Understanding Operations in Healthcare: Total Quality Management and Leadership

This essay discusses the application of logistics and operations in healthcare, with a focus on the Royal National Orthopaedic Hospital (RNOH). It explores the concepts of total quality management and leadership, and how they can be applied to improve the quality of services provided by the hospital. The essay also discusses the triple bottom line approach, which takes into account the economic, environmental, and social aspects of healthcare.

Running head: UNDERSTANDING OPERATIONS
Understanding Operations
Name of Student
Name of University
Author Note

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Introduction
According to Haksever and Render (2018), operations management is mainly
concerned with the designing and controlling process that is concerned with the production of
goods and services. It is involved with taking responsibility of the business operations that
are efficient in terms of application of few yet effective resources. This usually helps
organisations to meet the requirements of the customers and is concerned in managing an
entire production system. Operations help in the manufacturing of products, manage quality
and create services. It is considered as one of the major functions of an organisation along
with supply chain management.
Logistics is a detailed arrangement and implementation of complex operations within
an organisation. Christopher (2016) stated that logistics could be considered as a flow of
things that exists between the point of origin and the point of consumption so that the
requirements of the customers can be met. The resources that are managed include physical
items like the materials, equipments and any other products that are manufactured by an
organisation. The essay sheds light on the application of the concepts of logistics and
operations in order to understand related theories such as total quality management,
leadership and triple bottom line. The company considered for the essay is the Royal National
Orthopaedic Hospital (RNOH).
Introduction to the organisation and the topics
RNOH is a specialist orthopaedic hospital that is located in Greater London, United
Kingdom. It is part of the Royal National Orthopaedic Hospital NHS Trust (Rnoh.nhs.uk
2018). The purpose of the hospital is to provide comprehensive range of neuro-
musculoskeletal health care in the United Kingdom. The hospital was founded in 1905 and

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consists of about 220 beds and as an affiliation with the University College in London
(Rnoh.nhs.uk 2018).
One of the topics chosen for the essay is that of quality. Quality is an important issue
in hospitals as the quality normally denotes the services that are provided by the hospitals. As
stated by Mangan, Lalwani and Lalwani (2016) quality provides and organisation with an
added advantage in the market as it meets the expectations of the customers. In the case of
hospitals, the application of Total Quality Management Tools that is required for maintaining
quality is considered as an important aspect for development.
The second topic that is chosen is that of leadership. As stated by Mahadevan (2015)
leadership is important in hospitals due to the presence of a vast number of employees. In
order to maintain the association of the employees with one another it is necessary to ensure
that collaboration takes place. Glac (2015) also stated that leaders in hospitals have a huge
duty, as they need to maintain a balance between being strict with the employees and as well,
as remain friendly with the customers.
Choices of topic
Topic 1: Total Quality Management Tools
Originally started in Japan in the 1980s, the idea of TQM has spread to the western
countries and now has become an integral part of all firms. In case of the healthcare industry,
this plays quite significant role. Hospital initiatives, customer satisfaction and government
regulations have pushed the boundary of healthcare services and thereby the hospitals have
undertaken TQM services. Bromiley and Rau (2016) have defined that TQM is a
comprehensive strategy improving the quality of the services through implementation of

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collaborative strategy. The authors have further stressed that in the later part of the decade the
depiction of the healthcare industry have changed quite a lot.
At the beginning, it was just a producer-oriented industry but now it has shifted to
customer oriented where satisfying the customers are mantra. Thereby RNOH has also
undertaken this approach to provide the beast approach in all of UK. One of the most
prominent is the use of feedback through telephone (Mahadevan 2015). As per the latest
news, the director has introduced to feedback which the visitors and the patients can use to
provide their feedback on their time at the hospital and their experience of staying here as
well as giving some input on the services provided.
Rushton, Croucher and Baker (2014) have aligned with this citing that one of the most
important factors of TQM is the focus on customer and getting obsessed with the overall
quality of the service provided. This questionnaire has provided with enough proof that the
organisation is very much engrossed with procuring high quality service to their patients. The
first step is to identify their needs and factors making them feeling discomfort. Goetsch and
Davis (2014) have highlighted that although the above two factors are of primary importance,
however, without long-term commitment, the TQM services will fall flat incurring huge
losses for the company. In case of RNOH, they have used it to provide high quality of
nursing services.
They have started this rotation of the nurses where the nurses, mostly newly graduate,
are rotated among various nursing settings which considerably increases their knowledge thus
giving them enough training to handle any kind of situation. Therefore, the patients will get
elevated service, which is one of the primary goals of the company. At Arnold’s children
hospital, they have another way of introducing the TQM tools. They have implemented the
long-term commitment through investing in 5 Million dollars for the neurological care at

