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Total Quality Management : the development, application and analysis of a Total Quality Management paradigm in healthcare

Waddington, Michael E. (1995) Total Quality Management : the development, application and analysis of a Total Quality Management paradigm in healthcare. Doctoral thesis, University of Huddersfield.

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    The research programme focuses on Total Quality Management adoption and application.
    TQM which is established in a number of businesses and industries has more recently been
    introduced into healthcare. TQM definition and eclectic paradigm has been developed and
    tested for establishing quality performance and distinguishing radical change and continuous
    improvement approach. A number of critical elements and variables concerning
    implementation and application are identified which pertain to organisations which through
    size and bureaucracy operate with diverse missions, a wide range of systems and are
    characterised by degrees of rigidity from an employee mix of multiple knowledge,
    understanding competences skills and hence commitment.

    Research was conducted in healthcare provider organisations, which involved eighty-three
    NHS hospitals/Trusts, wherein two pilot, twelve TQM demonstration and sixty-nine sites
    were involved. The main focus concerned a case study Trust, which although
    demonstrating keen interest in quality management had not reached the formative stages of
    developing TQM definition or paradigm.

    The research framework is based on a number of approaches in that methods selected for
    evaluation were appropriate both to the situation and the context of TQM strategies being
    examined. Intention was to identify successes and failures of the TQM processes applied,
    establish similarities and distinguishable differences and determine extent to which TOM
    objectives were achieved and the impact of the processes on specific groups.

    The investigation was undertaken using longitudinal analysis which involved in-depth
    interviews with top managers and clinicians and a mix of employees, customers, potential
    customers and purchasers in the form of managers, consultants, hospital doctors, nurses,
    support services personnel, patients, members of the public and GPs. TOM Awareness and
    Action Seminars and Workshops involving personnel from a variety of international
    healthcare organisations provided an additional source of data. Self-completion
    questionnaires were also used.

    Data analysis compares and contrasts varying TQM models, processes, activities and results
    from degree of emphasis placed on critical elements and variables. Stage predictions and
    resulting outcomes are presented and quality of care improvements suggested from analysis
    of customer perceptions of quality and value. The findings show significant variations in
    approach between the hospitals/Trusts in matters which concern organisation, management
    and culture issues, resulting in a high proportion viewing TOM process as evolution from
    quality assurance to radical change, hospital process re-engineering and patient focused
    care A minority only included such processes in their application of TQM.

    Key conclusions result from attempt at establishing some measure of success and failure
    from TQM implementation and application. Findings contribute to the extant literature
    specifically in that beyond top management and clinician commitment to high level strategic
    focus is a combination of facilitator-led culture change, motivation and shared values
    directing attention to exceeding that of merely doing enough for reducing poor quality and
    customer complaints. Patient involvement in TOM is more problematic than literature
    suggests from both the patients and professionals perspectives of patient empowerment.

    Bottom-up action focused TQM paradigm working simultaneously with top down support
    and commitment requires barrier breaking, culture transformation and the establishment of
    internal/external customer and supplier chains and seeking to establish opportunities for
    continuous improvement and radical change in advance of attempts at in-depth
    implementation and evaluation. It is not over-statement to conclude that the majority of
    managers and clinicians were unaware of the costs of getting things wrong.

    Despite TOM being acted upon as driving force for competition most had limited knowledge
    of how much non-quality cost them, suggesting that they had not earlier thought it
    necessary to measure the costs of none or low quality. Research results, irrespective of
    applications definition or paradigm, question the views that TQM is long-term process.
    Whether these may be concluded as desire to integrate TOM with other foci or vacuum
    sucking in panaceas was unclear. It was clear however that although quality in healthcare
    is sacred total quality management is not.

    Item Type: Thesis (Doctoral)
    Additional Information: EThOS Persistent ID
    Uncontrolled Keywords: NHS hospital trusts, TQM Management, Medical care
    Subjects: R Medicine > R Medicine (General)
    H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
    H Social Sciences > HD Industries. Land use. Labor
    Schools: The Business School
    Depositing User: Graham Stone
    Date Deposited: 01 Jul 2009 11:44
    Last Modified: 28 Jul 2010 19:39


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