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Health-care delivery organizations (hospitals) constitute a complex adaptive system; hence, a contingency perspective is imperative to guide the design of customized approaches to quality management in different health-care settings. Accordingly, this paper aims to propose a contingency framework to advance the understanding of the relationship between situational factors and effectiveness of quality approaches in health-care organizations (HCOs), such as hospitals in India.

Related literature was reviewed to identify existing research and theories related to quality and quality approaches, situational factors of the HCOs (hospitals) and some existing logical evidence on public and private hospitals in India. Then a contingencies framework for quality and quality approaches was conceptualized.

This paper proposes contingent determinants arise out of conceptualization of the HCOs (hospitals) from different system perspective such as rational system, natural system, open system and integrative system; uncertainty because of physicians’ behaviour, nurses’ approach and a dual line of authority; and the task environment such as patients, competition and economic pressure. These determinants represent situational constructs to the quality enhancement of any attempt at quality approaches. While these determinants have an influence on the quality and quality approaches of the HCOs (hospital), it is imperative to build any quality improvement strategy to work effectively, i.e., quality approach is dependent on determinants of the contingencies of the hospital’s environment, be it external or internal. Propositions for future research are also incorporated.

This paper proposes a conceptual model as well as research propositions that need to be validated and confirmed empirically. It advances the research and theory related to quality and quality approaches in a health-care setting. It can enable policymakers, hospital managers to analyze and gauge the appropriateness of quality approaches in a given context before implementing them and could help to improve the introverted quality approaches and quality dimensions currently followed in HCOs (hospitals).

Contingency framework is a new approach for research on the effectiveness of quality approaches in hospitals. The fundamental idea behind this framework is that effectiveness of quality approaches can be understood best by examining its contingent determinants. Thus, it has the capacity to contribute to the efforts of government and policymakers to make the quality of care affordable to all in India. Essentially, we examine the contexts and variables that determine the effectiveness of quality approaches.

A quality management system (QMS) is defined as interacting activities, methods and procedures used to monitor, control and improve service quality. The purpose of this paper is to describe the QMS status using the Quality Management System Index (QMSI) in hospitals affiliated to Shahid Beheshti Medical Sciences University in Tehran, Iran.

In this cross-sectional study, 28 hospitals were investigated. A validated 46-item questionnaire was used for data collection. Data were analyzed using descriptive statistics, Pearson correlation, independent student’s t-test and regression analysis.

The mean QMSI score was 18.4: 15.3 for public and 20.9 for non-public hospitals (p=0.001). The lowest (1.96) and the highest (2.14) scores related to “Quality policy documents” and “Quality monitoring by the board,” respectively. The difference between public and non-public hospitals was significant in all nine QMSI dimensions (p=0.001). The QMSI score was higher in non-public and small hospitals than in public and large ones (p=0.05).

Most QMS studies come from developed countries, and there is no systematic information about the mechanisms and processes involved in implementing QMS in developing countries like Iran. This is the first study on Iranian hospital QMS using a newly developed tool (QMSI), and results showed that QMS maturity in these hospitals was relatively good, but the non-public hospitals status (private and charity) was far better than public hospitals.

This paper explores and interprets the linkage between total quality management (TQM) practices and organizational performance measures for improving the healthcare firms’ performance. Indian healthcare firms are aware of TQM practices and their benefits, but the awareness level varies among the firms and staff. The study looks into the effectiveness of quality awareness to meet quality performance in Indian hospitals.

A questionnaire based on previous research was circulated among the managers and medical staff. The model linking TQM and organizational performance is analyzed with structural equation modelling and confirmed the hypotheses stated. Interpretations to improve hospital performance are made.

The study identified ten relevant TQM factors and confirmed their importance towards the improved organizational performance of Indian hospitals. Top management initiative, continuous process improvement and team work are the most contributing TQM factors. Differences in the awareness levels by the management staff and medical staff are attributed. The managers and medical staff are aware of the benefits of TQM towards firm performance, but it is to be improved further.

Cross-validation and interpretation are affected due to the limited sample size. Longitudinal study is recommended to explore the individual hospital as specific cases. Larger sample size is suggested as an extended work to overcome the demographic and infrastructural limitations of the firms included.

The management is more interested in TQM, but there is lack of awareness among the staff. The quality awareness and customer focus by medical staff are the most weakly loaded factors, and the weaknesses can be remedied by the lead role by the hospital management in providing proper training and thereby improving the attitude of the medical staff.

