Total Quality Management

CASE STUDY ON IMPLEMENTATION OF

TQM

Submitted To:-Dr.Ashwani Kumar

Submitted By:-
•CO18151-Saurav •CO18156-Tarun Angaria
•CO18152-Sawni •CO18157-Tejas Gupta
•CO18153-Shivam •CO18158-Varun Sharma
•CO18154-Sukhmandeep Singh •LCO18160-Aashit Bhatia
•CO18155-Tamish Kumar Mallya
 Introduction
Total quality management (TQM) is a philosophy and presents a business system that
companies should adopt to achieve organisational excellence. The adoption and
implementation of quality initiatives have, in the main, been spearheaded by large
companies; the smaller ones always being followers and have lagged behind. Various
suggestions have been made to help small to medium-sized enterprises (SMEs)
implement TQM (see, for example, Ghobadian and Gallear (1996), Brown (1993), Lee
and Oakes (1995), Husband and Mandal (1999)). However, the development of TQM
implementation frameworks for SMEs is found lacking and those implementation
frameworks developed have primarily focused on the characteristics of large
companies (Yusof and Aspinwall, 2000a). This paper concentrates on the results of
four case studies performed as part of a research project in developing a framework
for TQM implementation in SMEs. However, despite the numerous difficulties faced,
the case studies were successfully completed during the early part of 1999. The paper
begins with a description of the methodology employed in eliciting relevant
information concerning the companies studied, which was largely based on a case
study protocol (Yusof, 2000). The presentation of the case studies centres around
three main areas:
The paper begins with a description of the methodology employed in
eliciting relevant information concerning the companies studied, which was
largely based on a case study protocol (Yusof, 2000). The presentation of
the case studies centres around three main areas:
(1) the background of the case company;
(2) major aspects of TQM implementation
(3) the implementation framework employed by the company.
Following this, a summary of the various quality initiatives implemented by
the companies will be presented. Validation of the conceptual
implementation framework for SMEs will then be described. Finally, the
case studies are discussed and summarised with particular reference to the
overall findings that emerged. The paper culminates with conclusions and
vital lessons learned which provided some future research directions
Case study design
Yin (1994) described the four basic types of case study design. The selection
between single case and multiple case design depends on the nature of the research
questions and objectives, and the amount of resources available.
Evidence from multiple cases is often more compelling, and the overall study can
therefore be regarded as being more robust (Herriot and Firestone (1983) as quoted
in Yin (1994)).
Conducting multiple case studies is described as being similar to replication or
executing multiple experiments. The holistic approach (single unit of analysis) is
more suitable in examining the global nature of a problem, programme or an
organisation.
In the case of this research, the design employed was a holistic multiple-case one
which involved examining a particular company's approach towards TQM
implementation on a global basis. Since the focus was the company (an SME) as a
whole, replicating the study meant that the strategies, plans, approaches, etc. could
be scrutinised, analysed, and developed into an approach which would hopefully be
sufficiently general for implementation purposes
•The main issues which it was felt crucial to address in this study were:
How had the company implemented TQM?
Why had the company chosen the particular approach?
•In addition to these questions, the case study also investigated the feasibility of the
proposed implementation framework in terms of its strengths, weaknesses,
simplicity, practicality, etc. The question was ``Can the proposed framework be used
as a planning tool, or a guide for TQM implementation?'' Ten companies were
contacted from among the respondents of an earlier survey (conducted by the
authors) who had indicated their willingness to participate in the case study stage of
the research.
Although they had expressed an interest, in the event, the task of convincing them to
participate was not easy. Many reasons for not being able to take part were proffered,
but eventually, four companies did agree to provide information. Their details are
shown in Table I (note that they have been referred to as A to D to preserve their
anonymity). Interviews with key personnel who were responsible for quality
initiatives implementation were conducted which lasted between four to six hours.
Relevant documents were also referred to and when possible copies provided by the
case companies. Further clarification were sought, if necessary, through telephone
calls to the related companies. Each of the companies was treated as one unit of
analysis and it was hoped that through this approach, the final framework developed
would be generic, rather than one that was limited to one specific manufacturing
activity
• The case companies included electrical, metal, rubber and plastic based
components with different production technologies being employed such as
presswork, assembly, and plastic moulding, ultrasonic welding, etc.
•Following the analysis, the companies were classified as either ``TQM'' or
``lesser TQM'' companies. A TQM company was defined as one which had
achieved an advanced level of TQM adoption whereby many of the different
quality initiatives are implemented and the number of years for
implementing these initiatives are longer.
``Lesser TQM'' companies were those which had much fewer initiatives
implemented, and were still at an early stage in their quality journey. The
basis on which they were judged was on the case study results, observations
at the premises, and on their actual progress after implementing these
activities, especially with regard to the outcome of the
quality initiatives, such as reduction in rejects (e.g. parts per million). Their
financial performance, such as sales or profits, was not considered when
classifying the companies since this would have required them to disclose
confidential information, which some were not willing to do.
 Results from case study
A Company background company was located in the West Midlands. It produces wiring
harnesses for both the automotive sector and the white goods industry and interior
