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The purpose of this paper is to develop a total quality management (TQM) model for healthcare organisations and validate it using a sample of Iranian healthcare organisations.

A validated questionnaire was used to collect data from all healthcare organisations that implemented TQM in Isfahan province, Iran.

Using the proposed model, TQM implementation was measured in healthcare organisations. The level of TQM success in Isfahan healthcare organisations was medium. The highest score was achieved in the dimension of “customer management”, followed by “leadership” and “employee management”. Employee management, information management, customer management, process management and leadership had the most positive effect on TQM success. Using a series of quality management techniques had “synergistic” effect on TQM success.

Top management support, effective management of human resources, full involvement of the entire workforce including physicians, education and training, team working, continuous improvement, a corporate quality culture, customer focus and using a combination of management techniques under a quality management system are necessary for TQM successful implementation.

A healthcare context-specific model of TQM was developed and tested and suggestions were provided for its successful implementation.

Healthcare organizations have addressed current error issues by adopting quality programs, which usually include strategic human resource management (HRM). However, little research has focused on the determinants of successful quality programs at healthcare organizations. The purpose of this paper is to examine the centrality of strategic HRM for addressing healthcare errors, error reduction barriers, quality management processes and practices, quality program results, and competitive advantage.

The methodology of this study involves the analysis of questionnaire data from the quality and/or risk directors of 587 US hospitals by factor analysis and regression analysis.

The findings focus on highly statistically significant relationships of strategic HRM with antecedent healthcare error sources, error reduction barriers, and quality management processes and practices, as well as the strategic HRM consequences of perceived quality program results and sustainable competitive advantage.

The limitations of perceptual data and common method variance are checked. Future research could investigate international effects.

The practical implications are that hospital errors can be successfully addressed with effective strategic HRM, quality management processes, and quality management practices.

The original contribution of this paper is the centrality of strategic HRM as a determinant of successful quality programs at healthcare organizations.

Many healthcare organisations have found it difficult to implement total quality management (TQM) successfully. The aim of this paper is to explore the barriers to TQM successful implementation in the healthcare sector.

This paper reports a literature review exploring the major reasons for the failure of TQM programmes in healthcare organisations.

TQM implementation and its impact depend heavily on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in healthcare organisations can be attributed to the strongly departmentalised, bureaucratic and hierarchical structure, professional autonomy, tensions between managers and professionals and the difficulties involved in evaluating healthcare processes and outcomes. Other obstacles to TQM success include lack of consistent managers' and employees' commitment to and involvement in TQM implementation, poor leadership and management, lack of a quality‐oriented culture, insufficient training, and inadequate resources. The review was limited to empirical articles written in the English language during the past 30 years (1980‐2010).

The findings of this article provide policy makers and managers with a practical understanding of the factors that are likely to obstruct TQM implementation in the healthcare sector.

Understanding the factors that obstruct TQM implementation would enable managers to develop more effective strategies for implementing TQM successfully in healthcare organisations.

The purpose of this paper is to highlight the usefulness of financial information as a complementary tool for quality programs implemented in healthcare institutions and, subsequently, to introduce an approach to its systematic management.

This paper begins with a description of the current status of quality management in healthcare services, continues with a theoretical explanation of the importance of financial indicators for making decisions, and finishes with a practical example showing how to integrate financial data into healthcare quality programs.

Financial indicators play a key role in healthcare quality management systems (QMSs). These indicators can be managed jointly with traditional non-financial measures, through introducing minor adjustments to the ISO 9000 model.

The approach presented in the second part of this paper was built based on theoretical arguments and on its use in industries other than healthcare. Hence, further research is needed to provide evidence of its practical application.

First, this work integrates disciplines which are usually managed separately, such as quality and accounting. Furthermore, it focusses on an industry such as healthcare, where QMSs are not highly developed.

This study aims to present Lean Six Sigma (LSS) deployment and sustainment strategies for the healthcare sector from a multi-level perspective. The objective is to present LSS implementation insights to enable policymakers, practitioners and academicians to test and develop an LSS framework for healthcare sectors.

The strategies identified are the result of a multi-method research design involving literature review, action research (AR) and Delphi study. Further, the AR portion of the study involved more than 10 years of projects focused on the deployment of LSS in the healthcare sector.

The strategies include a holistic view from the multi-level perspective, considering the Top Management Level, Middle Management Level and Operational Level. The authors ascertained 27 strategies across the three levels of organizational structure for the effective deployment of LSS. Further, the authors present a customized LSS “pocket guide” from the healthcare perspective for quick reference.

