Total Quality Management 

As a company moves to become more competitive, certain psychological needs of individuals should be reexamined. These include the need to achieve and to be recognized for that achievement, the need for group identity such as a work team or problem resolution team, and the need to exercise influence and some control over the causes of job satisfaction.

Employee responses positive for TQM were quite variable regarding perceptions of satisfaction and ranged from 20.8% to 79.2%. Statistical significance is noted in the differences in the evaluation of job performance. This gap reflects a more negative perception by employees than management regarding the fairness of job performance evaluation.

To increase satisfaction, supervisors need to understand the jobs performed by their employees. The hospital's management apparently is well aware of how individuals perform their jobs based on the responses of both groups. The hospital may want to consider why both management and employees perceive a low level of praise. It may be important for the hospital to consider perceptions regarding performance appraisals and promotional opportunities as well. The hospital may want to investigate the more negative perception by employees than management regarding the fairness of job performance evaluations.

The desire to change and ability to adapt to change are important in determining the potential level of success of a TQM program. Employee responses to statements related to desire to change range from 33.3% to 54.2% agreement. Many neutral responses may indicate uncertainty or the possibility of some resistance to change. Management express lower agreement to the ability to change (45.2% agreement) than is perceived by employees (54.2% agreement). Management takes a more negative view that policy changes occur too slowly. Differences are also noted in the need to make policy changes to improve the quality of health care, but not at a statistically significant level.

Findings imply potential challenges for TQM when the neutrality of this characteristic and the potential weakness of innovativeness are considered. Weakness in innovativeness and desire to change/ability to adapt to change often go hand in hand.

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For successful TQM effort, the future vision of the organization needs to be clear, compelling, and consistently presented in terms relevant to all members of the organization (Ciampa, 1992). Employees perceive objectives, goals, mission, and policies as being carefully explained and consistently pursued at the hospital. Sixty-seven percent

(66.7%) of employees agree that hospital objectives and goals are carefully explained. In addition, employees agree (79.2%) that the hospital's mission and goals are carefully explained. Management's view is less optimistic. Thirty-six percent (35.7%) of management agree, 35.7% disagree, and 28.6% are neutral regarding hospital objectives and goals being carefully explained to employees. These differences represent gaps in thinking of the two groups.

An additional gap is noted in management (16.7%) and employee (0.0%) disagreement with the statement that a quantitative system is in place to assess progres- in improving quality. This difference may be due in part to the large number of neutral responses noted by management (33.3%) and employees (50%). Common vision/ benchmarking is perceived as a weakness by both groups. Opportunities may exist for improved communication. The hospital's TQM program may be enhanced by clarifying and eliminating the perceived gaps which exist regarding employee understanding of objectives, additional use of performance indicators, and communication regarding these efforts. Such clarification can serve to focus organizational energies appropriately and foster goal attainment.