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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 250-255

Significance of total quality management practices in improving quality of services delivered by medical and dental hospitals

1 Hospital Administration, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Maharashtra, India
2 Dr. D. Y. Patil Vidyapeeth's, Global Business School and Research Centre, Pune, Maharashtra, India

Date of Submission23-Oct-2021
Date of Decision29-Oct-2021
Date of Acceptance12-Nov-2021
Date of Web Publication20-Dec-2021

Correspondence Address:
Devika Kanade
Hospital Administration, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_168_21

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Total quality management (TQM) is an administration attitude of uninterruptedly refining the quality of the goods/services/processes by concentrating on the customers' (patients') requirements and anticipations to augment consumer (patient) contentment stable performance. Successful TQM implementation leads to improved organizational performance success. The present review paper comprehensively presents relevant data from the literature pertaining to the impact of TQM implementation and barriers to execute the same in various hospitals. The review also stresses the need of TQM application in dental setups and hospitals. It also presents various gaps in TQM practices in improving the quality of services provided by the medical and dental hospitals, which need to be studied along with future directions.

Keywords: Health sector, hospitals, quality, service, total quality management

How to cite this article:
Kanade D, Kale S. Significance of total quality management practices in improving quality of services delivered by medical and dental hospitals. J Dent Res Rev 2021;8:250-5

How to cite this URL:
Kanade D, Kale S. Significance of total quality management practices in improving quality of services delivered by medical and dental hospitals. J Dent Res Rev [serial online] 2021 [cited 2023 Feb 5];8:250-5. Available from: https://www.jdrr.org/text.asp?2021/8/4/250/332923

  Introduction Top

Total quality management (TQM) is, “the management that stresses on improved services to customer hence achieve customer satisfaction and improve organizational performance. It is an administration attitude of uninterruptedly refining the quality of the goods/services/processes by concentrating on the customers” (patients') requirements and anticipations to augment consumer (patient) contentment stable performance.[1]

TQM is of utmost importance in health care. It makes the best use of the organizational resources to improve customer services and customer satisfaction, which is the goal of any health organization. TQM is based on various principles.

“Quality is doing the right things for the right people at the right time, and doing them right first time and every time.”[2]

As the customer is at the center in all the health care organizations (HCO), it is an essential indicator. For this, it is the customer experience that would play a major role. The healthcare organizations all over have been implementing TQM as a quality philosophy to analyze and improve the processes of an organization, the employee's efficiency and provide quality patient care. Quality services include quality in administration and also medical services such as diagnosis and treatment. TQM is a way to reduce the errors, reduce the time consumed, improve teamwork, and develop customer centeredness and overall performance. Quality is a continuous process with continuous improvement. Satisfied patients are those loyal patients who have received quality care and better clinical outcomes. The application of the effective quality management systems in health care is the way a framework is developed in an organization to analyze and improve health care, which definitely has advantages to the customer as well as to the organization. It increases quality and effectiveness of services offered to the patients.

It has been seen that all organizational processes necessary for delivering health services need to be controlled using a TQM system. TQM is one of the most important advancements in the management in recent times. TQM will thus help the HCO to overcome challenges and settle all problems. Hence, one would agree that successful TQM implementation is leading to improved organization performance success.

  Health Sector Top

India has been a known country with a history of ancient medicine, the Ayurveda. It is the largest service sector in India. India has public health care sector as well as private health care sector at large. However, most of the private health care providers are present in urban India, providing secondary and tertiary care health-care services. The public health-care infrastructure in rural areas needs to be improved for better affordability of the people in rural.[3]

Over the past decade, healthcare services have changed in India basically due to emerging technologies available at affordable cost. The doctor-to-population ratio in India is 1:2148. HCO and health care professionals all over the globe are trying to increase the health standard and standard of people. Health care sector has changed in the past few years due to clinical innovations, customer centeredness, increased facilities, and customer awareness. Good health care delivery is important and plays a crucial role in maintaining a healthy population.[4]

The major problem faced by the health care sector in India is the smaller number of medical staff in rural India. Most of the people in rural India are below poverty, cannot bear the minimum expenses, and cannot afford to visit the cities for health care.

India is stepping toward the need for community cleanliness, preventative health services, control of infectious or contagious diseases, and health care awareness, especially in rural India. The people are educated towards the importance of the same. Time and again the government has taken initiative for awareness of good health. But yet, there exists a vast difference in the quality of health care services in urban and rural India. The government of India is planning to upsurge community health utilizing 2.5% of the gross domestic product by 2025.[5]

Health care market in India is anticipated to stretch up to US $372 billion by 2022, due to rise in economy, more awareness about healthcare, lifestyle ailments, and rising awareness to insurance. India's largest health care scheme, Ayushman Bharat was started on September 23, 2018.[6] Although the first national population program was announced in 1951, India has to still go a long way to strengthen its health sector. India's strength lies in its qualified doctors, cost-effective health services, and availability of advanced technology. Health care is the right of every nation and we need to provide the basic health care needs to all in the society.

