Quality management emerged as a strategic objective for organizations to remain competitive in a highly uncertain and shifting business environment characterized by swift technological advances, shorter product life cycles, intense global competition, rising customer expectations, and the immediacy of the need to reduce management and operational costs (Lee et al., 2006; Soltani et al., 2008).
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In the pursuit of excelling in this competitive environment, global organizations are increasingly implementing a wide range of quality initiatives intended to address a broad spectrum of issues, such as improving process capability, ensuring customer satisfaction, business process re-engineering, enhancing delivery speed, and making the production or service capacity more flexible and customer-oriented (Cheng, 2009). This paper purposes to discuss a range of quality management frameworks, and critically evaluate how they are applied by PineBreeze medical clinic to enhance its profitability and competitive advantage.
Review of Quality Management Frameworks
Despite the wealth of literature on quality management, few researchers and organizational theorists interested in the area can articulate specifically what it is meant by the term ‘quality’, making it even more difficult to come up with a universal definition of what quality management really entails (Soltani et al., 2008). As a matter of fact, most professionals and quality organizations has resulted to using various themes to define quality management, leading to ambiguity of the principles that are used to evaluate quality management in organizations according to the existing quality management frameworks (Bandyopadhyay & Hayes, 2009). This paper will utilize a definition by the British Quality Association (BQA), which revolves around the variables of customer satisfaction, culture of excellence, continuous improvement, removal of performance barriers and errors, teamwork, training, and employee involvement (Soltani et al., 2008).
There exists a variety of international and national quality management frameworks that are mostly used to either reward or certify organizations according to how much they have worked towards satisfying the above named variables, otherwise referred in this paper as quality initiatives. Some of the frameworks are briefly discussed below:
The Malcolm Baldrige National Quality Award
Established in 1987 by the United States Congress to set a national-wide standard for quality excellence, the Malcolm Baldrige National Quality Award (MBNQA) is specifically “…designed to promote awareness of quality as an increasing important element in competitiveness, understanding of the requirements for quality excellence, and sharing of information on successful quality strategies and the benefits derived from the implementation of those strategies” (Magued, 2006, p. 198). The MBNQA was modelled on the Deming Prize, which had been tried and perfected in Japan from as early as the 1950s (Yang, 2009).
The MBNQA was originally designed to reward companies operating in the manufacturing, service, and small business sectors, but in 1999, eligibility for the award was expanded to education and healthcare sectors. The award evaluation is based upon a thorough set of standards that consist of seven main categories, namely: leadership capability, strategic planning, customer satisfaction, information and analysis, human capital focus, process management, and business outcomes (Lee et al., 2006). These standards are built upon a set of fundamental values and concepts, including “…customer-driven quality, leadership, continuous improvement, employee participation and development, fast response, design quality and prevention, long-range outlook, management by fact, partnership development, and corporate responsibility and citizenship” (Magued, 2006, p. 198).
The Deming Prize
The Deming Prize was instituted in 1951 by the Japanese Union of Scientists and Engineers (JUSE) to award professionals and groups for their contribution in the broad area of quality control (Magued, 2006). Unlike the MBNQA, which is very managerial in scope, the Deming Prize lays much focus on the nitty-gritty’s of quality improvement, not mentioning that it is intensely focused on the statistical methods of quality improvement rather than evaluating a holistic management system. According to Magued (2006), the Deming Prize “…is awarded in three categories: Deming Application Prize for Division, Deming Application for Small Business, and Quality Control Award for Factory” (p. 199).
The European Quality Award
The European Quality Award was specifically designed to enhance awareness among businesses operating in the European Community of the mounting need of adopting quality to their competitiveness in the increasingly shifting global marketplace (Magued, 2006). The award was also designed to raise awareness on how adoption of quality standards by businesses can raise the standards of life in the European Community (Soltani et al., 2008).
The award consists of two components, namely: the European Quality Prize and the Business Excellence Model. The European Quality Prize is awarded to organizations that actively demonstrate excellence in quality management practice as set out in the award criteria, while the Business Excellence Model is awarded to the most successful applicant (Magued, 2006). The award process and selection criteria are comparable to the Deming Prize and the Baldrige Award, though the European Quality Award places greater emphasis on a company’s impact on society
Canadian Award for Business Excellence
This award was specifically “…designed to stimulate and support quality-driven innovation within all Canadian enterprises and institutions, including business, government, education, and healthcare” (Magued, 2006, p. 199). The criteria for selection resembles the Malcolm’s award criteria, with the major award categories encompassing leadership capabilities, customer orientation, planning for improvement, human resource focus, process optimization, and supplier focus.