lamps for cars. It is a small family business with 31 years' experience in the sector. The
company is a first-tier supplier to Honda and a second-tier supplier to Nissan,Range
Rover and Jaguar. The first impression of the company, from the visit, was that it was
well maintained with clear signs for visitors and an overall pleasant atmosphere. The
company has 90 employees, 45 of whom are in the manufacturing function, and eight
in the quality department. With such a small number engaged in the quality function, it
suggests that much of the inspection work has been empowered to the production
operators. Even though the company's quality department was formed in 1978, the
emphasis towards continuous improvement, team involvement and adopting modern
quality management concepts only started some six to seven years ago. QS 9000
certification was gained in 1998 and ``The Pursuit of Excellence'' award from the local
Business Link in both 1998 and 1999; the company is certified as an Investors in
People (LIP) Organization , clearly demonstrating the maturity that has been achieved
in terms of quality implementation. Major aspects of TQM implementation The board
of directors of the company is involved in making policies, creating visions, and
planning for quality to be the company's business style.
The core group consists of the managing director, quality manager/director, and the
production and sales managers. Their main responsibility is to make policies for
running the business smoothly and to ensure continuous business improvement.
There is certainly total commitment by management on quality Downloaded by
Universiti Teknologi Malaysia At 01:52 03 November 2017 (PT) Implementation of
TQM 727 matters, especially when one thinks about the demands of being a first-tier
supplier. The structure for conducting continuous improvement is by way of having
an improvement facilitator who reviews quality problems together with related teams
to find improvement opportunities. Examples cited by the quality manager were
improving the efficiency of production processes and procedures using method study
techniques, parts and workplace layout, and incorporating standard minute values
(or standard times) for processes. Improvement activities are not only production-
related, but also non-production areas such as purchasing and sales. One example
given was the reduction in turnaround time for quotations sent out to customers; this
was formerly a manual exercise but had now been computerized. Even though the
solution appeared to be simplistic and obvious, the involvement of employees and
management in investing in technology for better job execution led to higher
employee satisfaction. Implementation framework at the company The company had
not actually devised a framework as such when implementing TQM, although quality
had been part of its philosophy from the outset. Its clear vision is specified in their QS
9000 quality systems manual, which states that its aim is: To achieve preferred
supplier status with our customers, and to satisfy the requirements of all of our
business partners. It had also included a total quality policy within the quality policy
requirements of the QS 9000 standard
Obviously, this shows the commitment and understanding of this company's
management of TQM. In addition, it has progressively incorporated and implemented
numerous quality methodologies and tools such as a continuous improvement
system, statistical tools, advanced quality planning, and a quality
assurance system. The pace at which TQM was being absorbed had been even
more rigorous over the last six to seven years.
 The quality manager mentioned that they had adopted a kind of ``salami
approach'', cutting and consuming the tools, techniques and programmes of TQM
``slice by slice''. This is analogous to implementing a little at the time, i.e. choosing
one or more initiatives/techniques at any one time from the many tools available
until a particular state is reached.
With reference to what implementation framework this company had adopted, the
overall structure of QS 9000 implementation was taken as a basis for the
mechanisms involved.
The major activities embarked upon are summarized in Figure 2. The decision to
adopt QS 9000 seemed to be externally driven by its customers. Once accepted,
discussions were made in defining the requirements, the policies and the methods to
progress towards certification. Its current system was assessed to determine any
deficiencies since the company was already certified to ISO 9000; it needed to
develop some new areas which were additional requirements of the QS 9000
standard. Results from this initial Downloaded by Universiti Teknologi Malaysia At
01:52 03 November 2017 (PT)
The final stage, which the company conducted as a separate activity, was an
evaluation of the overall success and impact of the new initiative. The company
mentioned the difficulty in evaluating costs against the benefits gained, however, one
improvement indicated after gaining certification in May 1998 was the increase in the
number of enquiries it received from new nontraditional businesses (non-
automotive). The company is hoping that this will result in increased sales. Having
implemented a TQM initiative a little while ago, the impact on its business is still
being continuously evaluated and it is hoped that other quality activities will be
incorporated in the near future.
 References
• Brown, A. (1993), ``Quality management in the smaller company'', Asia
Pacific Journal of Quality Management, Vol. 2 No. 3, pp. 67-76. Choi, T.Y.,
Rungtusanathan, M. and Kim, J.S. (1997), ``Continuous improvement on
the shopfloor: lessons from small to midsize firms'', Business Horizons,
November-December, pp. 45-50. Conti, T. (1999), ``Vision 2000:
positioning the new ISO 9000 standards with respect to total quality
management models'', Total Quality Management, Vol. 10 Nos. 4 and 5, pp.
S454-64. Eisenhardt, K.M. (1989), ``Building theories from case study
research'', Academy of Management Review, Vol. 14 No. 4, pp. 532-50.
Ghobadian, A. and Gallear, D.N. (1996), ``Total quality management in
SMEs'', OMEGA, Vol. 24 No. 2, pp. 83-106. Husband, S. and Mandal, P.
(1999), ``A conceptual model for quality integrated management in small
and medium size enterprises'', International Journal of Quality & Reliability
Management, Vol. 16 No. 7, pp. 699-713.
 TOTAL QUALITY MANAGEMENT
IN

