Successful Quality Care - Essay Example

Successful Quality Care The stated factors have led to an increase in the current healthcare professionals’ challenges. Despite the fact that theoretically the employment of quality management practices is a significant component in business performance enhancement, in reality, because of the organizational culture, a significant number of organizations have fallen in implementing their quality programs. This is in line with Rad (2006) who asserted that culture is vital for the successful factor in quality management implementation. Additionally, in reality, the connection between quality management success and organizational design may be varied in a particular cultural values degree. Davies and his co-authors (2000) define organizational culture as an organization’s values, norms and beliefs that shape its behavior. As healthcare organizations go through key reform of their processes of care delivery, they are now increasingly putting more emphasis on organizational culture and its role in driving innovation, facilitating change as well as bringing a transformation in a healthcare system (Shortell et al., 1995a & Ingersoll et al., 2000). Shortell and his co-authors (1995b) assert that successful quality care implementation initiatively calls for a significant devotion to a culture that emphasizes risk taking autonomy and empowerment. In their studies, Sahney & Warden (1991), Wardhani and co-authors (2009), Dean & Bowen (1994), Metri (2005), Hackman & Wageman (1995) and Powell (1995) have underscored the fact that organizational culture successfully drives quality management. According to Rad (2006), quality management practices’ success as an organizational change largely depends on the organizational culture. Apart from the fact that an organizational culture is of great importance to quality management practices’ success, the central function of organizational culture that creates and manages it is leadership. Leadership imposes the organizational purpose, beliefs, behaviors and leader’s values on the employees of an organization (Schein, 1985; Shaw, 2002; Senge, 1990; Oqbannan & Hrris, 2000). As much as an organizational culture’s leadership effects the culture, an organizational culture effects its leadership (Bass, p63, 1998). Furthermore, through the influence of daily practices, behaviors and tasks, the leadership style and values of the leaders shape an organizational culture (Sengupta, 2004 & Hofstede et al., 1990). Individual leadership motivations may also influence culture styles. If a leader prefers aggressiveness and outcomes, he/she may be motivated to develop an innovative form of culture (O’Reilly et al., 1991). Culture is a collection of enduring covert and overt rules, principles and values that guide organizational behavior (Burke & Litwin, p532, 1992). Moreover, Schein (2004) says that organizational culture is a dynamic phenomenon, which is in constant flux. He adds that employee interactions with each other create an organizational culture and that the behaviors of leadership within a structured set of norms that direct and constrain behavior shape it. Leaders must pay attention to the beliefs, assumptions, values and rites embedded in the organizational culture (Bass, p63, 1998). There has not been adequate examination of the issue of quality management practices in health services. This is from a theoretical perspective. The significance of leadership as a successful quality management aspect is well documented by such authors as Saraph and his co-authors (1989), Anderson and his co-authors (1994), Motwani (2001), Chowdhury and his co-authors (2002), Karuppusami & Gandhinathan (2006), Feigenbaum (2007) and Awan and his co-authors (2009). An analysis by Hackman & Wageman (1995) concluded that the movement’s founders regard quality as top management’s inescapable and ultimate responsibility. As far as the significance of leadership to quality management is concerned, there appears to be a strong consensus among the quality movement founders. This is apparent in the writings of Crosby (1979), Deming (1986), Feigenbaum (1983) and Juran (1994). The view of all these founders is that quality is a leadership responsibility. They also view TQM principles as leadership principles. Any organization or individual wishing to take their first steps on their journey toward quality must begin with a nearsighted organization leadership capability and culture examination (Mauro and Mauro, p37, 1999). Additionally, a recent study by Idris and Ali (2008) on quality management practices and leadership style’s impacts on the performance of a company revealed that financial performance can be enhanced by transformational leadership, mediated by best practice management. Put differently, an effectual management approach can result in much needed organizational change. The transformational leaders set the vision and motivate the followers to attain it through effective communication. In a hospital setting, there may be different cultural types in varying degrees. However, this could affect performance and there is therefore need for a thorough investigation as to whether the organizational culture influences quality performance in Saudi Arabian hospitals. Secondly, in their studies, many authors such as Schein (1985), Senge (1990), Rad (2006), Bass (1998), Oqbannan & Hrris (2000), Shaw (2002) among others claim that the administration of the quality management should be different in diverse organizational cultures. Rad (2006) argues that the organizational culture should have the support of the top management and be quality-oriented regardless of the national culture. Additionally, various studies by the above-mentioned authors indicated that leadership style directly affects organizational culture. There is also some preliminary finding and theoretical proposition that suggests that organizational culture may be a harmonious combination variable that leadership uses to influence various organizational outcomes (Oqbannan and Hrris, 2000 & Lim, 1995). 