Australian Business Excellence Award
According to Magued (2006), the criteria used to assess organizations for the Australian Business Excellence Award include “…leadership, strategy and planning, information and analysis, people, customer focus, processes, products and services, and organizational performance” (p. 199). The award differs from the Deming Prize since the framework emphasizes the evaluation of a holistic and interconnected nature of the management process. In this perspective, it can be argued that the award is similar in structure to the Baldrige award.
Quality Award in China
Being the highest award for quality in China, this award follows the footprints of world-famous quality awards such as the Baldrige Award, Deming Prize, and European Quality Award in implementing a strict set of criteria that is used to select recipients (Cheng, 2009). Specifically, recipients are evaluated along the core values of technology adoption, quality, integrity, environmental and social responsibility, utilizing excellence management, product or service advantages, and research and development (Fotopoulos et al., 2010).
The ISO 9000 standards were launched in 1987 with the aim to improve competitiveness for organizations around the world, and were followed by two revisions in 1994 and 2000, thus the ISO 9000:2000 framework. ISO 9000:2000 consists of three main components (Magued, 2006). The first, Quality Management Systems: Fundamentals and Vocabulary (ISO 9000:2000), elucidates the concepts and terms used in the other two standards, namely the Quality Management Systems: Requirements (ISO 9001:2000) and the Quality Management Systems: Guidelines for Performance Improvement (ISO 9004:2000).
It is imperative to note that ISO 9001:2000 provides the requirements that must be satisfactorily met by an organization prior to its certification, while ISO 9004:2000 “…establishes quality management system that does not only focus on meeting customer requirements but also on improving performance” (Magued, 2006, p. 194). Some of the requirements that must be met before certification include: management responsibility, resource management, customer satisfaction, product and/or service realization, and objective measurement, analysis, and improvement. Kuo et al (2009) suggests that the ISO 9000:2000 framework is a generic management system because it can be applied to any organization to assist in meeting its goals, particularly in customer satisfaction, quality management, complying with set regulations, and meeting environmental objectives.
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The Application of Quality Management Frameworks in PineBreeze Medical Clinic
Medical and health care systems, both in the country and abroad, are dynamic and under constant pressure. As the demand for quality healthcare services continue to escalate, along with the professional and operational costs of providing these services, growing attention is being directed towards the potential for health institutions to adopt quality management practices that will inarguably assist to lower healthcare spending, enhance client satisfaction, and improve the efficiency, quality, and safety of the services provided (Jamal et al., 2009).
The PineBreeze medical clinic offers professional medical consultancy in a variety of critical areas, but intense competition, demand for safe and effective healthcare services, shifting customer expectations, and the need to streamline the clinic’s processes ignited the desire to adopt some quality management frameworks inline with industry trends. This section specifically discusses the frameworks adopted by the clinic and how they have assisted it to become more competitive.
Integrated Management System
According to BSI (2007), “…an integrated management system [IMS] is a management system that integrates all of an organization’s systems and processes in one complete framework, enabling an organization to work as a single unit with unified objectives” (para. 1). PineBreeze medical clinic undertook to integrate its business and technical systems along an enterprise-wide integration model developed in 1999 by Ortiz and colleagues (Yang, 2009). The model is based on the following critical needs:
- to align business operations with the organization’s long-term strategy
- to share organization’s data used for decision-making
- to ensure that various systems within the organization are able to work with each other and relates well to other aspects outside the organization
- to generate tools that enable the management to objectively estimate the impact of decisions taken and to respond rapidly and efficiently
It is imperative to note that the IMS took into account the modelling and execution of the clinic’s strategy, business processes, customer needs and expectations, and human resources. In addition, the holistically integrated management system encompassed tools that would ensure: the commitment, support and leadership of senior management; quality objectives and strategies; employee involvement and empowerment; adoption of technology for process management and continuous improvement; quality control and quality assurance; employee training and education; relationship management with suppliers; benchmarking and strategic planning; and a corporate culture committed to quality (Yang, 2009).
IMS has not only helped the clinic to streamline its administrative functions through decreased paperwork and workload, but it has increased administrative efficiencies, demonstrated an enhanced efficacy to reduce medical errors through the enforcement of clinical guidelines and care protocols, enhanced quality in terms of providing more evidenced-based care processes, and reduced the clinic’s total operating costs through the streamlining of services and procedures (Shortell & McCurdy, 2009).
More importantly, IMS has invaluably assisted the clinic to computerize its medical records and use quality improvement programs by removing the barriers associated with a fragmented healthcare organization, such as duplication of roles, resistance from employees, low quality service, client disenchantment, and high operational costs (Jamal et al., 2009). Shortell & McCurdy (2009) suggests that integrating business processes provides organizations with a framework to adopt new approaches and systems in the future.
