A PROPOSED MODEL OF TOTAL QUALITY MANAGEMENT IMPLEMENTATION WITH RESPECT TO HEALTHCARE INDUSTRY

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1 A PROPOSED MODEL OF TOTAL QUALITY MANAGEMENT IMPLEMENTATION WITH RESPECT TO HEALTHCARE INDUSTRY Prof. SURAJ M. SHAH 1 Prof. NIRAV R. JOSHI 2 1 Assistant Professor, V.M. Patel Institute of Management (Faculty of Management), Ganpat University, Gujarat & Research Scholar, Ganpat University, Kherva, Mehsana. 2 Assistant Professor, V.M. Patel Institute of Management (Faculty of Management), Ganpat University, Gujarat & Research scholar, RK University, Rajkot. ABSTRACT Total quality management is an incorporated attempt considered to improve quality performance at every level of the service industry. Currently, there is a growing attention in the healthcare industry to concern total quality management (TQM) principles and practices to advance customer s quality of service and care. The most powerful reason behind this is enlarged competitive market, development of medical know-how and high quality healthcare service at rational costs. Therefore, the healthcare managers start to find new ways to provide services to meet customer s requirement and TQM best fits to them as this concept had success in other service industries also. This paper highlights some of the present relationships of TQM implementation in the healthcare industry and develops a TQM implementation framework for them. This structure consists of five different stages which are incorporated scientifically to accomplish favoured result. The paper concludes that this framework of TQM implementation can direct to a superior industry performance of the healthcare industry as well as it is useful to frame the strategy to hire employee & it also leads to customer and human resources satisfaction. Keywords - Total quality management; TQM implementation; Healthcare industry. INTRODUCTION After globalization Indian markets are completely opened up to the worldwide rivalry today's potent business strategy means attainment competitive advantages by achieving market advantage over its competitors. In order to get competitive advantage the hospital should offer worth to its customers that the competitors are incapable to perform so therefore the self-motivated challenges of total quality management provides strong competitive advantage to recover product quality, enhance speed of delivery of service, remove idle labour, ensures uniformity, improved management practices, increases the knowledge graph of an organization, delight the customers by providing total customer service and total satisfaction which eventually direct towards customers service industry development with enhance in its market share. Total quality management was developed by a management consultant William Deming, whose work had great impact on Japanese manufacturing. It focuses on ensuring that internal guidelines and process standards reduce errors. Total quality management (TQM) can be defined as an integrated organizational effort designed to improve quality at every level (Philip,1984). OBJECTIVES OF THE STUDY: The purpose of this study is to explore the current literature on TQM and its implementation in the healthcare industry, and to design and develop a TQM framework. Specifically, the objectives of the present study are twofold: icmrrjournal@gmail.com

2 1. To review the literature on TQM and its implementation in the healthcare industry. 2. To find out proposed model for TQM implementation in the healthcare industry. LITERATURE REVIEW: Total quality management (TQM) is a management idea, spread all over the world, with the goal of getting better the operational and business presentation of the firm; by recommend a universal approach to frequently develop the operational performance to constantly accomplish consumers needs (Agus, 2005; Powell, 1995). Dow, Samson, and Ford (1999) indicated that most of the studies about TQM incorporated ideas developed by quality experts to describe quality exercise. However, one of the recommended approaches to decide this problem more successfully and basically, and to get improved value to health care service providers, was the implementation of total quality management (TQM) approach (Manjunath, 2007; Yang, 2003; Moody, Motwani, & Kumar, 1998; Short & Rahim, 1995; Kim & Johnson, 1994). TQM have now taken a vital role in the health care quality management (McLaughlin & Simpson, 1999). By adapting the concepts of TQM, the health care service firms can change their usual quality improvement system to customer oriented system through a structure relating customer focus, process management, new tools and techniques, and teamwork (Klein, Motwani, & Cole, 1998). The concept of TQM was first implemented in the manufacturing sector in early 1980s followed by the service sector and other sectors. In the recent years, many health care service sectors have applied the principles and practices of TQM in order to explain most of the problems that they are presently facing (Chesanov, 1997; Counte, Glandon, Oleske, & Hill, 1995; Kim & Johnson, 1994). Several studies have also highlighted that successful implementation of TQM can end in considerably better result in health care service sector (Short & Rahim, 1995; Yang, 2003; Counte et al., 1995), The result of the research were:- 1) Advance quality of service. 2) Improved health care quality and performance. 3) Patient satisfaction. 4) Reduced operating cost of health care institutions. 5) Employee satisfaction and 6) Patient safety. The study by Yasin and Alavi (1999) demonstrated the use of market share model for achieving competitive advantage of TQM in health care and concluded that TQM participated to rise in market share and firm efficiency. Chow-Chua and Goh (2000) concluded that constant upgrading and modern approaches such as TQM have produced charge and time savings and helped to make more efficient work processes. They further concluded that large hospitals and public hospitals were more liable to implement TQM approach while medium sized hospitals tend to use continuous improvement as a medium for quality improvement. Pfau (1989) studied that TQM is an approach for continuously improving the quality of goods and services express through the input of all levels and functions of the organization. Tobin (1990) analysed TQM as the totally included attempt for attainment competitive advantage by continually recovering every component of firm culture. Deming (1982) offer an operational definition of TQM which provides a motivational meaning to the idea. Sink (1991) studied that TQM can be winning only if the meaningful work is converted into policies by the leadership of the organization. Ovretveit [2000] presented an overview of TQM initiatives in the European healthcare. He first describes reasons behind the rise in interest in health quality and quality methods in Europe in the last one and a half decade. He then explains how TQM is different from other approaches and its strengths icmrrjournal@gmail.com

