Management Dissertation: Performance and Staff Engagement of Hospitals

This management dissertation explores the performance and staff engagement of hospitals. It discusses the reasons for quality control initiatives, the role of ISO, and the limitations of quality assurance. The literature review highlights the challenges faced by healthcare organizations and the need for improvement in healthcare quality. The study also identifies gaps in the existing literature.

Running Head: MANAGEMENT DISSERTATION: PERFORMANCE AND STAFF ENGAGEMENT OF
HOSPITALS
Management Dissertation: performance and staff engagement of Hospitals
Student’s Name
University Name
Author’s Note

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MANAGEMENT DISSERTATION: PERFORMANCE AND STAFF ENGAGEMENT OF HOSPITALS
Table of Contents
Chapter 2: LITERATURE REVIEW..............................................................................................3
2.1 Requirement for quality initiatives and primary issues in quality.........................................3
2.2 Reasons for undertaking quality control initiatives in hospitals............................................4
2.2.1 Rising costs of Healthcare facilities....................................................................................4
2.2.2 enhanced knowledge and Expectations of the public......................................................4
2.2.3 Variations in Healthcare practices, errors as well as adverse events..............................5
2.2.4 Bureaucracy of Management framework........................................................................5
2.2.5 External imperatives........................................................................................................5
2.3 Quality Assurance in Healthcare industry.............................................................................6
2.4 Role played by ISO................................................................................................................7
2.5 limitations of quality assurance..............................................................................................7
2.6 Literature Gap........................................................................................................................9
Reference List............................................................................................................................10
2.7 Conceptual Framework........................................................................................................12

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MANAGEMENT DISSERTATION: PERFORMANCE AND STAFF ENGAGEMENT OF HOSPITALS
Chapter 2: LITERATURE REVIEW
2.1 Requirement for quality initiatives and primary issues in quality
In the present context, the cause for all major countries to implement institutes for improving the
Healthcare quality is in relation to issues like funding the ever increasing cost in Healthcare
system, utilisation, equity, changing spectrum of the epidemiology of harmful diseases,
competition, consolidation and demographic changes and others. In context to the above
highlighted issues Chiarini and Baccarani (2016), develops two most important challenges which
the Healthcare service organisations are facing today. These are ever increasing competition and
the constant as well as dynamic rise in demand of the customers. The success of the Reform as
well as quality control initiatives undertaken by the management of Healthcare facilities is
largely dependent on the political, economic as well as the social climate which determines
incentives as well as disincentives for participating in the efforts of reformation.
In the forward of the book: “effectiveness of quality control in the Healthcare organisations:
stories from worldly perspective”, Chiarini and Vagnoni (2017), provides importance to the fact
that Healthcare systems in the major industrial countries are undergoing faster and more dynamic
changes. according to the researcher, as he has highlighted in the book, the major challenges that
industrialized countries are facing in the context of providing Healthcare facilities are:
 Rapid increase in the life expectancy and enhanced sustenance of the aging population of
the country
 Huge success in biomedical research enabling incorporation of large volume of medical
knowledge which needs practical implementation in minimum time of 4 years
 Need for implementation of Hi-Tech medical procedures in daily Healthcare

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MANAGEMENT DISSERTATION: PERFORMANCE AND STAFF ENGAGEMENT OF HOSPITALS
 Growing threat from the chronic illnesses and parallel decline in acute infectious diseases
which is transforming the epidemiological spectrum of major diseases in the country
2.2 Reasons for undertaking quality control initiatives in hospitals
2.2.1 Rising costs of Healthcare facilities
This is a major issue affecting healthcare in almost all countries comma accounting for major
change in Healthcare frameworks also. For evidence Baidoun, Salem and Omran (2018),
identifies that in the USA, since 1980, significant number of failures, alliances and cooperative
as well as mergers of Healthcare units have been observed. Similarly, Smith et al. (2016),
identify that in UK also, concerns regarding cost in the state funded Healthcare facilities like the
NHS further aggravates the debate over the need for reform in hospitals. Analysing the outcome
of Healthcare opportunities in the various developed and developing countries, it can be reflected
that problems like ageing population, cost as well as overuse of Advanced Technologies in
Healthcare facilities, cost incurred due to poor service quality, lack of error detection skills,
medical malpractice and other similar issues along with lack of proper standard against which the
service of Healthcare Institutions can be measured are the major reasons because of which the
cost control of Healthcare provision has been difficult to control.
2.2.2 enhanced knowledge and Expectations of the public
Expectations of the customers of Healthcare industry has increased in contacts of waiting time,
particularly for surgical treatment, interpersonal aspects of care in complicated cases and so on.
Bright et al. (2015), addresses that these are the issues under this domain in UK, mainly.
Swensen, Kabcenell and Shanafelt (2016), argues that in Australia high growth in the
consumerism in the medical industry as well as the growing concern of the customers regarding