The strategies delineated in this study are based on the Indian healthcare section only; thus, further research in additional geographic contexts is needed. Also, further research is necessary to provide additional empirical validation of the effects of the identified strategies on LSS program outcomes and to verify that the strategies operate at the proposed organizational levels. Future research should also focus on identifying the interrelationships between strategies within and across levels, developing a “road map” for LSS implementation in hospitals and designing the LSS curriculum for medical schools and other medical training programs.

Observations of this study can contribute to developing a holistic framework for successful LSS implementation in the healthcare sector for academicians, practitioners and policymakers. This, in turn, ensures an enhanced value proposition, improved quality of life and reduced healthcare operational costs. Thus, it ensures a win-win situation among all the stakeholders of the healthcare sector.

The strategies put forth will enable the LSS researchers, academicians and, more particularly, practitioners to delve deeper into specific enablers and safeguard the LSS deployment from backlash. The research has two significant benefits. Firstly, it enhances the understanding of LSS from the healthcare perspective. Secondly, it provides direction for future studies with specific components for hospitals’ LSS framework, which can be further tested, refined and improved.

Facilities management (FM) professionals state that adopting FM will positively support core service delivery and ensure customer satisfaction. Evidences of such claim are important as it will enhance the rationale for institutionalising prudent FM service quality in hospitals in Ghana. This paper aims to assess the mediating effect of healthcare FM service quality on patients’ satisfaction and overall healthcare delivery.

This is a cross-sectional study involving adult patients at the Physician outpatient departments and Polyclinics of Komfo Anokye, Tamale and Cape Coast Teaching hospitals in Ghana. A questionnaire survey using a well-structured five-point likert scale based on the SERVQUAL dimensions and Healthcare core service dimensions rooted in the FM framework was used to collect data from 660 patients. Smart PLS was used to analyse the data of 622 valid questionnaires.

The study results revealed that FM service quality mediates the relationship between patients’ satisfaction and three of the constructs under core healthcare delivery. That is, (the quality of healthcare delivery, the quality of healthcare personnel and the adequacy of healthcare resources) – surprisingly, the fourth construct (the quality of administration process) was not supported.

There is no or at best very limited studies on the contribution of healthcare FM on patients satisfaction of core healthcare delivery in Ghana. Therefore, this study will enrich and contribute to knowledge in healthcare FM in general and that of a developing African country in particular.

The purpose of this paper is to put forward a quality cost management model for healthcare organizations, which is based on the quality management systems proposed in ISO 9000 international standards.

The model suggested here arose from the individual study of quality in healthcare, quality management systems and quality cost theories; and the analysis of problems emerging when these tools are combined in practice.

The traditional quality cost model, usually implemented in manufacturing companies, can also be applied to healthcare organizations that manage their processes according to ISO 9000 quality management systems.

This document is a general description of the model proposed and, therefore, just presents overall guidelines to managing quality costs in healthcare organizations.

Since most healthcare organizations are still stuck in the quality assurance stage, there has been little research conducted on quality cost specifically focused on this industry.

Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.

Recent literature has highlighted the importance of quality and governance in supply networks. Usually, the relationships between the actors are complex, comprising both formal and informal interactions. Despite recent advances in quality and governance in supply networks, extant literature highlights the lack of quality in healthcare supply-chain networks in relation to governance mechanisms. This paper aims to investigate the role of governance mechanisms and their influence on the quality of healthcare supply networks, and assumes that governance instruments can support quality performance.

A multiple-case research approach was employed. Six organisations in the Brazilian healthcare sector were analysed (four operate only with renal replacement therapy, one is a material supplier, and one operates with renal replacement therapy and collective procurement).

Findings showed that there is no formalised supply network structure in these organisations. A possible consequence of this is that the supply-network governance is dominated by informal relationships. In the quality dimension, managers' awareness is limited, but there are mechanisms in place to control the quality of the materials.

Healthcare managers can actively invest in the social aspects of the relationship between buyer and supplier, such as trust and commitment, thus increasing responsiveness in patient care. However, this informal procedure can lead to problems with tracking and reliability, ultimately leading to quality problems. Therefore, it is recommended that formal and informal governance instruments be used jointly to improve service quality.

This study suggests that the integration of formal and informal mechanisms of governance can improve the quality of supply networks. Additionally, if the administrative process is purely formal, network relationships and their efficiency will be impaired.

The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital.

The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital.

The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit.

The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives.

Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A & E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.