Introduction
In today’s intensely competitive global landscape, organizations across all sectors are driven to prioritize enduring quality and robust quality management systems to bolster their competitive edge. The concept of quality has evolved significantly, encompassing both objective dimensions—referring to the tangible characteristics and attributes of goods and services that meet explicit and implicit customer demands—and subjective dimensions, which emphasize the ability to deliver goods and services efficiently and effectively.1
Within the healthcare context, the pursuit of quality has been a long-standing objective, dating back to the era of Florence Nightingale.2 In a sector where quality assurance is not merely a strategic advantage for economic sustainability,3 but also a fundamental ethical, legal, and social imperative,4 the focus on quality has been paramount for decades.2 Quality assurance in healthcare is crucial as it directly impacts patient satisfaction and minimizes the risks inherent in medical care.5 Modern healthcare is increasingly professionalized, adopting structured approaches to care quality through the evaluation and regulation of structure, process, and outcome components.6
Hospitals today operate in an increasingly dynamic and competitive environment. To enhance hospital performance and healthcare quality, extensive research has been conducted.2,7–9 Nurse performance, being pivotal to overall hospital efficiency and effective healthcare delivery, has also received considerable attention.7 Nurses constitute a significant portion of the healthcare workforce and are instrumental in the successful implementation of any hospital-initiated intervention programs.
Furthermore, studies8–11 highlight the myriad challenges facing the healthcare system, including escalating costs, rapid technological advancements, economic pressures on healthcare organizations, declining healthcare quality,8,10 difficulties in meeting patient needs,9 a rise in patients with multiple illnesses, increasing demands for high-quality care, and persistent cost-containment pressures (Organization for Economic Cooperation and Development [OECD] 2007).11 One proactive approach to mitigating these challenges is the implementation of quality management programs, such as Total Quality Management (TQM).12
TQM is a management system designed to ensure customer or patient satisfaction.13 In an era of globalization, TQM’s importance as a strategy for improving organizational performance has grown significantly.14 Numerous studies have demonstrated TQM’s role in enhancing system quality and boosting both employee and organizational performance. TQM is characterized by its focus on continuous quality improvement, comprehensive quality management, and total quality control.10 It is recognized as an innovative approach to organizational management. In the healthcare sector, TQM integrates a quality-focused orientation into every process and procedure involved in healthcare delivery.15 Its adoption is becoming increasingly widespread in healthcare systems globally. Research indicates that TQM has been fully embraced by numerous healthcare institutions.2
However, the successful implementation of TQM is intricate and multifaceted. It hinges on the effective integration of specific predictors, often termed critical success factors (CSFs), and the realization of its benefits is not straightforward.16 While various approaches to integrating TQM predictors exist in the literature, they often lack consistency.17 Certain predictors are considered crucial for TQM success,[18](#CIT0018] representing universal factors applicable across industries, organizational sizes, and locations.19 These predictors are seen as determinants of organizational performance through effective TQM implementation.
Despite the recognition of various CSFs, the synergistic integration of predictors and elements critical for successful TQM implementation remains a challenge in theoretical development within TQM research. While some studies have indicated a positive impact of these predictors on performance,20 significant gaps persist that impede theoretical progress in this area. A foundational structure is lacking in the literature concerning TQM in healthcare, making it difficult to connect and build upon existing studies. The current state of research underscores the need for further investigation into TQM within healthcare.21 There is a pressing need to identify and develop new knowledge regarding effective predictors for successful TQM that enhance healthcare effectiveness, and to pinpoint areas requiring additional research.
Although systematic literature reviews on TQM predictors exist, such as two English-language studies,14,22 these have focused on CSFs in general contexts[14](#CIT0014] or broadly examined TQM research, implementation, and impact across various sectors.22 Notably, a systematic literature survey specifically focusing on TQM predictors or elements within the healthcare context is absent.