3 and weaknesses for healthcare quality improvement. Finally he concludes by presenting a summary of lessons for health organizations introducing TQM which arise from the European experience. Kunst and Lemmink (2000) studied that support on the hospital data examined the applicability of European Quality Assurance (EQA) model in recognized eminence development and business performance of hospitals. The findings of their study showed that dissimilar illustrative variables are linked with the development in TQM and company performance. Further, this study concludes that development in TQM directed to superior industry performance of the hospital, representing the efficiency/cost consequence and to an advanced perceived service quality by patients, indicating efficiency. A recent study by Salaheldin and Mukhalalati (2009) observed the implementation of TQM approach in the healthcare sector of Qatar. They identified the most execute TQM initiatives, the level of considerate and information of TQM, and the critical success factors of TQM implementation. The study found that there was a universal recognize between managers about the importance of topmanagement support and employee training and involvement in the TQM implementation program. Furthermore, the research recognized the fundamental role of the supplier in supporting quality upgrading in healthcare sector. MAJOR TQM PRACTICES IN HEALTH CARE SETTING INVESTIGATED FROM LITERATURE REVIEW: Lin and Clousing (1995) mainly focused on various TQM Practices like top-management commitment, teamwork and participation, continuous improvement and training and education. Hazilah (2009) mainly focused on various TQM Practices like (TMC) top-management commitment, teamwork and participation, process management, customer focus and satisfaction and resource management. Meyer and Collier (2001) mainly focused on various TQM Practices like top-management commitment, teamwork and participation, organization behavior and culture, continuous improvement and training and education. Carman et al. (1996) mainly focused on various TQM Practices like teamwork and participation, organization behavior and culture and continuous improvement. Kunst and Lemmink (2000) mainly focused on various TQM Practices like top-management commitment, process management, customer focus and satisfaction and management. resource Miller et al. (2009) mainly focused on various TQM Practices like top-management commitment, teamwork and participation, process management, customer focus and satisfaction and training and education. Mosadegh Rad (2005) mainly focused on various TQM Practices like top-management commitment, process management, customer focus and satisfaction and management. resource icmrrjournal@gmail.com

4 Salaheldin and Mukhalalati (2009) mainly focused on various TQM Practices like topmanagement commitment, resource management, organization behavior and culture, continuous improvement and training and education. Duggirala et al. (2008) mainly focused on various TQM Practices like teamwork and participation and resource management. Isouard (1999) mainly focused on various TQM Practices like top-management commitment, process management, resource management, continuous improvement and training and education. Kozak, Asunakutlu, and Safran (2007) mainly focused on various TQM Practices like topmanagement commitment, teamwork and participation, customer focus and satisfaction, resource management, organization behavior and culture, continuous improvement and training and education. Short and Rahim (1995) mainly focused on various TQM Practices like top-management commitment, teamwork and participation, process management and customer focus and satisfaction. Wardhani et al. (2009) mainly focused on various TQM Practices like top-management commitment, organization behavior and culture; and training and education. Arasli and Ahmadeva (2004) mainly focused on various TQM Practices like (PMZ) process management, customer focus and satisfaction, resource management and organization behavior and culture. There are five best practices in TQM implementation identified from the review of literature, namely, 1) top-management commitment or leadership, 2) teamwork, 3) process management 4) customer focus and satisfaction 5) Resource management

5 Topmanagement Commitment Upgraded quality of service Teamwork and participation Improved health care quality Process Management Resource Management Customer focus and satisfaction TQM Practices TQM Implem entation Patient satisfaction Reduced operating cost of health care institutions Employee satisfaction Patient safety Proposed TQM Model for healthcare industry Outcomes Implementation of the various TQM practices for the healthcare industry Stage-1: Top-management Commitment a) Building Management Commitment:- Top-management of the healthcare industry must focus on TQM principles, should communicate the reasons with the employees for adopting TQM, top-management assumes responsibility for quality improvement performance and reviews these activities frequently, and should involve all employees in quality focused training

