Item request has been placed! ×
Item request cannot be made. ×
loading  Processing Request

The influence of soft and hard TQM on quality performance and patient satisfaction in health care: investigating direct and indirect effects.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
  • Author(s): Alkhaldi RZ;Alkhaldi RZ; Abdallah AB; Abdallah AB
  • Source:
    Journal of health organization and management [J Health Organ Manag] 2021 Oct 28; Vol. ahead-of-print (ahead-of-print).
  • Publication Type:
    Journal Article
  • Language:
  • Additional Information
    • Source:
      Publisher: Emerald Country of Publication: England NLM ID: 101179473 Publication Model: Print Cited Medium: Internet ISSN: 1758-7247 (Electronic) Linking ISSN: 14777266 NLM ISO Abbreviation: J Health Organ Manag
    • Publication Information:
      Original Publication: Bradford, West Yorkshire, England : Emerald, c2003-
    • Subject Terms:
    • Abstract:
      Purpose: The present study conceptualizes total quality management (TQM) in terms of soft and hard aspects and examines their effects on quality performance and patient satisfaction. The indirect effects of soft and hard TQM on patient satisfaction through quality performance are also investigated.
      Design/methodology/approach: A multi-item questionnaire was prepared to gather primary data from a sample of 312 medical employees in private hospitals in Jordan. The measurement model was evaluated for validity and reliability and determined to be acceptable. Structural equation modeling (SEM) was applied to test the research hypotheses.
      Findings: The results revealed that soft TQM has a strong positive effect on quality performance and patient satisfaction. Hard TQM was found to positively affect quality performance but to a lesser extent compared to soft TQM. The effect of hard TQM on patient satisfaction, meanwhile, was not significant. Quality performance positively mediated the relationship between TQM - both soft and hard - and patient satisfaction.
      Originality/value: This study is one of the first to conceptualize TQM in terms of soft and hard aspects in a health care context. It offers valuable insights for managers of private hospitals looking to enhance quality performance and patient satisfaction. The results reveal that soft TQM is the primary driver of quality performance and patient satisfaction in the health care context, which is in stark contrast to the manufacturing sector.
      (© Emerald Publishing Limited.)
    • References:
      Abdallah, A.B. (2013), “The influence of ‘soft’ and ‘hard’ total quality management (TQM) practices on total productive maintenance (TPM) in Jordanian manufacturing companies”, International Journal of Business and Management, Vol. 8 No. 21, pp. 1-13.
      Abdallah, A. (2014), “Implementing quality initiatives in healthcare organizations: drivers and challenges”, International Journal of Health Care Quality Assurance, Vol. 27 No. 3, pp. 166-181.
      Abdallah, A. and Alkhaldi, R. (2019), “Lean bundles in health care: a scoping review”, Journal of Health Organization and Management, Vol. 33 No. 4, pp. 488-510, 2019.
      Abdallah, A.B., Dahiyat, S.E. and Matsui, Y. (2019), “Lean management and innovation performance: evidence from international manufacturing companies”, Management Research Review, Vol. 42 No. 2, pp. 239-262.
      Abdullah, M.M. and Tari, J.J. (2012), “The influence of soft and hard quality management practices on performance”, Asia Pacific Management Review, Vol. 17 No. 2, pp. 177-193.
      Aburayya, A., Alawadhi, D. and Taryam, M. (2019), “A conceptual framework for implementing TQM in the primary healthcare centers and examining its impact on patient satisfaction”, International Journal of Advanced Research, Vol. 7 No. 3, pp. 1047-1065.
      Ahire, S.L., Waller, M.A. and Golhar, D.Y. (1996), “Quality management in TQM versus non‐TQM firms: an empirical investigation”, International Journal of Quality & Reliability Management, Vol. 13 No. 8, pp. 8-27.
      Ahmed, S., Abd Manaf, N.H. and Islam, R. (2018), “Measuring lean six sigma and quality performance for healthcare organizations”, International Journal of Quality and Service Sciences, Vol. 10 No. 3, pp. 267-278.
      Al-Hyari, K., Abu Hammour, S., Abu Zaid, M.S. and Haffar, M. (2016), “The impact of lean bundles on hospital performance, does size matter?”, International Journal of Health Care Quality Assurance, Vol. 29 No. 8, pp. 877-894.