1) Quality Program: This is a systematic, documented and institutionalized set of procedures and practices within an organization used to verify and assure confidence in the processes of designing, manufacturing and delivering goods and/or services that agree with specifications and meet or exceed external and internal customers’ expectations 2) TQM: refers to creating an organizational system which promotes learning and cooperation to facilitate process management practices’ implementation that in turn brings about incessant improvement of products, services and processes, plus employee fulfillment. These are critical to customer satisfaction and eventually, to firm survival (Andersons et al., 1994). 3) Leadership style: This is the approach and manner of motivating people, implementing plans and providing direction. Included in this study are three types of leadership styles. These are transactional, non- transactional and transformational. 4) Malcolm Baldrige National Quality Award (MBNQA): This is a national recognition program named for a former U. S. Secretary of Commerce and that Public Law 100-107created. In 1987, President Reagan signed the MBNQA into law. Evans & Lindsey (1996) explain that it is designed in such a way that it recognizes organizations headquartered in the United States, which excel in quality achievement and quality management. The award measures organizational performance. It does this using the Baldrige Criteria, consisting of seven categories of organizational performance measures that focus on quality. 5) Chapter Two: 6) This chapter gives a descriptive literature overview on organizational culture, leadership style and quality management practices. It will also show the way the existing research basis builds on or extension prior theory. In addition, the study will review, analyze and cite the well-known research that examines the organizational culture, leadership style and quality management practices extensively. 7) Underpinning Theory of the Current Research This research draws from the organizational culture, leadership style and quality management practices theories. The theories of quality management practices form the basis of this research particularly Anderson et al.’s (1994) theory that traced Deming’s management method (1982) development. Review of literature indicates that Anderson et al. (1994) made the first attempt of synthesizing a quality management theory from Delphi method-based research, performed both on managers and on academic sources closely related with quality (Rungtusanatham, et al., 1998; Fisher, et al., 2005 & Chowdhury, et al., 2007). Anderson and his co-authors (1994) however point out that in Deming’s management method, the basic premise is that creating an organizational system that fosters quality management practices implementation including customer focus, continuous improvement and teamwork requires an effective leadership. Therefore, we can argue that the model can apply to all the organizations. The leadership theory applied in this research is drawn from Bass's (1985) theory who is working on the theory of transformational leadership. The work of Bass grew out of the 1978 qualitative examination of charismatic political leaders by James MacGregor Burns (Howell & Avolio, 1993) in addition to House's theory of charismatic leadership (Van, Fleet & Yukl, 1982) that stems from ideas originating from early work on charisma by Weber (Bass, 1990). In this current research, the organizational culture theory is drawn from Quinn and Rohrbaugh (1983) who developed the Competing Values Framework (CVF) that specifies a culture of an organization and gives insights into how a culture of a certain organizations may influence its change management ability, which is generally associated with quality and performance improvement. Theoretical framework Organizations have increasingly recognized the strategic significance of quality management practices. Numerous researches in the past have studied the inter-relationship between an organization’s quality of management practices, organization culture and leadership. The present research study borrows from such studies to posit a new model in this field that correlates the influence of specific leadership behaviors/independent variable under various organizational cultures/moderator variables on management practices’ quality/dependent variable that an organization follows. The transformational theory of leadership by Bass (1985 & 1990) stipulates that despite the fact that some people have inborn leadership qualities, one can also choose to become a leader and with time and experience, can learn leadership behaviors. The following are the types of leadership behaviors that people display as identified by Bass: 1. Transformational Leadership: This is where leaders believe that inspiring the workers to attain greater things brings good results for them and the organization as a whole. Transformational leaders are very passionate and place much energy in employee-motivation. 2. Laissez faire Leadership: In this type of leadership, leaders assume that employees have enough experience to solve all their problems mutually and that the intervention of a leader is not necessary in such matters. We can also be regard this as shying away from making decision. 