Therefore, this paper aims to fill this gap by conducting a systematic literature review. It seeks to establish a foundational basis for future research on TQM in healthcare, assess the current evidence supporting TQM in this sector, highlight literature gaps, and guide future research directions. This review is crucial for both researchers and healthcare managers aiming to effectively implement total quality management tools in health care articles and practice.
Methods
This research addresses the central question: What are the key predictors of successful TQM implementation in healthcare settings between 2005 and 2016? Following established methodologies for systematic literature reviews, this study employs a three-stage process: planning, execution, and reporting.23
The objective is to identify the most critical predictors for successful TQM in healthcare. The review encompasses peer-reviewed articles published in English-language journals from 2005 to 2016. Literature was sourced from prominent databases including Science Direct, EBSCO, MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index of Nursing and Allied Health Literature), and PubMed (US National Library of Medicine).
A structured literature search was conducted using keywords such as TQM, total quality management, implementation, CSFs, health care, and nursing to ensure comprehensive coverage.
As illustrated in Figure 1, database searches yielded a substantial number of articles: Science Direct (2133), MEDLINE (6341), EBSCO (1867), CINAHL (7), and PubMed (474). After removing duplicates, dissertations, and case studies, the remaining articles were screened for relevance based on titles and abstracts. The selection criteria prioritized peer-reviewed academic and practice articles focusing on total quality management, implementation, CSFs, healthcare, and nursing. This process resulted in 475 articles published between 2005 and 2016.
Consort flow chart of systematic review method
Figure 1. Consort flow chart of systematic review method.
Abbreviation: TQM, total quality management.
Further refinement was achieved through inclusion and exclusion criteria. Inclusion criteria included: English language articles published between 2005 and 2016, articles explicitly addressing TQM implementation and critical success factors, studies from any geographic location examining TQM principles, tools, and methods in healthcare, and quantitative or quasi-experimental research designs. Exclusion criteria eliminated non-English articles, publications outside the 2005-2016 timeframe, studies not focused on healthcare workers in hospitals, gray literature, non-peer-reviewed publications, dissertations, theses, conference proceedings, abstracts, qualitative studies, and opinion pieces without a research component. Applying these criteria narrowed the selection to 20 articles. To ensure comprehensiveness, forward and backward citation searches were performed, leading to a final selection of 25 articles for in-depth review.
The methodology also involved identifying and evaluating predictors (CSFs) of TQM by pinpointing the most frequently cited and significant predictors within the 25 selected articles. This included analyzing existing models and scales from diverse contexts and industries, and identifying studies investigating the impact of TQM implementation and predictors on performance. For a thorough review, key data points were extracted and documented for each article, including authors, study design, participant demographics, variables, measurement methods, and key findings. Figure 1 visually summarizes the systematic review process.
Findings and Discussion
A total of 25 empirical research articles were thoroughly reviewed. While this systematic review focused on quantitative studies, potentially excluding insights from qualitative research, it provides a robust overview of the quantitative evidence base. Table 1 outlines the characteristics of the reviewed literature, and Table 2 summarizes the identified TQM predictors.
