An analysis of the feasibility of developing a generic model for the implementation of total quality management within the National Health Service
This is an exploratory case study evaluating the process of TQM implementation in the 23 TQM demonstration sites in the NHS. These sites were set up in 1989 by the Department of Health as centres of excellence for the implementation of TQM. An earlier study' evaluating TQM in the NHS failed to adequately contextualise the reasons for the argument that orthodox TQM has failed in the NHS. Against this background, it became necessary to carry out an extensive reassessment of TQM initiatives in the NHS. The central thrust of the study involves the identification of: i.the differing modes of implementation of TQM across the sites; ii.the difficulties managers were encountering in the implementation of TQM - barriers to the implementation of TQM; iii.the critical key success factors for the successful implementation of TQM in theNHS; and, iv.based on empirical evidence seeks to determine whether a specific model of TQM is required in the NHS. As Francis Bacon noted, 'if anyone wants to understand nature, he has to study nature rather than base their understanding on Aristotle's postulations of nature. This is because Aristotle did not understand nature, his ideas about nature were not empirically determined'2 Hence, to gain a conceptual understanding of TQM, it is necessary to understand 'implementation' and not base understanding on the outmoded ideas of the Gurus, whose philosophies are not grounded in empirical data. Thus, the TQM literature is inundated with TQM models that are based on anecdotal evidence and the personal prescriptions of TQM writers'. This situation has led to a call by a number of writers' for an empirically determined implementation model for TQM; particularly in the healthcare setting. To determine whether such a model is required in the NHS, this exploratory study used a unique combination of qualitative and quantitative data to sample 23 Quality Managers at the 23 TQM sites in order to provide an accurate rendition of the TQM process in the NHS. The study makes a valid contribution to the quality literature, by contending that TQM has not failed in the NHS as earlier suggested by one stud?, but is yet to be tried. Allegations of failure arise from improper implementation, which is itself symptomatic of the lack of a context-specific model for the implementation of TQM in the NHS. The conclusion was reached from a number of perspectives: (1) the critique of current TQM literature which is based on the personal ideas of quality management proponents (Chapter Three). (2) a reconceptualisation of the implementation of TQM. The study suggests that the traditional paradigms of TQM lack adequate contextualisation. They only provide answers for the "what" of TQM in the form of step-by-step approaches, or of TQM as a vehicle for culture change, without providing the practising manager with the 'how' of the implementation process. This apparent limitation, the author suggests, makes TQM orthodoxy inappropriate to deal with the complexities of the NHS (Chapter Four). (3) the study also found that the suggestions in the literature that the barriers to the implementation of TQM have generic applicability across organisations is a misnomer. In most of the hospitals the difficulties that quality managers were facing were specific to the organisational context (Chapter Five). (4) seventeen critical success factors were identified as valid and specific to the NHS. These factors, unlike the 'Ten Critical Success Factors' identified by Black6 are of equal importance for the implementation of TQM and are not categorised on a scale of importance (Chapter Seven). In the final analysis, the study, as a major contribution to knowledge in the quality management field, provides the first empirically determined context specific model for the implementation of TQM in the NHS. The model represents the first problem specific model validated by the experiences of fifteen quality managers in the NHS. It provides an empirical understanding of the 'nature' of the implementation of TQM within the confines of the British National Health Service. In addition, a measurement framework to monitor the progress of TQM at various stages of the implementation process is offered (Chapter Seven).