3. Transactional Leadership: Here, leaders presume that incentives motivate people. There is the creation of clear structures in the organization that explicitly inform their subordinates exactly what is expected of them and implicitly inform what is not. It can be a wonderful and an uplifting experience for the workers to work for a transformational leader and this can make them put in an extra effort for their organization thereby attaining outstanding performance (Sousa & Voss, 2002 and Berson & Linton, 2005). In an organization, such leadership behaviors can bring about quality management practices (Waldman, 1994). However, to verify this assumption, very little research exists on this subject. This gives us the foundation and the reason for our research study. The basic aim of this research will be testing the suggestion that transformational and transactional leadership and non-transactional behaviors have an association with the realization of essential principles of quality management practices. Rad (2006) researched on the impact of cultural values on the success of the implementation of TQM in Isfahan University Hospitals (IUHs), Iran, 2004. He found out successful implementation of TQM barriers in an organization and its relationship with the organizational culture. He found out that in hospitals with organic organizational structure and medium organizational culture, success of TQM was higher than in bureaucratic and mechanistic hospitals whose organizational culture is weak. Thus, if it has to be successfully implemented, organizational culture should be attuned to TQM’s basic principle and values. Furthermore, for successful implementation of TQM, top management’s commitment and support is vital. The study however did not include various styles of leadership in the organizational culture to determine TQM implementation’s success. For that reason, culture has a direct bearing on quality improvement and organizational performance (Powell, 1995; Hackman & Wageman, 1995; Dean & Bowen, 1994; Metri, 2005; Wardhani et al., 2009 and Sahney & Warden, 1991). Quinn and Rohrbaugh (1983) came up with the Competing Values Framework (CVF) that specifies an organization’s culture and gives insights into the way an organization’s culture may influence its change management ability that is generally associated with quality improvement and performance. Their framework has two specific dimensions of culture: The first dimension relates to organizational structure preference along a scale between stability and control and flexibility and change. The second dimension pertains to organizational focus. The organizations can be differentiated along a continuum between an external and internal emphasis. While the external emphasis is on the organization’s development and well-being, the internal emphasis is on the development and wellbeing of the people in the organization. These two continua’s intersection led to the creation of four quadrants representing the four organizational culture type’s group culture, developmental culture, rational culture and hierarchical culture. The development of Deming’s management method (containing its fourteen point principle) was traced by Anderson et al. (1994). They positioned it within management theory context and then described their theory formulation. It stated that Deming management method’s effectiveness arises from leadership efforts toward the concurrent creation of a learning and cooperative organization to facilitate process and management practices’ implementation, which supports the survival of the organizational and the satisfaction of customers and through sustained employee fulfillment and continuous process, products, and services’ improvement (Anderson, Rungtusanatham & Schroeder, 1994). Anderson et al.’s (1994) model, like Bass’ (1985) leadership theory, argued that a visionary or a motivational leader can affect an organization’s management practices quality. One example is customer focus and continuous improvement. However, people may argue that Anderson et al.’s (1994) study focuses on organizations wanting to implement TQM. They also argue that the theory may not be valid for all organizations. Literature review indicates that the first effort of synthesizing a quality management theory from research based on Delphi method was by Anderson and Schroeder (1994). They carried this out both on managers and on academic closely related with quality (Rungtusanatham, et al., 1998; Fisher, et al., 2005; Chowdhury, et al., 2007). The Deming management method’s theoretical essence concerns creating an organizational system that promotes learning and cooperation for facilitating process management practices’ implementation, which then leads to continuous process, products and services’ improvement and the fulfillment of employees, which are critical to customer satisfaction, and eventually, to the survival of the organization. The crucial role played by organizational leadership in making sure that there is quality management success is implicit in this theoretical statement (Anderson, et al., 1994). The concern of the basic premise of Deming’s management method, however, is that an effective leadership is crucial in the creation of an organizational system, which fosters quality management practices’ implementation. That is, customers focus, continuous improvement and teamwork (Anderson et al., 1994). Therefore, we can argue that the model is applicable to all the organizations. Research design is establishing how to carry out the research and the methods used. Here, our concern is why we should collect certain data, what data to gather and how to gather it. This will assist us in our theoretical framework development. Cooper & Schindler (2003) assert that exploratory research can be conducted when a problem has not been clearly defined. This is because it provides insights into an issue or situation. Frequently, exploratory research depends on secondary research like reviewing available literature and/or data, or