TABLE OF CONTENTS PAGES

1. Introduction 2-3

2. Problem Statement 3-4

3. Research Question & Research Objectives 4-5

4. Significance of Study 5

5. Literature Review 5-6

6. Theoretical Background 7

7. Theoretical Framework 7-8

8. Conceptual Framework 9 - 10

9. Hypothesis 10 - 11

10. Research Methodology 11 - 12

11. Reference 13 - 14

12. Appendix 15

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 THE SIGNIFICANT OF TOTAL QUALITY MANAGEMENT (TQM)
TRAINING ON IMPROVING SERVICE PERFORMANCE IN PUBLIC
HEALTHCARE

1.0 INTRODUCTION

Improving quality is no longer considered as the duty of the manufacturing

department but it is everybody’s job in the organization. Quality improvement must
become a philosophy as well as a way of life. One movement which stressed this
view point is Total Quality Management (TQM). TQM is an approach that
organizations use to improve their internal processes and increase customer
satisfaction. When it is properly implemented, this style of management can lead to
decreased costs related to corrective or preventative maintenance, better overall
performance, and an increased number of happy and loyal customers. TQM can
also be defined as the continual process of detecting and reducing or eliminating
errors in manufacturing, streamlining supply chain management, improving the
customer experience, and ensuring that employees are up to speed with their
training. It aims to hold all parties involved in the production process accountable for
the overall quality of the final product or service. In another general definition, TQM
is a management approach to a long–term success through customer satisfaction
which requires significant resources both financial and human.

In today's world of intense competition, quality has become the vanguard of

customer service because delivery of high quality service often lead to sustainable
competitive advantage. Due to the rapid rate and change in global and niche
market, it has increased a pressure on organization to become more competitive in
the market . When customers are the ultimate judges of services or product quality,
thus the concept of TQM should apply not only in the manufacturing sector but also
in the service industry.

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 However, TQM concept is no longer restricted to manufacturing sector but to service
companies and non-profit organization. It is widely believed that its principle and
practices are equally relevant to service sector as both use facilities as inputs to
satisfy and surpass customers’needs. (Sirvanci, 2004; Lake and Mohanty (1995),
Yaya (2011). Thus, the TQM success in industry has encouraged healthcare
managers to examine whether it can work in the health sector accordingly.
According to Mosadeghrad, 2015, many healthcare organizations increasingly
implemented TQM principles to improve the quality of outcomes and efficiency of
healthcare service delivery .

In the past two decades the acknowledgement of medical errors, leading to patient
injury and even death, has generated potential healthcare legislation and consumer
awareness about considering and integrating quality in healthcare (Becher and
Chassin, 2001; Ruiz and Simon, 2004). Thus, TQM enables healthcare
organizations to identify customer requirements, benchmark for best practices and
improve processes to deliver appropriate care, and reduce the frequency and
severity of medical errors. TQM implementation may lead to higher quality care,
improved patient satisfaction, better employee morale, and increased productivity
and profitability (Alexander et al., 2006; Cauchick, 2006; Kunst and Lemmink, 2000;
Macinati, 2008).

2.0 PROBLEM STATEMENT

Most successful TQM training are still found in manufacturing rather than service
operational setting (Yassin, 2004). Practitioner believed that it is easier to measure
tangible process in the manufacturing rather than intangible process in service
industry and it will depends more on customer evaluation towards the measurement
of service performance. In manufacturing firms, training is more important
especially training in advanced statistical method while service firms training
focuses communication and interpersonal skills.

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 Besides that, a very few number of studies regarding TQM are found in service
industry relation. In addition, the relationship between TQM and customer
satisfaction (CS) has been neglected in Malaysia services industry in particular. In
reference to the assessment of TQM training in the public healthcare service, it is
also found that there is a lack of knowledge about TQM approach in public
healthcare service by the top management and participation from the employees.
Further searching about relevant data also found that there is a lack of data in
public service healthcare on how TQM training give positive impact in increasing
customer satisfaction, enhance customer relationship and customer focus
organization. Thus as suggested by Kaynak,(2003) in the study on quality
management, further research is necessary to identify the relationship between
TQM and customer relation/ satisfaction.

Hence, this research study is aimed at promoting awareness of TQM training

towards Malaysia public healthcare organization in order to improve performance in
Malaysia public healthcare.

3.0 RESEARCH QUESTION AND RESEARCH OBJECTIVE

3.1 Research Question

Given that customer satisfaction is important, is TQM training is an effective method
to improve service performance level? And whether TQM training help the
management to deploy service standard? These questions remain unanswered, and
hence, they are the main focus of our current research.
Specifically, following research questions (RQs) will be the focal point of this study:

RQ1: Does the effective TQM training lead to perceived customer

satisfaction to improve service performance level?

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 RQ2: Does the effective TQM training help organization deploy
service standard in customer relationship management to
exceed service performance level?

3.2 Research Objectives

Based on the research questions above, the objectives of this study are:

3.2.1 To measure perceived customer satisfaction

This study is to seek affirmation about right TQM training which can facilitate future
enhancements towards designing a customized customer satisfaction programme.

3.2.2 To measure perceived customer relationship

This study is to highlight strong and positive association between TQM training and
customer relationship towards overall service performance

4.0 SIGNIFICANCE OF THE STUDY

There are two significance of this study; firstly it could reinforces and refines the
knowledge of TQM training relating to customer satisfaction and customer relations
in order to achieve better service performance in public healthcare service industry
in Malaysia; and secondly it could provide information to top management of public
healthcare service in decision making on whether or not to implement TQM training
in their organization.

5.0 LITERATURE REVIEW

5.1 Total Quality Management

TQM can be defined in various ways. According to Terziouski (2006), Sakhtivel
(2005), Lagrosen (2001), TQM is a key element for improving the performance of

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companies and customer satisfaction as customer satisfaction is the leading criteria
for determining the service quality delivered to customers. Garvin (1983) Samson
and Terziovski (1999) explained that previous studies confirm that the effective
implementation of TQM can improve productivity and lead to improvements in
organizational performance. The TQM contents are full of exhortations about quality
for customers and customer orientation is considered to be one of the major factor.
Many studies shows the relationships between TQM lead to service quality in which
indirectly lead to customer satisfaction. Based on Sakhtivel (2005), customer
satisfaction is deemed to be leading criterion for determining the service quality
delivered to customers. However, to achieve long term competitive advantage in a
business, a high level of quality and customer satisfaction must not be ignored, they
are the basic building blocks and cannot be separated in any business options
(Shenawy, 2007).

5.2 Service Industry

Many studies proven that TQM are very successful in manufacturing sector rather
than in service sector. However, there are some cases whereby TQM in service
industry contribute to performance of organization in service sector. According to
Wen Yi Sit et al, (2009), TQM is very important in contributing to customer
satisfaction in service industry in Malaysia. TQM as the source of sustainable
competitive advantage for business organization in the effort to fortify their industry
stance. On the other hand, research done by Mahmoud M. Yasin, et al (2004)
shows that a rapid assessment methodology (RAM) was implemented, to improve
service quality in a healthcare operational setting. RAM attempts to integrate quality
improvement efforts in a form of system-wide quality improvement philosophy.
Furthermore, the relationship between TQM and innovation can determine the
organization performance and its development (Abdul Talib et al, 2013). Thus, TQM
is very important in the organisations in which quality is the prime differentiator
between the offerings of organizations. But the information and ideas on quality are
adopted must be taken care of (John McManus, et al,1996).

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 5.3 Healthcare Service Industry
The TQM success in industry has encouraged healthcare managers to examine
whether it can work in the health sector, accordingly, many healthcare organizations
increasingly implemented TQM principles to improve the quality of outcomes and
efficiency of healthcare service delivery (Mosadeghrad, 2015). Other study also
proven that training in TQM methods and principles could help to develop
healthcare managers, especially clinical professionals occupying management
positions (John Ovretvelt, 2000). There are some obstacles to transfer best
practices of TQM to the health sector (R. Nat Natarajan, 2006). However, TQM
enables healthcare organization to identify customer requirement, benchmark for
best practices and improve processes to deliver appropriate care and reduce the
frequency and severity of medical errors. It also may lead to higher quality care,
improve patient satisfaction, better employee morale and increase productivity and
profitability (Mosadeghrad, 2015).

6.0 THEORETICAL BACKGROUND

According to John McManus,et al, (1996), challenges the ideas of total quality
management first appeared in the immediate post war period, principally from
Deming and Juran, and it have continued ever since. Eventually, the ideas was
continued with other scholars such as Genichi, Taguchi, Felgenbaum and Crosby
whereby they generated the main principles of what is called as TQM as below:
• The pursuit of continuous improvement
• Commitment from senior management
• Knowledge of tools and techniques of total quality
• Awareness of total quality
• A belief that everyone has a responsibility of quality
• Understanding of customer specification and satisfaction

7.0 THEORETICAL FRAMEWORK

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 According to Mosadeghrad (2015), an extensive review of literature on quality
management models and frameworks was performed to identify critical factors for
successful TQM implementation in healthcare. He proposed a generic model of
TQM as in Figure 1, in which we refer it as guidelines to our theoretical framework.
The framework was developed to identify critical factors for successful TQM
implementation in healthcare. In total, 15 most common construct of TQ were
chosen for inclusion in the model, of which ten are enablers and five are results.
Enablers direct and drive the results. The model starts from the logical point of
leadership and management and ends with overall performance results. The belief
is that “excellent results with respect to organization, customer, employee, supplier
and society are achieved through leadership and management, strategic quality
planning, quality culture, education and training, employee management, customer
management, supplier management, resource management, information
management and process management”.

Figure 1: General model of TQM for healthcare organisations

8.0 CONCEPTUAL FRAMEWORK

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The conceptual framework of this study is being constructed from 4 hypothesis
labelled as H1, H2, H3 and H4 as shown at below diagram:

Figure 2: Conceptual Framework

• Customer requirement
Using information from customer complaints, key client studies and customer
expectation studies will help designing good TQM Training
• TQM training help organization to increase customer satisfaction and enhance
customer relationship by adds value to the customer. TQM Training equally
relevant to service sector as inputs to satisfy and surpass customers’ needs.
However, it is necessary to understand the unique characteristics of services for
an effective and successful implementation of TQM in service sector
• Geyskens et al (1999) view customer satisfaction as an important antecedent
variable for developing long-term marketer - customer relationship
• Common TQM practices for service sector include: top management, strategic
quality planning, employee management and involvement, supplier management,
customer focus, process management, continuous improvement, information
and analysis, knowledge and education are important for continuous and
industry-wide improvement (Fotopoulos and Psomos, 2009).

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 • Talib et al. (in press a, 2011f) identified 17 TQM practices for service industries
based on extensive literature review. They are top management commitment;
customer focus; process management; quality systems; teamwork;
communication, training and education; continuous improvement and
innovation; supplier management; employee involvement; information and
analysis; benchmarking; strategic planning; employee encouragement; quality
culture; human resource management; and product and service design
• Many healthcare organization increasingly implemented TQM principles to
improve the quality of outcomes and efficiency of healthcare service delivery
(Kunst and Lemmink, 2000; Macinati, 2008)
• TQM perception is associated with importance of customer’s satisfaction,
responsibility of upper-level management, measurement and reward system and
support of upper-level management (Kozak et al. (2007));
• Chien, et al, (2002) say that for a firm attempting to implement TQM, customers
satisfaction is an important objective to achieve;
• Crossby (1979) found that support in the writings of Ishikawa (1976,1985) who
emphasized the importance of training, problem solving and quality circles as a
method to achieve continuous improvement
• Feigenbaum (1991) stressed the need of leadership, a commitment to
incorporate quality in the organization's practices and the participation of the
entire workforce

9.0 HYPOTHESES

The hypothesis for this study is constructed from the theoretical and conceptual
framework of previous research related to TQM and organization’s performance as
below:
Hypothesis 1 There is a positive and significant relationship between effective TQM
Training and Perceived Customer Satisfaction
Hypothesis 2 There is a positive and significant relationship between effective TQM

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 Training and Perceived Customer Relationship
Hypothesis 3 There is a positive and significant relationship between Perceived
Customer Satisfaction and Healthcare Service Performance
Hypothesis 4 There is a positive and significant relationship between Perceived
Customer Relationship and Healthcare Service Performance

10.0 RESEARCH METHODOLOGY

Method
The type of our research is the quantitative research by using the survey questionnaire.
The research population will be the public healthcare provider in Selangor which
consists of the Public Hospital, healthcare clinic (Klinik Kesihatan) and Klinik Desa. The
data for this research were drawn from a cross-sectional questionnaire survey collected
from 80 public healthcare organization consists of Public Hospital, healthcare clinic
(Klinik Kesihatan) and Klinik Desa in Selangor.

Settings and participants

The unit of analysis is the organization which is the public hospital, healthcare clinic
(Klinik Kesihatan) and Klinik Desa. The list of hospital and health clinic will be retrieved
from Ministry of Health Malaysia website as at Appendix 1. Then, the manager or
quality managers of public healthcare in Selangor would be asked to participate in this
survey. There will be about 80 respondent in this study.
The pre-test will be conducted to the potential expert in public healthcare such as the
officers from the headquarter of Ministry of Health to answer the questions before the
full scale of study implemented. It is very important in order to identify any problems
such as unclear wording or questionnaire taking too long to administer. After the pre-
test has been conducted, the questionnaire will be finalized and administered before the
questionnaire distributed to the participants.

Questionnaire Design

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The survey questionnaire was divided into two section. The first part will consists of
general and demographic information about the healthcare organization. In the

second section of the survey, the degree of TQM training in the organization in which

will be divided into 6 sub-sections namely leadership, customer, people, information,

process and result. The data will be measured through 5 points of Likert Scale as
below:
i) Scale 1 (Started);
ii) Scale 2 (Partly Implemented);
iii) Scale 3 (Extensive Implemented);
iv) Scale 4 (Established System); and
v) Scale 5 (Continuously Improved).

The respondent will be given ample time to fill up the questionnaire, If they did not
respond within the period, we will assume that they are not agree to participate. The
questionnaire can be referred in the Appendix 2.

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REFERENCES
1. Ali Mohammad Mosadeghrad, (2015) “Developing and validating a total quality
management model for healthcare organization”, The TQM Jurnal, Vol.27
Issue:5,pp,544-564, https://doi.org/10.1108/TQM-04-2013-0051

2. Mahmoud M. Yasin, Jafar Alavi, Murat Kunt, Thomas W. Zimmerer, (2004) “TQM
practices in service organizations: an exploratory study into the implementation,
outcome and effectiveness”, Managing Service Quality: An Internaional Journal,
Vol.14 Issue:5,pp.377-389, https://doi.1108/09604520410557985

3. Wen-Yi Sit, Keng-Boon Ooi, Binshan Lin, Alain Yee-Loong Chong, (2009) : “TQM
and customer satisfaction in Malaysia’s service sector”, Industrial Management &
Data Systems, Vol. 109 Issue:7, pp.957-975,
https://doi.org/10.1108/02635570910982300

4. Abdul Talib Bon, Esam M.A. Mustafa, (2013) “Impact of Total Quality
Management on Innovation in Service Organization: Literature review and New
Conceptual Framework.

5. John J. McManus, Iain Hutchinson, (1996) "TQM in service design", Managing

Service Quality: An International Journal, Vol. 6 Issue: 1, pp.40-44,
https://doi.org/10.1108/09604529610108135

6. John Øvretveit, (2000) "Total quality management in European healthcare",

International Journal of Health Care Quality Assurance, Vol. 13 Issue: 2, pp.74-
80, https://doi.org/10.1108/09526860010319523 Permanent link to this
document: https://doi.org/10.1108/09526860010319523

7. Satish Mehra, Sampath Ranganathan, (2008) "Implementing total quality

management with a focus on enhancing customer satisfaction", International
Journal of Quality & Reliability Management, Vol. 25 Issue: 9, pp.913-927,

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 https://doi.org/10.1108/02656710810908070 Permanent link to this document:
https://doi.org/10.1108/02656710810908070

8. Keng‐Boon Ooi, Binshan Lin, Boon‐In Tan, Alain Yee‐Loong Chong, (2011) "Are
TQM practices supporting customer satisfaction and service quality?", Journal of
Services Marketing, Vol. 25 Issue: 6, pp.410-419,
https://doi.org/10.1108/08876041111161005 Permanent link to this document:
https://doi.org/10.1108/08876041111161005

9. Cheng Hwa Wang, Kuan Yu Chen, Shin Chun Chen, (2012) “Total Quality
Management: The Moderating effects of external environmental factors

10. Samir D. Baidoun, Mohammed Z. Salem, Omar A. Omran, (2018) “Assessment

of TQM implementation level in Palestinian healthcare organization: The case of
Gaza Strip hospitals”,The TQM Journal, Vol.30 Issue:2,pp.98-115,
http://doi.org/10.1108/TQM-03-2017-0034

11. Healthcare Criteria for Performance Excellence-Baldrige Performance

Excellence Program (2011-2012), National Institute of Standards and
Technology

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APPENDICES

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Appendix 1: List of hospital and health clinic in Selangor

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 QUESTIONNAIRE

We are carrying out survey entitled:

“THE SIGNIFICANT OF TOTAL QUALITY MANAGEMENT
(TQM) TRAINING ON IMPROVING PERFORMANCE IN PUBLIC
HEALTHCARE ”

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This set of questionnaire is being prepared as part of course requirement for MBA
Program.
Your kind cooperation and response are very much appreciated. Confidentiality of
your response is therefore assured as this survey is solely intended for academic
purpose. Your company identity will not be disclosed because the information will
be in aggregate form instead of one company response. Thank you.

Prepared By:
Noorziehan binti Sidin (ZP04100)
Izatul Ashikin binti Mohamad Alias (ZP04101)
Nor Idayuniza binti Rahmat (ZP04166)

SECTION I:
ORGANIZATION BASIC INFORMATION/DEMOGRAPHIC DATA

Organization’s Name : _______________________________

Location : _______________________________

Years of Operation : _______________________________

Average number of Employees in year 2018 :

I) Management : _________________
II) Clinical : _________________
III) Non-Clinical : _________________

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Allocation budget for employee training in year 2018 : __________

SECTION II
TQM TRAINING IN THE ORGANIZATION

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