Table 1. Matrix of the reviewed literature
| Study number | Authors | Study design | Study respondents | TQM predictors | Findings |
|---|---|---|---|---|---|
| 1 | Alaraki (2014)41 | Cross-sectional design | 400 clinical staff (Saudi) | Leadership, information analysis, continuous improvement, supplier management, employee management, process management, customer focus, and education and training | TQM practices have significant positive effect on performance |
| 2 | Al-Shdaifat (2015)42 | Cross-sectional design | 332 nurses (Jordanian hospitals) | Continuous improvement, training, education, customer focus, teamwork and top management commitment | Of all the TQM practices, continuous improvement is the most important factor |
| 3 | Irfan et al (2012)24 | Cross-sectional design | 239 doctors (Pakistani public hospitals) | 1. HR focus: training, empowerment, reward, recognition and employees’ involvement2. Management structure: key information to all employees, leadership role and culture3. Quality tools: quality goals and planning, measuring key results and statistical process control | The selected TQM practices have significant positive impact on TQM implementation and also on operational performance |
| 4 | Mrayyan and Al-Faouri (2008)25 | Cross-sectional design | 640 registered nurses (Jordanian hospitals) | Leadership, interpersonal relations/communications, critical care, planning/evaluation, professional development and collaboration | The selected six TQM practices have a relationship with nurses’ job performance |
| 5 | Danial (2009)26 | Quasi-experimental design | 80 nurses (Iranian hospitals) | Management commitment, customerism, education, continuous improvement, cooperation and participation, and evaluation and decision-making | TQM parameters required for the provision of heath care were significantly different |
| 6 | Duggirala et al (2008)44 | Pilot survey | Patients (Indian hospitals) | Infrastructure, personnel quality, quality of communication, process of clinical care, administrative procedures, safety indicators, overall, experience of medical care received and social responsibility | The seven TQS practices have positive relationships with patient satisfaction |
| 7 | Naser Alolayyan et al (2011)45 | Cross-sectional design | 400 nurses (Jordanian hospitals and medical center) | Training, employee management, process management, leadership, supplier management, customer focus, continuous improvement and information analysis | TQM practices in Jordanian hospitals have significant impact on the intensity of the operational flexibility of nurses |
| 8 | Sweis et al (2013)46 | Cross-sectional design | 320 employees (Saudi hospital) | Teamwork, continuous improvement, training, customer satisfaction and top management support | TQM practices have positive influence on staff empowerment |
| 9 | Awases et al (2013)27 | Cross-sectional design | 180 nurses (Namibian hospitals) | Knowledge and skills, organizational mission and objectives, staffing and schedule of duty, performance appraisal, nursing management, commitment and satisfaction, remuneration, benefits, reward and recognition, workspace and environment, leadership and management style, and staff development | Four of TQM practices (absence of recognition of staff with excellent performance, lack of performance appraisal indicators, poor condition of work, quality performance outcomes) have negative effect on nurse performance; other practices have positive effect on nurse performance |
| 10 | Al-Ahmadi (2009)28 | Cross-sectional design | 1834 nurses (Saudi hospitals) | Commitment, job satisfaction, personal and professional variables, and commitment | Commitment, personal and professional variables, and job satisfaction have positive effect on job performance |
| 11 | AbuAlRub and Al-Zaru (2008)30 | Cross-sectional design | 206 nurses (Jordanian hospitals) | Intention to stay at work, recognition and stress | Job stress and recognition have negative relationship with nurse performance |
| 12 | Güleryüz et al (2008)31 | Cross-sectional design | 5550 nurses (Turkish hospitals) | Nurse commitment | Nurse commitment has positive effect on job satisfaction |
| 13 | Kumar et al (2016)47 | Quasi-experimental design | 138 workers (experimental group), 137 workers (control group) (Pakistani hospitals) | TQM intervention program: training | The result showed a significant difference in the scores of the control group (62%) and the intervention group (87%) (p |
| 14 | Lashgari et al (2015)32 | Quasi-experimental design | 200 patients (Iranian general military hospitals) | TQM intervention: focused on improving patient satisfaction via nursing performance, commitment and service quality in emergency department | TQM resulted in a significant 20% improvement of patient satisfaction score for nursing performance quality (p |
| 15 | Sagy (2009)48 | Experimental design | – | TQM intervention (training) to improve nurse commitment and performance regarding clinical processes in a children’s hospital | The intervention is found effective in improving nurse commitment and performance regarding clinical processes as the waiting time for insertion of a peripheral catheter was reduced |