  Market Size Top

The Indian healthcare industry is currently a $65 billion industry and is upsurging at a rate of 15%. India is an emerging health care market. India is still facing multiple challenges but the rapidly growing healthcare market represents huge opportunities in the health sector especially medical and dental. Indian medical and dental healthcare industries have evolved over the years and still evolving. It has been a social sector backed by the government and is becoming a large sector in India with more and more investors preferring it.[7]

Medical and dental tourism is flourishing in India. An annual growth rate of 30% has been predicted in this sector. India is gaining popularity and is the preferred choice for medical tourism as it provides quality as well as economical options. Improved quality of care and advances in treatment are a reason of advantage for those who opted to travel for healthcare.[8]

India is a core center of information technology (IT) and IT-enabled service industry. In the last decade, health insurance has developed very rapidly and is using IT in gathering, analyzing, and transferring information whenever required. Electronic health record is there which systematically gather electronic information related to health about each patient/population. This has reduced the time frame of searching and collecting patient data. All data available at a click which in turn has increased the efficiency of employees and satisfaction of customers.[9]

  Investment Top

Health care sector is one of the fastest-growing sectors and investments in this sector seemed to be on a rise in recent times. Over the past decade, the health care industry has grown tremendously due to health awareness, lifestyle diseases, and provision of insurance which is known and invested by the customers which was lacking a few years ago. Yet more emphasis has to be given by the government towards health insurance which would further strengthen the investment. The government must also focus on public–private partnership that would drive investors and at the same time the low-economic stratum too would be benefited.

The hospital industry in India accounts for 80% of the total healthcare market. The hospital industry is anticipated to touch $132 billion by 2023 from $ 61.8 billion in 2017; rising at a compounded annual growth rate of 16% to 17%. The Indian medical tourism market is predicted to raise from its existing size of $3 billion to $7 to 8 billion by 2020.[1]

Healthcare sector is a growing sector. The sector can be divided into three groups:

  1. Healthcare providers
  2. Suppliers of products and services to the healthcare industry
  3. Customers.

Hence, the investors could invest either in products or in providing services. The best part for investors is that there are plenty of options to choose from.

  Literature Review Top

There have been various studies carried out and published in the literature on the impact of TQM on various hospitals across the country. The objectives of the study, the impact of TQM application and the findings of the studies have been summarized [Table 1].
Table 1: Various studies across the country, the impact of total quality management on the hospital services and the observations

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Abd El-Moneim and El-Tohamy.[17] studied the outcome of applying TQM on the services provided by the accredited government hospital. It was interpreted that the implementation of applying total management principles had a positive impact on the effectiveness of hospital. It was noted that it is not just top management responsibility, but requires team work, employee involvement. It is a continuous process to provide good quality and achieve customer satisfaction. It has been noted that the involvement right from the top management to the insufficient training programs for the employees would lead to poor implementation of TQM, which in turn would hamper better doctors, nurses, and cleaners has to be there which was a limitation. Shdaifat[18] studied the implementation of TQM in hospitals. It was interpreted that a foundation has to be established that will incorporate quality in the hospitals. Insufficient training to the employees is noted as limitations of the study which lead to poor implementation and performance. Aggarwal et al.[19] studied the TQM in health care. It is concluded that the application of a quality standards makes the health care to deliver a high quality measurable quality service. It is noted that the HCOs have to focus on TQM to achieve the desired outcomes.

Sadikoglu and Olcay[16] studied the effect of TQM practices on the performance and the barriers to TQM. It is been observed that the quality training is positively related to employee performance and also operational performance. The limitation of the study was the use of subjective parameters to assess the performance which cannot be relied on.

Zgodavova[11] studied on the TQM principles as an approach in health care institutions. It is concluded that there is an increase in no of patients and also reduced errors. The limitation observed is the need of the health care employees to understand the importance of TQM.

Patel[12] studied the TQM in health care. It was concluded that in the era of technology the demands of the customers have increased and TQM is a customer focused quality principle, which aims at continuous customer satisfaction. Limitations of the study were the involvement of the employees was not up to the mark and there was a resistance to the change.

Shortell et al.[10] studied on the difference in the concept of TQM/continuous quality improvement (CQI) to its implementation. It was concluded that the implementation of TQM/CQI results to both maintain and improve quality while controlling increases in costs and the limitations were noted as difficulty in implementing it in bigger hospitals. As the study design was cross-sectional the shortcomings noted are that it cannot be applied to all hospitals.

Oration studied quality management in health care. It was concluded that the health professionals need to be trained to understand the concept of TQM/CQI and training needs, which is to be focused on the care of patients apart from the treatment of patients for specific medical conditions. It was noted that the organizations don not change overnight but eventually accept the change.

Carman et al.[13] studied on the keys to successfully implement TQM in hospitals. It was found that overall performance was not that great, it influenced patient satisfaction scores.

It was noted that effects were affected by environmental impacts like competition.

It was also noted that the smaller hospitals would more easily implement another limitation noted was the typology, with visitors having a problem understanding it.

Dixon-Woods et al.[14] studied on the challenges in improving quality in health care. It is concluded that the improvement requires multiple approaches, often strong leadership, a participatory culture and also flexibility in implementation. Limitations noted are extensive development periods are needed and one cannot impose the professionals to follow TQM but gradually inculcate the quality principles.