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MANAGEMENT DISSERTATION: PERFORMANCE AND STAFF ENGAGEMENT OF HOSPITALS
quality to cost ratio has been demanding improvement in in Healthcare quality and aggravating
the need of monitoring the quality of service in Healthcare institutions. The issue of rising
consumerism is applicable for Ireland also along with the development of a highly educated
population which demands for the more efficiency from the Healthcare facilities.
2.2.3 Variations in Healthcare practices, errors as well as adverse events
Issues like this, initiates the media, provider, purchase as well as public interest in improvement
of the Healthcare delivery processes. As informed by the institute of medicine in USA the death
of 10 million patients every year in USA is accounting of preventable Healthcare errors in the
hospitals of the country (Durey et al. 2016).The concern regarding poor Healthcare service
quality is evident in the Healthcare system of Ireland also and this has called upon a patient as
well as 5,000 perspective for improvement of Health Care services. Brand et al. (2017), analyses
that in order to address the most common of the quality control requirements in Healthcare
facilities of most countries, effort should be provided towards enhancing the involvement of
physicians, database comparison as well as training of the clinical as well as non clinical staff.
2.2.4 Bureaucracy of Management framework
The management of Healthcare facilities have been facing challenges like inefficiency,
remoteness as well as wastefulness. Concerns regarding stifling management are a primary
concern in the Healthcare industry. On the contrary, Healthcare industry in Greece is suffering
from lack of effective management of Healthcare resources, inadequacy of infrastructure
development as well as poor budgetary control because of non-implementation of modern
financing system in the hospitals.
2.2.5 External imperatives

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MANAGEMENT DISSERTATION: PERFORMANCE AND STAFF ENGAGEMENT OF HOSPITALS
In order to ensure quality control and total qualities management in the hospitals, government of
various countries has implemented regulations as well as provided authority to the regulatory
Agencies for managing healthcare quality in the hospitals. In this context, Healthcare industry of
Ireland is facing genuine threat in terms of providing best medical care since professional
autonomy of hospitals is at state accounting to the anticipated legislation. Analysing this
condition, it can be reflected that the development and implementation of the insurance policy
under National Health Care scheme in meaning of the developed countries like America and also
in poor African countries as implemented by the Red Cross and UNICEF, has led to the
emergence of a schedule for reimbursement of fixed monetary value to the Healthcare providers
because of which they have been under the application of promoting quality control management
as well as total quality management in their hospitals (Hofler & Thomas, 2016).
2.3 Quality Assurance in Healthcare industry
There are two fundamental approaches for management of quality which are Quality Assurance
as well as total quality control. Quality Assurance emphasizes on defining the the various
dimensions of health care service and health processes which needs to be followed for quality
control in Healthcare institutions. In this context Lewis et al. (2016), provided that regular
inspection from external authorities ensure the following of a set standard. Search quality control
inspection takes various forms like a tradition, regulation, and external Peer assessment for
external audit. Examples of external audit approaches are the BS 5750 and JCAHO of USA.
Similarly NHS in England is a wildly popular scheme of medical training inspection. In this
context, mention that a project of the European Union, named ExPeRT was launched in order to
research for scope, mechanism as well as utility of external metrics of quality control for
improvement in Healthcare. The research outcomes show that patience, public as well as various

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MANAGEMENT DISSERTATION: PERFORMANCE AND STAFF ENGAGEMENT OF HOSPITALS
corporate bodies are largely promoting external mechanism of quality control at National levels
in European countries. this is not only out of the urge to develop the quality of Healthcare service
provided to patients but individual interest of various external stakeholder groups are also
associated with the process (Chiarini & Vagnoni, 2017). Evidence government is concerned
about proper implementation of the health policy; the statutory bodies are alert about registration
and documentation of hospitals and so on.
2.4 Role played by ISO
The ISO has a significant role to play for development of uniformity as well as aligning the
member countries for ratification of standards in Healthcare service and their strict
implementation. Majority of the countries are members of ISO (Baidoun, Salem & Omran,
2018). Standardization of quality systems has been implemented by the ISO which needs to be
implemented in specific domains of Healthcare services particularly in countries like Germany
and Switzerland.
2.5 limitations of quality assurance
Analysing the empirical findings from various scholarly articles, the researcher enlisted the
following limitations:
 Quality Assurance is driven by standards and give importance to compliance with the
standards
In general there should be in house professionals who will give a regular check on the
compliance as well as identification of problem areas on a sporadic basis. Their basic objective
will be ensuring continuous enhancement of improvement in quality of Healthcare service and
regular motivation of the staff so that they become more conscious about quality Healthcare.

