An evaluation of the use of TQM (Total Quality Management) to gain competitive advantage in Private Healthcare

A case study of Eko Hospital,Lagos, Nigeria.

By

ABSTRACT

This report focussed on evaluation of the use of TQM (Total Quality Management) to gain competitive advantage in Private Healthcare. The researcher chose the case of Nigeria hospital. The researcher achieved the following objectives

To study the literature on TQM

To study the implications of TQM in health care

To study the implications of TQM in private health care

To study the use of TQM to gain competitive advantage

The researcher used mixed research for this purpose. The researcher collected primary data and analysed the data using SPSS. This research filled gaps in the literature.

TABLE OF CONTENTS

ABSTRACTII

TABLE OF CONTENTSIII

CHAPTER 1: INTRODUCTION1

1.1 INTRODUCTION1

1.2 BACKGROUND6

1.3 INTRODUCTION TO HOSPITAL8

The Chronological History8

The Concept9

Mission10

1.4 PROBLEM STATEMENT10

1.5 RESEARCH AIMS AND OBJECTIVES11

1.6 RESEARCH QUESTIONS11

1.7 HYPOTHESIS12

1.8 SIGNIFICANCE12

CHAPTER 2: LITERATURE REVIEW16

2.1 TQM DEFINED16

2.2 HISTORY OF TQM17

2.3 THEORIES OF TQM18

Deming Theory18

Hellsten and Klefsjo Theory18

Garvin Theory19

Ishikawa and Imai Theory19

2.4 IMPLEMENTATION OF TOM IN ORGANIZATIONS20

2.5 CONSEQUENCES OF TOM IMPLEMENTATION22

2.6 BENEFITS OF TQM25

2.7 COMPETITIVE ADVANTAGE27

2.8 TQM AND COMPETITIVE ADVANTAGE28

2.9 TQM IN HEALTH CARE29

The Influence of Manufacturing30

The Healthcare Setting32

A Focus on Processes35

The Cost of Quality and the Concern for Management Control36

Performance Measurement39

Management Information Systems40

A Culture for TQM in Health Care41

2.10 THE QUALITY IMPROVEMENT MOVEMENT IN HEALTH CARE43

2.11 TQM VARIABLES IN HEALTH CARE45

System Perspective45

Customer Focus46

Upper Management Commitment46

Quality Department47

Involvement of ALL organizational members47

Quality Culture48

Teamwork48

Management by Fact49

Continuous Improvement50

Training and Education50

Suppliers50

2.12 PROBLEMS IN IMPLEMENTING TOM IN HEALTH CARE INDUSTRY51

2.13 SUMMARY52

CHAPTER 3: METHODOLOGY54

3.1 MIXED RESEARCH54

3.2 CLASSIFICATION OF RESEARCH METHODS54

Multi-method studies55

Mixed method studies55

3.3 STEPS IN MIXED METHODOLOGY55

3.4 STRENGTH AND WEAKNESS OF THE MIXED RESEARCH56

Strengths56

Weaknesses57

3.5 INSTRUMENT FOR DATA COLLECTION57

3.6 DATA COLLECTION PROCESS57

3.7 POPULATION58

3.8 SAMPLE AND SAMPLE SIZE58

3.9 DATA ANALYSIS AND TECHNIQUE58

3.10 RELIABILITY/DEPENDABILITY58

3.11 TRIANGULATION60

VALIDITY61

ETHICAL CONSIDERATIONS63

CHAPTER 4: DATA AND ANALYSIS64

4.1 QUANTITATIVE DATA ANALYSIS64

4.2 HYPOTHESIS TESTING78

Chi square test78

4.3 INTERVIEW DATA ANALYSIS79

The Role of the Board79

The Role of Senior Management80

The Impact on Middle Management81

The Impact on Staff84

The Union-Management Relationship85

Physician Involvement87

CHAPTER 5: CONCLUSIONS89

CHAPTER 6: RECOMMENDATIONS96

REFERENCES106

APPENDICES128

QUESTIONNAIRE128

QUANTITATIVE PART128

GENDER128

EXPERIENCE128

DUE TO TQM, THE STAFF OF YOUR HOSPITAL HAS BECOME MORE QUALITY CONSCIOUS130

INTERVIEW QUESTIONNAIRE133

CHAPTER 1: INTRODUCTION

1.1 INTRODUCTION

The current hospital industry is largely characterized by cost control within a hospital and competition among hospitals. The changes in the regulatory environment of reimbursement and accreditation agencies as well as the emergence of managed care systems are credited for these changes in the hospital industry. Namely, since 1980s, the hospital care industry has dramatically changed in response to the introduction of prospective payment systems (PPSs) by the federal government and the private third party payers such as Blue Cross and Blue Shield, and the appearance of alternative delivery systems such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

There are other environmental factors that are causing hospitals to pursue efficiency. These forces include the growth of assorted ambulatory health care delivery systems, competition among hospitals, more regulatory pressures created by the Health Care Financing Administration and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), increasing salary demands for healthcare professionals, adoption of advanced medical technologies, and uncertain political environment on the healthcare ...