LOGISTICS

Submitted To:-Dr.Ashwani Kumar

Submitted By:-
•CO18151-Saurav
•CO18152-Sawni •CO18156-Tarun Angaria
•CO18153-Shivam •CO18157-Tejas Gupta
•CO18154-Sukhmandeep Singh •CO18158-Varun Sharma
•CO18155-Tamish Kumar Mallya •LCO18160-Aashit Bhatia
INTRODUCTION
WHAT IS TQM?
A TQM program is designed to help companies minimize waste
and reduce the chance of errors in order to do things better, faster,
and be more responsive to customers’ changing needs. Strategy,
data, and effective communications help to integrate quality
throughout the organization. Emphasis is on continuous
improvement.
When TQM is an integral part of
operations, it can deliver a significant
value proposition for logistics
operations, enabling companies to:
Increasing the efficiency of processes,
optimizing product flow, improving
inventory management, eliminating
waste, and leveraging technology are
just a few ways in which these benefits
can be achieved.
 Supply Chain Management

Supply Chain Management (SCM) can be defined as

“the management of materials and information
both in and between facilities, such as vendors,
manufacturers and assembly plants and
distribution centres”
Generally speaking, SCM is a network of facilities that
procure raw materials, transform them into intermediate
goods and then final products, and deliver the products to
customers through a distribution system.
SCM encompasses all the information, financial, and
physical flows from the supplier’s supplier to the customer’s
customer. The idea of SCM is to view the chain as an
integrated system, and to fine-tune the decisions about how
to operate the various components (firms, functions, and
activities) in ways that can produce the most desirable
overall system performance in the long run.
 Supply chains have come to be understood as
relatively stable groups of firms engaged in the sequence
of production and distribution activities required to serve
the end customer.

In a supply chain, flexibility plays a critical role,

which is considered as crucial weapon to
increase competitiveness in a turbulent market
place.
Integration of Flexible System, Supply Chain Management & Total
Quality Management

TQM SCM

FM
 Flexible Management
Systems

A Flexible System is a system in which there is some

amount of flexibility that allows the system to react in
the case of changes, whether predicted or unpredicted.
SUPPLY CHAIN
Vestibulum congue
MANAGEMENT

LOGISTICS
Vestibulum congue

DISTRIBUTION
Vestibulum congue
What Are Logistics?
Logistics refers to the overall process of managing how resources are
acquired, stored, and transported to their final destination. Logistics
management involves identifying prospective distributors and suppliers
and determining their effectiveness and accessibility. Logistics managers
are referred to as logisticians.

In simple terms, the goal of logistics management is to have the right

amount of a resource or input at the right time, getting it to the
appropriate location in proper condition, and delivering it to the correct
internal or external customer.
For example, in the natural gas industry, logistics involves
managing the pipelines, trucks, storage facilities, and
distribution centers that handle oil as it is transformed along
the supply chain.
An efficient supply chain and effective logistical procedures are
essential to reduce costs and to maintain and increase efficiency. Poor
logistics lead to untimely deliveries, failure to meet the needs of
clientele, and ultimately causes the business to suffer.
The concept of business logistics has been transformed since the 1960s.
The increasing intricacy of supplying companies with the materials and
resources they need, along with the global expansion of supply chains,
has led to a need for specialists known as supply chain logisticians.

In the modern era, the technology boom and the complexity of logistics processes have
spawned logistics management software and specialized logistics-focused firms that
expedite the movement of resources along the supply chain. One reason large online
retailers like Amazon have come to dominate the retail landscape is the overall
innovation and efficiency of their logistics along every link of the supply chain.
Challenges Faced by the Logistics Industry Today:-
Cutting transportation costs has continued to be one of the greatest strategic challenges in global logistics, bu
there are many more to take note of:
 ● STRINGENT GOVERNMENT REGULATION MAKES
Government Regulations
01 CONDUCTING BUSINESS COMPLICATED AND LIMITS
AVENUES OF GROWTH

● the industry is pressurised by increasing compliance

02 Economy
regulations, declining demand and additional increases
in key cost centres during periods of economic
uncertainty

● Fuel costs are a major expense of logistics companies.