      Alavi, J. and Yasin, M.M. (2008), “The role of quality improvement initiatives in healthcare operational environments”, International Journal of Health Care Quality Assurance, Vol. 21 No. 2, pp. 133-145.
      Albuhisi, A.M. and Abdallah, A.B. (2018), “The impact of soft TQM on financial performance: the mediating roles of non-financial balanced scorecard perspectives”, International Journal of Quality & Reliability Management, Vol. 35 No. 7, pp. 1360-1379.
      Alkhaldi, R. and Abdallah, A. (2019), “Lean management and operational performance in healthcare: implications for business performance in private hospitals”, International Journal of Productivity and Performance Management, Vol. 69 No. 1, pp. 1-21, 2020.
      Aoun, M. and Hasnan, N. (2015), “Health-care technology management: developing the innovation skills through implementing soft TQM among Lebanese hospitals”, Total Quality Management & Business Excellence, Vol. 28 Nos 1-2, pp. 1-11.
      Baron, R. and Kenny, D. (1986), “The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations”, Journal of Personality and Social Psychology, Vol. 51 No. 6, pp. 1173-1182.
      Beuran, M., Negoi, I., Paun, S., Vartic, M., Stoica, B., Tănase, I., Negoi, R. and Hostiuc, S. (2014), “Quality management in general surgery: a review of the literature”, Journal of Acute Disease, Vol. 3 No. 4, pp. 253-257.
      Boyer, K.K., Gardner, J.W. and Schweikhart, S. (2012), “Process quality improvement: an examination of general vs. outcome-specific climate and practices in hospitals”, Journal of Operations Management, Vol. 30, pp. 325-339.
      Brown, T.A. (2015), Confirmatory Factor Analysis for Applied Research, 2nd ed., The Guilford Press, New York, NY.
      Byrne, B.M. (2016), Structural Equation Modelling with AMOS: Basic Concepts, Applications, and Programming, 3rd ed., Routledge, New York, NY.
      Chiarini, A. and Baccarani, C. (2016), “TQM and lean strategy deployment in Italian hospitals: benefits related to patient satisfaction and encountered pitfalls”, Leadership in Health Services, Vol. 29 No. 4, pp. 377-391.
      Clark, D.M., Silvester, K. and Knowles, S. (2013), “Lean management systems: creating a culture of continuous quality improvement”, Journal of Clinical Pathology, Vol. 66 No. 8, pp. 638-643.
      Cleven, A., Mettler, T., Rohner, P. and Winter, R. (2016), “Healthcare quality innovation and performance through process orientation: evidence from general hospitals in Switzerland”, Technological Forecasting and Social Change, Vol. 113 No. Part B, pp. 386-395.
      Das, A., Paul, H. and Swierczek, F.W. (2008), “Developing and validating total quality management (TQM) constructs in the context of Thailand's manufacturing industry”, Benchmarking: An International Journal, Vol. 15 No. 1, pp. 52-72.
      De Souza, L.B. (2009), “Trends and approaches in lean healthcare”, Leadership in Health Services, Vol. 22 No. 2, pp. 121-139.
      Esain, A.E., Williams, S.J., Gakhal, S., Caley, L. and Cook, M.W. (2012), “Healthcare quality improvement - policy implications and practicalities”, International Journal of Health Care Quality Assurance, Vol. 25 No. 7, pp. 565-581.
      Ettorchi-Tardy, A., Levif, M. and Michel, P. (2012), “Benchmarking: a method for continuous quality improvement in health”, Health Care Policy, Vol. 7 No. 4, pp. 19-101.
      Fornell, C. and Larcker, D.F. (1981), “Structural equation models with unobservable variables and measurement error”, Journal of Marketing Research, Vol. 18 No. 1, pp. 39-50.
      Gadenne, D. and Sharma, B. (2009), “An investigation of the hard and soft quality management factors of Australian SMEs and their association with firm performance”, International Journal of Quality and Reliability Management, Vol. 26 No. 9, pp. 865-880.
      Gadolin, C. and Andersson, T. (2017), “Healthcare quality improvement work: a professional employee perspective”, International Journal of Health Care Quality Assurance, Vol. 30 No. 5, pp. 410-423.
      Ghosh, M. (2014), “Measuring patient satisfaction: an empirical study in India”, Leadership in Health Services, Vol. 27 No. 3, pp. 240-254.
