Professional Documents
Culture Documents
(Lahore),26(5),2603-2616,2014
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S.M. Irfan, 2Daisy Mui Hung Kee, 1Rashid Waheed Qureshi, 3Rashid Hussain
ABSTRACT: Due to the rising costs of health care, complexities in diseases and in its diagnostics, huge equipment and
treatment costs, high customer expectations for quality, has built a tremendous pressure on health care institutions in
almost all the developed and developing economies to transform their old fad working system to cost effective, patient
focus, efficient and high quality services. Thus to deliver high quality of health care services, to gain patient and their
families satisfaction, quality has taken a central position. To ensure quality, patient safety, preventive measures to
control infections, and gain patient and their families satisfaction, there is a growing trends among the health care
institutions to implement quality standard and systems. Majority of the well know hospitals around the globe has
adopted or adapted quality management systems to address the above issues. Total Quality Management (TQM) is a
well proven strategic management system in all sectors of industry to achieve excellence in business by focusing on
customer needs and wants for superior quality and cost effective services or products. This study aimed to identify the
critical success factors (CSFs) of TQM for the successful implementation of TQM in health care sector of Pakistan.
After a careful and comprehensive review of 135 studies on TQM and also considering the importance of contextual
factors of hospital settings in Pakistan, this study proposed 9 CSFs of TQM for health care sector: top management
commitment and leadership role, human resource focus, process management, supplier quality management, quality
data and reporting, strategic quality management, patient focus, continuous quality improvement, and services focus.
Descriptive statistics and Pareto analysis were employed to identify the core CSFs of TQM for health care. Suggested
CSFs of TQM can be employed in order to achieve excellence in health care services.
Keywords: TQM, critical success factors (CSFs), health care in Pakistan, Pareto Analysis
1. INTRODUCTION
The rising costs of healthcare, complexities in diseases and
in its diagnostics, huge equipment and treatment costs and
high customer expectations for quality, has built a
tremendous pressure on health care institution in the
developed and developing countries to transform their old
conventional
working system with efficient quality
management systems. Rapid developments in medicines and
medical field, advancement of technologies for patient
diagnostics and treatment, cost effective, specialized and
high quality healthcare services have created a competitive
environment in the healthcare market. The increasing
demand for better quality of health care services, and patient
safety issues has put an immense pressure on health care
institution to develop a positive consumer culture, increased
efficiency, flexibility, and improved quality of healthcare
services [1, 2]. Thus old models of assuring quality through
self-defined quality standards by healthcare provider are no
longer sufficient to solve quality problems in the healthcare
sector. Thus, Health care institutions require immediate
reforms to address the quality and patient safety issues [3]
Some of the hospitals has adapted or adopted quality
management systems, standards, and also have been
accredited by quality and health care quality accreditation
agencies but still a large number of hospitals are providing
lower level of required health care services to the patient.
This issue has been of a major concern for health care
managers and they need to redesign strategies by focusing
on patient requirement for high quality of services at
affordable costs [4]. According to health care industry in
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3 RESEARCH METHODOLOGY
Main aim of this study is to identify the CSFs of TQM in
health care keeping in view, the contextual factors of
Pakistani working environment, organizational structures,
and organizational culture. First step is to identify the
appropriate research articles for this study, we used
academic journals and databases like; Science Direct and
Scopus, Taylor Francis, EBSCO Host, Emerald, Willey on
line library, and Google Scholars. For specific articles we
used phrases, Critical Success Factors for TQM, TQM
implementation, Instrument for TQM implementation,
CSFs
of
TQM,
TQM
in
health
care/manufacturing/services, and TQM practices. After
a detailed review of articles only those articles were
selected where, TQM CSFs or TQM practices were
discussed and tested either theoretical or empirically and
selection process is given in the Figure 2.
To avoid duplication of the selected articles, researchers
import references into reference manager Endnote X7. For
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Labels
Top Management
Commitment and
Leadership role
Human Resource
Focus
Quality Data and
Reporting
Customer Focus
Process management
Supplier Quality
Management
Product /Service
quality Design
Continuous quality
improvement
Strategic quality
planning
Benchmarking
Quality management
system
Sci.int.(Lahore),26(5),2603-2616,2014
Fig. 5
Sci.int.(Lahore),26(5),2603-2616,2014
Labels
1.
2.
3.
4.
5.
TMC
HRF
QDR
CSF
PRM
6.
SQM
7.
CIM
8.
9.
10.
11.
SDG
SQP
BEN
QCL
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
QMS
COM
SPC
SRP
CUL
RCM
JIT
SER
TCM
CQL
TSY
ZDF
FLX
COP
OPQ
OBH
QCR
IPT
30.
31.
32.
33.
EIM
DCM
DSI
SRM
34. OPS
35. STF
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Fig. 2
Fig. 6
comprehensive review of literature and these dimensions
are best fit in the context of Pakistani public as well as
private hospitals. The model developed in this paper
provides a promising theoretical perspective to explore
CSFs of TQM in Pakistani health care sector. We have
attempted to tie various literature reviews and research
regarding on TQM and CSFs together to identify the CSFs
in healthcare setting. Ultimately, we believe that nine CSFs
which are considered as core CSFs of TQM and provides a
guarantee for its success provided the barriers and obstacles
discussed in literature should be addressed first.
5.1 Top Management Commitment and Leadership
Role
Role of top management is the foremost important and
considered as a fist enabler in TQM implementation in any
organization. The key challenge for the top management is
to effectively manage the relationships among companys
vision, mission, strategies, quality values, and to make a
clear understanding among the employee. Any strategic
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7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
REFERENCES
1. Lee, A.W. Ng, and K. Zhang, The quest to improve
Chinese healthcare: some fundamental issues.
International Journal of Health Care Quality
Assurance. 20(5): p. 416-428, 2007.
2. Mosadegh Rad, A survey of total quality management
in Iran: barriers to successful implementation in health
care organizations. Leadership in Health Services.
18(3): p. 12-34, 2005.
3. Koeck, C. and V. Kazandjian, Doing better: a global
medical interest. The Effectiveness of CQI in Health
Care: Stories from a Global Perspective, ASQC
Quality Press, Milwaukee, WI. 1997.
4. Mosadegh Rad, The impact of organizational culture
on the successful implementation of total quality
management. The TQM Magazine. 18 (6): p. 606-625,
2006.
5. Short, P. and Rahim, Total quality management in
hospitals. Total Quality Management. 6(3): p. 255-264,
1995.
6. Manjunath, U., B.A. Metri, and S. Ramachandran,
Quality management in a healthcare organisation: a
case of South Indian hospital. The TQM Magazine.
19(2): p. 129-139, 2007.
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