The current issue and full text archive of this journal is available at www.emeraldinsight.
Organizational culture and total quality management practices: a Sri Lankan case
Department of Management and Organization Studies, Faculty of Management and Finance, University of Colombo, Colombo, Sri Lanka
Purpose – The purpose of this paper is to identify the effect of organizational culture (OC) on the total quality management (TQM) practices of a Sri Lankan public sector hospital, which practices Japanese 5-S based TQM and has won several national quality awards. Design/methodology/approach – The data are gathered through direct observations, short-time interviews, participative observations, in-depth interviews, and obtaining relevant documentary evidence by the employment of grounded theory. The director, divisional heads, doctors, nursing sisters and nurses, paramedical staff, midwifery staff, clerical staff, and support staff of the hospital are appropriately considered as the informants during the employment of the above data gathering techniques. The data are analyzed qualitatively in line with the research variables. Findings – As cultural characteristics of the hospital, the study identiﬁed low power distance, low uncertainty avoidance, low individualism, and low masculinity. The study identiﬁed high senior management commitment, high staff commitment, high stakeholder focus, high integration of continuous improvement, high quality culture, high measurement and feedback, and high learning organization characteristics as TQM practices of the hospital. Moreover, the study found that the supportive culture of the hospital has positively impacted on its TQM practices. Research limitations/implications – To overcome the limitations of the OC framework adopted in the present study, the paper invites future studies to examine the issue from a broader and new culture perspective. Originality/value – Recently, many organizations in Sri Lanka irrespective of their category and industry have been practicing TQM in order to stay competitive in both domestic and international markets. But empirical studies on the topic are very limited in the Sri Lankan context. This study as a case of a Sri Lankan public sector hospital aims to ﬁll that gap. Keywords Organizational culture, Sri Lanka, Public sector organizations, Total quality management, Hospitals Paper type Case study
OC and TQM practices
Received November 2007 Revised May 2009, August 2009 Accepted August 2009
Introduction Total quality management (TQM) has become a world-wide topic in the twenty-ﬁrst century. Having its roots partly in the USA and partly in Japan, it was primarily adopted by some Japanese companies in the decades immediately after World War II. With the greater successes of Japanese companies during the 1980s, companies all over the world found that it was necessary to have good quality management practices in order to stay competitive (Lagrosen, 2002; Stahl and Grigsby, 1997). But many approaches to quality management, including TQM hardly give long-term success to organizations. This is mainly because of the problematic nature of organizational culture (OC) within which managers ﬁnd it difﬁcult to practice their
The TQM Journal Vol. 22 No. 1, 2010 pp. 41-55 q Emerald Group Publishing Limited 1754-2731 DOI 10.1108/17542731011009612
As a key example. What kind of TQM practices are there in the hospital? RQ3. a decision may be taken by one person or group and the order for its implementation is carried out by other persons or groups. this study used some Hofstedian cultural dimensions (Hofstede.” In the second scenario. 1998. some Sri Lankan public sector organizations have achieved a certain degree of success.TQM 22. Padhi. 1991) to conceptualize the culture of the hospital: (1) Power distance (PD). 2000). With the “ideational” culture perspective. 2002). such efforts face an enormous challenge due to many negative reasons. researchers who adopt the cultural theory in business research attempt to follow two strands: “ideational” in which their attention is to attitudes and values expressed by organizational participants. The issue is seen to be more critical in public sector organizations in Sri Lanka when they try to implement new management systems. But by implementing new management systems. The situation is termed “high PD. Therefore. the Sri Lankan public sector hospital. the intended purpose was further divided into and speciﬁed by the following three questions: RQ1. 1995. the two actors take decisions and implement them together. the purpose of the study reported in this paper was to identify the effect of OC on the TQM practices of the above mentioned Sri Lankan public sector hospital.1
TQM activities. Kroslid. Kaye and Dyason. Kaye and Anderson. However. 1994. It has been found that the reforms and innovative programmes introduced in public sector organizations in Sri Lanka are less compatible with the attitudes and skills of the organizational participants. In a decision-making situation in an organization. studied in this research. and “institutional” or “material” in which they concentrate upon structural aspects such as division of labor. 1999. status. Therefore. This situation may lead to unequal power relationships in organizations. has won several national quality awards for being more responsive to the public demands through the implementation of Japanese 5-S based TQM activities. The challenge is mainly due to the cultural and behavioural mismatch within Sri Lankan organizations when they try to practice quality management within their organizational boundaries (Nanayakkara. understanding the effect of OC on the implementation of TQM practices in organizations is important (Dale. those innovative programs become simply technical. and reward structures of organizations. Although quality management practices need to be adopted in Sri Lankan organizations in order to enhance their business performance. What kind of culture is there in the hospital? RQ2. Hence. career. rather than managerially meaningful to the organizations (Samarathunga and Bennington. this study was motivated by the need of examining the TQM practices implemented by the said hospital within its cultural set up. This situation may lead to less unequal power relationships in
. How has the culture of the hospital affected its TQM practices? Conceptual framework As in Tayeb (1988). In the ﬁrst scenario. 1992). at least two types of power and authority scenarios are seen. Hence.