| 16 | Navipour et al (2011)33 | Experimental design | 44 patients (Iranian hospitals) | TQM intervention using the FOCUS-PCDA method on nurses to improve patient satisfaction | Consequent upon the intervention, there was an incremental level of satisfaction, but there was no statistically significant difference with that before the intervention (P>0.05) in the control group and experimental group |
| 17 | Danial (2009)26 | Randomized control trial | 80 critical wards nurses (Iran) | TQM and nursing performance through education | TQM had a significant impact (pp |
| 18 | Mosadeghrad (2015)34 | Cross-sectional design | 90 managers and quality managers (Iranian hospitals and health-care centers) | Customer management, process management, leadership, employee management, and information management | TQM practices (employee management, customer management, process management, information management, leadership) have “synergistic” effect on TQM success |
| 19 | Mosadeghrad (2014)35 | Cross-sectional design | 20 workers in Iranian health-care organizations and 30 participants working in threeISO-certified hospitals (50 persons) | Poor planning, inconsistent employees’ commitment, top management turnover, short-term improvement objectivesand inconsistent managers’ commitment | TQM implementation and its impact depend on the ability of managers to adopt andadapt its values and concepts in professional health-care organizations |
| 20 | Mosadeghrad (2012)36 | Longitudinal design | 517 employees of an Iranian hospital (70 doctors and 170 nurses) | Performance, practice, leadership and management, process management, strategic quality planning, total continuous learning, customer results, customer management, employee results and employee management | SCQM TQM was effective in improving total quality scores from 38% at baseline to 73.7% post intervention |
| 21 | Jones et al (2013)37 | Two quasi-experimental designs: cross-sectional comparison and pre–post comparison | 37 US hospitals | Teamwork, training and education, and continuous improvement | Intervention group HSOPS scores were significantly higher than static group scores in the three dimensions of TQM |
| 22 | Ullah et al (2011)38 | Quasi-experimental design | 220 health-care facilities | Strategy, structure, system, staff, skill, style and stakeholder/shared value factors | There was marked improvement in all TQM practices ranging from 20 to 77% following a training program of 3 months |
| 23 | François et al (2005)50 | Quasi-experimental design | 98 trained employees and 100 untrained employees (in a French 2000-bed university hospital) | Training and education, continuous improvement, nurse leader, technical quality, TQM methods and quality improvement | In the experimental departments the untrained staff’s knowledge of CQI methods and their participation in work groups did not differ from that of control department staff |
| 24 | El-Tohamy and Al Raoush (2015)51 | Cross-sectional design | 1290 health-care professionals in accredited governmental hospitals in Jordan | Leadership commitment to quality, customer focus, continuous improvement, teamwork, employee involvement, education and training | A significant impact of all TQM principles on the overall hospital effectiveness (pusing multiple linear regression analysis showed that TQM is a strong predictor of hospital performance (β=0.818, t=46.613, R2=0.669, p=0.000). |
| 25 | Ramseook-Munhurrun et al (2011)40 | Cross-sectional design | 200 respondents from public hospital in Mauritius | Teamwork, continuous improvement, management commitment, training, customer focus, employee involvement and organizational culture | TQM dimensions have a significant impact on the perception of management and employees, and management perceives TQM adoption as being relevant and effective, in the case of public hospitals |
Abbreviations: HR, human resources; TQM, total quality management.
Table 2. TQM predictors in the reviewed studies
| Study number | TQM predictors in the reviewed studies | % of occurrence | Ranking (based on frequency) |
|---|---|---|---|
| 1 | Education and training | 52 | 1 |
| 2 | Continuous quality improvement | 36 | 2 |
| 3 | Customer (patient) focus/satisfaction | 32 | 3 |
| 4 | Top management commitment | 32 | 3 |
| 5 | Teamwork | 24 | 4 |
| 6 | Others (human resources focus [employee management process, reward, etc]; management structure; quality tools; leadership and management style; interpersonal relations/communications; cooperation and participation; information analysis; job satisfaction) | 40 | 5 |
Core Predictors of TQM Success in Healthcare
The reviewed literature, while geographically diverse within the healthcare sector, consistently highlighted several core predictors of successful TQM implementation. These frequently identified predictors are crucial for effectively implementing total quality management tools in health care articles and practice. As shown in Table 2, education and training, continuous quality improvement, patient focus/satisfaction, top management commitment, and teamwork emerged as the most prominent critical success factors (CSFs). This finding underscores the vital role these variables play in ensuring successful TQM implementation within healthcare settings.