6 b) Leadership Style and Change in Organizational Top-management should communicate and work to a much more open-minded style with their coworkers and authorities need to guide, educate and to encourage the subordinates. c) Setting the Management Principles and Quality Foremost management principle is to change the traditional organizational culture to be quality oriented and customer-oriented culture. It Consists special attention for patient care, regular qualityfocused training program for managers and other employees, and scope of improvement through feedback system. d) Quality Leadership and Role of Physicians Top-management should lead and promote value in the organization, they should motivate all to participate in quality improvement planning and physicians should be involved for clinical and nonclinical-based quality improvement initiatives. Stage-2: Teamwork and participation a) Resource Management Organizations should provide sufficient support to HR and professionals to achieve patient care and service. Technological developments will result in innovations in products and services. b) Personnel Management Improving level of expertise, development of open communication in organization, and competencies and responsibilities will help in developing good personnel management in the organizations. A clear competency for personnel will avoid conflicts. c) Policy and Strategy Another important task for implementing TQM in the healthcare industry is the focus towards customer requirements and expectations. This can be done by taking care of the patients, taking into account the opinions of stakeholders, development of formulating and evaluating strategy. d) Training Resources Organization should maintain sufficient resources for employee training. Quality-focused training should be given to all managers and technical employees as well as to non-technical employees. Stage-3: Process Management a) Delivering the Concepts of Quality to Employees Management needs to change employees concepts into the correct concepts of quality such as medical treatment quality, service quality, zero defect that is to do the right thing right first time, and customer satisfaction. b) Conduct TQM Educational and Training Program To impart the knowledge employees education and training are fundamental principles for implementation of TQM icmrrjournal@gmail.com

7 c) Standardizing the Processes and Management The customer service processes and internal operation procedures should be standardized and well managed to assure the quality of medical treatment such as prior appointment system, quick registration, computerized on-line information, and doctor-to-bed ratio. d) Management By Fact Organization should assure the service delivery processes by means of performance measure. Working procedures and norms should be available for all, use of guidelines and procedures for dealing with complaint, and feedback system should be used to improve care or service. Stage-4: Resource Management a) Teamwork Development Teamwork and participation are essential components of TQM implementation program. Especially in hospitals, it requires co-operation among all related departments and centers. There should be formation of quality improvement teams and quality councils to remove interdepartmental barriers. Approach like quality circle, cross-functional teams etc. are better options. b) People-Based Management One of the core concepts of TQM is to remove barriers and empower people to work in teams. For example, in hospitals, nurses and doctors come together to discuss standards and service design. There should be inter-professional cooperation to work as team. There is need of team-working across entire specialties or groups of specialties. c) Employee Relations To ensure better relations among staff members, cross departmental teams should be developed and employees should be recognized for their superior quality improvement performance. d) Supplier Participation Supplier involvement is vital and important in supporting quality improvement activities. A management worker- supplier partnership helps in creating conducive work environment and improvement. Stage-5: Customer focus and satisfaction a) Customer Focus The hospitals need to be proactive in analyzing the requirements from customers in order to take action to fulfill the needs of customers. Customer satisfaction should be consistently monitored and regularly reported to hospital management. b) Performing Regular Survey of Customer Regular customer satisfaction survey should be conducted to know the problems and necessary steps should be taken for further improvement. Benchmarking & Benchmarking and hospital audit will be useful to gain competitive advantage icmrrjournal@gmail.com

8 c) Customer Feedback Customer feedback should be taken based on scoring system addressing various dimensions.various feedback practices should be followed like feedback form, questionnaire, customer Participation meetings etc. and same is sent to quality department for further action and improvement. d) Performance Measurement Performance measurement is one of the important factor in implementing TQM to ensure continuous improvement. There should be a procedure or mechanism to measure performance in the organization. Managerial Implications For the successful implementation of TQM philosophy in the health care institution some of the managerial implications of the current study are: Health care service providers will be able to use TQM model as a strategic competitive weapon for achieving desirable outcomes such as Improved quality, patient satisfaction, Employee satisfaction, patient safety and improved performance. Model will enable Health care service providers to pay more attention to the vital role of topmanagement and employees and staff in the TQM initiation, implementation, and success stages. As per the singh s report in BMJ quality and safety, it was estimated that 5.08% patients receive an inaccurate diagnosis. Proposed model will be useful to improve diagnosis through improved service. As per the HCAHPS (Hospital Consumer Assessment of health care providers and systems) patient dissatisfaction is increasing because of lack of safety measures in hospitals and higher costs. Proposed Model will be helpful to reduce patients dissatisfaction and will also boost employee satisfaction through proper resource management. Proposed Model will be helpful to implement Management by Fact ( using process management) where by all employees will collect data about the work they perform and by using that information they will make decisions which affects their work. Health care service providers can draw attention in enhancing the organization culture and developing teamwork and participation at all levels. Proposed TQM model gives prior importance to training and education. Health care service providers can understand the importance of satisfying all internal and external stakeholders upon the implementation of TQM Model. This model will be helpful to improve health care quality along with service quality. It will also raise the standard of living. CONCLUSION The successful implementation of Total quality Management model needs extensive planning and most importantly participation of every single member who is benefitted out of the organization(management, suppliers, clients and even customers). Without the participation of each and every employee, total quality management model would be a complete failure. Total Quality Management model begins with research and collecting information about end-users followed by planning and full participation of employees for successful implementation. Top level Management needs to make other team members aware of the benefits of total quality management icmrrjournal@gmail.com

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