Juran. More uncertainty of decisions leads to a greater degree of ambiguity. 1999. superiors and subordinates. the gender roles of the participants are distinguished as the male members focus more on material success than the female members. 1995. (2) Uncertainty avoidance (UA). 1986. Using the “ideational” culture perspective. There are at least two types of behavioural patterns of organizational participants behind this that can be identiﬁed. In the ﬁrst scenario.” On the other hand. This situation is called “IND. a lower degree of uncertainty tolerance behaviour can be shown by a participant. 1979. a higher degree of uncertainty tolerance behaviour can be shown by a participant. This is termed low UA or high-risk-taking behaviour. In the second scenario.
OC and TQM practices
. Kaye and Dyason. they can display a relatively higher attachment to the organizational goals rather than to their own goals. Most of the reactions of organizational participants can be explained using the way their gender roles appear in the workplace. there can be variations in the ways that participants attach themselves to their personal goals over the organizational goals.” Using the “ideational” culture perspective. Kroslid.” In the second scenario. Dale. it is assumed that in organizations. Crosby. This situation is called “femininity” or “low MAS. 1998. it is assumed that in organizations. and it is termed “low PD.organizations. Padhi.” Using the “ideational” culture perspective. and vice-versa. it is assumed that in organizations. In the ﬁrst scenario. stakeholder focus (SF). Most of the reactions of organizational participants can be explained by their attachment to the organizational goals. 1985. and so on. This situation is called “MAS. it is assumed that in organizations. . integration of continuous improvement (ICI). 1991. senior management commitment (SMC). In the ﬁrst scenario. gender roles of the participants overlap as both male and female participants tend to function interactively with each other. the following variables were used to conceptualize TQM practices of the hospital: . 1994. there can be variations in the power and authority gaps between seniors and juniors. . This situation is termed high UA or low-risk-taking behaviour. staff commitment (SC). Most of the decisions in organizations involve a degree of uncertainty. This situation is called “collectivism” or “low IND. 2000). (4) Masculinity (MAS). when he or she (a group as well) faces an uncertain situation. there can be variations in the ways that participants tolerate the uncertain situations they face. there can be variations in the ways that gender roles of the participants appear in the workplace.” Using the “ideational” culture perspective. There are at least two types of scenarios that can be seen in relation to this. they can display relatively a higher attachment to their own goals than the organizational goals. . Feigenbaum. Based on the grounded data and some existing literature on TQM (Deming. when he or she (a group as well) faces an uncertain situation. Ishikawa. (3) Individualism (IND). 1995. At least two types of reactions can be seen pertaining to how organizational participants attach themselves to the organizational goals. Kaye and Anderson.
Moreover. A Sri Lankan public sector hospital. administrative ofﬁcer. The in-depth interviews were carried out with the director. the empirical data were gathered through direct observations.
quality culture (QC). ﬁve in-depth interviews were carried out to see the effect of OC variables on the TQM variables. Conceptual research framework
. was selected as the case. However. and support staff of the hospital were appropriately interviewed as the informants. divisional heads. in-depth interviews. which practices Japanese 5-S based TQM activities. senior medical ofﬁcer. the extent of the interviews ranged from short-time interviews to in-depth interviews based on the data gathering requirements. short-time interviews. measurement and feedback (MFB). participative observations. and learning organization (LO). The director of the hospital was initially contacted to seek permission to conduct the empirical study. midwifery staff. and obtaining relevant documentary evidence following the grounded theory (Glaser and Strauss. The indicators were used to develop data gathering schedules for the short-time and in-depth interviews.TQM 22. . the OC and TQM variables were further speciﬁed into the indicators shown in Tables I and II. Methodology/approach The case method was employed as the strategy of this research. nursing sisters and nurses. The short-time interview sample consisted of 100 informants who represented the above staff categories. doctors. For the data gathering purpose. 1967). and senior matron since they actively handle 5-S based TQM activities in the hospital. The director.
TQM variables Senior management commitment (SMC) OC variables Staff commitment (SC) Power distance (PD) Stakeholder focus (SF) Uncertainty avoidance (UA) Individualism (IND) Masculinity (MAS) Integration of continuous improvement (ICI) Quality culture (QC) Measurement and feedback (MFB) Learning organization (LO)
Figure 1. respectively. paramedical staff.
The possible relationship between the two types of research variables was conceptualized as shown in Figure 1. Once the permission was given. . accountant. Two speciﬁc questions were asked for each indicator of OC and TQM variables in order to gather data through the short-time interviews. clerical staff.1
1 6. 2000). Robbins. Stahl and Grigsby.2 4. Handy. 1991.1 4.1 3.” But some other scholars (Schein.2 2. TQM variables and indicators
The data were analyzed qualitatively (Silverman.2 5.2 4. For them. For this purpose. 1982.2 3. Based on the short-time interview results.2 3. Peters and Waterman. OC variables and indicators
Variables (1) SMC (2) SC (3) SF (4) ICI (5) QC (6) MFB (7) LO
Indicators 1. the analysis was further extended to see the effect of OC variables on the TQM variables. 1982. 2005.1 4.1 2. Some narratives of the respective informants taken down during the in-depth interviews were also highlighted in the discussion.1985)deﬁneOCcombiningboth“subjective”and“objective”or“material”aspects.2 Degree of director’s two-way communication style Degree of director’s involvement with the staff Degree of staff willingness to know about TQM Degree of staff involvement in TQM activities Clarity of continuous improvement oriented strategy formation Success of continuous improvement oriented strategy deployment Degree of vertical ICI Degree of horizontal ICI Degree of focus to initiate a QC Degree of maintenance of a QC Degree of adherence to service performance evaluation Degree of adherence to service performance feedback Degree of self-assessment of continuous improvement Degree of enhancing staff knowledge and skills
Table II.1 7. 1985.1 3. 1997) deﬁne OC in a “subjective” or an “ideational” aspect.2 Degree of boss-subordinate positional gaps Degree of centralized decision making of the director Degree of employee strictness to rules and regulations Degree of employee resistance to possible changes taken place in the workplace Degree of employee performance evaluation using their individual work results Degree of employee willingness to work alone than work as teams Degree of staff distribution unequally between male and female categories Degree of male and female staff members’ willingness to work separately than work interactively
OC and TQM practices
Table I.2 2.Variables (1) PD (2) UA (3) IND (4) MAS
Indicators 1.1 1.1 1.
.1 2.2 6. Deal and Kennedy. OC is “a system of shared values. Johnson. the contents and patterns of relationships between the OC and TQM variables were checked and veriﬁed using the in-depth interview results.2 7. OC and TQM The concept of OC has been deﬁned by different scholars in different ways.1 5. The case discussion was completed following the results of the analysis. Most of these scholars (Hofstede. The OC and TQM variables were evaluated as “low” “medium” and “high” using the answers given to each question by the interviewees during the short-time interviews. 1988.
UA. gynecological. 1979. it became a teaching hospital of the Medical Faculty of Colombo. It was brought under the administrative control of the Committee of the Colombo Group Hospitals in 1958. 1986. Ishikawa. These units are supported by three operating theatres. mission. 1998.” For Hofstede. values. symbols. but is also comprised of features of organizations like artifacts.000 deliveries taking place annually with an average of 27 percent cesarean deliveries. It operates with ﬁve maternal and gynecological units. one Radiology Department. 2000) identify TQM with some key organizational practices. and quality policy of the hospital are presented as follows. The hospital also provides specialized neonatal intensive care and fertility services.TQM 22. The goal
Healthy children to be born in the Castle Street Hospital for Women with a minimum disability to mothers who are cared for so they can be free of complications.
Provision of quality maternal. Kroslid. 1994. Kaye and Dyason. and MAS vs femininity as major characteristics common to the cultures of organizations. attitudes towards OC are partly affected by national culture elements. 1995. Padhi. IND vs collectivism. and neonatal care services and training of health personnel using current medical practices and the efﬁcient use of resources in a friendly environment of good working relationship where the patient care needs will be of the highest priority.1
For them. They recognize TQM with some requirements for organizational success. The concept of TQM has evolved with the quality guru’s ideas (Deming. 1999. one laboratory. Crosby. and some Paramedical units. In his cross-cultural studies at IBM companies. The units work in harmony to ensure the essential and emergency care at tertiary levels.000 to 18. objectives. one blood bank. Hofstede (1991) deﬁnes OC as “the collective programming of the mind that distinguishes the members of one organization from another. For this. There are 16. OC is not only a system of shared values. The vision
A government hospital with a sense of quality. goals. and other structural elements. strategies. and neonatal care services for the public. Using the national culture view. he recognizes PD. gynecological.
The values The hospital highly values the responsiveness to the people. Feigenbaum. Presently it functions as the largest maternity hospital in Sri Lanka with a capacity of 450 beds providing maternal. 1985). 1995. and one neonatology unit. two intensive care units. Kaye and Anderson. it walks an extra miles to enhance the care of people with dignity and compassion.
. In 1964. 1991. Most of the contemporary TQM researchers (Dale. The vision. Juran. The case The Castle Street Hospital for Women was established in 1950 as a public sector maternity hospital in Sri Lanka.
and the National Productivity and Quality Award in 2003 are among the quality awards won by the hospital. Continuous improvement through productivity concepts. Human resource development and involvement for performance excellence. Table III shows the interview results. The interview sample consisted of 100 informants who represented different staff categories of the hospital. In order to ascertain the results of the OC variables. and Shitsuke (training and self-discipline)) based TQM activities in order to deliver a better service to the public. the Sri Lankan National Quality Merit Award in 2002.
OC and TQM practices
Since April 2000. . The strategies . . . The quality policy
We are committed to TQM.
Interviewee perception Low Medium High 112 124 142 116 56 36 34 52 32 40 24 32 Percentage Medium 28 18 17 26
Variables (1) (2) (3) (4) PD UA IND MAS
Low 56 62 71 58
High 16 20 12 16
Evaluation Low Low Low Low Table III. Leadership development to improve health systems. We dedicate ourselves to satisfy our customers’ expectations. We practice continuous improvement in all aspects of our performance. . Seiso (cleanliness). . Interviewee perception of the OC variables
. Seiketsu (standardization). the selected informants were interviewed during the short-time interviews. To ensure there will be no preventable stillbirths. . The results were considered as the interviewee perception of the OC variables. It has won several national quality awards for its high quality sense and care of service. A similar process was carried out to ascertain the results of the TQM variables. Seiton (orderliness). . To ensure safe delivery and surgical procedures free of complications.The objectives . The results were considered as the interviewee perception of the TQM variables. Customer centered responsive service provision. Analysis and results The analysis addressed the three research questions which were already mentioned at the beginning of the paper. To reduce the maternal mortality rate (MMR) of the hospital 25 percent below the national ﬁgures. The interview results are shown in Table IV. Mistake prooﬁng. The Best 5-S Implementation Merit Award in 2001. the hospital has been practicing Japanese 5-S (5-S abbreviates the Japanese words Seiri (tidiness). To reduce the neonatal mortality rate (NMR) by 5 percent annually.
However. Interviewee perception of the TQM variables
OC indicators Low PD 1. High ICI 4.1. High MFB 22.214.171.124. High SMC 1.1. the analysis was further extended to see the effect of OC variables on the TQM variables.2. High ICI 4. The results are summarized in Table V.2 High SMC 1. High LO 7.1. High MFB 6.1.2. High LO 126.96.36.199 Low IND 188.8.131.52.2. Discussion Culture of the hospital Low PD. High MFB 6. High SMC 1.2 Low MAS 4. High ICI 4.2. High SC 2. High QC 5.2. High LO 7.2. High ICI 4.1. for greater clarity.1.2
Affected TQM indicators High SMC 1.2 High SMC 1.2.2.TQM 22.2. High QC 5. High SF 3.2. High SF 3. High SC 2.1. High SC 2.2 High SC 184.108.40.206. High SMC 1.2.1. High SC 2.2
. High ICI 4.1.1. High LO 7. High MFB 6.1. The purpose of the in-depth interviews was to identify the possible effect of each OC indicator on the TQM indicators. High SC 2.1.1 Table V. High SC 2. the boss-subordinate positions and their relationships do not create unnecessary power gaps to discourage the teamwork behaviour of the employees. High SF 3. High QC 5. The inequalities between the hierarchical positions have been minimized.1. High SF 3. High QC 5. High MFB 6. High SF 3. High MFB 6. High QC 5.1
Using the short-time interview results. High QC 5. ﬁve in-depth interviews were carried out. High LO 7.2. while they are asked to
Variables (1) (2) (3) (4) (5) (6) (7) SMC SC SF ICI QC MFB LO
Interviewee perception Low Medium High 4 28 16 30 10 36 34 14 30 38 36 22 48 58 182 142 146 134 168 116 108
Low 2 14 8 15 5 18 17
Percentage Medium 7 15 19 18 11 24 29
High 91 71 73 67 84 58 54
Evaluation High High High High High High High
Table IV.2 High SMC 1.2 Low IND 3. High MFB 6. High SC 2. High ICI 4. High ICI 4. High LO 7. High QC 5. High ICI 4.1. High LO 7.1 Low UA 2. High ICI 4.2. High SF 220.127.116.11. For this purpose.1.1. High LO 7.2. High SF 3.1. High QC 5.1 Low PD 1.2. High QC 5. High SC 18.104.22.168. High ICI 4. High ICI 4.2 Low UA 2. Hence. High SMC 1. High LO 7. High QC 22.214.171.124.2. High SC 2.2. Summary of the in-depth interview results Low MAS 4.1. High QC 5.2. The subordinates respect the bosses and their competence.2 High SMC 1.1. High MFB 6. High MFB 6.1. High SC 126.96.36.199.1. High SF 3. High SC 2.2 High SC 2.1. High MFB 6. The management (the director represents the senior management and the Divisional Heads represent the middle management) encourages employees to take operational level decisions. High SMC 1. High LO 188.8.131.52. The bosses also like to see competence displayed by their subordinates. High MFB 6.2.2 High SMC 1. High MFB 6. High LO 7. High SC 184.108.40.206.2. the effect is shown in Figure 2. High ICI 4. High SF 3. High SF 3.2. High SF 220.127.116.11. High MFB 6. High LO 7. High SC 2.1.2. High SF 3.1.
Demonstrating the effect of OC variables on TQM variables
implement strategic decisions taken by the management. the managers and staff members tolerate possible changes that take place in the hospital. They like to be exposed to the new changes in order to enhance the productivity of the hospital. strategies. Low UA. and performance indicators set by the Ministry of Health. Moreover. circulars. For example. According to the short-time interview results.OC variables
OC and TQM practices
High SMC Low PD
Low UA High SF
High ICI Low IND
Low MAS High MFB
Figure 2. The director. and quality policy in line with their vision and mission. But the management has introduced systematic and relatively ﬂexible goals. they are most often punctual at work. replied that:
We like to see the competence of our people and they are welcome anytime to display their talents. procedures. This is because the director follows a decentralized decision-making policy. The hospital has to follow the formal rules.
The organizational chart of the hospital (Figure 3) reﬂects its ﬂexible decision-making and reporting structure. The ﬂexible decision-making and reporting structure has helped the director to employ his decentralized decision-making policy at the stake of the continuous improvement. objectives. addressing the point. the Japanese 5-S based TQM activities have
. The systematic and ﬂexible environment has motivated staff members to the work. Hence. the low PD variable accounted for 56 percent of interviewee perception.
quality control circles (QCC). and the support staff members. Addressing this point. because both are necessary to quality improvement in the hospital (the Senior Matron also had a similar opinion to this). and emotions in relation to both their work life and family life. Low IND. Organizational chart of the hospital
Support staff (paramedical)
been adopted in the hospital without substantial resistance by the staff.1
Doctors Senior medical officer
Nursing sisters and nurses Clerical staff (medical and non-medical) Support staff (medical and non-medical) Clerks (finance)
Figure 3. The management recognizes the overall performance of the hospital considering both teamwork and individual work results of the employees. 71 percent of interviewee
. The work team of the nursing staff consists of the matrons (Nursing Ofﬁcers Special Grade I). and the support staff members. They also engage in small group activities: the work improvement teams (WIT).g. The Accountant responded favourably to this:
We appreciate both teamwork results and individual worker results. feelings. the Administrative Ofﬁcer said that:
The management and our employees instead of avoiding risks. the employees have given more priority to achieve the objectives of the hospital. the tidiness. nurses (Nursing Ofﬁcers Grades II A and II B). orderliness.TQM 22. like to accept the risks encountered in the workplace. The management and staff members like this team environment. because it gives them a chance to share ideas. clerks.e. At the same time. and suggestion systems (SS).
A work team comprises of a small group which belongs to a particular division. Each work team forwards their quality-related problems (e. midwives. nursing sisters (Nursing Ofﬁcers Grade I). For example. Likewise. Consequently.
The interviewee perception of low UA dimension accounted for 62 percent. they are encouraged to function as work teams. the administrative work team consists of the administrative ofﬁcer. This environment has facilitated employees to enjoy their intergroup activities within the hospital. Each worker is encouraged to perform his or her job to the utmost. Hence. other divisions also have their own work teams. according to the interview results (i. and cleanliness of the wards and ofﬁces) to the assembly meetings through their representatives.
the management becomes conversant with the weak points of the day-to-day activities. For example. The focus of the management to meet the expectations of the employees and patients of the hospital is well expressed by its mission. the senior medical ofﬁcer replied that:
There is no difference between the male and female employees in the hospital. chief pharmacist. lectures. High SF. Within this supportive communication environment. goals. both male and female members contributed interactively to continuous improvement through the WIT. administrative ofﬁcer. This is achieved mainly through the small group activities in which staff members are empowered to come out with new ideas and suggestions. strategies. matrons. matrons. accountant. doctors. The low MAS dimension accounted for 58 percent of the interviewee perception. and SS. the administrative ofﬁcer. and chief pharmacist) and their staff have been given reasonable freedom to participate in the decision-making process.perception). doctors. This provides the staff members a greater chance to become actively involved in the continuous improvement activities. For example. The work force of the hospital consists of its director. values. accountant. the director has introduced the 5-S based TQM system which consists of the WIT. chief pharmacist. The operational level staff members usually provide such operational information to their heads. High SC. the director usually discusses progress of the 5-S activities with the administrative ofﬁcer. and other clerical and support staff members. and quality policy of the hospital are well communicated and deployed to the other divisions. This two-way communication facilitates an open communication environment in which the vision. accountant. The staff members of each division obtain information about their work targets from the respective heads. senior medical ofﬁcer. periodical seminars. Addressing this issue. objectives. nursing sisters and nurses. The director has introduced a two-way communication system in which both top-down and bottom-up information ﬂows are in effect. nursing sisters and nurses.e. The overall work force is reasonably represented by both male and female employees.
OC and TQM practices
The interaction between the male and female staff members was clearly seen when they engaged in the small group activities. TQM practices of the hospital High SMC. but they enjoy working interactively and giving a better service to the patients. he discusses the progress with the senior medical ofﬁcer. There. matrons. and training programs are conducted to develop staff skills. In addition to this.e. senior medical ofﬁcer. QCC. Further. strategies. low IND (i. midwifery staff. In addition to this. The staff members forward their ideas and suggestions during the periodical meetings and when they engage in small group activities. Low MAS. the director’s commitment was evidenced as the core TQM practice of the hospital. they obtain new information about the continuous improvement programmes during their periodical meetings. high teamwork) was evidenced as the core cultural characteristic of the hospital. and SS. mission. paramedical staff. The divisional heads (i. According to the interview results (91 percent of interviewee perception). goals. The key job positions have also been reasonably distributed among the male and female staff members. and other staff members at the periodical meetings. objectives. and quality policy. QCC.
However. it was suggested that overall. Overall. The TQM activities are practiced through the small group activities: WIT. high MFB. and global ﬁgures and possible variances are identiﬁed. and high LO. The ICI activities within the hospital is mainly done through inter-group interactions. NMR. and SS). For this purpose. low IND.