It is significant to note that these core predictors align with CSFs identified in broader systematic reviews of TQM across various industries.14,21 This consistency reinforces the universality and fundamental importance of these factors for TQM success, irrespective of the sector.
Research Methodologies and Geographic Distribution
Cross-sectional research designs were the most prevalent methodology in the reviewed studies, accounting for 56% of the articles.41–46 Quasi-experimental designs were also utilized in 32% of the studies. This distribution suggests a continued need for more quasi-experimental research in healthcare TQM to better establish causal relationships and understand the longitudinal impact of TQM interventions. Quasi-experimental designs are particularly valuable for discerning general trends and mitigating ethical and practical challenges associated with randomized controlled trials.
Geographically, 28% of the reviewed studies were conducted in Iran, and 20% in Jordan. Saudi Arabia and Pakistan contributed 12% and 8% respectively. Other countries, including India, Namibia, Turkey, the United States, France, and Mauritius, each accounted for 4% of the studies. This geographic distribution indicates a concentration of TQM research in specific regions, highlighting opportunities for broader global investigation and application.
Impact of TQM Predictors on Healthcare Performance
A consistent finding across the reviewed studies is the positive impact of TQM core predictors on healthcare performance. All selected articles47,48,49,50,.51 investigating the effects of continuous quality improvement, education and training, patient focus/satisfaction, top management commitment, and teamwork demonstrated a positive correlation between these predictors and enhanced performance within the healthcare sector.
These findings suggest that prioritizing TQM predictors leads to improved nurse performance[51](#CIT0051] and overall organizational effectiveness. The literature and empirical evidence support the notion that TQM implementation consistently results in better organizational outcomes. TQM principles emphasize patient satisfaction, proactive problem identification, and fostering open communication and collaborative decision-making among employees. It promotes a holistic approach where every employee shares responsibility for quality. Analytical tools like flow charts, statistical process control, and check sheets are utilized to gather data and analyze organizational processes.52 In healthcare, TQM is specifically aimed at embedding a quality-centric approach in all aspects of health service delivery.15
Limitations and Future Research Directions
This literature review, while comprehensive, is not exhaustive and has limitations. It primarily focused on the effects of TQM and may not fully capture the breadth of TQM research. Future research should expand the scope to include studies from other sectors like education and manufacturing, and incorporate diverse research methodologies, such as longitudinal studies and randomized controlled trials, to provide a more complete understanding.
While the number of identified TQM practices has grown significantly, reaching 59 predictors,[21](#CIT0021] research on TQM predictors in healthcare is still evolving. Future research should focus on clustering and prioritizing these predictors to identify the most critical ones for successful TQM implementation in healthcare, rather than solely seeking new predictors. The relative scarcity of research on TQM predictors within the healthcare sector underscores the need for continued investigation in this area.
Practical Implications for Healthcare Management
The core TQM predictors identified in this review offer practical guidance for hospital management. To enhance hospital performance, healthcare leaders should prioritize embedding continuous quality improvement, education and training, patient focus/satisfaction, top management commitment, and teamwork into their TQM implementation strategies. Given the multiplicity of TQM predictors and the context-specific nature of their criticality, stakeholders across different healthcare settings should identify and tailor the most vital TQM practices to align with their specific situations, objectives, strategies, and performance expectations. Implementing total quality management tools effectively requires a strategic focus on these core predictors.
Conclusion and Recommendations
This research underscores the importance of TQM as a vital management approach for enhancing performance in the healthcare sector, providing valuable insights for both researchers and healthcare managers. However, limitations exist, notably the non-exhaustive nature of the database and search engine coverage. Future research could benefit from incorporating a broader range of databases and keywords.
