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Organizational culture and totalquality management practices:

a Sri Lankan caseK.A.S.P. Kaluarachchi

Department of Management and Organization Studies, Faculty of Management and Finance, University of Colombo,

Colombo, Sri Lanka

Abstract

Purpose – The purpose of this paper is to identify the effect of organizational culture (OC) on thetotal 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-timeinterviews, participative observations, in-depth interviews, and obtaining relevant documentaryevidence by the employment of grounded theory. The director, divisional heads, doctors, nursingsisters and nurses, paramedical staff, midwifery staff, clerical staff, and support staff of the hospitalare appropriately considered as the informants during the employment of the above data gatheringtechniques. The data are analyzed qualitatively in line with the research variables.

Findings – As cultural characteristics of the hospital, the study identified low power distance, lowuncertainty avoidance, low individualism, and low masculinity. The study identified high seniormanagement commitment, high staff commitment, high stakeholder focus, high integration of continuous improvement, high quality culture, high measurement and feedback, and high learningorganization characteristics as TQM practices of the hospital. Moreover, the study found that thesupportive 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 newculture perspective.

Originality/value – Recently, many organizations in Sri Lanka irrespective of their category andindustry have been practicing TQM in order to stay competitive in both domestic and internationalmarkets. But empirical studies on the topic are very limited in the Sri Lankan context. This study as acase 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

IntroductionTotal 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 primarilyadopted by some Japanese companies in the decades immediately after World War II.With the greater successes of Japanese companies during the 1980s, companies all overthe world found that it was necessary to have good quality management practices inorder to stay competitive (Lagrosen, 2002; Stahl and Grigsby, 1997).

But many approaches to quality management, including TQM hardly givelong-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 current issue and full text archive of this journal is available at

www.emeraldinsight.com/1754-2731.htm

OC and TQMpractices

41

Received November 2007Revised May 2009,

August 2009Accepted August 2009

The TQM Journal

Vol. 22 No. 1, 2010

pp. 41-55

q Emerald Group Publishing Limited

1754-2731

DOI 10.1108/17542731011009612



TQM activities. Hence, understanding the effect of OC on the implementation of TQMpractices in organizations is important (Dale, 1994; Kroslid, 1999; Kaye and Anderson,1998; Kaye and Dyason, 1995; Padhi, 2000).

Although quality management practices need to be adopted in Sri Lankan

organizations in order to enhance their business performance, such efforts face anenormous challenge due to many negative reasons. The challenge is mainly due to thecultural and behavioural mismatch within Sri Lankan organizations when they try topractice quality management within their organizational boundaries (Nanayakkara,1992). The issue is seen to be more critical in public sector organizations in Sri Lankawhen they try to implement new management systems. It has been found that thereforms and innovative programmes introduced in public sector organizations inSri Lanka are less compatible with the attitudes and skills of the organizationalparticipants. Therefore, those innovative programs become simply technical, ratherthan managerially meaningful to the organizations (Samarathunga andBennington, 2002).

But by implementing new management systems, some Sri Lankan public sectororganizations have achieved a certain degree of success. As a key example, theSri Lankan public sector hospital, studied in this research, has won several nationalquality awards for being more responsive to the public demands through theimplementation of Japanese 5-S based TQM activities. Hence, this study was motivatedby the need of examining the TQM practices implemented by the said hospital within itscultural set up.

Therefore, the purpose of the study reported in this paper was to identify the effectof OC on the TQM practices of the above mentioned Sri Lankan public sector hospital.However, the intended purpose was further divided into and specified by the followingthree questions:

RQ1. What kind of culture is there in the hospital?

RQ2. What kind of TQM practices are there in the hospital?

RQ3. How has the culture of the hospital affected its TQM practices?

