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Unit 10: Structural Intervention

Notes
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Caselet Managing Change in the NHS

n a review of TQM research, Hackman and Wageman (1995) found that over 80% of
published assessments of TQM were descriptions of what happened when the
Iprogramme was installed in one particular organisation. Less than 15% of the studies
of TQM programmes documented actual behavioural changes following TQM adoption.
Those that did address work behaviours relied on anecdotal descriptions of particular
quality teams and their problem solving processes.
Numerous case reports provide some evidence of a positive impact from TQM but they
are almost all based on experiences in a single case, mostly written by a member of the
focal organisation. In contrast, broad-based, large-scale surveys generally reveal
dissatisfaction with the results of TQM (Little, 1992; Shortell et al., 1995).
A particular difficulty with TQM is that a wide range of disparate interventions, some
related to TQM and some not, are included under the TQM banner. The dilution and
Transmogrification of TQM pose particular difficulties for those who seek to evaluate it.
The loose adoption of TQM rhetoric, in the absence of the implementation of TQM
principles, combined with a dearth of studies on behaviour change, has meant that there
is a gap in knowledge about the effects of TQM interventions and the means by which
those effects are generated.
In health, the literature contains reports about individual organisational experiences and
provides suggestions for improved implementation (for example, Motwani, Sower and
Brashier, 1996; Nwabueze and Kanji, 1997; Zabada, Rivers and Munchus, 1998). There are,
however, few empirical studies that provide comparative information about the impact
of TQM on health care organisations. Barsness et al. (1993) presented self-reported data
from hospital Chief Executives and Directors of Quality Improvement from 3303 community
hospitals in the USA. Researchers used a relatively stringent definition of TQM to
differentiate between participating and non-participating hospitals. They found that TQM
hospitals were more satisfied with their quality improvement efforts, had board members
more involved, greater perceived impact on human resource development, greater
perceived impact on productivity and profitability, and greater cost savings than
non-participating hospitals. They found no significant differences between the two groups
in terms of patient outcomes.

Similarly, Shortell et al. (1995) studied 40 hospitals and found no relationship between
TQM implementation and length of stay, or perceived clinical impact. Joss and Kogan's
(1995) evaluation of TQM in the NHS found little evidence of staff empowerment, or
changes in health status. They concluded that implementation was piecemeal, and rarely
focused on core organisational processes of the NHS - that is, clinical practice - concentrating
instead on peripheral and administrative activities. These findings may reflect the reluctance
of medical staff to engage in TQM efforts where TQM has been tried in hospitals so far
doctors are often not effective on quality improvement teams. They arrive late or not at all
to the meetings, they dominate when they are present; and they sometimes leap to solutions
before the team has done its proper diagnostic work on the process.

Source: http://www.sdo.nihr.ac.uk/files/adhoc/change-management-review.pdf

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