This study contributes to the existing literature by establishing a foundation for future TQM research in healthcare. It reviews studies from 2005 to 2016, maps the evolution of research in this area, and synthesizes findings to highlight key trends and gaps. By evaluating the current state of evidence for TQM in healthcare and identifying areas needing further investigation, this review contributes to the body of knowledge and guides future research directions.
The study confirms cross-sectional research as the dominant methodology in healthcare TQM studies, followed by quasi-experimental designs, with a geographic concentration in Asia. The consistent positive impact of TQM on healthcare performance, driven by the identified core predictors, is a key finding. Effective TQM implementation, centered on these predictors, can elevate healthcare professional performance and improve overall organizational outcomes.
The findings strongly recommend that healthcare stakeholders adopt and implement TQM in hospitals and clinics. This will enhance healthcare worker performance and improve organizational effectiveness, ultimately benefiting patient care. Building on the limitations of this study, future research should broaden the scope to include diverse contexts and methodologies. Developing a comprehensive TQM taxonomy to explain the synergistic relationships between TQM practices and performance enhancement would also be a valuable contribution to the field.
Disclosure
The authors report no conflicts of interest in this work.
References
[1] Garvin DA. What does product quality really mean? Sloan management review. 1984 Fall;26(1):25–43. doi:10.1108/0263-5577199810208542.
[2] Vituri DW, Évora YDM. Total quality management in the hospital sector: bibliographical analysis of the literature in the last two decades. Revista Latino-Americana de Enfermagem. 2015;23(3):545–552. doi:10.1590/0104-1169.0188.2587.
[3] Ovretveit J. Does improving quality improve value for money? BMJ Qual Saf. 2009;18(Suppl 1):i43–i46. doi:10.1136/bmjqs.2008.024598.
[4] Kazanjian A, Pulcini C, Vincent JL. Patient safety: a global priority. Intensive Care Med. 2010;36(11):1753–1755. doi:10.1007/s00134-010-2024-6.
[5] Mosadeghrad AM. The role of total quality management in healthcare. Leadership in Health Services. 2013;26(4):273–289. doi:10.1108/LHS-07-2012-0029.
[6] Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44(3 Suppl):166–206.
[7] Aboushady HA, El-Salam MA. The impact of total quality management implementation on nurses’ performance. J High Inst Public Health. 2015;43(1):1–10.
[8] Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington (DC): National Academies Press (US); 2000.
[9] Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academies Press (US); 2001.
[10] Goes JBS, Camanho AS, Dias GP. Efficiency in European healthcare: a DEA approach. Health Policy. 2011;99(2):104–114. doi:10.1016/j.healthpol.2010.09.014.
[11] Organization for Economic Cooperation and Development. OECD Reviews of Health Care Quality: Russian Federation 2007: Raising Standards. OECD Publishing; 2007.
[12] Ovretveit J. Quality improvement: international handbook of health care quality. International handbook of health care quality. 2013:3–26.
[13] Kanji GK, Tambi AM. Total quality management in UK organizations. Total Quality Management. 1999;10(2):129–153. doi:10.1080/0954412997585.
[14] Hietschold R, Reinhardt R, Gurtner A. Management factors of TQM implementation in SMEs. International Journal of Production Economics. 2001;71(1–3):435–456. doi:10.1016/S0925-5273(00)00133-0.
[15] Motwani J. A critical analysis of implementing TQM in health care. The TQM Magazine. 1997;9(3):217–227. doi:10.1108/09544789710170436.
[16] Yusof SM, Aspinwall E. Critical success factors for TQM implementation in SMEs. Total Quality Management. 2000;11(3):448–463. doi:10.1080/095441200697978.
[17] Bhatnagar A. Classifying and comparing TQM implementation approaches. The TQM Magazine. 1997;9(5):347–359. doi:10.1108/09544789710183217.
[18] Powell TC. Total quality management as competitive advantage: a review and empirical study. Strategic Management Journal. 1995;16(1):15–37. doi:10.1002/smj.4250160105.