Conceptual frameworkAs in Tayeb (1988), researchers who adopt the cultural theory in business researchattempt to follow two strands: “ideational” in which their attention is to attitudes andvalues expressed by organizational participants, and “institutional” or “material” inwhich they concentrate upon structural aspects such as division of labor, career, status,and reward structures of organizations. With the “ideational” culture perspective, thisstudy used some Hofstedian cultural dimensions (Hofstede, 1991) to conceptualize the

culture of the hospital:(1) Power distance (PD). In a decision-making situation in an organization, at least

two types of power and authority scenarios are seen. In the first scenario, adecision may be taken by one person or group and the order for itsimplementation is carried out by other persons or groups. This situation maylead to unequal power relationships in organizations. The situation is termed“high PD.” In the second scenario, the two actors take decisions and implementthem together. This situation may lead to less unequal power relationships in

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organizations, and it is termed “low PD.” Using the “ideational” cultureperspective, it is assumed that in organizations, there can be variations in thepower and authority gaps between seniors and juniors, superiors andsubordinates, and so on.

(2) Uncertainty avoidance (UA). Most of the decisions in organizations involve adegree of uncertainty. More uncertainty of decisions leads to a greater degree of ambiguity, and vice-versa. There are at least two types of behavioural patternsof organizational participants behind this that can be identified. In the firstscenario, a higher degree of uncertainty tolerance behaviour can be shown by aparticipant, when he or she (a group as well) faces an uncertain situation. This istermed low UA or high-risk-taking behaviour. In the second scenario, a lowerdegree of uncertainty tolerance behaviour can be shown by a participant, whenhe or she (a group as well) faces an uncertain situation. This situation is termedhigh UA or low-risk-taking behaviour. Using the “ideational” cultureperspective, it is assumed that in organizations, there can be variations in theways that participants tolerate the uncertain situations they face.

(3) Individualism (IND). Most of the reactions of organizational participants can beexplained by their attachment to the organizational goals. At least two types of reactions can be seen pertaining to how organizational participants attachthemselves to the organizational goals. In the first scenario, they can displayrelatively a higher attachment to their own goals than the organizational goals.This situation is called “IND.” In the second scenario, they can display arelatively higher attachment to the organizational goals rather than to their owngoals. This situation is called “collectivism” or “low IND.” Using the“ideational” culture perspective, it is assumed that in organizations, there can bevariations in the ways that participants attach themselves to their personalgoals over the organizational goals.

(4) Masculinity (MAS). Most of the reactions of organizational participants can beexplained using the way their gender roles appear in the workplace. There are atleast two types of scenarios that can be seen in relation to this. In the firstscenario, the gender roles of the participants are distinguished as the malemembers focus more on material success than the female members. This situationis called “MAS.” On the other hand, gender roles of the participants overlap asboth male and female participants tend to function interactively with each other.This situation is called “femininity” or “low MAS.” Using the “ideational” cultureperspective, it is assumed that in organizations, there can be variations in theways that gender roles of the participants appear in the workplace.

Based on the grounded data and some existing literature on TQM (Deming, 1986;

Juran, 1995; Crosby, 1979; Feigenbaum, 1991; Ishikawa, 1985; Dale, 1994; Kroslid, 1999;Kaye and Anderson, 1998; Kaye and Dyason, 1995; Padhi, 2000), the followingvariables were used to conceptualize TQM practices of the hospital:

. senior management commitment (SMC);

. staff commitment (SC);

. stakeholder focus (SF);

. integration of continuous improvement (ICI);

OC and TQMpractices

43



. quality culture (QC);

. measurement and feedback (MFB); and

. learning organization (LO).

The possible relationship between the two types of research variables wasconceptualized as shown in Figure 1.

Methodology/approachThe case method was employed as the strategy of this research. A Sri Lankan publicsector hospital, which practices Japanese 5-S based TQM activities, was selected as thecase. The director of the hospital was initially contacted to seek permission to conductthe empirical study. Once the permission was given, the empirical data were gatheredthrough direct observations, short-time interviews, participative observations, in-depthinterviews, and obtaining relevant documentary evidence following the groundedtheory (Glaser and Strauss, 1967).

The director, divisional heads, doctors, nursing sisters and nurses, paramedicalstaff, midwifery staff, clerical staff, and support staff of the hospital were appropriatelyinterviewed as the informants. However, the extent of the interviews ranged fromshort-time interviews to in-depth interviews based on the data gathering requirements.The short-time interview sample consisted of 100 informants who represented theabove staff categories. For the data gathering purpose, the OC and TQM variableswere further specified into the indicators shown in Tables I and II, respectively.

The indicators were used to develop data gathering schedules for the short-time andin-depth interviews. Two specific questions were asked for each indicator of OC andTQM variables in order to gather data through the short-time interviews.