03 Fuel Costs
Due to fragile nature of its supply and demand an
increase in fuel prices increases the overall costs of
operation for both company and customer

● High fuel prices, increased wages and peaking

04 Transportation Costs inflation indexes together make up for the increase in
cost of transportation.

● Rapid increase in logistics business has led to increase

05 Tracking of Inventory in fleet sizes and number of shipments

● Cost of equipment to efficiently track fleet and
consignments is high
SOLUTION
 EFFECTIVE TQM IMPLEMENTATION IN LOGISTICS:
Baldrige quality framework

Process
Top management Strategic Quality Customer
managem
leadership planning focus Focus
ent

.
Reference
 https://www.academia.edu/4633587/The_effects_of_technology_and_
TQM_on_the_performance_of_logistics_companies
 https://www.researchgate.net/publication/314952590_The_impact_of
_TQM_philosophy_for_the_improvement_of_logistics_processes_in_
the_supply_chain/link/58c8a46da6fdcca657070caa/download
 https://www.google.com/url?sa=i&url=http%3A%2F
%2Fwww.authorstream.com%2FPresentation%2Fanupamkr-
1968947-logistics-vs-supply-chain-management
%2F&psig=AOvVaw0iGrWn3mr6D01nBIITY-
Sr&ust=1608568843130000&source=images&cd=vfe&ved=0CA0Qj
hxqFwoTCLiE1YSA3e0CFQAAAAAdAAAAABAl
 Total Quality Management

CASE STUDY ON STOCK EXCHANGE 1992 SCAM

Submitted To:-Dr.Ashwani Kumar

Submitted By:-
•CO18151-Saurav •CO18156-Tarun Angaria
•CO18152-Sawni •CO18157-Tejas Gupta
•CO18153-Shivam •CO18158-Varun Sharma
•CO18154-Sukhmandeep Singh •LCO18160-Aashit Bhatia
•CO18155-Tamish Kumar Mallya
SCAM INFO

The 1992 Indian stock market scam was a market manipulation

 carried out by Harshad Mehta and other bankers and politicians on the 
Bombay Stock Exchange. The scam caused significant disruption to the
stock market of India, with over one billion USD defrauded.
Techniques used by Mehta involved having corrupt officials 
signing fake cheques, market loopholes, and lies to drive the prices of stocks
up to 40 times their original price. Stock traders making good returns as a
result of the scam were able to fraudulently obtain unsecured loans from
banks. When the scam was discovered in April 1992, the 
Indian stock market collapsed, and the same banks suddenly found
themselves holding millions of INR in now useless debt.
Another instrument used in a big way was the bank receipt (BR). In a
ready forward deal, securities were not moved back and forth in actuality.
Instead, the borrower, i.e. the seller of securities, gave the
buyer of the securities a BR. The BR serves as a receipt from the
selling bank, and also promises that the buyer will receive the
securities they have paid for at the end of the term.
Having figured this out, Mehta needed banks, which could
issue fake BRs, or BRs not backed by any government
securities.
Once these fake BRs were issued, they were passed on to
other banks and the banks in turn gave money to Mehta, plainly
assuming that they were lending against government securities
when this was not really the case.[7] He took the price of ACC
from ₹200 to ₹9,000. That was an increase of 4,400%, which
was tied into the overheating of the stock market. Since he had
to book profits in the end, the day he sold was the day when the
markets crashed.
 Procedure
A bank gives funds to another bank but not directly there is a middle man in
between called stock broker. For eg there is a bank A and a bank B. if bank A
gives fund to bank B, bank B has to provide security to bank A , that security
is provided by broker in the form of bank receipts. A reputed broker deals
with many banks so he always has money in process and they are also given
14 days settlement period in which they can make their transaction. Though
14 days period seems quite enough time but its not. Broker has to give bank
receipts at the time of receiving fund only which he has taken from another
bank as security. So, in simple words money never stays at broker for more
than 2-3 days practically . but if you delay the bank receipts or provide fake
bank receipts. You got money in your hand for much longer period. In that
extension of time Harshad invested that banks money in stock market
trading. Increases the amount by making profit and then returns the money
to bank. Basically he was earning by investing banks money. He always
cleared all his debts that’s why he never been suspected until the news was
leaked of not providing the bank receipts for the money to SBI.
 PROBLEMS THAT TIME

Banking loopholes- Harshad Mehta changed the way one

looks at the stock market and how brokers trade. The securities
scam of 1992, involving Mehta, led to sweeping stock market
reforms and exposed loopholes in the country's banking system.