Effectiveness of hospital operations is highly dependent on customer focus. Properly communicated, committed and trained staff with good-quality awareness can better implement TQM and thereby improve hospital performance. Lead role by the management is very important, and the paper lists ways to attain these outcomes.

Very little is reported from the Indian healthcare sector linking TQM and outcome performance. The quality awareness, customer focus, communication and learning by the medical staff are to be improved, and the paper suggests ways to link TQM more effectively to improve the performance in hospitals. These findings may be useful to the managers, medical staff and researchers in healthcare to bring better results.

The paper seeks to present findings from an evaluation of a quality management system implemented in a low‐income country hospital.

This is a single‐case before and after evaluation.

The quality system, although only 70 per cent implemented, resulted in increasing compliance with a few selected standards and produced modest improvements in patient satisfaction and utilisation. Hospital doctors and managers wanted to continue to develop the system and described conditions they thought important to spread to other hospitals.

No objective, clinical outcomes data were gathered, and the short timescale meant that the system was not fully implemented at the time of the evaluation.

It is possible to improve patient care in rural hospitals with a few extra resources, in a culture not familiar with management processes, and to engage otherwise poorly motivated doctors in systematic improvement. However, certain conditions are necessary for introducing, sustaining and spreading quality improvement programmes.

This study and report is one of the first, detailed and systematic evaluations of a hospital quality management system in a highly resourced constrained situation in an Arabic country, which has implications for improving health care in other developing countries.

The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a setting of devolved governance.

This qualitative study used thematic analysis of interviews with public hospital medical directors. For additional context, findings were framed by themes from a review of hospital safety and quality in the same jurisdiction.

Varying approaches and levels of complexity were described about what and how performance data are reviewed, prioritised, and quality improvements implemented. Although no consistent narrative emerged, facilitators of improvement were suggested relating to organisational culture, governance, resources, education, and technologies. These hospital-level perspectives articulate with and expand on the system-level themes in a state-wide review of hospital safety and quality.

The findings are not generalisable, but point to an underlying absence of system-wide agreement on how to perceive, retrieve, analyse, prioritise and action hospital performance data.

Lack of electronic medical records and an inefficient incident reporting system limits the extent to which performance and incident data can be analysed, linked and shared, thus limiting hospital performance improvement, oversight and learning.

Variable approaches to quality and safety, standards of care, and hospital record keeping and reporting, mean that healthcare consumers might expect inconsistency across Victorian hospitals.

The views of medical directors have been little researched. This work uses their voice to better understand contextual factors that situate and impact on hospital quality and safety towards understanding the mixed effectiveness of hospital quality improvement strategies.

The purpose of this paper is to review the implementation of seven components of quality systems (QSs) linked with quality improvement in a sample of Australian hospitals.

The authors completed a systematic review to identify QS components associated with measureable quality improvement. Using mixed methods, the authors then reviewed the current state of these QS components in a sample of eight Australian hospitals.

The literature review identified seven essential QS components. Both the self-evaluation and focus group data suggested that none of the hospitals had all of these seven components in place, and that there were some implementation issues with those components that were in use. Although board and senior executives could point to a large number of quality and safety documents that they felt were supporting a vision and framework for safe, high-quality care, middle managers and clinical staff described the QSs as compliance driven and largely irrelevant to their daily pursuit of safe, high-quality care. The authors also found little specific training in quality improvement for staff, lack of useful data for clinicians on the quality of care they provide and confusion about how organisational QSs work.

This study provides a clearer picture of why QSs are not yet achieving the results that boards and executives want to achieve, and that patients require.

This is the first study to explore the implementation of QSs in hospitals in-depth from the perspective of hospital staff, linking the findings to the implementation of QS component identified in the literature.

The purpose of this paper is to examine an operational process through the use of a clinical practice improvement method to implement clinical pathways in the Amber Hospital's (name changed for privacy reasons) cardiology unit. This quality framework has been adopted as a means of preventing adverse events, to ensure quality of care is provided to all patients.

A quality assurance case study approach was adopted along with the clinical practice improvement method – a framework that allows continuous quality improvement to be applied in a practical way to clinical processes, in order to improve delivery of care. The clinical practice improvement method is broken into five cycles: project, diagnostic phase, intervention, impact, and sustaining improvement. The paper explains these cycles, demonstrating how each was achieved.

