Abstract
Assessment of the pilot project on service quality improvement in public hospitals with TQMQuality improvement for hospital services currently received enormous interest. In 1993, the Health Systems Research Institute, Thailand initiated the pilot project on service quality improvement in public hospitals using the total quality management (TQM) approach. The duration of the project was 2 years. Eight public hospitals in Bangkok and nearby provinces participated. Our study aims to assess and outcomes of the TQM pilot project in public hospitals by applying criteria modified from the Malcolm Baldrige National Quality Award and to determine a set of selected knowledge, attitudes and practices perceived by the top and the middle management and operating personnel in service quality management using TQM concepts. A combination descriptive study designs were conducted by a retrospective ocumantal review with two site-visit key performances interviews and a post-intervention cross-sectional survey during July 1996 and March 1997. The results revealed that the project was systematically organized in providing 2-day TQM training for senior management and middle management and in setting structures to support TQM activities in hospitals. However, participating hospitals had different levels of progress in TQM implementation; two of them were classified as having "breakthrough" progress while the other six hospitals were classified as having "incremental" progress. The following factors were identifies as contributing to the differences: the senior and middlemanagement leadership commitment and continuity, information system and analysis, strategic plans development, human resources training in quality tools and analytic techniques and management, involvement in patient care services process which brought about visible organizational outcome and had impact on customers. In addition, hospital personnel from the two groups of hospitals had significantly different levels of opinions towards policy deployment, hospital status, knowledge on TQM, attitudes towards quality improvement, process management and hospital outcomes. The three most important factors that contributed to success or failure of TQM project in their opinions were attitude and involvement of all personnel, the senior management attitude and strong support, and training in TQM. Consequently, we suggest a new model for effective TQM implementation in public hospitals by emphasizing changing "process first", quality policy deployment, TQM training, enhancement of strategic and tactical action planning, key services process focus, and closer to both internal and external customers and also their expectations by pre-and post-intervention customer surveys.