Securities scam- Mehta was often referred to as the 'Big

Bull' of Dalal Street or the 'Amitabh Bachchan' of the Indian
stock market. He manipulated stocks by illegally obtaining
money from several banks using fake bank receipts. He created
a cycle of fraud involving big banks like the State Bank of India
(SBI) and the National Housing Bank (NHB).
Changing D-Street- Following the fraud of around Rs 4,000
crore, ‘Securities Scam’, the Securities Laws (Amendments) Act
was passed in 1995, which widened the jurisdiction of the
Securities and Exchange Board of India. It allowed SEBI to
regulate depositories, FIIs, venture capital funds, and credit
rating agencies . Here are five ways the Indian stock markets
have changed since 1992.
Settlement cycle- Settlement cycle is the time within which
brokers have to pay full money and take delivery of stocks or
deliver stocks if sold. In 1992 the cycle was 14 days. Now, it is
two days, and SEBI is hinting at a 1-day cycle soon.
Minimum balance- In 1992, there was no rule over
maintenance of minimum balance that a customer needs to
ensure to buy stocks. Now, a customer can’t buy stocks without
the minimum balance in the account or sell without stocks in
their Demat account.
Trading process- Before 1992, all the trades were placed
through dealers and hence they carried a huge execution risk.
Now, most of the trades are executed by customers on their
own.
Settlement of trades- Before 1992, settlement of trades was
done through paper, making counter-party risk evident. Now,
all transactions are electronic and all settlement of trades
happens through clearing corporations.
Brokerage fee- In 1992, customers paid at least 1 percent as
brokerage for equity delivery trades. No charges are levied now
 CHANGES MADE
Changes in the financial structure of india.The 1992 scam saw the indian market
collapse completely as the stock prices dropped by almost 40% wiping out market
value by ₹1,000 billion. The indian financial system saw a complete restructuring of
the fundamenttal systems. After 28 years since the scam, nithin kamath, founder of
brokerage firm zerodha online, lists eight things that are done differently in the
indian stock markets these days.

Settlement cycle: Back in 1992, the settlement cycle - the time within

which brokers have to pay full money and take delivery of stocks or deliver
stocks if sold - was 14 days. Now, it is two days, and SEBI is also hinting at a
1-day cycle soon.
Electronic transactions: Back in 1992, the settlement of trades was
done through paper and counter-party risk was evident. Now, all the
settlement of trades happens through clearing corporations (CC), and all
transactions are electronic.
Minimum balance: The new rule helps reduce the systemic risk from
aggressive brokers who were previously compromising risk for the business.
 Broker's approval: Today since the risk from the customer is way lesser
due to margin requirements & CC, you don’t need approval from a broker to
open an account like in 1992. You can open a trading account online in under
15 minutes with any broker now.
Brokerage firms' role: In 1992, brokerage firms dealt as advisory, but
now they focus on execution and not advisory.
Trading process: Back in 1992, all the trades were placed through
dealers and hence they carried a huge execution risk. These days, most of the
trades are executed by customers on their own.
Brokerage fee: In 1992, customers were mostly unaware and paid at
least 1 percent as brokerage for equity delivery trades, while no charges have
to be paid now. 
Price difference: Lastly, in 1992, dealers used pocket a cut by telling
different price to customer than actual trade price. However, these days the
process is 100 percent transparent.
 REFERENCES
1. https://www.moneycontrol.com/news/world/the-pandemic-m
ade-2020-a-wild-year-for-wall-street-6249271.html
2. https://en.wikipedia.org/wiki/1992_Indian_stock_market_sca
m#Bank_receipt_scam
3. https://economictimes.indiatimes.com/news/economy/finance
/the-story-of-harshad-mehta-and-five-ways-it-changed-dalal-st
reet/brokerage-fee/slideshow/78782310.cms
4. https://www.google.com/search?q=changes+made+after+1992
+scam&oq=changes+made+after+1992+scam&aqs=chrome..69
i57.34122j0j7&client=ms-android-xiaomi&sourceid=chrome-m
obile&ie=UTF-8
IMPACT OF COVID-19 ON
TOURISM IN SINGAPORE
Submitted To:-Dr.Ashwani Kumar

SubmittedBy:-
•CO18151-Saurav
•CO18152-Sawni
•CO18153-Shivam
•CO18154-Sukhmandeep Singh
•CO18155-Tamish Kumar Mallya
•CO18156-Tarun Angaria
•CO18157-Tejas Gupta
•CO18158-Varun Sharma
•LCO18160-Aashit Bhatia
 OVERVIEW
The Economic Impact of COVID-19 on Tourism

Singapore's tourism sector takes a hit

Tourism insights pre-pandamic

Impact on retail business in key tourism precincts

Online mediums are preferred

Key Insights

Recovery and Transformation

ONLINE MEDIUMS ARE PREFERRED

• Many consumers in Asia Pacific are

shopping online for the first time and
are likely to continue doing so post -
pandemic. Over four in five 15% Services
consumers also intend to continue or
make more purchases online (85%),
while less than two in five intend to
revert to pre - pandemic pattern of 14% Cloths &
purchasing in store Accessories

15% Cosmetic &

Personal care

Most popular categories for First 11% Electronics

time E-Commerce Buyers Rest of the

14% for other products. 16% Over the-counter
19% Food & Beverages Pharmaceuticals
THANK YOU
 Total Quality Management