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MANAGEMENT DISSERTATION: PERFORMANCE AND STAFF ENGAGEMENT OF HOSPITALS
However, in countries like USA and Australia it has been observed that the clinical indicators
that have been set by the government for Quality Assurance and accreditation have developed a
lot of parameters but almost none of them have been able to keep pace with the expectation of
the public from the Healthcare service industry (Smith et al. 2016).
 The QA assume that Quality Assurance agencies are the best guide
In this context, the Healthcare organisations avoid regular quality checking and rather try to
implement one-size-fits-all review approaches. This means that the same methodology is used
for retrieving all organisations of Healthcare irrespective of the nature of service provided by
them. As indicated by Chiarini and Vagnoni (2017), this can never ensure proper quality check
up hospitals as the quality monitoring needs of various hospitals are different.

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2.6 Literature Gap
The scholarly literature that has been studied for the purpose of this literature review
imposes more attention on the issues that have been affecting the health care organisation in
terms of staff performance. Very less attention have been given on how the patient health is
affected or how the mortality rate of the patients have been impacted as an impact of the issues
that have been facing the health care organisations in recent times.

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Reference List
Baidoun, S. D., Salem, M. Z., & Omran, O. A. (2018). Assessment of TQM implementation
level in Palestinian healthcare organizations: The case of Gaza Strip hospitals. The TQM
Journal, 30(2), 98-115.
Brand, S. L., Coon, J. T., Fleming, L. E., Carroll, L., Bethel, A., & Wyatt, K. (2017). Whole-
system approaches to improving the health and wellbeing of healthcare workers: A
systematic review. PloS one, 12(12), e0188418.
Bright, F. A., Kayes, N. M., Worrall, L., & McPherson, K. M. (2015). A conceptual review of
engagement in healthcare and rehabilitation. Disability and rehabilitation, 37(8), 643-654.
Chiarini, A., & Baccarani, C. (2016). TQM and lean strategy deployment in Italian hospitals:
Benefits related to patient satisfaction and encountered pitfalls. Leadership in health
services, 29(4), 377-391.
Chiarini, A., & Vagnoni, E. (2017). TQM implementation for the healthcare sector: The
relevance of leadership and possible causes of lack of leadership. Leadership in Health
Services, 30(3), 210-216.
Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., & Bessarab, D.
(2016). Improving healthcare for Aboriginal Australians through effective engagement
between community and health services. BMC health services research, 16(1), 224.
Hofler, L., & Thomas, K. (2016). Transition of new graduate nurses to the workforce challenges
and solutions in the changing health care environment. North Carolina medical journal,
77(2), 133-136.

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Lewis, E., Cardona-Morrell, M., Ong, K. Y., Trankle, S. A., & Hillman, K. (2016). Evidence still
insufficient that advance care documentation leads to engagement of healthcare
professionals in end-of-life discussions: A systematic review. Palliative medicine, 30(9),
807-824.
Smith, N., Mitton, C., Hall, W., Bryan, S., Donaldson, C., Peacock, S., ... & Urquhart, B. (2016).
High performance in healthcare priority setting and resource allocation: A literature-and
case study-based framework in the Canadian context. Social science & medicine, 162,
185-192.
Swensen, S., Kabcenell, A., & Shanafelt, T. (2016). Physician-organization collaboration
reduces physician burnout and promotes engagement: the Mayo Clinic experience.
Journal of Healthcare Management, 61(2), 105-127.

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Poor performance and
lack of staff
engagement in
hospitals
Improvement of total
quality management
and staff performance
Need to comply with the
health care regulations
and standards of the
country
Limitations of quality
assurance
Campaigns
Role played by
ISO
Implementing new
methods of Quality
Assurance in Healthcare
industry
Acute need of
undertaking quality
control initiatives in
hospitals
Requirement for quality
initiatives and primary
issues in quality
2.7 Conceptual Framework