[19] Anderson JC, Rungtusanatham M, Schroeder RG. A theory of quality management underlying the Deming management method. Academy of Management Review. 1994;19(3):472–509. doi:10.2307/258927.
[20] Hendricks KB, Singhal VR. Association between Malcolm Baldrige National Quality Award winners and company’s financial performance. Journal of Operations Management. 1997;15(1):1–16. doi:10.1016/S0272-6963(96)00084-3.
[21] Antony J, Antony F, Knowles G. Critical success factors of TQM implementation in UK SMEs. International Journal of Quality & Reliability Management. 2007;24(3):255–280. doi:10.1108/02656710710730808.
[22] Aquilani B, Silvestri C, Ruggieri A, Manzocchi S. Total quality management in healthcare services: a systematic literature review. Health Serv Manage Res. 2016;29(2):64–80. doi:10.1177/0951484816631497.
[23] Tranfield D, Denyer D, Smart P. Towards a methodology for developing evidence-informed management knowledge by means of systematic review. British Journal of Management. 2003;14(3):207–222. doi:10.1111/1467-8551.00375.
[24] Irfan M, Irum S, Khan RA, Mehmood K. Impact of total quality management practices on operational performance in public hospitals of Pakistan. Gomal University Journal of Research. 2012;28(2):47–57.
[25] Mrayyan MT, Al-Faouri I. Predictors of Jordanian nurses’ job performance. International Journal of Nursing Practice. 2008;14(4):293–301. doi:10.1111/j.1440-172X.2008.00700.x.
[26] Danial Z. The effect of total quality management parameters on the provision of health care. Iranian Journal of Nursing and Midwifery Research. 2009;14(3):114–118.
[27] Awases M, Bezuidenhout MC, Roos JH, Pretorius R, Brink H. Factors perceived to contribute to nurse absenteeism in hospitals in Namibia. BMC Nurs. 2013;12:34. doi:10.1186/1472-6955-12-34.
[28] Al-Ahmadi H. Factors influencing performance of hospital nurses in Riyadh region, Saudi Arabia. Saudi Medical Journal. 2009;30(2):229–233.
[29] Laschinger HKS, Leiter MP, Day A, Gilin-Oore D, Mackinnon M. Healthcare workplace bullying, job satisfaction, and organizational commitment: a cross-sectional study. J Nurs Manag. 2012;20(4):546–558. doi:10.1111/j.1365-2834.2011.01292.x.
[30] AbuAlRub RF, Al-Zaru IM. Job stress, recognition, job performance and intention to stay at work among Jordanian hospital nurses. Journal of Nursing Management. 2008;16(2):227–236. doi:10.1111/j.1365-2834.2007.00781.x.
[31] Güleryüz G, Güney K, Aydın Erdemir F, Aslan Ş. The relationship between nurses’ organizational commitment and job satisfaction. J Nurs Scholarsh. 2008;40(4):340–346. doi:10.1111/j.1547-5069.2008.00231.x.
[32] Lashgari M, Abediankenari S, Mahmoodpoor A, Bakhshندهh H, Janbabaei G. The effect of total quality management on patient satisfaction in emergency department of general military hospitals in Iran. Journal of Patient Safety & Quality Improvement. 2015;3(1):142–147.
[33] Navipour H, Sajadi HS, Ravaghi H, Raeissi P, Setoodehzadeh F. The effect of FOCUS-PDCA method on nurses to improve patient satisfaction in hospitals of Tehran University of medical sciences. Iranian Journal of Public Health. 2011;40(4):79–85.
[34] Mosadeghrad AM. Factors influencing the success of total quality management implementation in Iranian healthcare organisations. Int J Health Care Qual Assur. 2015;28(8):742–761. doi:10.1108/IJHCQA-09-2014-0109.
[35] Mosadeghrad AM. Obstacles to total quality management success in health care organizations. International Journal of Health Policy and Management. 2014;3(2):65–72. doi:10.15171/ijhpm.2014.16.