qualitative approaches including informal discussions with management, employees or consumers. Since we aim to incorporate different variables’ (leadership style on practices of quality management) correlation in our model, it is great to select a descriptive technique that focuses on a mathematical based approach (Cooper & Schindler, 2003). Furthermore, a quantitative approach is primarily deductive and is best suited to prove or disprove a hypothesis. Therefore, in our study, we will use a quantitative approach. We will conduct our study by using a cross-sectional survey design (Fink, 2003). A self-administered questionnaire will be our survey instrument. This is a commonly used method of data collection in survey research (Bourque & Fielder, 2003). The next section explains the rationale for using a questionnaire-based survey method design. Figure 5 outlines the research design. Rationale for using self-administered questionnaire The self-administered questionnaire is the most common quantitative research method as it gathers opinions and information in a timely and cost-efficient manner (De Vaus, 1995; Schwab, 2005; Fink, 2003; Bourque & Fielder, 2003). According to Schwab (2005), although there are many organizational research techniques, the questionnaire are most commonly used. Additionally, a questionnaire is a preferred data collection technique from a professional sample for instance hospital managers (Bourque & Fielder, 2003). Mailed questionnaire has several advantages. For instance, it can be used to reach a great number of respondents across a wide geographic distance. Compared with other methods, it is less expensive and it reduces the number of research workers. Moreover, one can put strategies in place to permit an almost simultaneous recipient of the questionnaire by all respondents (Babbie, 1973; Bourque & Fielder, 2003). In this research, the target sample will be spread all over the country; consequently, the use of a postal survey technique permits the coverage of a wide geographic area by a researcher. The researcher can also obtain data from respondents without making a commitment to meet them personally at an appointed time or place. Another advantage of self-administered questionnaires is that they have a lower cost outlay compared to other techniques like in-person and telephone interviews. For example, a mailed questionnaire costs about seventy-five percent less than an in-person interview (Bourque & Fielder, 2003). While undertaking this study, lack of sufficient fund support will restrict in organizing one to one interviews with managers in relatively large county. Alternatively, mailed questionnaire permits the researcher to target all hospital managers across the country with less cost. Lastly, there is a timing advantage, because it can be assumed that the respondents will get their questionnaires at almost the same time. Therefore, it can be assumed that the possible influence on the circumstances and situations of the respondents is relatively equal for all of these respondents (Bourque & Fielder, 2003). Consequently, self-administered questionnaires will select as the most suitable method in the present study. 3.4 Sampling All the MOH hospitals in Saudi Arabia will be the target population. The Health Statistical Year Book (2008) points out that there are 231 MOH hospitals in Saudi Arabia, located in 19 health regions (6 sub-regions and 13 main regions) across the country. As Figure 6 (the MOH organizational chart) indicates, each hospital has one manager – a Chief Executive Officer. Presently, the MOH has 231 hospital managers and since this target population (231) is small, the aim of the research is to target all the MOH hospital managers in Saudi Arabia as the present study’s sample. In this case, this study will cover all units of the target population. All information on the MOH hospitals will be obtained from the General Directorate for Hospitals at the MOH in Saudi Arabia. The researcher will take a list of all hospitals from MOH that has each hospital’s information including date of establishment, name, location postal address, number of beds and the hospital manager’s contact details. Data Collection At this stage, we will prepare and collect our study’s data. The collected data will provide information about a particular topic. Nevertheless, we will start distributing the questionnaires in all MOH hospitals in Arabic and English languages. To be included in the questionnaire will be a cover letter to assure the survey’s authenticity to the participants (Medical Research Ethical Committee’s approval from the MOH) as well as their details’ confidentiality clause. This study will take place during early 2010 and it will last for a period of three months. This time is appropriate because it does not contain many holidays and most of the employees will be accessible for the purpose of our study. For confidentiality purposes, the reply-paid envelope will be provided to the hospital managers and they will use it to return their completed questionnaires to the researcher directly. In addition, to facilitate the process of returning the questionnaires, the researcher will provide direct email options and fax number. A follow-up reminder letters strategy will be developed to enhance the response rate. Given that there is a direct contact numbers’ list of all MOH hospitals managers, the researcher will keep this list as a respondents’ checklist. Consequently, the researcher will be in a position to contact those who did not respond to the initial survey to make sure that these respondents are willing to take part in the research. A second copy of the questionnaire will be sent to these respondents. Therefore, only the researcher will access the information contained in the survey forms. Read More