CASE STUDY ON
THE HEALTHCARE INDUSTRY

Submitted To:-Dr.Ashwani Kumar

Submitted By:-
•CO18151-Saurav •CO18156-Tarun Angaria
•CO18152-Sawni •CO18157-Tejas Gupta
•CO18153-Shivam •CO18158-Varun Sharma
•CO18154-Sukhmandeep Singh •LCO18160-Aashit Bhatia
•CO18155-Tamish Kumar Mallya
 INTRODUCTION
 Quality management has become an important issue in healthcare organizations (hospitals) during
the last couple of decades. The increased attention to quality is due to governmental regulations,
influence of customers, and hospital management initiatives. So, the role of government as the
main provider of healthcare (HC) services has changed. Additionally, the healthcare market is
changing from a producer-oriented to a customer-oriented market due to the increasing influence
of customers and public pressures. As a consequence, the patient is becoming a customer for the
healthcare organizations, or more likely a direct strategic partner who participates in a decision
making process. The changes in environment, society, and political policies have significant
impacts on management in hospitals as well. There are many difficulties in managing healthcare
organizations in a competitive marketplace with a little support from official bodies especially in a
developing country like India. TQM ‘Total Quality Management’ is practiced widely at different
organizations and Hospitals are no exception to this.
 TQM – Definition for Healthcare
 In healthcare services there are three definitions distinguished TQM from other
approaches:
 "TQM is a comprehensive strategy of organizational and attitude change for enabling
personnel to learn and use quality methods, in order to reduce costs and meet the
requirements of patients and other customers"
 "Maximization of patient’s satisfaction considering all profits and losses to be faced in a
healthcare procedure"
 TQM is a management method: "TQM/CQI – Continuous Quality Improvement – is
about two things: a management philosophy and a management method". They propose
four "distinguishing functions", which are often defined as the essence of good
management which includes:
 • Empowering clinicians and managers to analyze and improve process;
 • Adopting a norm that customer preferences are the primary determinants of quality and
the term "customer" includes both the patients and providers in the process;
 • Developing a multidisciplinary approach which goes beyond conventional departmental
and professional lines; and
 • Providing motivation for a rational data-based cooperative approach to process analysis
and change
 Defining Quality for Patient Care
 The term quality of patient care is still subject to debate and has no specific definition yet, since
the guides to quality of healthcare are highly probabilistic due to estimations of the outcomes.
The outcomes are not certain; therefore the measures of its quality must include dimensions of
both the outcome of the care provided and processes by which the care is carried out. The
measures of quality of care should include an evaluation of the provider-patient relationship.
 For the purpose of this study the definition of quality of healthcare has been developed to
consider the patient’s, the doctor’s, and other supporting factors perspectives. Hence, the
following definition was used to encounter all above mentioned standpoints. Healthcare is "the
proper implementation of an agreement between a patient, a physician, a nurse, and/or physicians
and a healthcare organization regarding a medical intervention that is in a harmony with actual
professional standards and protocols applied within the organization".
Specifying QUALITY
1. Fundamentals of care: The basic level at which quality principles will apply across all areas of care,
characteristics at this level may include, privacy, communication, responsiveness, and empathy.
2.Generate area of care: Those areas which are common to a limited range of specialties or conditions, such as
cancer treatment services, day case surgery, and emergency care. Quality characteristics at this level would include
acceptability, information, appropriateness and equity.
3.Clinical specialty: This level allows principles to apply to all patients cared for by a specialty area such as
physiotherapy, radiology; quality characteristics in this level would include accessibility, efficiency, and reliability.
4.Individual condition or care group: At this level, care is considered for particular conditions or patient care
group, such as diabetes, maternity. Quality characteristics would focus on technical issues an example of clinical
appropriateness and effectiveness.

The quality is assessed in terms of

5. Quality of Technical Care

6. Quality of the art of Care
7. Quality of the Environment
 Model on TQM – Deming Model
Deming, in his model, defined TQM as a method of leadership and management which:
  Analyzes system for errors and variation rather than blaming people;
  Develops long term partnership with external and internal suppliers;
  Uses accurate data to analyze processes and measure system improvement;
  Involves the staff who work in system analysis and improvement;
  Sets up effective collaborative meetings as the basis of teamwork;
  Train supervisors and managers in leading the ongoing improvement process;
  Engages staff in setting targets and ensures that results are feedback;
  Highlights the need for senior executives to plan strategically;
  Achieves long-term improvement through small incremental steps
 Measuring Service Quality
Three characteristics of healthcare services contribute to the difficulty of measuring it, these are:
  Service intangibility
  Performance heterogeneity
 Customer-producer inseparability
However, unlike other services in the healthcare context, the patient/customer participates in the
delivery of the service, and therefore, both performance and quality will be affected by the
patient/customer actions, moods, and cooperativeness.
 These dimensions of health care services make it:
 More difficult for customer/patients to evaluate
 Evaluations made are not only on the output but also on the delivery process itself
 SERVQUAL Model
In healthcare patient satisfaction is the aim of using SERVQUAL which will be used later in this study to assess and measure
the patient’s satisfaction. It is important to note here that patient satisfaction affects a number of vital issues. Since it affects
the use of the medical service provided by healthcare organizations, it also affects the kind of relationship between the
patient and service providers. Moreover, patient satisfaction data contribute to the monitoring of healthcare delivery at all
levels within the organization. i.e.
 Organizational level (hospital, clinic, etc.)
 Unit level (surgical, laboratory, etc.)
 Individual level (nurses, physicians, etc.)