. In addition to this. and low MAS. based on the OC and TQM conceptualization. high SF. objectives. high SC. the small groups belonging to each division discuss what they need to improve in their divisions. lectures and staff training facilitate knowledge sharing and skills development of the staff members. WIT. For example. Findings Addressing the three research questions. High ICI. still birth rate. For example. However. The annual rates are compared with the historical.e. MMR.e. and SS. all these activities have created a strong learning culture in the hospital. strategies. The adopted cultural dimensions (Hofstede. They characterized the supportive culture of the hospital.TQM 22. the continuous improvement activities are carried out in small groups (i. the Divisional Heads function as intermediaries of the continuous improvement activities. goals. the ﬁndings of the study are summarized as follows. seminars. high teamwork) was evidenced as the core cultural characteristic of the hospital. the common meetings and notice boards also convey messages to the staff members. High MFB. Overall. The small group activities and other staff development programs such as periodical meetings. the supportive culture of the hospital has positively impacted on its TQM practices. low IND (i. However. High QC. The management evaluates service performance of the hospital using some service outcome rates. low UA has positively impacted on high SMC. death reviews and near death reviews are done in order to overcome the future deaths of the patients. They are communicated to the operational level staff members through the divisional heads. Initially. and quality policy. The variances are discussed in the management and staff meetings and relevant action is taken in order to continuously improve the service performance. The director has initiated a continuous improvement oriented infrastructure in the hospital by clearly deﬁning its mission. national. Hence. QCC. Thus. High LO. 1991) were evidenced with low PD. The respective decisions taken in the management meetings are conveyed to the staff members by each divisional head. and perinatal mortality rate are determined and evaluated annually. this small group based teamwork environment creates and maintains a QC that helps continuous improvement. Later. QCC. The hospital practices Japanese 5-S based TQM activities as its self-assessment techniques for continuous improvement. the suggestions are forwarded by each divisional head to the management meetings. The effect of the culture of the hospital on its TQM practices The ﬁnal results of the analysis suggested that each culture variable has positively impacted on the respective TQM variables.1
The hospital enhances its service responsiveness to patients mainly through the committed (the director’s commitment is at the core) and participative staff engaged in continuous improvement activities. low IND has positively impacted on all TQM variables conceptualized in the study. low UA. values.
However. However. Padhi. Thus. the paper invites future studies to examine the issue from a broader and new culture perspective. 1995. the supportive culture of the hospital has positively impacted on its TQM practices. Ishikawa. Moreover. Juran. Feigenbaum. Further. Samarathunga and Bennington. it has won several national quality awards for being more responsive to public demands through TQM implementation. UA. and MAS variables in order to identify their effect on TQM practices. it was mentioned that the reforms and innovative programs introduced in public sector organizations in Sri Lanka are less compatible with the attitudes and skills of the employees. However. it was found that each cultural characteristic of the hospital has positively impacted on its TQM practices.e. The present study based on its ﬁndings suggests that the quality management achievements of the hospital are mainly due to its supportive culture which has positively impacted on its TQM practices. overall. it was mentioned that Sri Lankan organizations face a quality management challenge due their cultural and behavioural mismatch. The ﬁndings may also be useful to public sector healthcare managers and administrators in Sri Lanka to successfully practice TQM within a supportive OC.The adopted TQM variables based on the TQM literature (Deming. More speciﬁcally. Thus. 1985. many organizations in Sri Lanka irrespective of their category and industry have been practicing TQM in order to stay competitive in both domestic and
OC and TQM practices
. Crosby. high SC. 1994. IND. high SF. 1986. In other words. They characterized TQM practices of the hospital. 1998. high ICI. Conclusions At the beginning of the paper. Moreover. 1999. the success of TQM practice of the hospital has been achieved through its supportive culture. 1992. 2002). the ﬁndings may be useful to managers of the hospital so they could concentrate upon its supportive culture in order to sustain the success of its TQM practice in the future. high commitment of the director) was evidenced as the core TQM practice of the hospital. and high LO. Originality/value Recently. the Sri Lankan public sector hospital under study has been practicing Japanese 5-S based TQM activities successfully since 2000. Dale. Kaye and Anderson. Thus. 1991. to overcome the limitations of the OC framework adopted in the present study. Research limitations This study conceptualized the concept of OC adopting some Hofstedian cultural dimensions (Hofstede. high MFB. the low IND cultural characteristic of the hospital has positively impacted on all its TQM practices. 1991) with an “ideational” perspective in order to identify the effect of OC on TQM practices. 1995. Thus. Kaye and Dyason. high SMC (i. high QC. Managerial implications The present study found that the supportive culture of the hospital has positively impacted on its TQM practices. Kroslid. the study conceptualized the culture of the hospital adopting PD. 2000) were evidenced with high SMC. the ﬁndings of the present study reinterpret the previous research evidence (Nanayakkara. 1979.
The TQM Magazine. Silverman.L.E. NJ. D. London. WI. Organizations and National Culture: A Comparative Analysis. Strategic Management Journal.