Moreover, five in-depth interviews were carried out to see the effect of OC variableson the TQM variables. The in-depth interviews were carried out with the director,

senior medical officer, administrative officer, accountant, and senior matron since theyactively handle 5-S based TQM activities in the hospital.

Figure 1.Conceptual researchframework

TQM variables

Senior management

commitment (SMC)

Staff commitment (SC)

Stakeholder focus (SF)

Integration of continuousimprovement (ICI)

Quality culture (QC)

Measurement and feedback (MFB)

Learning organization (LO)

OC variables

Power distance (PD)

Uncertainty avoidance (UA)

Individualism (IND)

Masculinity (MAS)

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The data were analyzed qualitatively (Silverman, 2000). The OC and TQM variableswere evaluated as “low” “medium” and “high” using the answers given to eachquestion by the interviewees during the short-time interviews.

Based on the short-time interview results, the analysis was further extended to seethe effect of OC variables on the TQM variables. For this purpose, the contents andpatterns of relationships between the OC and TQM variables were checked and verifiedusing the in-depth interview results.

The case discussion was completed following the results of the analysis. Somenarratives of the respective informants taken down during the in-depth interviews werealso highlighted in the discussion.

OC and TQMThe concept of OC has been defined by different scholars in different ways. Most of these scholars (Hofstede, 1991; Robbins, 2005; Peters and Waterman, 1982; Stahl andGrigsby, 1997) define OC in a “subjective” or an “ideational” aspect. For them, OC is “asystem of shared values.”

But some other scholars (Schein, 1985; Johnson, 1988; Deal and Kennedy, 1982;Handy,1985)defineOCcombiningboth“subjective”and“objective”or“material”aspects.

Variables Indicators

(1) PD 1.1 Degree of boss-subordinate positional gaps1.2 Degree of centralized decision making of the director

(2) UA 2.1 Degree of employee strictness to rules and regulations2.2 Degree of employee resistance to possible changes taken place in the workplace

(3) IND 3.1 Degree of employee performance evaluation using their individual work results3.2 Degree of employee willingness to work alone than work as teams

(4) MAS 4.1 Degree of staff distribution unequally between male and female categories4.2 Degree of male and female staff members’ willingness to work separately than work

interactively

Table I.OC variables and

indicators

Variables Indicators

(1) SMC 1.1 Degree of director’s two-way communication style

1.2 Degree of director’s involvement with the staff (2) SC 2.1 Degree of staff willingness to know about TQM

2.2 Degree of staff involvement in TQM activities(3) SF 3.1 Clarity of continuous improvement oriented strategy formation

3.2 Success of continuous improvement oriented strategy deployment(4) ICI 4.1 Degree of vertical ICI

4.2 Degree of horizontal ICI(5) QC 5.1 Degree of focus to initiate a QC

5.2 Degree of maintenance of a QC(6) MFB 6.1 Degree of adherence to service performance evaluation

6.2 Degree of adherence to service performance feedback(7) LO 7.1 Degree of self-assessment of continuous improvement

7.2 Degree of enhancing staff knowledge and skills

Table II.TQM variables and

indicators

OC and TQMpractices

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For them, OC is not only a system of shared values, but is also comprised of features of organizations like artifacts, symbols, and other structural elements.

In his cross-cultural studies at IBM companies, Hofstede (1991) defines OC as “thecollective programming of the mind that distinguishes the members of one organization

from another.” For Hofstede, attitudes towards OC are partly affected by nationalculture elements. Using the national culture view, he recognizes PD, UA, IND vscollectivism, and MAS vs femininity as major characteristics common to the cultures of organizations.

The concept of TQM has evolved with the quality guru’s ideas (Deming, 1986; Juran,1995; Crosby, 1979; Feigenbaum, 1991; Ishikawa, 1985). They recognize TQM withsome requirements for organizational success. Most of the contemporary TQMresearchers (Dale, 1994; Kroslid, 1999; Kaye and Anderson, 1998; Kaye and Dyason,1995; Padhi, 2000) identify TQM with some key organizational practices.

