Implementation of Total Quality Management Principles in Public Health Institutes in the Republic of Croatia

Implementation of Total Quality Management Principles in Public Health Institutes in the Republic of Croatia

Ivana Škarica (Teaching Institute of Public Health of Primorje-Gorski Kotar County, Rijeka, Croatia) and Ana-Marija Vrtodušić Hrgović (Faculty of Tourism and Hospitality Management, University of Rijeka, Rijeka, Croatia)
DOI: 10.4018/978-1-7998-8960-1.ch040
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Due to the growing prominence of quality management systems in health, this article presents the theoretical background and the results of an empirical study conducted among the Institutes of public health in the Republic of Croatia, with the aim to determine the level of implementation of TQM principles. The research was based on a questionnaire built on the Kanji model. According to the quality managers' perception, all analyzed TQM principles have been implemented at high level. Although in general a high level of implementation exists, certain TQM principles have been implemented to a larger extent than others. The research was also focused on finding if the difference among QM managers' perceptions exists depending on the status of ISO 9001 (implemented/not implemented/plan to implement). The differences were found in relation to the activities connected with people-based management and continuous improvement. Based on the research results, specific areas of improvement, i.e. activities that foster implementation of TQM principles, are emphasized.
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Public health activities and programs are crucial for the general health of society since they represent the essence of preventive health care. Therefore, the quality of services provided in Institutes of public health is crucial, and the application of total quality management principles provides the foundation for the improvement of public health activities and programs in general.

“Any organization’s effort to achieve continuous quality improvements must involve applying various quality related programs and tools. Such efforts are important for improving the quality of services and increasing business performance, especially in health care organizations since the quality of care and service is a top priority” (Lee, 2012, p. 387). Quality of health care is a formidable challenge in the 21st century. Recently, an emerging interest in total quality management (TQM) has been propelled by the need to control costs and the desire to improve the quality of care (Lin & Clousing, 1995, p. 69).

According to Al-Shdaifat (2015), TQM is one of the most prominent developments in management for the past two decades, and it is defined as a management philosophy concerned with people and work processes that focuses on customer satisfaction and improves organizational performance (pp. 461-462). As stated by Lin and Clousing (1995), TQM in the health care environment is not just a program with a finite beginning and end, but a process that evolves dynamic changes in the health institution” (p.70). Health organizations face many challenges these days and TQM is a one of the best ways for health organizations to cope with all of them.

Experts state the key TQM principles include the following: customer focus, obsession with quality, scientific approach, long-term commitment, teamwork, continual improvement systems, education and training, freedom through control, unity of purpose, and employee involvement and empowerment (Al-Shdaifat, 2015, p. 462). Authors like Rao (2015), Kaluzny, McLaughlin, and Simpson (1992), Al-Shdaifat (2015), and Balasubramanian (2016) emphasize customer satisfaction as a prime purpose of quality while others also indicate teamwork, education, leadership and continuous improvement (Mosadegh Rad, 2005; Salaheldin & Mukhalalati, 2009).

All the above principles were also identified by other authors like Dubey and Singh (2011), Yusof (2003), Luo (2013), Mahmood, Qadeer, and Ahmed (2014), and Ramseook-Munhurrun, Munhurrun, and Panchoo (2011). Research results indicate extensive use of TQM principles within the health care sector including implementation in public health care sector. Similar research papers were published by Lazibat, Burčul and Baković (2007) who investigated the implementation of TQM in hospitals in Croatia, while Žabica, Lazibat, and Dužević (2014) also investigated the implementation of ISO 9001 in Croatian hospitals.

Considering the importance of quality standards in the public health sector, and the fact that the stated topic is insufficiently represented in the extant literature, this paper aims to present the theoretical background as well as the results regarding the level of implementation of TQM principles in the Institutes of public health in Croatia to analyze the current state regarding understanding and application of TQM practice in institutes of public health. The research was based on a questionnaire distributed to the Quality Managers in all 21 county Institutes of public health. All questionnaires were returned of which 20 were fully completed and represented the base for the analysis.

Special emphasis is given to the implementation of TQM in the health sector. The paper also includes a part related to the presentation of public health in the Republic of Croatia from the aspect of organization and legislative framework. The research methodology and results are explained on which the conclusions and suggestions for future research are based.

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