Barriers to TQM Strategies in King Abdul Aziz University Hospital

This research aims at establishing the barriers of implementing a total quality management strategy in King Abdul Aziz University Hospital. A total quality management is important in developing good quality and standards in such a healthcare organization. This study will use the hospital information and evaluation reports to establish the major problems that are encountered in implementing total quality management in the institutions and the recommendations of the actions that can be taken to improve the efficiency of total quality management in the institution.

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Organization Background and Evaluation

Talal bin Abdul Azi, a Royal Highness Prince, was the founder of King Abdul-Aziz University Hospital in 1955. The university hospital is presumed to be one of the best hospitals in Saudi Arabia despite having challenges in its administration. It has limited appropriate personnel in primary health nursing such as Surgery, Dermatology, Nutrition, Anesthesia, and healthcare guiding and counseling for patients with diabetes (Alharbi, & Yusoff, 2012, p59). It is as a result of high growing numbers of patients. The application of Total Quality Management strategies is dismal in the healthcare sector in Saudi Arabia. Its implementation is in small scale hence ineffective. The success of King Abdul-Aziz University Hospital calls for the divided devotion by the management to make the final plans that will initiate the quality standards in healthcare provision. Failure to implement the TQM techniques is one of the biggest problems facing the healthcare industry around the globe (Almalki, FitzGerald, & Clark, 2011, p 784). The paper focuses on determining the obstacles that lead to the wrong implementation of the Total Quality Management techniques in KAUH and the possible ways that the management can use to overcome them to acquire a successful transformation in service delivery.

Findings (Barriers towards the implementation of TQM)

Language and cultural barrier

The King Abdul Aziz University Hospital lacks enough nurses and physicians who have sufficient background information about non-Muslim culture and Muslim culture as well. The university hospital is struggling to achieve cultural competence as one of the primary cause of poor service delivery. Moreover, language factor is one of the obstacles to the implementation of Total Quality Management strategies (Aljuaid, Mannan, Chaudhry, Rawaf, & Majeed, 2016, p.e008988). It leads to problems with clarity while giving instructions and information to patients who doesn't understand Arabic accent. A communication barrier between the healthcare provider and a patient is a clear indicator of inability to apply Total Quality Management techniques. Ana productive relationship among the players in health sector boosts confidence and trust. However, poor patient's feedback and ignorance on the discussion of the treatment details the implementation of a total quality management program (Talib et al. 2013).

Bureaucracy

The healthcare service provided by King Abdul Aziz University Hospital is in the public sector. It implies that the ministry of finance provides the funding for its operation through the control of the Ministry of Health MOH). It is confronted with bureaucracy constraint to access facilities that enable the application of the total quality management (Alhwairini, & Foley, 2012,p 187). Similarly, the public policy is playing a significant role in redirecting the hospital's resources to quality programs. The government has allowed the development of hospitals in educational institutions to promote quality of service, with little effort to enhance the quality of the services. The hospitals lack efficient primary health care information system. Although the systems are not new in Saudi Arabia, previous efforts have proved to be futile. Lack of National Health Information System (NHIS), makes it difficult for the management to make critical decisions (Gimenez-Espin et al. 2013).

Poor Strategic Planning

Poor strategic planning is as a result of inadequate management system in place. It includes some functionary parts that are interdependent in achieving a common goal. The KAUH lacks proper processes, policies, and procedures (Dehnavieh et al. 2013). TQM is a systems management tool that aims to improve the overall organization output. For it to be effective, the team should be developing on a continuous basis. It implies that the system should not be obsolete but rather up to date to overcome challenges of structural rigidity. According to Deming, he emphasized his philosophy of improving the system continually and forever to improve quality and productivity so that costs can be reduced (Deming, 103, 1986). The King Abdul Aziz University Hospital lacks the strategy of updating the systems frequently. It is the reason why the implementation of TQM is struggling to hold ground.

Lack of an Appropriate Culture that Supports TQM Programs

Organizational cultural values play a critical role in the implementation process of quality healthcare standards. According to Schein (1985), he defines corporate culture as a pattern of shared fundamental assumptions, discovered, and invented by a given group as it learns to deal with its problems of internal integration and external adaptation. It is the duty of the top level management to ensure that healthcare errors are minimal (Stock, McFadden, & Gowen III 2006). Organization's culture shapes the attitudes and values of the hospital to promote quality healthcare service. A Cultural misunderstanding between patients and the expatriate physicians contributes to high degrees of dissatisfaction and low-quality health care provision. It is because Saudi Arabia is an Islamic country with the follows the Islam culture. The rising number of expatriates accelerates the problem of poor quality and satisfaction. The Saudi Arabia employs physicians and nurses from areas such as India, Malaysia, Australia and America. It 's hard to execute TQM strategies since the human resource personnel comprises of a mixture of expatriates and the Arabs. For instance, the expatriate nurses have problems with meeting the religious and cultural expectations of patients. The University hospital top level management helps in managing cultural diversity issue.