The caseThe Castle Street Hospital for Women was established in 1950 as a public sectormaternity hospital in Sri Lanka. It was brought under the administrative control of theCommittee of the Colombo Group Hospitals in 1958. In 1964, it became a teachinghospital of the Medical Faculty of Colombo.

Presently it functions as the largest maternity hospital in Sri Lanka with a capacityof 450 beds providing maternal, gynecological, and neonatal care services for thepublic. The hospital also provides specialized neonatal intensive care and fertilityservices. There are 16,000 to 18,000 deliveries taking place annually with an average of 27 percent cesarean deliveries. It operates with five maternal and gynecological units,and one neonatology unit. These units are supported by three operating theatres, twointensive care units, one blood bank, one laboratory, one Radiology Department, andsome Paramedical units. The units work in harmony to ensure the essential and

emergency care at tertiary levels.The vision, mission, values, goals, objectives, strategies, and quality policy of thehospital are presented as follows.

The vision

A government hospital with a sense of quality.

The mission

Provision of quality maternal, gynecological, and neonatal care services and training of health personnel using current medical practices and the efficient use of resources in afriendly environment of good working relationship where the patient care needs will be of thehighest priority.

The valuesThe hospital highly values the responsiveness to the people. For this, it walks an extramiles to enhance the care of people with dignity and compassion.

The goal

Healthy children to be born in the Castle Street Hospital for Women with a minimumdisability to mothers who are cared for so they can be free of complications.

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The objectives. To reduce the maternal mortality rate (MMR) of the hospital 25 percent below the

national figures.

.

To reduce the neonatal mortality rate (NMR) by 5 percent annually.. To ensure there will be no preventable stillbirths.. To ensure safe delivery and surgical procedures free of complications.

The strategies. Leadership development to improve health systems.

. Human resource development and involvement for performance excellence.

. Continuous improvement through productivity concepts.

. Mistake proofing.

. Customer centered responsive service provision.

The quality policy

We are committed to TQM. We practice continuous improvement in all aspects of ourperformance. We dedicate ourselves to satisfy our customers’ expectations.

Since April 2000, the hospital has been practicing Japanese 5-S (5-S abbreviates the Japanese words Seiri (tidiness), Seiton (orderliness), Seiso (cleanliness), Seiketsu(standardization), and Shitsuke (training and self-discipline)) based TQM activities inorder to deliver a better service to thepublic. It has won several national quality awardsforits high quality sense and care of service. The Best 5-S Implementation Merit Award in2001, the Sri Lankan National Quality Merit Award in 2002, and the National Productivityand Quality Award in 2003 are among the quality awards won by the hospital.

Analysis and resultsThe analysis addressed the three research questions which were already mentioned atthe beginning of the paper. In order to ascertain the results of the OC variables, theselected informants were interviewed during the short-time interviews. The interviewsample consisted of 100 informants who represented different staff categories of thehospital. Table III shows the interview results. The results were considered as theinterviewee perception of the OC variables.

A similar process was carried out to ascertain the results of the TQM variables. Theinterview results are shown in Table IV. The results were considered as theinterviewee perception of the TQM variables.

Interviewee perception PercentageVariables Low Medium High Low Medium High Evaluation

(1) PD 112 56 32 56 28 16 Low(2) UA 124 36 40 62 18 20 Low(3) IND 142 34 24 71 17 12 Low(4) MAS 116 52 32 58 26 16 Low

Table III.Interviewee perception of

the OC variables

OC and TQMpractices

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Using the short-time interview results, the analysis was further extended to see theeffect of OC variables on the TQM variables. For this purpose, five in-depth interviewswere carried out. The purpose of the in-depth interviews was to identify the possibleeffect of each OC indicator on the TQM indicators. The results are summarized in

Table V.However, for greater clarity, the effect is shown in Figure 2.

