The Exploration of Causes of the Performance of TQM Implementation In Hospitals In Taiwan

Transcription

1 The Exploration of Causes of the Performance of TQM Implementation In Hospitals In Taiwan Shih-Wang Wu Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Taiwan P.O.BOX 62-13, Tainan, Tainan City 70899, Taiwan ext.5225, Yafang Tsai Department of Health Policy and Management, Chung-Shan Medical University, Taiwan No.82, Sec. 2, Chongsing Rd. Taichung City 404, Taiwan ext.17176, ABSTRACT The administrators perceived the turbulent environment and difficult to operate after the implementation of NHI (National Health Insurance). The president of hospital usually adopted TQM (Total Quality Management) to improve the competence because that there is always many miscommunication, low efficient and waste besides the changing of environment. We try to explore the causes that can effect the performance of TQM implementation, and expect to suggest how to modify the way to adjust and plan. We adopt the structural questionnaire to collect the data, and try to understand the influence of TQM perception on the operation performance. We take staffs who have worked over six months in three regional hospitals that applying TQM over one year in middle Taiwan as our objectives. The significant results showed us that male, elder, higher education and married staff showed higher TQM perception. The staffs belong to paramedical department showed higher TQM perception than nursing department. Finally, we found the staffs perception of TQM activities will positively influence the performance of TQM implementation significantly. Keywords: Total Quality Management (TQM), Perception, Performance

2 INTRODUCTION The health care service is a special kind of service industry in the customer-orientation era. The administrators of hospitals set the goal to satisfy their customers, because of customers requirement are not only on medical technique and professional knowledge, but also on service quality. Implementing TQM (Total Quality Management) will lead to higher quality, and will give customers more guarantee and trust, and will positively influence the performance finally. Thus, the health care services can be improved wholly and continuously and pursue quality and performance by implementing TQM. It also can improve the satisfaction of internal and external customers. The study tries to explore if the difference of individual characteristics will show different degree of perception on TQM activities, and tries to explore if staffs perception on TQM activities will influence the performance of TQM implementation. LITERATURE REVIEW TQM implementation in health care industry Carey and Teeter (1995) implement TQM in Martin Router Hospital to reduce the mistakes successfully. They proposed the model of TQM provide a best process management of nursing quality. According to the findings of previous researches, we can understand that quality improving and TQM implementation is the best method to compete with others, and we can design the best way of operation to reach our goal. The TQM Activities The characteristics of health services are division of labor and team cooperation, TQM activity is, too. Stephanie et al. (2000) proposed the professional developing activities can push staffs to explore other skill, knowledge and great attitude besides their basic capability. They also emphasized that increasing the chance to develop staffs professional skill in complicated medical environment will improve staffs job satisfaction. The TQM activity is a kind of professional developing activities. The higher the perception of staffs on TQM activity is, the more the professional skill training. The staffs will show better job satisfaction, and will satisfy their customers. The Performance of TQM TQM as the resource of potential competitive advantage could face their customers better, improve customers satisfaction, strengthen internal communication, and motivate

3 staffs participation. It also could make staffs more aggressively, solve problem better, decrease cost, and make closer to their suppliers. All of these will improve organizational competitive advantage, and we also can adopt these to be indicators to evaluate our performance. METHODOLOGY We adopted structural questionnaire to collect our data. We modified the items according to professional suggestion and pretest of questionnaire, and accomplish the final version with Likert s five point scale. Cronbach s α of questionnaire are all higher than 0.7, they all show good reliability. We take staffs who have worked over six months in three regional hospitals that applying TQM over one year in middle Taiwan as our objectives. We issued 180 questionnaires and 140 valid questionnaires were collected with a response rate 77%. We propose three hypotheses as follows. H1: Different individual characteristics will show significantly different degree of perception on TQM activities. H2: Different department characteristics will show significantly different degree of perception on TQM activities. H3: The degree of staffs perception on TQM activities will significantly influence the performance of TQM implementation. RESULTS The significant results of ANOVA on degree of perception on TQM activities showed that several different individual characteristics will show significantly different degree of perception. Male staffs are better than female; staffs age higher than 41 years-old show higher degree; staffs graduated from university and institute show higher degree than whom educational degree is high school; married staffs show higher degree than single. The H1 is partially supported. There is just one significant result on department characteristics, which is the Para-medical department show higher degree on customization of service process than nursing department. The H2 is partially supported. The results show the degree of staffs perception on TQM activities will positively influence the performance of TQM implementation significantly. The result of regression analysis is as table 1. The H3 is totally supported.

