Total Quality Management 

Hospitals around the country are challenged to implement total quality management (TQM) programs. Experience in quality management has identified seven key characteristics of organizations possessing excellent quality programs. These characteristics include influence, responsibility/autonomy, innovativeness, desire to change, satisfaction, teamwork, and common vision/benchmarking (Ciampa, 1992).

The perceptions of managers and non-managers are important in measuring these organizational characteristics. Individuals act based on their perceptions. Even if perceptions are inaccurate, they still form the foundation for individual and group actions (Whetten and Cameron, 1991). Unfortunately, hospital management does not always consider the level of commitment, expense, and time that the TQM effort requires. The development and implementation of TQM may take at least two to three years to complete and cost $50,000 to $300,000 (Atchison, 1992). If an organization is not properly prepared for the TQM effort, its future health is in jeopardy.

For total quality management to succeed, it must be accepted and driven by the managers who are responsible for implementation. The assessment of a hospital's readiness for TQM must begin with the hospital's top management and their attitudes. Top management must be willing to put as much energy and time into the TQM process as will be needed to make it succeed. Likewise, hospital employees must have input into the design and implementation of the TQM process. Within the hospital, key groups must be formed to determine the organization's approach to TQM.

Much of the literature supports the need for agreement and understanding between employees and managers for successful quality programs. However, few studies have developed assessment criteria or an instrument to assess readiness. The TQM literature suggests that success comes to organizations ready for a change in climate. Determining levels of readiness or conversely resistance to change is an important step, yet few organizations assess readiness in starting a TQM implementation. This paper will highlight an assessment of a major hospital's readiness to implement a continuous quality improvement program. Discussion of the survey of both managers and employees regarding these characteristics is presented. Like manufacturing organizations, hospitals and other service providers are challenged to implement improvement programs.

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Assessment instruments were developed to measure the perceptions of the hospital's management and employees

regarding critical organizational characteristics. Variations of statements used in the instruments were validated in previous research (British Telecom, Vol. 1 and 2,1984; Cook, Hepworth, Wall, and Warr, 1981; and Taylor and Bowers, 1972). Separate instruments were developed and pre-tested for managers and employees. Copies of both instruments are available upon request.

On both instruments, individuals indicated their perceptions regarding various statements, using a five-point Likert-type rating scale ranging from strongly disagree to strongly agree. The perceptions of both groups were compared using a Z-test to compare the significant differences in the responses of employees and managers. Gaps or responses that were significantly different between the two groups were assessed using a 95% confidence level.

In considering responses, the percentages are a guide to help identify relative strengths and weaknesses. The more consistent and the larger the positive responses are for the various organizational characteristics, the greater the likelihood a successful TQM effort.

The degree to which individuals feel they have influence within their organization is important to a TQM program. Responses to statements on influence had the strongest percentages of agreement. Management also responded positively and consistently to statements about their perceptions of the ability of the typical employee to influence change (69.0% to 78.6%). No gaps are present regarding the influence characteristic. Influence is a strength for the hospital's TQM efforts based on employee and management responses. The hospital's employees are likely to accept change, and are likely to be energetic, persistent, and committed in accepting greater responsibility/autonomy and in participating in teams.

To be Continued