DiscussionCulture of the hospital Low PD . The inequalities between the hierarchical positions have been minimized.Hence, the boss-subordinate positions and their relationships do not createunnecessary power gaps to discourage the teamwork behaviour of the employees.The subordinates respect the bosses and their competence. The bosses also like to seecompetence displayed by their subordinates. The management (the director representsthe senior management and the Divisional Heads represent the middle management)

encourages employees to take operational level decisions, while they are asked to

Interviewee perception PercentageVariables Low Medium High Low Medium High Evaluation

(1) SMC 4 14 182 2 7 91 High(2) SC 28 30 142 14 15 71 High(3) SF 16 38 146 8 19 73 High(4) ICI 30 36 134 15 18 67 High(5) QC 10 22 168 5 11 84 High(6) MFB 36 48 116 18 24 58 High(7) LO 34 58 108 17 29 54 High

Table IV.Interviewee perception of the TQM variables

OC indicators Affected TQM indicators

Low PD 1.1 High SMC 1.2, High SC 2.1, High SC 2.2, High ICI 4.1, High ICI 4.2, High QC 5.1,High QC 5.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2

Low PD 1.2 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High ICI 4.1, High ICI 4.2,High QC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2

Low UA 2.1 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2Low UA 2.2 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2,

High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2Low IND 3.1 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2,

High ICI 4.1, High ICI 4.2, High QC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2,High LO 7.1, High LO 7.2Low IND 3.2 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2,

High ICI 4.1, High ICI 4.2, High QC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2,High LO 7.1, High LO 7.2

Low MAS 4.1 High SC 2.2, High SF 3.1, High SF 3.2, High ICI 4.1, High ICI 4.2, High QC 5.2,High MFB 6.2

Low MAS 4.2 High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2, High ICI 4.1, High ICI 4.2, HighQC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2

Table V.Summary of the in-depthinterview results

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implement strategic decisions taken by the management. This is because the directorfollows a decentralized decision-making policy. The director, addressing the point,replied that:

We like to see the competence of our people and they are welcome anytime to display theirtalents.

The organizational chart of the hospital (Figure 3) reflects its flexible decision-makingand reporting structure. The flexible decision-making and reporting structure hashelped the director to employ his decentralized decision-making policy at the stake of the continuous improvement.

According to the short-time interview results, the low PD variable accounted for 56percent of interviewee perception.

Low UA. The hospital has to follow the formal rules, circulars, procedures, andperformance indicators set by the Ministry of Health. But the management hasintroduced systematic and relatively flexible goals, objectives, strategies, and qualitypolicy in line with their vision and mission. The systematic and flexible environmenthas motivated staff members to the work. Hence, they are most often punctual at work.Moreover, the managers and staff members tolerate possible changes that take place inthe hospital. They like to be exposed to the new changes in order to enhance theproductivity of the hospital. For example, the Japanese 5-S based TQM activities have

Figure 2.Demonstrating the effectof OC variables on TQM

variables

OC variables

Low PD

Low UA

Low IND

Low MAS

TQM variables

High SMC

High SC

High SF

High ICI

High QC

High MFB

High LO

OC and TQMpractices

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been adopted in the hospital without substantial resistance by the staff. Addressing

this point, the Administrative Officer said that:

The management and our employees instead of avoiding risks, like to accept the risks

encountered in the workplace.

The interviewee perception of low UA dimension accounted for 62 percent.

Low IND . The management recognizes the overall performance of the hospital

considering both teamwork and individual work results of the employees. Each worker

is encouraged to perform his or her job to the utmost. At the same time, they are

encouraged to function as work teams. The Accountant responded favourably to this:

We appreciate both teamwork results and individual worker results, because both are

necessary to quality improvement in the hospital (the Senior Matron also had a similar

opinion to this).

A work team comprises of a small group which belongs to a particular division. For

example, the administrative work team consists of the administrative officer, clerks,

and the support staff members. The work team of the nursing staff consists of the

matrons (Nursing Officers Special Grade I), nursing sisters (Nursing Officers Grade I),

nurses (Nursing Officers Grades II A and II B), midwives, and the support staff

members. Likewise, other divisions also have their own work teams. Each work team

forwards their quality-related problems (e.g. the tidiness, orderliness, and cleanliness

of the wards and offices) to the assembly meetings through their representatives. Theyalso engage in small group activities: the work improvement teams (WIT), quality

control circles (QCC), and suggestion systems (SS). This environment has facilitated

employees to enjoy their intergroup activities within the hospital. The management

and staff members like this team environment, because it gives them a chance to share

ideas, feelings, and emotions in relation to both their work life and family life.