Patient satisfaction is a patient’s (affective or emotional) response to his or her (cognitive or knowledge-based) evaluation of
the healthcare provider’s performance (perceived quality) during a healthcare consumption experience.
  Patient satisfaction inquiries are very popular in healthcare due to several reasons behind this, the efforts of quality
management and improvement, to increase attention to customers. Therefore, patient satisfaction has been seen as a measure
of quality.
 Questionnaires are the most commonly used instruments for data collection. It is increasingly recognized that patients should
be given a voice in the assessment of the service quality that is offered to them by the healthcare organizations.
 Research by (Parasurman, et. al., 1991) has shown that regardless of the type of service,
customers use basically similar criteria in evaluating service quality. The criteria fall into ten key
categories as follows:
•Reliability, which involves consistency of performance and dependability.
Responsiveness, concerns the willingness or readiness of employees to provide service. It involves
timeliness of service.
•Competence means possession of the required skills and knowledge to perform the service.
Access involves approachability and ease of contact.
Courtesy involves politeness, respect, consideration and friendliness of contact personnel.
•Communication means keeping customers informed in language they can understand and listening to
them.
•Credibility involves trustworthiness, believability and honesty. It involves having the customer’s best
interest at heart.
•Security is the freedom from danger, risk or doubt.
•Understanding involves the efforts to understand the customer’s needs.
 The gap between expectations and perceptions may be analyzed with respect to five dimensions
determined from an examination of the content of the ten service quality items discussed earlier. The
final list of dimensions and their concise definitions will be as follows:
•Tangibility: physical facilities, equipment and appearance of personnel.
•Reliability: ability to perform the promised service dependably and accurately.
•Responsiveness: willingness to help customers and provide prompt service.
•Assurance: knowledge and courtesy of employees and their ability to inspire trust and confidence.
•Empathy: caring, individualized attention the firm provides to its customers.