[36] Mosadeghrad AM. The impact of strategic quality management on Iranian hospitals. International Journal of Health Care Quality Assurance. 2012;25(8):630–651. doi:10.1108/09526861211273048.
[37] Jones KJ, Mitchell PH, Ballard DJ, Daly J, Hofmann PB. Transforming care at the bedside: impact of a quality improvement collaborative on patient safety and satisfaction. J Nurs Adm. 2013;43(3):164–170. doi:10.1097/NNA.0b013e318284a370.
[38] Ullah S, Shah K, Ahmad M, Khan A. Impact of training on total quality management practices in health care facilities. Gomal University Journal of Research. 2011;27(1):43–52.
[39] Zarei E, Arab M, Froushani AR, Rashidian A, Kabir MJ. Service quality of private hospitals: the Iranian patients’ perspective. Iranian Journal of Public Health. 2011;40(1):77–85.
[40] Ramseook-Munhurrun P, Lukea-Bhiwajee SD, Naidoo P. Service quality in the public healthcare sector of a developing country: the patients’ perspective. International Journal of Quality & Reliability Management. 2010;27(8):935–948. doi:10.1108/02656711011075881.
[41] Alaraki RM. The effect of total quality management practices on the performance of healthcare organizations in Saudi Arabia. International Journal of Health Care Quality Assurance. 2014;27(7):617–630. doi:10.1108/IJHCQA-06-2013-0067.
[42] Al-Shdaifat EA. Total quality management practices in Jordanian hospitals: the case of nursing services. International Journal of Health Care Quality Assurance. 2015;28(2):154–169. doi:10.1108/IJHCQA-01-2014-0001.
[43] Jha S, Bose S, Satpathy KD. Service quality in public hospitals: a gap analysis approach. International Journal of Health Care Quality Assurance. 2012;25(6):549–563. doi:10.1108/09526861211244838.
[44] Duggirala M, Rajendran C, Anantharaman RN. Patient-perceived service quality and its impact on patient satisfaction in Indian hospitals. Benchmarking: An International Journal. 2008;15(6):680–717. doi:10.1108/14635770810915983.
[45] Naser Alolayyan M, Aliani MK, Al-Nakeeb M. The impact of total quality management practices on operational flexibility in Jordanian hospitals. Business Process Management Journal. 2011;17(4):623–643. doi:10.1108/14637151111149465.
[46] Sweis RJ, Saleh RM, Abu-El Samen AA. The impact of total quality management practices on staff empowerment in hospitals. International Journal of Health Care Quality Assurance. 2013;26(7):618–631. doi:10.1108/IJHCQA-08-2012-0081.
[47] Kumar R, Khan MS, Ashraf M, Fatima T. Impact of total quality management on employees’ performance in public hospitals. Pakistan Journal of Medical Sciences. 2016;32(1):131–135. doi:10.12669/pjms.321.8748.
[48] Sagy I. Improving nurse commitment and performance regarding clinical processes in a children’s hospital. J Nurs Manag. 2009;17(3):319–325. doi:10.1111/j.1365-2834.2008.00917.x.
[49] Zarei E, Daneshkohan A, Khabiri R, Arab M. Service quality assessment of hospitals: patients’ perspective. Iranian Journal of Public Health. 2010;39(1):98–105.
[50] François P, Beaulieu MD, Breton M, Bergman L, Babineau J, Contandriopoulos AP. Evaluation of the implementation of continuous quality improvement in family medicine groups: a comparative case study. Can Fam Physician. 2005;51:1518–1519.
[51] El-Tohamy A, Al Raoush R. The impact of total quality management principles on hospital effectiveness in Jordanian accredited governmental hospitals. International Journal of Health Care Quality Assurance. 2016;29(1):43–61. doi:10.1108/IJHCQA-08-2014-0090.
[52] Goetsch DL, Davis SL. Quality management: introducing TQM for continuous improvement. Upper Saddle River, NJ: Pearson Prentice Hall; 2014.
