hospitals participating or not participating in the multi-layered programme and (3) hospital size has an effect on development stage.

SETTING

Dutch hospital sector between 1995 and 2007.

PARTICIPANTS

Hospital organizations.

INTERVENTION

Changes through time.

MAIN OUTCOME MEASURE

Quality management system development stage.

RESULTS

Since 1995, hospital quality management systems have reached higher development levels. Programme participants have developed their quality management system more rapidly than have non-participants. However, this effect is confounded by hospital size.

CONCLUSIONS

Study results suggest that the combination of policy measures at macro level was accompanied by an increase in hospital size and the further development of quality management systems. Hospitals are entering the stage of systematic quality improvement.

Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department

BACKGROUND

Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality.

METHODS

As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness.

RESULTS

Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction.

CONCLUSION

Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of causes revealed the necessity of improvement. According to rules of quality management correcting measures and subsequent examination of effectiveness were performed. These changes resulted in higher satisfaction of patients, referring colleagues and clinic staff the like. Additionally the clinic is able to cope with an increasing demand for appointments in outpatients' departments, and the clinic's human resources are employed more effectively.