4 Table1. Regression Analysis of the degree of staffs perception of TQM activities and the performance of TQM implementation Independent variable Dependent variable R 2 Beta P value The degree of staffs The performance of TQM * perception on TQM activities implementation *** P<0.005 DISCUSSION The results showed that different individual characteristics will show significantly different degree of perception of TQM activities. We think that male are always more aggressive, so that they will show higher degree of perception than female. Staffs are older than 41 years-old show higher degree because of their rich experience. The staffs education degree is higher than university show higher degree of perception of TQM activities. We believe that is because their well training of systematic improving, so they show higher degree. About the marriage status, the married staffs show higher degree than single. We think that because the married staff care about their job and hunger for stable work, so that that will concern their organization more than single. The results showed that different department characteristics will show significantly different degree of perception of TQM activities. The Para-medical department show higher degree on customization of service process than nursing department. We believe the reason is nurses always do their work by physician s order, so that they can not adjust their work according to customer s opinion immediately. The staffs belong to Para-medical department can rearrange their process easier because of their independence. Maybe the administrators could improve the efficiency by rethink the process of departments working. The results show the degree of staffs perception on TQM activities will positively influence the performance of TQM implementation significantly. We believe that staffs who understand the importance and benefit of TQM will show higher degree of perception on TQM activities, and will create better performance.

5 CONCLUSIONS If the TQM be well controlled, the staffs will perform better. We recommend that if administrators wish their organizations could exist longer and get more competitive advantage, they should ask themselves how many additional value can be provided to their customers. The purpose of TQM is to improve the operation quality, increase the medical quality, meet their customers need, and continuously innovate via staffs effort. Finally, we proposed three conclusions according to the discussion as follows. 1. The elder, married and well education staffs show better performance what the administrators want. The administrators should keep the excellent staffs, and adjust their work and position to strengthen their service quality. On the other hand, the administrators should create good culture and training system, and retain appropriate rotation rate in order to nurture more excellent staffs. 2. The administrators could take the para-medical departments to be benchmark of hospitals. Other departments could visit these departments and learn from them well, especially nursing department. The administrators also can rethink and redesign the process of nursing, and strengthen their integrated thinking in order to improve the whole medical service quality. 3. The higher the staffs perception of TQM activities is, the higher the staffs degree of adaptability and performance of TQM implementation. The administrators should announce appropriately and have a common consensus, thus will increase the efficiency and effectiveness of TQM implementation. REFERENCE Barney,J.B.(1986),Oraganizational culture: can it be a source of sustained competitive advantage, Academy of Management Review,11, Cameron, K. S.(1985) Cultural Congruence Strength and Type Relationships to Effective, Working paper, Business School, University of Michigan. Carey, R.G., and J.L. Teeters CQI Case Study: Reducing Medication Errors. Joint Commission Journal on Quality Improvement, 21(5): Chatman, J.A.and Jehn, K.A.(1994)Assessing the relationship between industry characteristics and organizational culture: how different can you be, Academy of Management Journal, 37, Deal, T. E. and Kennedy, A. A.(1982),Corporate Cultures, Addison-Wesley, Mass Dension, D. R.(1984) Bringing corporate culture to the bottom line, Organizational Dynamics, 13, Gordon, G.(1985), The relationship of corporate culture to industry sector and corporate

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