The clinical practice improvement method at Amber Hospital was found to provide superior performance in the clinical pathway allocation process and improved patient care. Having an appropriate and effective action plan involving clinical pathways helps to prevent service hindrances that may have adverse impact on hospital management processes leading to adverse events. The Amber Hospital case study has not only identified the physical constraints but also the constraints in relation to organization policies and operation procedures.

The paper highlights the need for organizations to have a “no blame” culture, which acknowledged that errors do and will occur. However, it is also recognized that it is important to have reliable data collection on these errors, in order to reduce the frequency and severity of adverse events. Lack of available data was a severe limitation.

The practical aim of this project was to improve recommended drug treatment in patients with Acute Coronary Syndrome through the implementation of clinical pathways. The author also wanted to measure the utilization rate of these pathways. While there were four pathways implemented, the majority of patients were allocated to pathway 1B. Hence, data were collected on those specific patients.

Quality operational framework, using a clinical practice improvement method, demonstrated how clinical pathways for Acute Coronary Syndrome were implemented successfully at the Amber Hospital. The report provides evidence that through conducting a CPI project, quality improvements were made in recommended drug treatment for patients diagnosed with Acute Coronary Syndrome, and to correct pathway allocation.

To face profound changes from decreasing funding, growing patient expectations and increasing competition in the health-care market, public hospitals began to implement effective quality management (QM) practices following manufacturing and other service industries. However, there was little knowledge relevant to the impact of QM practices on the performance of public hospitals. The study aims to shed some further light on this issue.

The paper extends the previous empirical research to the health-care sectors and suggests the research framework of QM practice-performance relationships in public hospitals. For validation purposes, a cross-sectional survey involving 204 quality managers and directors of large public hospitals was carried out between April and October 2013 in Zhejiang Province, China. Structural equation modeling was used to test the hypothesized relationship between QM practices and hospital performance.

Empirical results support that the implementation of QM practices can bring many benefits to sample hospitals. The dimensions of employee relations and process management are directly related to the health-care and non-health-care performance of public hospitals.

It explores the relationship between QM practices and hospital performance based on empirical results from Chinese public hospitals, whereas few studies have been conducted within the context of public health-care sectors in developing countries. The empirical results could enhance hospital managers’ understanding of the nature of QM practice-performance relationship and help mangers re-allocate more resources to those elements of the QM systems that have the most significant impact on hospital performance.

The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.

A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.

The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.

The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.

This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.

The purpose of this paper is to assess the level of total quality management (TQM) implementation in Palestinian governmental and non-governmental hospitals using the Malcolm Baldrige National Quality Award (MBNQA) framework.

The study is based on collecting data using a survey questionnaire that was designed according to the MBNQA criteria. In total, 363 questionnaires from governmental and non-governmental hospitals operating in Gaza Strip were analyzed to assess the level of TQM implementation level in all hospitals (governmental and non-governmental).

The main results of this study indicate that Palestinian hospitals operating in Gaza Strip perform at a relatively acceptable level. Comparing results shows that the performance of non-governmental hospitals is better with higher degree of TQM implementation than the governmental hospitals. Detailed analysis identifies improvement opportunities-related specific aspects of the human resources focus and the performance results.

Although this study has collected data from one Palestinian Territory, the Gaza Strip, it still identifies the critical factors and practices for TQM implementation within the Palestinian healthcare organizations to improve performance.

This paper suggests that business excellence models such as the MBNQA criteria can be used to assess the level of implementation of quality practices and identify the strengths and weaknesses to improve the quality of service delivery, processes, and performance of hospitals.

Despite the widespread use of TQM in the developed countries, little attention has been placed to implement and assess the quality initiatives by organizations in the developing countries and even fewer in low-income Arab countries (Aamer et al., 2017; Øvretveit and Al Serouri, 2006). In addition, a very few number of studies in reference to the assessment of TQM implementation in the Palestinian context, in general, and in healthcare organizations, in particular, highlight the need for this study. To move the field in that direction, the goal of this research was to assess the level of TQM implementation in the healthcare organizations (mainly hospitals) in Gaza Strip (one of the least fortunate areas of the Palestinian-occupied territories) where no prior similar research studies could be found. Therefore, this study contributes to filling this gap in the literature by providing empirical assessment of TQM level of implementation in Gaza Strip hospitals.