Total Quality Management, Safety and Stakeholders Satisfaction: Model for Healthcare Administration
Authors: - Roselle Marie D. Azucena , - Joy C. Ashipaoloye 
Published: November 2023

The health care industry has undergone turbulent change over the past decades. The industry and political leaders have grappled with several issues that impact access to care, quality of care, and the cost of care. The COVID-19 pandemic highlighted these challenges even more, as hospitals struggled to treat the overwhelming influx of patients and worked to prevent the spread of disease. For private hospitals, the challenge is even more overwhelming with a transition towards the VUCA (Volatile, Uncertain, Complex, Ambiguous) world of the healthcare landscape.
The increasing rivalry of players in the private hospital industry demand that administrators drive the optimal performance of hospitals as well as the provision of high-quality, safe, effective, and efficient services amidst the high rivalry of players in the industry. For optimum medical services to be provided, managers and planners must have some knowledge of the hospital performance based on the relevant index. Therefore, it is important to identify the factors affecting the overall performance of the hospital.
Today’s patients, like any other customers, are well informed, discerning, and demanding. This is not only because of the availability of extensive information about the variety of similar products and services available to them but also from the improved marketing capabilities of the hospital to introduce their best services by promoting their respective state-of-the art medical equipment and excellent hospital experience they can offer to patients. This situation necessitates the service provider strive to provide their customers with products and services of greater value. To effectively do this, hospitals must be consistent with what their patients need and want and are willing to pay for. Health care providers in turn, must be willing to provide service with quality and safety to ensure customer satisfaction (Medina, 2016).
The study explored Total Quailty Management, safety, and stakeholder’s satisfaction: model for healthcare administration. More specifically, it describes the profile of respondents. For the doctors and employee respondents, the description was in terms of age, gender, civil status, educational level, annual income, job tenure, job position and TQM training. For patients, the description was in terms of age, gender, civil status, educational level, work industry, job position, annual income, length of hospital service experience and hospital services utilized.
It determines Total Quality Management in terms of: policy and strategy documents availability, personnel attributes, protocols, guidelines and procedures, elements of quality and safety management systems, process and outcome evaluation and patient involvement. It determines safety in terms of: hospital’s surge capacity, infection control prevention measures, case management, human resources, diagnostic capability, and logistic and supply chain management. It determines customer satisfaction by considering patients, employees, and doctors in terms of: tangibility, reliability, responsiveness, assurance, empathy, and affordability. It tests the effects of the demographic profile of respondents on the agreement to TQM, Safety and Customer Satisfaction. It tests the relationship and interactions between three variables of interest using PLS-SEM. The structural model was examined to determine the relationships among the three variables that led to a mediation framework for healthcare administrators.
The study employed two research designs - descriptive, and causal/explanatory designs. Participants were patients, employees, and doctors of the selected Level 2 and 3 hospitals based on the classification of the Department of Health in the Philippines with a total of 600 respondents, comprised of 200 patients, 200 doctors and 200 employees as supported by an accredited statistician through random sampling. The respondents came from ten private hospitals, three coming from South Luzon, two from Manila, three from North Luzon, one from Visayas and 1 from Mindanao.
Result shows that there were two stakeholders for the study, the Employee/MD respondents, and the patient respondents. Majority of the respondents are from North Luzon region, operate in a level 2 hospital, work in a hospital that can accommodate 100 to 199 inpatients for full-time healthcare and accommodation in the hospitals, have been working for a hospital that has been operating for at least 10 years, 100 to 199 accredited doctors, work in a hospital that has at least 500 employees, employees are mostly medical doctors, have stayed with the same hospital for at least 10 years, mostly female employees, aged between 30 to 60 years old, married, postgraduate degree, professional or technical occupation, monthly house income of at least 100,000 pesos, have undergone TQM training, got their treatment in the South Luzon region, belong to healthcare industry, regular workers, receive 10,000 to 29,999 pesos for their monthly salary, experienced hospital services for 1 to 3 years, patients avail both inpatient services and outpatient services during their healthcare from the hospital.
Stakeholders agree on all the dimensions and attributes of TQM. Policy and strategy documentation had the highest agreement score while elements of quality and safety management and process and outcome evaluation were given the lowest agreement score. More so they agree on all the dimensions of safety. Infection control and prevention and case management had the highest agreement scores while surge capacity got the lowest agreement score. Furthermore, they agree on all the dimensions of customer satisfaction. Assurance and empathy were given the highest agreement score while affordability was given the lowest agreement score.TQM and safety have a significant and direct effect on customer satisfaction. TQM has a moderate mediation between safety and customer satisfaction. The proposed mediation framework of total quality management between safety and customer satisfaction with multigroup analysis illustrates how each variable affects another variable. More so, safety has a significant effect on the TQM.
The researcher recommends that the management may focus on a more intensive stratification and profiling of stakeholder and patients considering comparative analysis across the different levels of hospitals besides the regions. The hospital management staff may establish key results areas that are shared by departments that will enhance various discipline to work together for the improvement of the services rendered by the hospitals through an unbaissed quality audit department for a more efficient and effective management that will ultimately lead to the delight of stakeholders.
The management staff may further promote awareness and visibility of quality promoters in the hospitals by creating a process and work teams to improve collaboration between healthcare workers and management for an integrated development policy through a more effective and efficient IT systems and the use of data to improve hospital policies. The hospitals under study may draw up facility plans and processes to ensure capacity to address surges of future pandemics by ensuring more competent since the hospitals within the study are valued for their ability to admit inpatients and prioritization depending on the situation at hand in the hospital.
The researcher posited that the hospitals under study may invest more mechanisms, stations and graphics relating to infection control in the hospital to improve general sentiment for this attribute. Generate improvement for presence of psychosocial teams and availability of minimum number of personnel within the hospitals. The hospitals may include in their future provisions; adequate and convenient parking spaces, information brochures, improvement of appointed time, records retrieval, quality and affordable health care, competent health care practitioners with experiences and trainings, improved facilties, better safety culture, accurate billing charges, good feedback mechanism to ensure continuous improvement.
Future researchers may review the dimensions of the variables under study and include other demographics not utilized in this study for a more comparative analysis.