Integrated approach to healthcare quality management:a case study

Purpose - The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and helps evaluate performance of health care services dynamically. Design/methodology/approach - This paper uses logical framework analysis (LFA), a matrix approach to project planning for managing quality. This has been applied to three acute healthcare services (Operating room utilization, Accident and emergency, and Intensive care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This paper shows LFA application in three service processes in one hospital. However, ideally this is required to be tested in several hospitals and other services as well. Practical implications - In the paper the proposed model can be practised in hospital-based healthcare services for improving performance. Originality/value - The paper shows that quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in health care delivery and corrective measures are taken for superior performance, there is an absence of an integrated approach, which can identify and analyze issues, provide solutions to resolve those issues, develop a project management framework (planning, monitoring, and evaluating) to implement those solutions in order to improve process performance. This study introduces an integrated and uniform quality management tool. It integrates operations with organizational strategies. © Emerald Group Publishing Limited.

Does role clarity explain employee-perceived service quality? A study of antecedents and consequences in call centres

Purpose – Role clarity of frontline staff is critical to their perceptions of service quality in call centres. The purpose of this study is to examine the effects of role clarity and its antecedents and consequences on employee-perceived service quality. Design/methodology/approach – A conceptual model, based on the job characteristics model and cognitive theories, is proposed. Key antecedents of role clarity considered here are feedback, autonomy, participation, supervisory consideration, and team support; while key consequences are organizational commitment, job satisfaction and service quality. An internal marketing approach is adopted and all variables are measured from the frontline employee's perspective. A structural equation model is developed and tested on a sample of 342 call centre representatives of a major commercial bank in the UK. Findings – The research reveals that role clarity plays a critical role in explaining employee perceptions of service quality. Further, the research findings indicate that feedback, participation and team support significantly influence role clarity, which in turn influences job satisfaction and organizational commitment. Research limitations/implications – The research suggests that boundary personnel in service firms should strive for more clarity in perceived role for delivering better service quality. The limitations are in sample availability from in-house transaction call centres of a single bank. Originality/value – The contributions of this study are untangling the confusing research evidence on the effect of role clarity on service quality, using service quality as a performance variable as opposed to productivity estimates, adopting an internal marketing approach to understanding the phenomenon, and introducing teamwork along with job-design and supervisory factors as antecedent to role clarity.

Analysing the commitment - service quality relationship:a comparative study of retail banking call centres and branches

Adopting an internal marketing approach, this paper attempts to provide a deeper understanding of the organisational commitment—service quality relationship in the service context. This is done by empirically testing the relationships that the three components of organisational commitment (affective, continuance and normative) have with the service quality of customer-contact employees. The hypotheses were framed by critically reviewing the extant literature in the areas of services marketing and human resource management. A large sample comparative study was conducted on employees in call centres and branches of a major retail bank in UK. We explore the important question of how the three components of organisational commitment influence the employee-perceived service quality differently in call centres and in branches. The findings indicate that in branches, both affective commitment and continuance commitment have significant positive impact on service quality while in call centres, only affective commitment is found to affect service quality significantly. Having established the commitment—service quality relationship, the implications for designing internal marketing strategies are further discussed.

Quality improvement in professional local government services : a longitudinal study

This sustained longitudinal study, carried out in a single local authority, investigates the implementation of a Total Quality Management (TQM) philosophy in professional local government services. At the start of this research, a large majority of what was written about TQM was polemical and based on limited empirical evidence. This thesis seeks to provide a significant and important piece of work, making a considerable contribution to the current state of knowledge in this area. Teams from four professional services within a single local authority participated in this research, providing the main evidence on how the quality management agenda in a local authority can be successfully implemented. To supplement this rich source of data, various other sources and methods of data collection have been used: 1) Interviews were carried out with senior managers from within the authority; 2) Customer focus groups and questionnaires were used; 3) Interviews were carried out with other organisations, all of which were proponents of a TQM philosophy. A number of tools have been developed to assist in gathering data: 1) The CSFs (critical success factors) benchmarking tool; 2) Five Stages of Quality Improvement Model. A Best Practice Quality Improvement Model, arising from an analysis of the literature and the researcher's own experience is proposed and tested. From the results a number of significant conclusions have been drawn relating to: 1) Triggers for change; 2) Resistance of local government professionals to change 3) Critical success factors and barriers to quality improvement in professional local government services; 4) The problems associated with participant observation and other methodological issues used.

Internal service quality and its impact on external service quality:a study of the role of internal customer types and the dimensions which are used to assess internal suppliers within an organisation and how this affects external service quality

This research explores the role of internal customers in the delivery of external service quality. It will consider any potentially different internal customer types that may exist within the organisation. Additionally, it will explore any potential differences in the dimensions that are used to measure service quality internally and externally. If there are different internal customer types then there may be different dimensions which are used to measure service quality between these types and this will be considered also. The approach adopted given the depth and breadth of understanding required, was an action research case based approach. The research objectives were:(i) To determine the dimensions of internal service quality between internal customer supplier cells. (ii) To determine what variation, if any, there is in the dimension sets between internal customer supplier cells. (iii) To determine any ranking in the dimensions that could exist by internal customer supplier cell type. (iv) To investigate the impact of internal service quality on external service quality over time. The research findings were: (i) The majority of the dimensions used in measuring external service quality were also used internally. There were additions of new dimensions however and some dimensions which were used externally, for internal use, had to be redefined. (ii) Variation in dimension sets were revealed during the research. Four different dimension sets were identified and these were matched with four different types of internal service interaction. (iii) Differences in the ranking of dimensions within each dimension set for each internal customer supplier cell type were confirmed. (iv) Internal service quality was seen to influence external service quality but at a cellular level rather than company level. At the company level, the average internal service quality at the start and finish of the research showed no improvement but external service quality had improved. Further investigation at the cellular level showed that improvements in internal service quality had occurred. Those improvements were found to be with the cells that were closest to the customer.The research implications were found to be: (i) some cells may not be necessary in the delivery of external service quality. (ii) The immediacy of the cell to the external customer and number of interactions into and out of that cell has the greatest effect on external customer satisfaction. (iii) Internal service quality may be driven by the customer affecting those cells at the front end of the business first. This then cascades back to those cells which are less immediate until ultimately the whole organisation shows improvements in internal service quality.

Environmental and nature conservation : a facet study of concern for the quality of the natural environment

A multi-variate descriptive model of environmental and nature conservation attitudes and values is proposed and empirically supported. A mapping sentence is developed out of analysis of data from a series of Repertory Grid interviews addressing conservation employees' attitudes towards their profession's activities. The research is carried out within the meta-theoretical framework of Facet Theory. A mapping sentence is developed consisting of 9 facets. From the mapping sentence 3 questionnaires were constructed viewing the selective orientations towards environmental concern. A mapping sentence and facet model is developed for each study. Once the internal structure of this model had been established using Similarity Structure Analysis, the elements of the facets are subjected to Partial Order Scalogram Analysis with base coordinates. A questionnaire was statistically analysed to assess the relationship between facet elements and 4 measures of attitudes towards, and involvement with, conservation. This enabled the comparison of the relative strengths of attitudes associated with each facet element and each measure of conservation attitude. In general, the relationship between the social value of conservation and involvement pledges to conservation were monotonic; perceived importance of a conservation issue appearing predictive of personal involvement. Furthermore, the elements of the life area and scale facets were differentially related to attitude measures. The multi-variate descriptive model of environmental conservation values and attitudes is discussed in relation to its implications for psychological research into environmental concern and for environmental and nature conservation.

Total quality management in English language teaching:a case study in Turkish higher education

The need to improve the management of language learning organizations in the light of the trend toward mass higher education and of the use of English as a world language was the starting point of this thesis. The thesis aims to assess the relevance, adequacy and the relative success of Total Quality Management (TQM) as a management philosophy. Taking this empirical evidence a TQM-oriented management project in a Turkish Higher Education context, the thesis observes the consequences of a change of organizational culture, with specific reference to teachers' attitudes towards management. Both qualitative and quantitative devices are employed to plot change and the value of these devices for identifying such is considered. The main focus of the thesis is the Soft S's (Shared Values, Style, Staff and Skills) of an organization rather than the Hard S's (System, Structure, Strategy). The thesis is not concerned with the teaching and learning processes, though the PDCA cycle (the Action Research Cycle) did play a part in the project for both teachers and the researcher involved in this study of organizational development. Both before the management project was launched, and at the end of the research period, the external measurement devices (Harrison's Culture Specification Device and Hofstede's VSM) were used to describe the culture of the Centre. During the management project, internal measurement devices were used to record the change including middle-management style change (the researcher in this case). The time period chosen for this study was between September 1991 and June 1994. During this period, each device was administered twice within a specific time period, ranging from a year to 32 months.

The experience of living with age related macular degeneration:A longitudinal study into the impact of age related macular degeneration on quality of life

In this thesis I contribute to the understanding of the experience of living with Age-Related Macular Degeneration (AMD) and its impact on quality of life through the use of a pragmatically guided mixed methods approach. AMD is a condition resulting in the loss of central vision in old age which can have a huge impact on the lives of patients. This thesis includes: literature reviewing; qualitative meta-synthesis; surveys and descriptive statistics; observation; and analysis of in-depth interviewing, in order to build a picture of what it is like for older people to live with AMD. I present the findings from six separate studies each designed to answer specific research questions. I begin with a mixed methods study to determine how well the most commonly used measure of quality of life for AMD patients’ represents patient experiences. I then go on to investigate the experiences of patients with AMD through a meta-synthesis of qualitative research and finally present four of my own empirical studies three of which investigate the experiences of patients with different types of AMD: early dry AMD, treatable wet AMD and advanced wet AMD and the final study investigates what it is like for a couple living together with AMD. Throughout the qualitative studies I use Interpretative Phenomenological Analysis (IPA) to develop an understanding of the experiences and life contexts of patients with AMD. Through rigorous analysis, I identify a range of themes which highlight the shared and divergent experiences of individuals with AMD and the need to acknowledge patients’ past, present and potential future life contexts and experiences when providing services to older people with AMD. I relate the findings of the six studies to the wider psychological literature on chronic illness and make recommendations for services for patients with AMD to be provided holistically within a lifeworld-led health care model.