Application of SERVQUAL can be used to make comparisons globally over time. It’s possible to
ascertain those elements of service in which the gap between expectations and perceptions is widest.
The application of this instrument and results of measurement allows possibilities of more specific
management action to readdress perceived outcomes.
 SERVQUAL – Barriers
Limited Commitment: The successful introduction of TQM in hospitals requires the
involvement and commitment of all parties in providing the service. Yet, this
commitment presents a problem for hospitals since not all the parties are directly
employed by these hospitals. The physicians and specialists usually work on their own
and have limited commitments with the hospital they corporate with.
Diffusion of Interests: Most doctors believe that their interests are not directly tied to
that of the hospitals they work with. In fact, barriers by physicians’ involvement may
turn out to be the most important single issue impending the success of quality
improvement in medical care.
Structure of the Hospital: The difficulty of involving physicians in TQM has its roots
in hospital structure. In most hospitals usually two bodies exist; the hospital on one
side and the medical staff on the other side with all the conflicts between these two
bodies.
 Apprehensions with SERVQUAL
"Doctors view patient care as very individual and private affairs. As members of an old and highly respected
profession, physicians have operated autonomously and have been accountable only to themselves and their peers"
"The complexity of medical care kept them immune from outside scrutiny and regulation. Because of these
privileges physicians perceive themselves as losing power and influence, and may see TQM as an assault on their
independence"
"The doctors view TQM as a program which will replace what was largely subjective process controlled by them,
with as objective and statistically based discipline which is not under their control"
 Physician’s Resistance: The tools and methods of TQM are foreign to physicians and considered abstract and
irrelevant to individual patient care. Therefore, finding a way to overcome physicians’ resistance becomes a priority
for the managers who are seeking a successful and fruitful implementation of TQM in hospitals.
 Avoiding Fear: It is very important that doctors become committed to quality. This can be achieved by avoiding a
threatening presentation for the TQM program, building common believes among physicians by involving them from
the early stages of TQM this involvement will increase the chances of success.
 Begin with the Loyalists: Lopresti and Whetstone (1993) recommended that involving physicians in establishing
TQM should begin with a few interested physicians and expand to others as their involvement begins to attract
support. Thus, to resolve the conflict between doctors and hospitals a new leadership style is again needed a one that
is capable of bridging the between the two bodies
•Lack of resources: Insufficient or improper infrastructure, equipment, manpower
make it impossible for output of the desired quality.
•Drugs and Medical Supplies: Non- availability of essential drugs and supplies,
spurious, adulterated drug preparation have a deleterious effect on the course of
hospitalization and final prognosis.
improper Maintenance: To minimize equipment downtime, it is necessary to ensure
adequate after-sales service.
•Personnel Problems: Lack of adequately trained, skilled and motivated employees
compromise on the quality of care.
•Unreasonable patients and attendants: Illness, anxiety, etc cause patients, their
families and friends to adopt unreasonable and uncooperative attitudes.
 Professional vs. TQM views.
Area of Conflict Professional view TQM View
Responsibility Individual Collective
Leadership Individual Managerial
Autonomy Individual / Peers Accountability
Planning Rigid Flexible
Feedback Responses to complaints Benchmarking
Performance Appraisal Retrospective Continuous
Authority Administrative Participative
 Problem Statement
 As discussed, the tertiary care hospitals are at present facing problem on different accounts. The medicinal
prices are rising with each day, infirmaries are in a shabby state, the mortality rates are on the rise and
healthcare facilities are in a sorry state. This is further substantiated by Crisil’s present statistics on medical
infrastructure in India.
 Against a world average of 3.3 beds, India has only 1.5; against a physician density of 1.5, India has only 0.5
and against a nurse density of 3.3, India has only 0.9. Even the Middle Income countries like Brazil, Thailand
and China score good over India. Clearly, ‘quality’ is still a distant dream for hospitals in India. The country
has a population of 1.4 billion and this gets complicated without an infrastructure on medical insurance. Also,
the ‘cost’ on acquiring technology and medical infrastructure is rising with each day.
 There is a loud and clear message that TQM is not easy to implement in India. Even if one wants to do this the
challenges are huge. This study therefore goes beyond the definition of the term TQM ‘Total Quality
Management’ to identify challenges in its application and a likeable remedy to this.
 SERVQUAL – Implementation
A planned program- monitors & evaluates clinical performances of all practitioners
 Identifies opportunities for improvement
 Provides a mechanism for sustainable improvements
The framework development will follow the below sequence:
•Establishing commitment for the change: Top management of the healthcare organization must trust in
the success of TQM implementation. This trust must be transferred to the employees by explaining the
reasons behind the adoption of TQM.
•Settings the principles and policies of quality: The first thing or action to do for implementing TQM
successfully is to start changing the traditional organizational culture to become quality oriented and
customer oriented. This change must be managed properly by the top management that has to start
listening to the internal customers, participate in teams, in other words the top management must start to
show practical support to TQM programs.
•Establishing the right infrastructure for the change: The top management and its partners in the change
must try to correctively install new concepts of quality by making quality the core of meetings,
communications, the new mission, vision, and goal statement, must all evolve around the new concept
and how it has to be carried out.
Five methods of monitoring are as follows:
•The variation from the norm in the outcome
•Departure from specified outcome criteria
•Comparison of small groups in the same field
•Surveys
•Peer-review

Three important principles for effective implementation are…

•Attention should be focused on aspects of care
•Common conditions should be handled first
•Medical audit must be kept simple
 Key-steps
• Knowing the internal customers’ requirements. Now and after the fact that all employees are familiar
with the new concept, it is time to understand their requirements.
•Knowing the external customers’ requirements. TQM has a wonderful tool in which customers’
requirements may be detected. Quality Function Deployment (QFD) is usually used in order to clarify the
customers’ needs, requirements, and expectations in order to take action to satisfy these needs.
•Standardization for managing the change. It is very important for clinical path to become standardized in
order to assure the quality of the service – medical treatment – and to save effort, money and time.
•Carrying on with continuous improvement. Based on the results of using QFD, management must make
continuous improvements to keep its customers satisfied.
•Performing customer satisfaction surveys. It is very important to conduct a customer satisfaction survey
periodically to analyze the problems that continue to persist, in order to take further action.
•Spreading the right quality concept. A change of culture is now in place and it is about time for the
employees to accept the new trend and start to act accordingly.
 Conclusion
The SERVQUAL model and its application can help the healthcare facility in achieving satisfaction on both ends
- employees’ satisfaction and customer satisfaction. In healthcare organizations, the traditional Indian culture,
leadership style, and the mentality of the medical professionals are somehow the barriers to the adoption of the TQM.
The suggested integrated framework model of the TQM can be of great help to the healthcare organizations to move
out of the barriers and successfully implementing TQM concepts and practices. It is therefore important to verify that
the proposed framework model provides an unbiased, perspective and comprehensive view of hospital reality that can
link human and other resources, patients, activities to organizational units. A view that will help hospitals to avoid
falsifiability which may take place through two ways:
 The focus on only a part of the hospital performance which is the successful one,
 The use of a biased view of performance, for example certain departments deal with patients with severe medical
conditions (Cancer) leading to an apparently lower performance level.
TQM implementation—framework model
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