Correspondence: KS HayatiDepartment of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, UPM Serdang, Selangor Darul Ehsan, 43400, Malaysia, Email hayatik@upm.edu.my
Received 2018 Dec 4; Accepted 2019 Jul 11. Copyright © 2019 Alzoubi et al.This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
Synergistic integration of predictors and elements that determine the success of total quality management (TQM) implementations in hospitals has been the bane of theoretical development in the TQM research area. Thus, this paper aims to offer a systematic literature review to provide a foundation on which research on TQM can be built and to identify the predictors of successful TQM in the health-care context.
A systematic literature survey was adopted in this paper, involving the review of 25 relevant researched articles found in the databases Science Direct, EBSCO, MEDLINE, CINAHL and PubMed.
The systematic literature survey reveals five variables to be core predictors of TQM, signifying how important these variables are in the successful implementation of TQM in the health-care context. Also, it is revealed that the identified core predictors have positive effects on an improved health-care system. However, the systematic survey of the literature reveals a dearth of studies on TQM in the health-care context.
As TQM has become an important management approach for advancing effectiveness in the health-care sector, this kind of research is of value to researchers and managers. Stakeholders in the health sectors should introduce and implement TQM in hospitals and clinics. Nevertheless, this study has limitations, including that the databases and search engines adopted for the literature search are not exhaustive.
Keywords: total quality management, total quality management implementation, health care, commitment, systematic literature review, critical success factors
Given the snowballing global economic competition and other external pressures, organizations have been compelled to pursue enduring quality and quality management which will, in turn, enhance their competitive advantage. Quality as a concept has metamorphosed over the years, and it involves objective quality bordering on the characteristics and quality of goods and services that meet implicit and explicit customer demands. It also includes subjective quality which denotes the capability to produce goods and services in the best, effective and efficient manner. 1
Looking at the health-care context, quality has always been aimed at since the time of Florence Nightingale. 2 Given that quality assurance is a requisite for economic survival, 3 and that it is an ethical, legal and social rights matter, 4 the health sector has been worried about it for more than a decade .2 Quality assurance is significant as it concerns customer satisfaction and the reduction of risks connected with health care to a minimum. 5 In the present time, health care has become a developing profession with an approach to care quality via the appraisal and regulation of structure, process and care result components. 6
Given the ever-increasing competitive and dynamic environment in which hospitals operate, and the need to augment hospitals’ performance and health-care quality, researchers 2 , 7 – 9 have conducted considerable research on enhancement of health-care quality. Moreover, given that nurse performance is crucial to the overall performance of the hospital and effective health-care system, there has been a research focus on nurse performance. 7 Nurses represent a large percentage of the health workers in any hospital. Nurses would play a significant role in the implementation of any intervention programs introduced by any hospital.
Moreover, research 8 – 11 has shown that the health-care system is facing a myriad of challenges which include high care cost, swiftly increasing dependence on technology, economic pressure on health organizations, reduction in health-care quality, 8 , 10 fulfillment of patients’ needs, 9 augmented numbers of patients who are suffering from multiple illnesses, increased demand for high-quality care, increased health-care costs and cost-containment pressures (Organization for Economic Cooperation and Development [OECD] 2007). 11 Some studies have indicated that an active way of surmounting health-care challenges is through an intervention program that will border on quality management (eg, total quality management [TQM]). 12
TQM is a system implemented by the management of an organization to achieve the satisfaction of customers/patients .13 The importance of TQM as a strategy to improve organizational performance has grown in this era of globalization. 14 Numerous research has revealed the role of TQM in the enrichment of system quality and enhancement of both employee and organizational performance. TQM is known for continuous quality improvement, quality management and total quality control. 10 TQM is held to be an innovative approach to the management of organizations. In the medical sector, TQM integrates quality orientation in all processes and procedures in health-care delivery .15 It is now being widely adopted in the medical sector of many countries. The research by Vituri and Évora 2 indicates that the literature on TQM in health sectors reveals that TQM has been fully adopted in some health institutions.
The implementation of TQM, upon which the success of TQM hinges, is intricate and complex; it depends on a good combination of certain predictors (ie, critical success factors [CSF]), and its benefits are difficult to accomplish .16 Different means of integrating predictors of TQM, although inconsistent, have emerged in the literature. 17 Some predictors have been considered crucial to TQM success, 18 and thus the exceptional predictors which can be adopted by organizations, irrespective of their industry, type, size or location. 19 These predictors are regarded as the determinants of firm performance via effective implementation of TQM.
Nevertheless, synergistic integration of predictors and elements, otherwise known as CSFs and which determine the success of TQM implementation, has been the bane of theoretical development in the TQM research area. Some of these predictors have been reported, by extant studies, 20 to have a positive impact on performance.
Likewise, substantive problems exist and can hamper theoretical development in the research area. The literature lacks foundation and structure on which the research on TQM in the health-care context is based, and connections between studies on TQM in the health-care context can hardly be drawn. The current state of extant research on TQM in the health-care context indicates that there is a need for more research in the area. 21 New knowledge development regarding identification of fitting predictors for successful TQM that enhance effectiveness in the health-care sector should be developed and where further research needs to be done should be identified.
Considering the extant works on a systematic literature review on predictors of TQM, two English written studies 14 , 22 are discernible, but Hietschold et al 14 focused on CSFs of TQM in general contexts while Aquilani et al 22 focused on the identification of TQM research, implementation of TQM research and impact-of-TQM-on-performance research in general contexts. Besides these two studies, no studies have focused on the systematic literature survey of predictors/elements of TQM in the health-care context.
Therefore, undertaking a systematic literature review in this aspect of research is germane, and this paper is poised to do as such. This paper conducts a systematic literature survey to provide a foundation stone on which research on TQM in the health-care context can be built, to evaluate the current state of evidence for TQM in the health-care context, to reveal inadequacies in the literature and to point to where further research needs to be done.
This research is guided by the following research question: what are the predictors of successful TQM in the health-care context between the period of 2005 and 2016? Like the two previous studies on a systematic literature review of TQM, this paper adopts and applies the three core steps of planning, execution and reporting that constitute a systematic literature survey. 23
This research seeks to obtain the most important predictors of successful TQM in the health-care context. This includes the review of published peer-reviewed works in English-language journals, which were published between 2005 and 2016. The literature was sourced from Science Direct, EBSCO, MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index of Nursing and Allied Health Literature) and PubMed (US National Library of Medicine).
As part of the process of systematic literature analysis in this paper, a structured search of the academic literature was conducted to find published articles that identified TQM, total quality management, implementation, CSFs, health care and nursing. The keywords used in the search are TQM, total quality management, implementation, critical success factors, health care and nursing.
As presented in Figure 1 , a search of Science Direct, MEDLINE, EBSCO, CINAHL and PubMed yielded 2133, 6341, 1867, 7 and 474 articles, respectively. Then, repeated citations, dissertations and case studies were deleted. Via reading of the title and abstract, the remaining articles were narrowed down by relevance. Only peer-reviewed academic and practice articles that focus on total quality management, implementation, CSFs health care and nursing were selected. This exercise yielded a total of 475 articles which were published between 2005 and 2016.