Total quality management in public health care: a study of Italian and Irish hospitals

It has been said that, of all the inventions, innovations and initiatives affecting health care organizations worldwide over the past few years, perhaps none has been more influential or pervasive than the Total Quality revolution. Nevertheless, many few studies have tried to evaluate the real impact of TQM in health care organizations. This paper reports on the findings of a qualitative research study that investigates, through multiple in-depth case studies of 14 Italian and Irish hospitals, the real extent to which TQM (Kanji's model) is adopted within health organizations and the way it is put into practice. Research findings reveal-in the wide range of experiences that emerge-considerable commonalities between the two countries in the impact of quality revolution. Hospitals, located in widely scattered sites, closely resemble one another in the flaws and discrepancies between the theory of TQM and how it is put into practice. The potential change, which has been called a revolution, becomes a series of unrelated, 'spotlight' initiatives, which are not seen as the expression of a unitary philosophy. Such initiatives are more boasted about than implemented, and do not influence, in substance, the clinicians' practices. Hospitals tend to construct formal compliance mechanisms for institutional pressures concerning the quality of health services, i.e. by creating new departments or offices specialized in dealing with such demands, by introducing new roles responsible for compliance, by planning procedures for quality improvement, and by adopting the vocabulary of TQM. Nevertheless structure is decoupled from practices, programmes are independent from actions, and facts are different from words. Such research findings are interpreted through the resource dependence theory.