      Haddad, T.H. and Jaaron, A.A.M. (2012), “The applicability of total productive maintenance for healthcare facilities: an implementation methodology”, International Journal of Business, Humanities and Technology, Vol. 2 No. 2, pp. 148-155.
      Hadid, W., Mansouri, S.A. and Gallear, D. (2016), “Is lean service promising? A socio-technical perspective”, International Journal of Operations and Production Management, Vol. 36 No. 6, pp. 618-642.
      Hair, G., Black, B., Babin, B., Anderson, R. and Tatham, R. (2010), Multivariate Data Analysis, 7th ed., Pearson, Upper Saddle River, NJ.
      Halis, M., Twati, M.R. and Halis, M. (2017), “Total quality management implementation in the healthcare industry: findings from Libya”, Management Issues in Healthcare System, Vol. 3, pp. 4-21.
      Hayes, A.F. (2013), Introduction to Mediation, Moderation, and Conditional Process Analysis, The Guilford Press, New York, NY.
      Ho, D.C.K., Duffy, V.G. and Shih, H.M. (2001), “Total quality management: an empirical test for mediation effect”, International Journal of Production Research, Vol. 39 No. 3, pp. 529-548.
      Hong, P., Yang, M.G. and Dobrzykowski, D.D. (2014), “Strategic customer service orientation, lean manufacturing practices and performance outcomes: an empirical study”, Journal of Service Management, Vol. 25 No. 5, pp. 699-723.
      Hussain, A., Stewart, L.M., Rivers, P.A. and Munchus, G. (2015), “Managerial process improvement: a lean approach to eliminating medication delivery”, International Journal of Health Care Quality Assurance, Vol. 28 No. 1, pp. 55-63.
      Jarrett, P. (2006), “An analysis of international health care logistics: the benefits and implications of implementing just-in-time systems in the health care industry”, Leadership in Health Services, Vol. 19 No. 1, pp. 1-10.
      Jones, D. and Mitchell, A. (2006), Lean Thinking for the NHS, NHS Confederation, London, available at: (accessed 5 February 2020).
      Judd, C.M. and Kenny, D.A. (2010), “Data analysis in social psychology: recent and recurring issues”, in Gilbert, D., Fiske, S.T. and Lindzey, G. (Eds), Handbook of Social Psychology, 5th ed., Wiley, New York, NY, Vol. 1, pp. 115-139.
      Kenny, D.A., Kashy, D. and Bolger, N. (1998), “Data analysis in social psy-chology”, in Gilbert, D., Fiske, S.T. and Lindzey, G. (Eds), Handbook of Social Psychology, 4th ed., McGraw-Hill, New York, NY, Vol. 1, pp. 233-265.
      Kline, R.B. (2016), Principles and Practice of Structural Equation Modeling, 4th ed., The Guilford Press, New York, NY.
      Krejcie, R.V. and Morgan, D.W. (1970), “Determining sample size for research activities”, Educational and Psychological Measurement, Vol. 30, pp. 607-610.
      Lollar, J.G., Beheshti, H.M. and Whitlow, B.J. (2010), “The role of integrative technology in competitiveness”, Competitiveness Review: An International Business Journal, Vol. 20 No. 5, pp. 423-433.
      Lovaglio, P.G. (2012), “Benchmarking strategies for measuring the quality of healthcare: problems and prospects”, The Scientific World Journal, Vol. 7 No. 1, pp. 1-13.
      Manos, A., Sattler, M. and Alukal, G. (2006), “Make healthcare lean”, Quality Progress, Vol. 39 No. 7, pp. 24-30.
      MOH (2016), “Jordan ministry of health”, available at: (accessed 21 January 2020).
      Mosadeghrad, A.M. (2013), “Obstacles to TQM success in health care systems”, International Journal of Health Care Quality Assurance, Vol. 26 No. 2, pp. 147-173.
      Munechika, M., Sano, M., Jin, H. and Kajihara, C. (2014), “Quality management system for health care and its effectiveness”, Total Quality Management and Business Excellence, Vol. 25 Nos 7/8, pp. 889-896.
      Nelson-Peterson, D. and Leppa, C. (2007), “Creating an environment for caring using lean principles of the Virginia mason production system”, Journal of Nursing Administration, Vol. 37 No. 6, pp. 287-293.
      Ng, J.H.Y. and Luk, B.H.K. (2019), “Patient satisfaction: concept analysis in the healthcare context”, Patient Education and Counseling, Vol. 102 No. 4, pp. 790-796.