High costs of implementing a TQM program

The costs of running the King Abdul Aziz University Hospital costs are too high hence adoption and implementation of the Total Quality Managements strategies. It requires a lot of time and facilities to execute the TQM plan (Oakland 2014).

Poor Management and Development of Human Resources

The provision of primary health care has improved over time in the hospital; however, the medical staff is poorly managed. The working team is working under stressful conditions because of a high number of patients. It is hard to attain quality service because of overworking the doctor, and the nurses. The ratio of one doctor to more than one patient is high. However, a report by Al-Awa et al. indicated that the nursing staff faces Multilanguage and major multicultural obstacles to quality service (Al-Harbi, 2011, p 10). Though the patient safety has improved, the high number of employee turnover is a discouraging factor to TQM programs. An organization that retrenches its employees it certainly cannot achieve the smooth implementation of the TQM program. The hospitals that maintain high performing workers with better remuneration benefits successfully manages to put in place the TQM system. It 's hard to monitor and evaluate the performance of a new employee it requires a collapse of the defined period before assessing the performance.

The achievement of an outstanding TQM system requires that every department works towards realizing this goal. It is not an individual effort to make it successful. Thus, every department should engage in quality performance and employees satisfaction. The top level management has to acknowledge and observe a class in delegating the duties. In Saudi Arabia, the managers are likening to father-figures in society due to traditional beliefs. A manager acts as a father-figure has the involved in convincing the staff to conform to quality service delivery.

Lack of Leadership Commitment

Research in palliative care showed a low score for the nurses compared to the physicians. There is a need to develop excellent leadership skills among the hospital nurses with a culture of safety consciousness. There is a need to strengthen teamwork as well as developing the professional competencies of the physician and the subordinates'. It will lead to increased hospital capacity to function properly and deliver on the patient's needs. In addition to this, the attitude of the medical staff should embrace a medical practice that is backed by scientific evidence to avoid resistance to evidence-based medicine. Hughes findings show that nurses spent a lot of time with patients, unlike the physicians. Thus, it is the responsibility of every nurse to report on the progress of the patients to the several doctors' to avoid medical error when treatment is in progress. The three styles of leadership include autocratic, participative, and laissez-faire (Al-Awa, De Wever, Melot, & Devereux, 2011, p 23). The direction of KAUH is more of autocratic than participative. Given this, the management makes decisions without consulting other organizations members. The course of action does not give elaborate of policies hence causing anarchy among the staff members since the nurses and physicians are under stress to deliver high unrealistic targets.

The leadership should switch to the freestyle which takes into consideration the grievances of all parties including the patients. The making of instruction will be after a series of consultation. As a result, it is easy to accept managerial ideas, improve the attitude of the employee towards TQM and boost their morale (Al-Homayan, Shamsudin, Subramaniam, & Islam, 2013, p 2584). The nurses and physicians lack autonomy in carrying out their duties. The management team should, therefore, allow them to exercise their functions without strict supervision and interference as qualified professionals. For example, the surgeons are technical workers; they should have freedom to perform their duties as per the qualification and experience rather than controlling his or her competency.

A leader is a motivator and a role model; the KAUH leaders are failing to give the necessary motivation to the working staff. The commitment of employees bases on the reinforcement effort that the management has put in place (Bateman & Snell, 116, 2002). The employees who lack information about TQM may miss the necessary motivational force to embrace a continuous advancement in organizational philosophy. Since the organization success comes with staff' motivation, the management should come up with policies and structural framework that allow the employ to have work autonomy, appreciate each effort that gears towards achieving quality healthcare and develop career-wise (Das et al., 45, 2011).

Lack of Exposure by the physicians on the TQM Program

The introduction of TQM in the healthcare sector is new in Saudi Arabia. The present long-serving workers have little or no experience with the TQM programs. They are on the brink of resisting transformation of the medical sector in KAUH. The change in cultural beliefs requires a total shift in all departments of an organization. The new TQM program poses psychological and physical fear. Most of the working staff in the university believes that TQM is against their will and professional practice hence causing...