  The Relationship between Total Quality Management Practices and Performance Top

According to Alshourah,[20] overall TQM practices can positively affect hospitals' quality performance. They have focused on various factors and derived that the following parameters affect the hospitals' quality performance.

  1. Leadership commitment and backup to quality
  2. Quality strategic planning
  3. Training and participation
  4. Information and data
  5. Process management
  6. Supplier quality management
  7. Customer focus
  8. Continuous improvement.

TQM practices lead to various yields:

  • Better productivity and manufacturing output
  • Good quality output
  • Satisfactory employee performance
  • Innovations
  • Satisfied customers
  • competitive benefit
  • More market revenue
  • Impressive financial output.

Leaders/managers/coordinators in a TQM system working in an organization back employee growth form a multipoint interaction between the employees (doctors), administrators, and consumers. The leaders inspire employee contribution in decision and policymaking and authorize the staffs.

Staff on higher posts should exhibit better governance than old-style administration to upsurge employees' understanding of quality actions in TQM implementation. Comprehension and practice management are positively linked to performance. Effectual knowledge managing confirms that staffs find well-timed coherent, dependable, precise, and essential data and knowledge, as they want to do their work successfully and capably. The organizations should give essential coaching to all staff to develop their competencies. Efficient guidance in TQM fetches success for the organizations. Staffs' efficient expertise and learning ability will offer sustainability of TQM in the organization. Real guidance will increase staffs' faithfulness to the organization and their efficiency leading to customer contentment. Supply chain supervision, customer focus, and tactical quality planning are also equally important in improving TQM.[21]

  Reasons of and Barriers to Total Quality Management Practices Top

Hospitals function in a competitive, complicated, and vibrant environment in which, the healthcare delivery service, i.e., medical, dental, etc., becomes more difficult, challenging, and sophisticated for leaders, suppliers, and employees. Although applying TQM is a challenging exercise, the healthcare calls for a continuous process of quality improvement.[22] The most challenging and fundamental constraint is the assessment of quality performance. There are various reasons which can affect the TQM practices[16] and are summarized in [Table 2].
Table 2: Reasons of and barriers to TQM practices

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There is a need to employ TQM in health care institutions to recognize customer requirements, deliver the best services, development, and provision of suitable care and magnitude of medical inaccuracies. It has been suggested many times in the literature to implement TQM to maintain the standards of the medical or dental hospitals. Many leaders have gradually applied TQM to develop the overall standards of the services provided by the hospitals.

  Dental Set Ups or Hospitals Top

Thus, irrespective of the type of hospitals, TQM is the need of the hour. Other than the above-mentioned aspects, few additional things are needed to be focused on when it comes to a dental set up. TQM is actually a time-proven protocol, which works as a modus to advance communications between all stakeholders, i.e., dentists (staff), patients, and the technicians who do the laboratory work. TQM process effectively eradicates most of the causes for rework or amendments. Thus, in a dental setup or dental hospital, various vital points are needed to be focused on like:

  • Best and predictable outcomes
  • Augmented productivity and profits
  • Amplified patients' satisfaction
  • Improved company superiority, generosity, and faithfulness.[23]

Recognizing the patients' health knowledge about dental service industries leads to productive communication among the dental staffs and the patients, which is crucial for launching a TQM in dental field. The dentistry field is not just a branch of medical sciences but also involves cosmetic and aesthetic aspect also. Thus, patients' opinions and comfort also matters when it comes to the function and appearance. Thus, effectual communication is essential which results in improved patients' involvement leading to their complete satisfaction, which has a foundation role in dental practice. The TQM starts right from the moment patient enters the dental office. The waiting area protocol especially in the current pandemic situation, taking verbal and written informed consents till the last appointment of treatment including the ease of fee payment should be followed. Thus, dentists need to focus on their patients' dental complaints and engage in positive relationships with their patients by delivering necessary complete information concerning their dental problems which also includes clarity irrespective of the costs of services.[24]

  Conclusion and Future Directions Top

After reviewing all the papers, it has been observed that there are many research gaps related to TQM practices in improving the quality of services provided by the medical hospitals. As the research is customer-focused, the health care sector staff members have to understand the importance of TQM. They should have the awareness and knowledge about TQM to deliver better services. If the employee involvement is not sufficient enough to achieve customer satisfaction, the results will not be as desired. The involvement of all the staff is necessary. It has been also observed that customer satisfaction perception may vary. Quality management is a continuous process; hence, if not followed regularly the results could vary. If proper training to employees is not given, the employees would fail to understand the importance of TQM, hence not achieving desired the quality of services. There could be problems like the HCO could resist the change and a lack of self-motivation among the employees. The customer perception would be a challenge as a customer would be very happy with a definitive service but another customer would not be totally happy with the same quality of services provided. Thus, variation in the customer satisfaction levels is expected.

More and more studies should be carried out on TQM in various medical hospitals and allied centers. Ayurvedic, homeopathy, physiotherapy hospitals should also carry out such studies to improve the overall quality of the services provided by them.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2]


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