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Florida. Androniceanu (2017) have stated that now the number of the children is coming with
neurological issues so this is a necessary step to provide all kinds of services to the patients.
Another important tool of TQM is effective teamwork, which can do wonders for the
organisation. At Arnold’s they have introduced community services to integrate their services
at the local places and communicating with the children. They have introduced satellite
offices to expand their services. In these services, there will be kid’s friendly waiting and
emergency rooms. This will decrease the dissatisfaction and the complaints of the patients
regarding their in-patient time. At RNOH, they have implemented training and emergency
rotation of the nurses as platform to build teamwork. Teamwork is quite crucial at a hospital
where multidisciplinary teams come together to work on a complex case involving care
providing to any patient or even saving one’s life.
Dale et al. (2016) have opined that at RNOH, they provide a strong support to the
nurses discouraging them to work alone and pushing them to work in teams so that they get
the basic training of the working in multispecialty teams from the very day of their joining.
This gives better result in handling adverse situations. Moreover, this also encourages them to
analyse the issues and barriers faced in such teamwork. Coming to the next tool, called
education and training, RNOH is doing excellent services by providing a platform for over 60
on-going researches and training simultaneously.
The hospital has also tied up with University College London Institute of
Orthopaedics and Musco-skeletal sciences to provide research services. Ross (2017) is of
opinion that what puts this hospital in front is their input of patient’s feedback and their
nonprofessional knowledge in the on-going research. Arnold’s is a good hospital but this firm
has surpassed it by providing all round services and using TQM services to excel its
performance and provide better patient care.

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Topic 2: Leadership
Leadership in hospital industries can be considered as one of the topics that need to be
considered in terms of hospital sector. This is mainly because the leadership techniques in
hospitals focus on the application of more than one effective technique in the hospitals. As
stated by Bolman and Deal (2017) it is necessary that leadership be imposed in hospitals so
that it can continue to reap the benefits of provided. In the case of RNOH, the importance of
leadership is that it can help with aligning the mission and vision of the hospital. It is
necessary that an organisational vision and mission be formulated and maintained so that it
can help in its growth.
In the case of RNOH, the mission of the hospital is to provide the best health care in
the English region. At the same time, spreading all across England is also necessary as it can
help in the growth of the hospital. Brandon‐Jones (2015) stated that in order to achieve this, it
is necessary that hospitals have a good leader. RNOH can benefit from a leader as it can gain
the necessary guidance required for the development of the hospital. Leaders can define the
manner in which the hospital needs to be maintained so that effective mission and vision can
be made. As seen from the case of Arnold’s children, leadership provided by Arnold helped
the hospital to reach a good high for its development and process. Therefore, it can be said
that leadership provides effective analysis of the vision and mission and this can help RNOH
to complete achieving its aims.
At the same time, leadership can help in establishing an effective communication
strategy. This includes making the employees belief that communication with the leaders is
possible and that it can help them to bring about changes in an organisation. According to
Fairhurst and Connaughton (2014), for a hospital like RNOH, communication is important as
it is one of the largest and fast growing hospitals in Britain. Hence, it is important that