      Nicholas, J. (2012), “An integrated lean-methods approach to hospital facilities redesign”, Hospital Topics, Vol. 90 No. 2, pp. 47-55.
      Nicolaou, N. and Kentias, G. (2017), “Total quality management implementation failure reasons in healthcare sector”, Journal of Health Science, Vol. 5, pp. 110-113.
      Papadopoulos, T. (2011), “Continuous improvement and dynamic actor associations”, Leadership in Health Services, Vol. 24 No. 3, pp. 207-227.
      Poksinska, B. (2010), “The current state of lean implementation in healthcare – literature review”, Quality Management in Health Care, Vol. 19 No. 4, pp. 319-329.
      Psomas, E., Vouzas, F. and Kafetzopoulos, D. (2014), “Quality management benefits through the ‘soft’ and ‘hard’ aspect of TQM in food companies”, The TQM Journal, Vol. 26 No. 5, pp. 431-444.
      Ramadevi, D., Gunasekaran, A., Roy, M., Rai, B.K. and Senthilkumar, S.A. (2016), “Human resource management in a healthcare environment: framework and case study”, Industrial and Commercial Training, Vol. 48 No. 8, pp. 387-393.
      Reis, J., Juker, D., Volk, M. and Stevenson, C. (2020), “Patients' expectations for and experiences with primary healthcare services received from a patient centered medical home”, Patient Education and Counseling, Vol. 103 No. 6, pp. 1223-1229.
      Sahoo, S. (2019), “Lean manufacturing practices and performance: the role of social and technical factors”, International Journal of Quality and Reliability Management, Vol. 37 No. 5, pp. 732-754.
      Schattenkirk, D. (2012), “Building sustainable internal capacity for quality within a healthcare environment”, The TQM Journal, Vol. 24 No. 4, pp. 374-382.
      Shazali, A., Habidin, F., Ali, N., Khaidir, A. and Jamaludin, H. (2013), “Lean healthcare practice and healthcare performance in Malaysian healthcare industry”, International Journal of Scientific and Research Publications, Vol. 3 No. 1, pp. 1-5.
      Shrout, P. and Bolger, N. (2002), “Mediation in experimental and nonexperimental studies: new procedures and recommendations”, Psychological Methods, Vol. 7 No. 4, pp. 422-445.
      Staiger, R.D., Schwandt, H., Puhan, M.A. and Clavien, P.A. (2019), “Improving surgical outcomes through benchmarking”, British Journal of Surgery, Vol. 106 No. 1, pp. 59-64.
      Talib, F., Asjad, M., Atrii, R. and Khan, A. (2019), “Ranking model of total quality management enablers in healthcare establishments using the best-worst method”, The TQM Journal, Vol. 31 No. 5, pp. 790-814.
      Toussaint, J. and Gerard, R. (2010), On the Mend: on the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry, Lean Enterprise Institute, Cambridge, Massachusetts, MA.
      Trist, E. (1981), The Evolution of Socio-Technical Systems: A Conceptual Framework and Action Research Program, Occasional Paper, 2, Ontario Quality of Working Life Centre, Ontario.
      Trist, E. and Bamforth, K. (1951), “Some social and psychological consequences of the longwall method of coalmining”, Human Relations, Vol. 4 No. 1, pp. 3-38.
      Xiong, J., He, Z., Deng, Y., Zhang, M. and Zhang, Z. (2017), “Quality management practices and their effects on the performance of public hospitals”, International Journal of Quality and Service Sciences, Vol. 9 Nos 3/4, pp. 383-401.
      Zeng, J., Phan, C.A. and Matsui, Y. (2015), “The impact of hard and soft quality management on quality and innovation performance: an empirical study”, International Journal of Production Economics, Vol. 162 No. 1, pp. 216-226.
      Zhao, X., Lynch, J.G. and Chen, Q. (2010), “Reconsidering Baron and Kenny: myths and truths about mediation analysis”, Journal of Consumer Research, Vol. 37 No. 2, pp. 197-206.
    • Contributed Indexing:
      Keywords: Hard TQM; Health care; Patient satisfaction; Quality performance; Soft TQM; Total quality management
    • Publication Date:
      Date Created: 20211028 Date Completed: 20211029 Latest Revision: 20211029
    • Publication Date:
    • Accession Number:
    • Accession Number: