The TQM Journal

Improta, Giovanni; Balato, Giovanni; Ricciardi, Carlo; Russo, Mario Alessandro; Santalucia, Ida; Triassi, Maria; Cesarelli, Mario

2019 The TQM Journal

doi: 10.1108/tqm-10-2018-0142

Since healthcare spending accounts for approximately 6.6 per cent of the gross domestic product, reducing waste in health facilities is necessary to generate significant cost savings. After previous work concerning the application of Lean Six Sigma (LSS) to hip surgery, the purpose of this paper is to use LSS as the correct methodology to analyse a clinical pathway. Fast track surgery was introduced to the Complex Operative Unit of Orthopaedic and Traumatology of the University Hospital “Federico II” to improve quality and further reduce costs associated with prosthetic hip replacement surgery.Design/methodology/approachThe DMAIC (Define, measure, analyse, improve, control) roadmap was used as the typical problem-solving approach of the LSS methodology. A rigorous process of defining, measuring, analysing, improving and controlling business problems can be used to reach fixed goals. The paper was written following the Standards for Quality Improvement Reporting Excellence (SQUIRES Guidelines).FindingsIn this work, the authors found that multiple variables could influence the length of hospital stay (LOS) for inpatient treatment, thereby increasing patient management costs due to longer periods of hospitalisation. Therefore, LSS analysis of the implemented corrective actions demonstrated the efficacy and efficiency of the novel protocol. The average LOS was reduced from 10.66 to 7.8 days (−26.8 per cent).Originality/valueThe introduction of fast track surgery was validated through a rigorous LSS analysis, which demonstrated that the new protocol benefitted both patients and the hospital.

Nizamidou, Christina; Vouzas, Fotis; Gotzamani, Katerina

2019 The TQM Journal

doi: 10.1108/tqm-08-2018-0106

The purpose of the paper is twofold: first, to examine the interaction of quality, safety and crisis management (CM), and second, to explore the role played by an HR department in terms of CM.Design/methodology/approachThis paper consists of two parts: theoretical and empirical. The theoretical part follows the approach of an extended literature review. The empirical part illustrates the statistical analysis of the obtained data from Greek organizations that employ the largest number of employees, regardless of their business sector.FindingsThe statistical analysis allowed the authors to confirm their main research hypotheses. First, it showed the interrelationship that exists between safety, quality and CM. Second, it presented the impact of this relationship on human resources and the vital role of HR department, in case of a crisis.Practical implicationsOrganizations and their top management can review and redesign their CM procedures according to the findings of this survey, aiming a fast recovery and a return to normalcy.Originality/valueBased on the literature review, there has been a little research work on the interrelationship between safety, quality and the level of CM familiarity and the role of HR department at the times of crisis. The added value of attaining this goal may become a motivational element for any organization and its top management to continue investing more in safety, quality and CM issues.

Ab Wahid, Roslina

2019 The TQM Journal

doi: 10.1108/TQM-12-2018-0185

PurposeThe purpose of this paper is to describe how a large public university sustains its ISO 9001 quality management system (QMS) for the past 20 years. At the same time, this paper also provides a snapshot on the problems and challenges faced and overcame by the university in its quality journey.Design/methodology/approachThis is a case study and therefore it describes interventions and experiences within the university as the subject understudy.FindingsThere are four main phases of QMS that the university has undergone, namely, initiation, internalisation, alignment and improvement in the last 20 years. Critical success factors for implementing and maintaining the QMS are commitment from people, training and good communication. Some of the problems and challenges encountered have included a lack of knowledge and understanding of the processes and standards, lack of relevant skills, lack of commitment and cooperation from people, lack of resources and poor communication.Originality/valueThis paper provides insights into the world of QMS’s sustainability in a large public university that will be useful as a guide for academic managers and administrators. It also presents the issues of transitioning from the previous to the current standard experienced by the university which has not been discussed by many.

Elahi, Fazal; Ilyas, Muhammad

2019 The TQM Journal

doi: 10.1108/tqm-11-2018-0173

The purpose of this paper is to test the relationship of process approach (PA), customer focus approach (CFA) and school quality with the moderation of professional certification of school principal to fill the gap of quality management practices in private schools.Design/methodology/approachStudy applied quantitative design with the sample of 401 principals of private schools. Questionnaires were adapted from different studies, and pilot study was carried out. Confirmatory factor analysis was done along with structural equation modeling.FindingsResults indicate that the process approach has a significant effect on functional quality and academic quality of schools. Customer focus approach medicates the relationship of process approach and functional quality. The study found no evidence of the relationship of moderation of professional certification of school principal with process approach, functional quality and academic quality.Practical implicationsStudy contributed through the generation of new dimensions of school quality, putting professional degree of school principal as a moderator and by providing basis to understand the implementation of quality management system in schools. The outcomes of study will guide school managers to implement the process management approach to improve the school quality.Originality/valueOriginality of the study is defined in three ways; first, it is first study that examines the relationship of process approach, customer focus approach and school quality with the moderation of professional certification of principal. Second, it chooses “single” schools that have not been subject of any quantitative research exclusively. Third, it is a first attempt to examine the working of private schools in Pakistan with respect to quality management principles.

G., Rejikumar; Asokan Ajitha, Aswathy; Nair, Malavika S.; Sreedharan V., Raja

2019 The TQM Journal

doi: 10.1108/tqm-10-2018-0136

The purpose of this paper is to identify major healthcare service quality (HSQ) dimensions, their most preferred service levels, and their effect on HSQ perceptions of patients using a Taguchi experiment.Design/methodology/approachThis study adopted a sequential incidence technique to identify factors relevant in HSQ and examined the relative importance of different factor levels in the service journey using Taguchi experiment.FindingsFor HSQ, the optimum factor levels are online appointment booking facility with provision to review and modify appointments; a separate reception for booked patients; provision to meet the doctor of choice; prior detailing of procedures; doctor on call facility to the room of stay; electronic sharing of discharge summary, an online payment facility. Consultation phase followed by the stay and then procedures have maximum effect on S/N and mean responses of patients. The appointment stage has a maximum effect on standard deviations.Research limitations/implicationsTheoretically, this study attempted to address the dearth of research on service settings using robust methodologies like Taguchi experiment, which is popular in the manufacturing sector. The study implies the need for patient-centric initiatives for better HSQ through periodic experiments that inform about the changing priorities of patients.Practical implicationsThe trade-off between standardization and customization create challenges in healthcare. Practically, a classification of processes based on standardization vs customization potential is useful to revamp processes for HSQ.Originality/valueThis study applied the Taguchi approach to get insights in re-designing a patient-centric healthcare servicescapes.

Ershadi, Mohammad Javad; Eskandari Dehdazzi, Rouhollah

2019 The TQM Journal

doi: 10.1108/tqm-05-2018-0062

The purpose of this paper is to study the role of organizational forgetting in the impact of strategic thinking on the implementation of an organizational excellence model. Furthermore, the factors with main effects on the implementation success of the organizational excellence model are investigated. The two main causes of organizational forgetting, including purposefulness and randomness, along with the three main factors of strategic thinking (vision, creativity and systematic thinking) also are explored. Enablers and results, which are the two key parts of an organizational excellence model are considered as well.Design/methodology/approachA model based on structural equations is designed, in which organizational forgetting factors, strategic thinking measures and main parts of a business excellence model are incorporated based on the literature. A total of 297 Iranian companies in which an organizational excellence model had been implemented are selected for investigation. A questionnaire is designed and distributed among the experts, middle managers and top managers of these companies. Based on Cochran’s formula, the sample size of 168 is obtained, for which the response rate is 100 percent. Main statistical measures such as χ2 ratio to degree of freedom, non-soft fitness index (RMSEA), fitness index (GFI) and modified fitness index (AGFI) are used to assess the performance of the proposed model.FindingsAccording to the results of the statistical significance tests, the role of organizational obsessive mediators in the establishment of the organizational excellence model has been largely confirmed. Furthermore, the mediator role of organizational forgetting in the final impact of strategic thinking on implementing an organizational excellence model has been widely endorsed. Failure to use knowledge from learning, the inability of a company in coding and documenting knowledge and lack of incentives to share it are the most important factors in the forgetting of knowledge in companies.Research limitations/implicationsAs top managers, middle managers and experts are hard to reach due to the wide geographical spread of the organization under study, a questionnaire is designed and distributed among them. The impact of organizational forgetting on other quality management systems such as ISO 9001 and ISO 4001 needs another research to be conducted in the future.Practical implicationsUsing new experiences, increasing the competency of employees and managers experience through organizational learning, employee and managerial assessment and organizational strategy assessment are the main practical methods for considering organizational forgetting in the process of implementing organizational excellence models.Originality/valueThis research addresses organizational forgetting besides strategic thinking as joint main roles for implementing organizational excellence, whereas previous research works only considered strategic thinking as a factor. Furthermore, a structural equation model is developed for appraisal of effect of different factors.

Rodgers, Bryan A.; Antony, Jiju; He, Zhen; Cudney, Elizabeth A.; Laux, Chad

2019 The TQM Journal

doi: 10.1108/tqm-03-2019-0089

The purpose of this paper, builds on previous studies that explored the research patterns over 15 years, is to consider the current status of the integration of Lean and Six Sigma. More specifically, this research addresses whether Lean and Six Sigma are stronger together and explores the reasons why Lean researchers and practitioners may be less likely to integrate Six Sigma in their work.Design/methodology/approachThe research utilises a survey of 25 established and respected academics and practitioners from 16 countries. The questionnaire is analysed using a direct content approach and coded in NVivo.FindingsThe findings suggest that challenges may lie in the perception and understanding of statistics as well as short-term rather than long-term focus on improvement. The findings also suggest that academics and practitioners believe that Lean Six Sigma has developed over time and will continue to develop and improve as a methodology rather than being replaced with a new methodology.Research limitations/implicationsThe survey has a sample size of 25, albeit all respondents are established and very experienced practitioners and academics.Practical implicationsFor organisations that are introducing or refreshing their continuous improvement initiatives, this research identifies some of the challenges and provides the opportunity to address them to maximise the opportunities for success and sustainability.Originality/valueThe value of this paper is that it further addresses the debate over the integration of Lean and Six Sigma for many organisations which still employ Lean alone, but beyond this it explores how they will continue to develop and whether they are a permanent edition to the quality management landscape or a transition to something else.