ISO 9001: 2008 was published on November 14 2008 to replace the ISO 9001:2000 edition, but it should be noted that the new version did not introduce new requirements for certification: rather, it only introduced some clarifications to the existing requirements in addition to introducing a number of changes intended to enhance consistency with the existing ISO 14001: 2004 Environmental Management (McDonald, 2008). Among other things, the ISO 9001:2000 required organizations to demonstrate their capability to consistently provide products and services that meet customer expectations and regulatory requirements (Gutierrez, 2010).
PineBreeze medical clinic ensures adherence to this requirement by developing frameworks, such as client feedback programs, that provides knowledge of customer requirements in addition to giving the management a framework through which customer needs and expectations can be measured and appropriate interventions taken with speed to reduce customer dissatisfaction. The clinic has also implemented customer service standards that all employees are encouraged to adhere to in their engagement with clients.
In addition to disseminating customer information to all departments of the institution, PineBreeze has also developed tools to monitor the extent of customer complaints and take remedial measures. The clinic’s administration takes proactive measures to reduce client wait-times in addition to offering quality services that reflects the value for money on the part of clients. The clinic constantly involve its employees in designing strategies that will facilitate timely appointments with patients, professional treatment of patients, and patient-satisfaction with results of the treatment. According to Khan & Khan (2008), these are fundamental elements of measuring and evaluating the quality of service provided. All these strategies are aimed to enhance client satisfaction and are in line with the ISO 9001:2008 regulatory requirements (McDonald, 2008).
ISO 14001: 2004
ISO 14001:2004 details requirements for an environmental management system that offers an organization the capacity to initiate and implement policies and objectives which take into account legal requirements and information about important environmental aspects to which the organization identifies and subscribes in the process of controlling and influencing the stated environment (ISO, 2010). All organizations that aspire to establish, implement, preserve and improve an environmental management system and guarantee conformity with the stated environmental policy are eligible to apply for certification.
PineBreeze medical clinic have undertaken self-determination to not only care for the environment, but to raise pro-ecological awareness of its employees and clients by publishing monthly newsletters on environmental protection. Furthermore, the clinic has developed and implemented measures aimed at minimizing material, resource and energy consumption to prevent pollution. It’s Green Revolution environmental management system, intended to encourage paperless interaction with clients, has worked well to conserve the environment, and has received accreditation from external professional bodies tasked with the responsibility of managing the environment.
The clients have responded well as can be witnessed by the increase in demand for the monthly newsletters and delight in paperless interactions. According to Matuszak-Flejsman (2009), environmental management systems must focus on “…designing products and services so as to limit natural resource consumption and at the same time maintain quality” (p. 413). In addition, the facility is partnering with the local county council in providing proper waste disposal bins and developing ways through which waste can be economically utilized in a spirited attempt aimed at continual improvement of its public image and reputation.
ISO 18001:2007 OHSAC
ISO 18001:2007 is an occupational health and safety (OH&S) standard that requires organizations to, among other things, establish an OH&S standard for the organization that complies with the requirements of ISO 18001; develop an OH&S policy; Analyze OH&S hazards and select controls; respect legal and non-legal OH&S requirements; establish OH&S objectives and programs; establish responsibility and accountability; ensure competence and provide training; and establish communication and participation (Praxion Research, 2010).
PineBreeze medical clinic is well aware of the fact that health and safety of patients and employees are foremost factors in quality management in a healthcare setting. The institution’s factual approach to decision-making ensures responsible care is provided to clients and the employees’ health is guaranteed in their interactions with the patients. According to Hansen (2006), organizations must continuously communicate with stakeholders and customers to ensure their safety, health and environmental performance. To facilitate this communication, PineBreeze has developed a one-stop management system that covers all the safety and health needs of clients and employees.
The institution has also developed flexible programs that can be used to respond to varying circumstances, and constantly undertake disaster training programs for its employees. This implies that the employees are involved in efforts geared towards enhancing the health and safety of clients and of their own. Strategies have been put in place to significantly improve process measurement and performance while curtailing risk and other liabilities related to non-conformance over time.
In addition to ensuring safe work places, these strategies also aim to provide evidence that a particular product has been inspected or tested before being given to a patient, ensuring that nonconforming products are not used, proper handling and storing of products, safe storage of client data and information, and planning and implementing both scheduled and unscheduled internal quality audits. According to Hansen (2006), these processes go a long way in ensuring the health and safety of all stakeholders. Fotopoulos et al (2010) posits that contractors and suppliers should be involved in efforts geared towards ensuring the safety of products inline with the concept of mutually beneficial supplier relationships.