Consequently, the employees have given more priority to achieve the objectives of the

hospital. Hence, according to the interview results (i.e. 71 percent of interviewee

Figure 3.Organizational chart of thehospital

Director

Senior

medical

officer

Nursing

sisters and

nurses

Administrative

officerAccountant

Clerical staff

(medical and

non-medical)

Clerks

(finance)

Chief

pharmacist

Midwives

Support staff

(medical and

non-medical)

Paramedical

staff

MatronsDoctors

Support staff

(paramedical)

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perception), low IND (i.e. high teamwork) was evidenced as the core culturalcharacteristic of the hospital.

Low MAS . The work force of the hospital consists of its director, administrativeofficer, accountant, senior medical officer, doctors, matrons, nursing sisters and nurses,

midwifery staff, chief pharmacist, paramedical staff, and other clerical and supportstaff members. The overall work force is reasonably represented by both male andfemale employees. The key job positions have also been reasonably distributed amongthe male and female staff members. Addressing this issue, the senior medical officerreplied that:

There is no difference between the male and female employees in the hospital, but they enjoyworking interactively and giving a better service to the patients.

The interaction between the male and female staff members was clearly seen when theyengaged in the small group activities. For example, both male and female memberscontributed interactively to continuous improvement through the WIT, QCC, and SS.The low MAS dimension accounted for 58 percent of the interviewee perception.

TQM practices of the hospital High SMC . The director has introduced a two-way communication system in whichboth top-down and bottom-up information flows are in effect. This two-waycommunication facilitates an open communication environment in which the vision,mission, goals, objectives, strategies, and quality policy of the hospital are wellcommunicated and deployed to the other divisions. For example, the director usuallydiscusses progress of the 5-S activities with the administrative officer. In addition tothis, he discusses the progress with the senior medical officer, doctors, matrons,nursing sisters and nurses, accountant, chief pharmacist, and other staff members atthe periodical meetings. Within this supportive communication environment, the

director has introduced the 5-S based TQM system which consists of the WIT, QCC,and SS. According to the interview results (91 percent of interviewee perception), thedirector’s commitment was evidenced as the core TQM practice of the hospital.

High SC . The staff members of each division obtain information about their worktargets from the respective heads. Further, they obtain new information about thecontinuous improvement programmes during their periodical meetings. The staff members forward their ideas and suggestions during the periodical meetings and whenthey engage in small group activities. There, the management becomes conversantwith the weak points of the day-to-day activities. The operational level staff membersusually provide such operational information to their heads. This provides the staff members a greater chance to become actively involved in the continuous improvementactivities.

High SF . The focus of the management to meet the expectations of the employeesand patients of the hospital is well expressed by its mission, goals, values, objectives,strategies, and quality policy. The divisional heads (i.e. the administrative officer,accountant, senior medical officer, matrons, and chief pharmacist) and their staff havebeen given reasonable freedom to participate in the decision-making process. This isachieved mainly through the small group activities in which staff members areempowered to come out with new ideas and suggestions. In addition to this, periodicalseminars, lectures, and training programs are conducted to develop staff skills.

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The hospital enhances its service responsiveness to patients mainly through thecommitted (the director’s commitment is at the core) and participative staff engaged incontinuous improvement activities.

High ICI . The ICI activities within the hospital is mainly done through inter-group

interactions. Initially, the small groups belonging to each division discuss what theyneed to improve in their divisions. Later, the suggestions are forwarded by eachdivisional head to the management meetings. The respective decisions taken in themanagement meetings are conveyed to the staff members by each divisional head.Thus, the Divisional Heads function as intermediaries of the continuous improvementactivities. In addition to this, the common meetings and notice boards also conveymessages to the staff members.

High QC . The director has initiated a continuous improvement orientedinfrastructure in the hospital by clearly defining its mission, goals, values, objectives,strategies, and quality policy. They are communicated to the operational level staff members through the divisional heads. However, the continuous improvement activitiesare carried out in small groups (i.e. WIT, QCC, and SS). Overall, this small group basedteamwork environment creates and maintains a QC that helps continuous improvement.

High MFB . The management evaluates service performance of the hospital usingsome service outcome rates. For this purpose, MMR, NMR, still birth rate, and perinatalmortality rate are determined and evaluated annually. The annual rates are comparedwith the historical, national, and global figures and possible variances are identified.The variances are discussed in the management and staff meetings and relevant actionis taken in order to continuously improve the service performance. For example, deathreviews and near death reviews are done in order to overcome the future deaths of thepatients.

