The perceptions of quality managers and quality coordinators about the implementation of critical success factors of total quality management in general hospitals in Saudi Arabia

Abstract

This thesis examined the implementation of the critical success factors (CSFs) of Total Quality Management (TQM) in Saudi general hospitals by conducting a survey of 241 quality managers and coordinators using the Malcolm Baldrige National Quality Award (MBNQA) model for healthcare as the theoretical framework for the study design. It also ascertained whether there are differences between these hospitals regarding the implementation of the six critical success factors of TQM (leadership, strategic planning, customer focus, measurement, process management, and workforce) according to the participant’s characteristics and hospital size. The study also examined the perceived level of change in the outcomes of TQM implementation in these healthcare facilities and the relationships between TQM implementation and hospital outcomes. Furthermore, it measured the level of satisfaction of quality managers and quality coordinators with TQM implementation and, the relationship between this level of satisfaction and their socio-demographic characteristics and hospital size. Review of the literature on TQM implementation in Saudi healthcare organisations has revealed that the CSFs have not been broadly and systematically investigated. It was found that most of the available studies on TQM implementation in Saudi hospitals are, at best, methodologically descriptive without investigating these constructs through a systematic, reliable and an all-encompassing excellence model. Also the few available studies on TQM implementation in Saudi healthcare organisations are limited to specific geographical region(s) or city(ies) of the country. This study fills this gap by examining the implementation of the CSFs of TQM in Saudi General Hospitals. The MBNQA model for healthcare excellence is adopted as a tool for examining the CSFs on the ground that it is a generally accepted, reliable and valid model of quality. This study employed quantitative research methods to gather empirical data from quality managers and quality coordinators. Research participants were selected through a systematic random sampling technique. The researcher distributed 421 self-administered questionnaires to quality experts in General Hospitals across the 13 administrative regions of Saudi Arabia out of which 241 questionnaires were returned representing a response rate of 57 per cent). Thereafter, primary data were analysed using SPSS program v. 17 including descriptive statistics, univariate analyses (t-test, ANOVA, and correlation coefficients), and multivariate analysis (MANOVA). Major findings of the study are: First, four of the six CSFs of the MBNQA model (leadership, customer focus, measurement and process management) were considered to be relatively well implemented in the general hospitals. There was variation in the implementation of the strategic planning dimension while the work force dimension was reported to be relatively not well implemented. Also, six elements of workforce and one element of strategic planning were identified which were not implemented. Second, there was no difference on the perceptions of the respondents regarding the implementation of the six CSFs of TQM according to participant gender, nationality and age characteristics, whereas the level of education, field of study of the participants and the hospital size affect their perceptions on TQM implementation. Third, the performance of General Hospitals had slightly improved in three areas—patient outcomes, financial outcomes, and hospital effectiveness—while it gets worse in the area of employee outcomes, when compared to their situation the year before this study was carried out. Fourth, the relationship between TQM implementation and hospital outcomes was positive and this relationship was analysed by using four criteria for measuring the outcomes: (1) patient outcomes,(2) financial outcomes, (3) employees outcomes, and (4) hospital effectiveness. A weak correlation was found between TQM and financial outcomes, whereas there were moderate relationships between TQM and employees outcomes, patient outcomes as well as hospital effectiveness. Finally, majority of respondents were dissatisfied with TQM implementation in General Hospitals. There was also variation in the level of satisfaction experienced by respondents according to hospital size. It was found that those that are working in large General Hospitals were more satisfied than their counterparts in small size General Hospitals. While the research limitations were stated, the study strongly recommends further studies dealing with other levels of healthcare services in Saudi Arabia’s public sector and private hospitals in order to have a holistic picture and broader knowledge of TQM implementation in Saudi healthcare system. Also further research is needed to gauge the perceptions of other health workers, aside from quality professionals. This has the advantages of providing a broader perspective on different issues relating to the CSFs of TQM implementation in Saudi healthcare system. In terms of policy implications, the thesis advocates the following findings and suggested actions amongst others: while the amount of financial resources that are channelled by the Saudi government into general hospitals is significant, the study found that it is still insufficient. Therefore there is the need for sufficient allocation of financial resources to the general hospitals and the practice that allows variations in the allocations of financial resources between large hospitals and their small counterparts where the former are favoured at the expense of the latter needs to be stopped. Moreover, workforce is an important CSF of TQM and this study found that this dimension relatively not well implemented in the general hospitals. To rectify this situation, it is recommended that the workforce of general hospitals should be given important considerations by the MOH and the management of these healthcare organisations. Furthermore, there is the need for the MOH to decentralise its medical training facilities, especially those relating to TQM through setting up new training facilities in TQM in each of the 13 regions of the country. This is recommended to empower the general hospitals located in regional areas to increase the professional competencies of their staff in TQM implementation through continuous quality training that can be easily acquired in regional areas.