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leadership play a vital role in the development of the hospital particularly on the idea of
communication within one hospital department with another.
Similarly, it is also in the best interest of the leaders to ensure smooth communication
as it can help in providing effective guidance as well as groom a future leader. Hence, it can
be said that communication along with mission and vision are some of the most important
aspects on which leadership needs to focus its strategies. In the words of Northouse (2018),
the importance of leadership does not end with it. One of the main components of hospitals is
to ensure that its gains buy-in from senior members. This involves selling of medicines to the
customers at a price that is normally higher than the average sales. Hence, clear and constant
communication with the stakeholders is important and leaders need to instigate the
communication with the clients.
Therefore, after considering this it can be said that leadership plays a vital role in the
development of work practises in an organisation. In the case of hospitals such as RNOH,
leadership needs to align with the hospitals demands and ensure that every employee
understand the respective roles that can help them to gain success in the hospital. Another
important aspect of leadership is that it can help in developing a future leader for the
business. This is considered as an important aspect for the success of a hospital as without
this particular aspect it can be difficult for any hospital to continue with the development of
its vision and mission statement.
As stated by Bolman and Deal (2017) it is important for hospitals to develop a future
leader so that the reputation of the hospital can be kept intact. In the case of RNOH, the
development of a future can help the hospital identify the activities that need to be taken into
consideration so that it can maintain its stature as the number one hospital in UK.

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Another important aspect that needs to be considered is the fact that leadership
choices affect the working of an organisation. As observed by Antonakis, J. and Day (2017)
leadership in hospitals is considered as tough as the customer satisfaction need to be
maintained along with good employee performance. For RNOH, the leadership takes a proper
balance shape as it helps in identifying the strategy and the systems that are required for
success.
Triple Bottom Line approach
According to Govindan, Soleimani and Kannan (2015), the application of the Triple
Bottom Line approach in hospitals can be considered as effective since it takes into account
the three most important things that help in the approach of hospitals in the society as well as
with the customers. These include consideration of approaches related to society,
environment and economic. Discussion of the three concepts is provided to understand its
applicability at RNOH.
Economic approach: As stated by Oakland (2014) it is necessary for every
organisation to gain profit from its activities. However, in the case of hospitals, particularly
RNOH, the focus is divided between gaining profit as well as serving the customers. Most of
the times, the aspect of profit is seen as an economic benefit that can help a hospital sector
like RNOH to continue with its business activities in an efficient manner.
Environmental approach: This includes safeguarding the planet from any harmful
activities. As observed by Hitt, Xu and Carnes (2016) it is necessary for every organisation to
maintain a sustainable environment so that the community can be safe. In the case of RNOH,
it is necessary to ensure that the disease it treats does not spread after dumping the wasted
bed sheets and other equipments. This usually requires understanding the activities that can

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help in sustainable development and the manner in which RNOH can gain the trust of the
people.
Social approach: The people usually provides fair and beneficial business practise.
According to Glac (2015), without the support of the customers, it can be difficult for
hospitals to grow. RNOH can use its reputation to expand in the UK market by gaining the
support of the customers. As seen from earlier analysis, good quality services provided by
RNOH allow the hospital to attain its objectives of expansion.
Recommendation
Therefore, after careful analysis of the condition of RNOH it can be said that the
hospital needs to ensure that the quality of services provided are well maintained in order to
reach its objectives of expansion. RNOH need to ensure that it draws inspiration from the
competition it receives so that it can continue to work in a dominating manner in the markets
of United Kingdom. Therefore, it can be said that benchmarking can be a form of
recommendation for RNOH.
Along with this, it is also necessary that leadership at the hospital improve. The
leaders need to understand the style that is appropriate for maintaining a specific motivation
factor at the hospital. For RNOH it is important that the leadership activities adopted by the
hospital comply with the requirements of the customers, as the customers are the main source
of motivation for the hospital.
Conclusion
Therefore, it can be concluded that for RNOH to succeed in the international market,
it is important it continue to improve the quality of services that it provides to the people.
Operations and logistics are important source of business activities that are needed to be

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controlled along with emphasis on the Triple Bottom Line approach. For RNOH to succeed,
it is essential that a proper leadership style be chosen so that it can continue to develop in the
business. One of the important analyses that have been made is the fact that the application of
these theories along with the maintenance of operations and logistics can have a positive
effect on any organisation.

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