High LO . The hospital practices Japanese 5-S based TQM activities as itsself-assessment techniques for continuous improvement. The TQM activities are

practiced through the small group activities: WIT, QCC, and SS. The small groupactivities and other staff development programs such as periodical meetings, seminars,lectures and staff training facilitate knowledge sharing and skills development of thestaff members. Overall, all these activities have created a strong learning culture in thehospital.

The effect of the culture of the hospital on its TQM practicesThe final results of the analysis suggested that each culture variable has positivelyimpacted on the respective TQM variables. For example, low UA has positivelyimpacted on high SMC, high SC, high SF, high MFB, and high LO. However, low INDhas positively impacted on all TQM variables conceptualized in the study. Hence,based on the OC and TQM conceptualization, it was suggested that overall, the

supportive culture of the hospital has positively impacted on its TQM practices.

FindingsAddressing the three research questions, the findings of the study are summarized asfollows. The adopted cultural dimensions (Hofstede, 1991) were evidenced with lowPD, low UA, low IND, and low MAS. They characterized the supportive culture of thehospital. However, low IND (i.e. high teamwork) was evidenced as the core culturalcharacteristic of the hospital.

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The adopted TQM variables based on the TQM literature (Deming, 1986; Juran,1995; Crosby, 1979; Feigenbaum, 1991; Ishikawa, 1985; Dale, 1994; Kroslid, 1999; Kayeand Anderson, 1998; Kaye and Dyason, 1995; Padhi, 2000) were evidenced with highSMC, high SC, high SF, high ICI, high QC, high MFB, and high LO. They characterized

TQM practices of the hospital. However, high SMC (i.e. high commitment of thedirector) was evidenced as the core TQM practice of the hospital.

Moreover, it was found that each cultural characteristic of the hospital haspositively impacted on its TQM practices. However, the low IND cultural characteristicof the hospital has positively impacted on all its TQM practices. Thus, overall, thesupportive culture of the hospital has positively impacted on its TQM practices.

Managerial implicationsThe present study found that the supportive culture of the hospital has positivelyimpacted on its TQM practices. In other words, the success of TQM practice of thehospital has been achieved through its supportive culture. Thus, the findings may beuseful to managers of the hospital so they could concentrate upon its supportiveculture in order to sustain the success of its TQM practice in the future. The findingsmay also be useful to public sector healthcare managers and administrators in SriLanka to successfully practice TQM within a supportive OC.

ConclusionsAt the beginning of the paper, it was mentioned that Sri Lankan organizations face aquality management challenge due their cultural and behavioural mismatch.Moreover, it was mentioned that the reforms and innovative programs introduced inpublic sector organizations in Sri Lanka are less compatible with the attitudes andskills of the employees.

However, the Sri Lankan public sector hospital under study has been practicing

Japanese 5-S based TQM activities successfully since 2000. Further, it has won severalnational quality awards for being more responsive to public demands through TQMimplementation. The present study based on its findings suggests that the qualitymanagement achievements of the hospital are mainly due to its supportive culturewhich has positively impacted on its TQM practices.

Thus, the findings of the present study reinterpret the previous research evidence(Nanayakkara, 1992; Samarathunga and Bennington, 2002).

Research limitationsThis study conceptualized the concept of OC adopting some Hofstedian culturaldimensions (Hofstede, 1991) with an “ideational” perspective in order to identify theeffect of OC on TQM practices. More specifically, the study conceptualized the culture

of the hospital adopting PD, UA, IND, and MAS variables in order to identify theireffect on TQM practices. Thus, to overcome the limitations of the OC frameworkadopted in the present study, the paper invites future studies to examine the issue froma broader and new culture perspective.

Originality/valueRecently, many organizations in Sri Lanka irrespective of their category and industryhave been practicing TQM in order to stay competitive in both domestic and

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international markets. But empirical studies on the topic are very limited in theSri Lankan context. This study performed as a case of a Sri Lankan public sectorhospital aims to fill that gap.

References

Crosby, P.B. (1979), Quality is Free: The Art of Making Quality Certain, McGraw-Hill,New York, NY.

