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Purpose – This paper seeks to look at healthcare service quality from the viewpoint of its negative impact on the industry when there is a deficiency in the delivery of service quality. To measure this impact, the potential loss of customers due to poor quality service is measured. A potential customer loss model is proposed. To address the competitive and financially driven healthcare delivery business, a three‐pillar approach, termed the Excellent Healthcare Service Model (EHSM), is introduced. This approach advocates that the healthcare industry should use a system view to deliver quality healthcare by taking into account quality, cost, and efficiency factors in a holistic manner. Design/methodology/approach – In this paper a survey questionnaire was used to gather data necessary to compute impact of deficient healthcare service. The questionnaire was administered to a sample of 400 people and the survey method used was intercept interview. Customer loss and potential customer loss due to deficient service were computed. Findings – In this paper, findings from the research indicated that, in the healthcare industry, for every 100 customers that experienced deficient service, about 70 customers would be unlikely to patronize the same organization again. In addition, for the same 100 customers who have experienced deficient service, about 75 of them will go on to tell on average nine family members and friends about their experiences. Through word of mouth from these 75 dissatisfied customers, there will eventually be about 465 persons who might have been potential customers but will probably not patronize the organization at all based on what the dissatisfied customers have told them. Practical implications – The ideas presented in this paper provide a new way of looking at service quality performance, through the impact of deficient service. With this knowledge, economic impacts of poor service quality could easily be quantified, and such economic‐based results are usually a better motivator for managers and workers to deploy quality improvement initiatives. Originality/value – The results and ideas presented in this paper are valuable for the healthcare industry. It provides an alternative approach to quantify service quality performance. The paper also proposes a system‐based approach to enhance service process performance.

The purpose of the paper is to determine the impact of cultural values on the success of TQM implementation in Isfahan University Hospitals (IUHs), Iran, 2004.

In this paper survey questionnaires were used to elicit responses from hospital managers and employees. Data collected included the characteristics of organizational culture in IUHs and the degree of TQM success and its implementation problems in these hospitals.

The paper finds that TQM success in IUHs was medium. Implementation of TQM was very low, low, medium and highly successful respectively in 16.7, 16.7, 58.3 and 8.3 percent of hospitals. TQM had the most effect on process management, focus on customers and leadership and management and less effect on focus on suppliers, performance results, strategic planning and focus on material resources. Human resource problems, performance appraisal and strategic problems were the most important obstacles to TQM success respectively. A total of 75 and 25 percent of hospitals had mechanistic and organic structure respectively. In total 41.6 percent of hospitals had weak organizational culture versus 58.4 percent medium culture. The success of TQM in hospitals with organic organizational structure and medium organizational culture was higher than mechanistic and bureaucratic hospitals with weak organizational culture (p<0.05).

The paper shows that TQM requires a quality‐oriented organizational culture supported by senior management commitment and involvement, organizational learning and entrepreneurship, team working and collaboration, risk taking, open communication, continuous improvement, customers focus (both internal and external), partnership with suppliers, and monitoring and evaluation of quality. By replicating this study in different countries and contexts the results could be very helpful for developing a model of TQM that can be implemented successfully in a cross‐cultural context.

The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and helps evaluate performance of health care services dynamically.

This paper uses logical framework analysis (LFA), a matrix approach to project planning for managing quality. This has been applied to three acute healthcare services (Operating room utilization, Accident and emergency, and Intensive care) in order to demonstrate its effectiveness.

The paper finds that LFA is an effective method of quality management of hospital‐based healthcare services.

This paper shows LFA application in three service processes in one hospital. However, ideally this is required to be tested in several hospitals and other services as well.

In the paper the proposed model can be practised in hospital‐based healthcare services for improving performance.

The paper shows that quality improvement in healthcare services is a complex and multi‐dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in health care delivery and corrective measures are taken for superior performance, there is an absence of an integrated approach, which can identify and analyze issues, provide solutions to resolve those issues, develop a project management framework (planning, monitoring, and evaluating) to implement those solutions in order to improve process performance. This study introduces an integrated and uniform quality management tool. It integrates operations with organizational strategies.

Purpose – The core theme of this paper is that, to provide the best kind of process systems to support a “quality” healthcare provider, it is essential to “engineer‐in” quality as early as possible – effectively at the specification and design phase. It extends to the healthcare context a novel approach, which provides a transparent model of how an envisioned structure delivers services and fulfils stakeholders' needs. Design/methodology/approach – In the paper a new construct, developed by the authors, is described and then extended to the healthcare sector. The underpinning theories of the new construct are discussed and examples for a health care service are presented. Findings – The paper finds that there is a full literature on quality and TQM, but relatively little offers practical tools for supporting design and implementation processes that enhance the likelihood of achieving quality operations. The presentation and discussion of the construct presented argue that the approach presented here can achieve this aim. Practical implications – In the paper, as with many ventures, organisations charged with healthcare delivery are presently facing the dual challenges of seeking to satisfy widely extended stakeholder groups and implement complex ICT systems to support e‐fulfilment. To ensure that quality is “engineered‐in”, a holistic, integrated and quality approach is required, and Total Quality Management (TQM) principles are the obvious foundations for this. Originality/value – The paper shows that electronically delivered information and funds transaction systems do offer healthcare organisations great potential, but many large integrated ICT systems have notoriously disappointed the stakeholder health care service. An integrative view of the delivery system design, based on the literature from strategic management, business process design, e‐business design, and TQM, has yielded a unique construct, which integrates these views in a transparent model readily accessible to the various domain experts. The specific role of this in healthcare fulfilment system design applications is demonstrated.

As the importance of health care is growing worldwide and it has undergone a significant change, this paper aims to report a case study in a hospital complex that implemented an excellence model framework.

Reported in this paper is a case research approach in a hospital in Brazil. Data were gathered through semi‐structured interviews, direct field observation and archival data records. Then, the aggregation of results was done a posteriori to construct the case study.

The empirical evidence in the paper has shown that the introduction of the quality management framework based on a national quality award enhanced quality awareness and improved service quality and organizational performance. In addition, the use of the framework at the hospital supports organization leadership in the journey towards quality excellence.

The paper is limited to a single case study. Replications among other samples are needed to validate current findings. In addition, because quality management initiatives are not necessarily constant over time, there is a need to conduct longitudinal studies on a periodical basis. Nevertheless, there is a certain degree of generalization of what has been learned from the case study.

This paper is one of the few published studies that report and discuss the implementation of a quality management system based on a performance excellence framework in a country in South America.

The purpose of this paper is to analyze the opportunities and challenges in the healthcare sector for learning and transferring from other sectors the concepts, best practices, and tools for improving quality, safety, and productivity. Design/methodology/approach – In this paper, the various approaches for improving quality, safety, and productivity are considered. How these approaches are being used in healthcare are analyzed. The obstacles to their successful implementation in healthcare are discussed. Findings – The paper finds that there are many approaches, best practices, tools, and technologies for improving quality and safety – which have proved their worth in other industries – that are relevant for the healthcare sector. There are some characteristics of the healthcare industry that distinguish it from other industries. Although the managerial processes in the healthcare industry are similar to those of other industries, the prevalent norms, culture, practices, and the regulatory framework can promote or hinder efforts to improve performance. These characteristics influence the extent to which the best practices in other industries are relevant and transferable to the healthcare sector. Originality/value – In this paper, prospects for utilizing the opportunities are assessed. The paper identifies a number of obstacles to the transfer of best practices to the healthcare sector. Insights are provided into factors that are critical to addressing those obstacles. These are of value to the practitioners in healthcare and to the academics, who want to pursue further research on this topic.