References Crosby. pp. New York.G. New York. London. Deal.W. In Search of Excellence. Deming. (2000). IL. Vol. and Dyason. M. Sage. Addison-Wesley. (1991). Feigenbaum. (1994). 7 No. D. NY.asp Peters. Lessons from America’s Best Run Companies. Cultures and Organizations.P. (1988). In Search of Quality Management-Rethinking and Reinterpreting.TQM 22. M. Institute of ¨ ¨ Technology. Linkoping University. Kroslid. What is Total Quality Control. Milwaukee. Out of the Crisis. McGraw-Hill. A. Glaser. London. Prentice-Hall. San Francisco. pp. Juran. L. Vol. Cambridge. Total Quality Control. Reading. NY. 24 No. This study performed as a case of a Sri Lankan public sector hospital aims to ﬁll that gap. M. Blackwell. (1985).M.B. Harper & Row. 1. (1985). London. B.G. “Quality management in Europe: a cultural perspective”. C. Vol.E. A. (1986). Sage.1
international markets. 275-83. Englewood Cliffs. (1995). MA. S. Managing Quality. (1985). Vol. Schein. The Discovery of Grounded Theory. McGraw-Hill.V. Josses-Bass. Quality Press. W. Stahl.H.isixsigma. (1988). 33-7. (1999).
. Cambridge University Press.com/library/content/ c021230a. Quality is Free: The Art of Making Quality Certain. CA.A. and Bennington. Handy. Chicago. But empirical studies on the topic are very limited in the Sri Lankan context. Ishikawa. and Kennedy. pp. A. and Grigsby. New York. 5. Organizational Culture and Leadership. Doing Qualitative Research: A Practical Hand Book. Kaye. (2002). 485-506. (1992). Postgraduate Institute of Management. Penguin Books. (1995). Software of the Mind. Johnson. S. the Rights and Rituals of Corporate Life. Vol. pp. G. P. R. the Evolution Trends and Future Directions of Managing for Quality. M. K. D. (2005). Linkoping. (1982). “The eight elements of TQM”. Lagrosen. Kaye. (1967). McGraw-Hill. Prentice-Hall. MA. (1997). NY. The TQM Magazine. New Delhi. available at: www. T. Corporate Cultures. 16 No. Aldine. G.J. Strategic Management. R. (2002). Padhi. 1. Robbins. Tayeb. “New public management: challenge for Sri Lanka”. “Continuous improvements: the ten essential criteria”.M. 5. and Waterman. Hofstede. (1982). pp. Samarathunga.J. J. M. “The ﬁfth era”.H. Can Sri Lankans Take the Quality Challenge? A Cultural Analysis. 75-91.D. 87-109. (1998). “Rethinking incrementalism”. Organizational Behavior. 9 No. and Anderson. 1. Strategies for Qualitative Research. NY. (1991). (1979). Asian Journal of Public Administration. Prentice-Hall. Understanding Organizations. the Japanese Way. International Journal of Quality & Reliability Management. Dale. Cambridge. T. Colombo. New York. The History of Managing for Quality. 14 No. B. Total Quality and Global Competition. and Strauss. G. (2000). R. E.B. Nanayakkara. N.
S. Rhodes. Japan.P. Sri Lanka.emeraldinsight. He has written and published several text books and research papers in relation to the ﬁeld of management and organizational studies prior to this paper. in Sri Lanka.com
OC and TQM practices
To purchase reprints of this article please e-mail: reprints@emeraldinsight. His speciﬁc research interests belong to OC. OC and managerial behaviour. University of Sri Jayewardenepura. In 2004. University of Colombo. Sri Lanka in 1998. K. and OC and TQM practices. Hosei University. Kaluarachchi can be contacted at: samankalu@yahoo. Presently.P. He has worked as a marketing manager at the Direct Marketing International (Pvt) Ltd in Sri Lanka and as an accounts trainee at the KPMG Ford.com Or visit our web site for further details: www.About the author K.com/reprints
.A. University of Colombo. He is a member of the Association of Accounting Technicians of Sri Lanka and a licentiate member of the Institute of Chartered Accountants of Sri Lanka. he works as a Lecturer at the Faculty of Management and Finance. Thornton and Co. Kaluarachchi obtained his Bachelor of Commerce (special) degree (with a second class upper division pass) from the Faculty of Management Studies and Commerce.A.S. Sri Lanka (on study leave) and a PhD candidate at the Graduate School of Business Administration. he obtained his Master of Business Administration degree from the Faculty of Graduate Studies.