Dale, B.G. (1994), Managing Quality, Prentice-Hall, London.

Deal, T.E. and Kennedy, A.A. (1982), Corporate Cultures, the Rights and Rituals of Corporate Life,Addison-Wesley, Reading, MA.

Deming, W.E. (1986), Out of the Crisis, Cambridge University Press, Cambridge.

Feigenbaum, A.V. (1991), Total Quality Control , McGraw-Hill, New York, NY.

Glaser, B.G. and Strauss, A.L. (1967), The Discovery of Grounded Theory, Strategies for Qualitative Research, Aldine, Chicago, IL.

Handy, C.B. (1985), Understanding Organizations, Penguin Books, New York, NY.

Hofstede, G. (1991), Cultures and Organizations, Software of the Mind , McGraw-Hill, London.

Ishikawa, K. (1985), What is Total Quality Control, the Japanese Way, Prentice-Hall, EnglewoodCliffs, NJ.

Johnson, G. (1988), “Rethinking incrementalism”, Strategic Management Journal , Vol. 9 No. 1,pp. 75-91.

Juran, J.M. (1995), The History of Managing for Quality, the Evolution Trends and Future Directions of Managing for Quality, Quality Press, Milwaukee, WI.

Kaye, M. and Anderson, R. (1998), “Continuous improvements: the ten essential criteria”, International Journal of Quality & Reliability Management , Vol. 16 No. 5, pp. 485-506.

Kaye, M.M. and Dyason, M.D. (1995), “The fifth era”, The TQM Magazine, Vol. 7 No. 1, pp. 33-7.

Kroslid, D. (1999), In Search of Quality Management-Rethinking and Reinterpreting , Institute of Technology, Linkoping University, Linkoping.

Lagrosen, S. (2002), “Quality management in Europe: a cultural perspective”, The TQM Magazine, Vol. 14 No. 5, pp. 275-83.

Nanayakkara, G. (1992), Can Sri Lankans Take the Quality Challenge? A Cultural Analysis,Postgraduate Institute of Management, Colombo.

Padhi, N. (2000), “The eight elements of TQM”, available at: www.isixsigma.com/library/content/c021230a.asp

Peters, T.J. and Waterman, R.H. (1982), In Search of Excellence, Lessons from America’s Best RunCompanies, Harper & Row, New York, NY.

Robbins, S.P. (2005), Organizational Behavior , Prentice-Hall, New Delhi.

Samarathunga, R. and Bennington, L. (2002), “New public management: challenge for Sri Lanka”, Asian Journal of Public Administration, Vol. 24 No. 1, pp. 87-109.

Schein, E. (1985), Organizational Culture and Leadership, Josses-Bass, San Francisco, CA.

Silverman, D. (2000), Doing Qualitative Research: A Practical Hand Book, Sage, London.

Stahl, M.J. and Grigsby, D.W. (1997), Strategic Management, Total Quality and Global Competition, Blackwell, Cambridge, MA.

Tayeb, M.H. (1988), Organizations and National Culture: A Comparative Analysis , Sage, London.

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About the authorK.A.S.P. Kaluarachchi obtained his Bachelor of Commerce (special) degree (with a second classupper division pass) from the Faculty of Management Studies and Commerce, University of Sri Jayewardenepura, Sri Lanka in 1998. In 2004, he obtained his Master of Business

Administration degree from the Faculty of Graduate Studies, University of Colombo, Sri Lanka.He is a member of the Association of Accounting Technicians of Sri Lanka and a licentiatemember of the Institute of Chartered Accountants of Sri Lanka. He has worked as a marketingmanager at the Direct Marketing International (Pvt) Ltd in Sri Lanka and as an accounts traineeat the KPMG Ford, Rhodes, Thornton and Co. in Sri Lanka. Presently, he works as a Lecturer atthe Faculty of Management and Finance, University of Colombo, Sri Lanka (on study leave) anda PhD candidate at the Graduate School of Business Administration, Hosei University, Japan. Hehas written and published several text books and research papers in relation to the field of management and organizational studies prior to this paper. His specific research interests belongto OC, OC and managerial behaviour, and OC and TQM practices. K.A.S.P. Kaluarachchi can becontacted at: [email protected]

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