The Adoption of Six Sigma Methodology
Jones et al (2010) defines Six Sigma “…as a set of methodologies and techniques used to improve quality and reduce costs utilizing a structured and disciplined methodology for solving business problems” (p. 416). The Six Sigma methodology has received broad attention from managers and organizational theorists for its capacity to enhance business process capability through focusing on customer needs and expectations.
More importantly, Six Sigma has been recognized as a viable approach for organizational change and transformation, which integrates components of quality management and aspects of business process re-engineering (Cheng, 2009). In this perspective, the model can offer invaluable assistance to PineBreeze medical clinic in terms of negotiating organizational change, reducing waste, and remaining competitive in the ever shifting business environment through business process re-engineering.
Six Sigma have been correlated to increased profit margins in organizations that have already adopted the framework due to its ability to not only focus on customer needs and expectations, but its capacity to provide a framework through which quantifiable measures can be defined for achieving specific organizational objectives (Jones et al., 2010). These benefits can be employed to shape the clinic’s performance and profitability, not mentioning that they can be combined with other benefits arising from the existing ISO 9001:2008 quality framework to enhance customer focus and system approach to management. The implications are that PineBreeze will benefit through huge savings, thus maintain its competitive advantage.
A broadly accepted framework for implementing a Six Sigma methodology is the DMAIC process, which basically entails defining, measuring, analyzing, improving, and controlling as key processes of a standard framework (Jones et al., 2010). Such a process could be invaluable to PineBreeze in its attempts to gain good control of its holistic business processes by narrowing down on a few critical areas. For example, DMAIC could be used to evaluate some of the key areas in the facility that are already in existence but continue to perform inadequately by eliminating unproductive stages, developing and implementing new metrics, and employing technology to drive improvement.
According to Jones et al (2010), “…Six Sigma has a strategic component aimed at not only developing commitment to it, but also active involvement of higher management” (p. 416). Consequently, this component will strengthen PineBreeze’ leadership to actively identify key processes of the facility, measure their relevancy, effectiveness and efficiency, and implement improvements of the non-performing processes in an effort geared towards increasing profitability and maintaining competitive advantage. Here, the methodology can be used to improve on what has already been achieved by IMS and ISO 9001:2008 quality initiatives. It should be noted that organizations should initiate the Six Sigma methodologies by integrating them with their core business strategies (Cheng, 2009).
Benefits and Problems of the Quality Management Frameworks
Various quality management initiatives have their own benefits and challenges. PineBreeze medical clinic has already implemented IMS, ISO 9001:2008, ISO 14001: 2004, and ISO 18001:2007 OHSAC, and intends to implement Six Sigma in the future. A common benefit that is characteristic of all the quality frameworks is that business processes are improved, leading to profitability and sustenance of competitive advantage (Khan & Khan, 2004). IMS necessitates a holistic management of all business processes, enabling organizations to diagnose arising challenges with ease for rapid response (Magued, 2006).
Quality frameworks such as ISO 9001:2008 and Six Sigma offers the organization a framework to increasingly focus on customer needs and customer satisfaction, implying that they are able to offer high quality products and services, thus enhancing their profitability and competitive advantage. ISO 14001:2004 enables the organization to improve its public image and reputation by engaging in environmental management practices (Matuszak-Flejsman, 2008).
ISO 18001:2007 OHSAC benefits employees, neighbours, and product or service users in terms of giving them safer environments and safe products and services (Magued, 2006). Overall, it can be safely argued that the quality frameworks offer the benefits of staying in business, enhanced reputation, competitive advantage, improvement in business, increased productivity, improvement in long-term profitability, a reduction in liability of defective products and services, a reduction in waste, and a reduction in total costs (Khan & Khan, 2004).
In terms of problems, it is often expensive and time consuming to implement many of the quality frameworks. The process of certification for frameworks such as ISO 9001:2008 and ISO 14001: 2004 may take up to one year to complete (Magued, 2006). Resistance during the implementation phase may be demonstrated by managers and employees who would like to maintain the status quo. Still, the perceived benefits may not be realized immediately, thus some of the existing frameworks cannot be used to fix an urgent problem.
The current trend is that customers are interested not only in the quality of products or services offered to them, but also in the quality and standing of the organizations that offer them (Magued, 2006). As such, the only way to go for organizations is to adopt quality management frameworks that will align their business processes with the fulfilment of customer demands and expectations so as to remain competitive and profitable. Organizational resources need to be carefully utilized, and gaps which lead to wastage need to be eliminated. This can only be achieved through the implementation of quality management frameworks.
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