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Introduction
Healthcare organisations face a number of serious challenges, particularly concerning effectiveness, efficiency and quality. Therefore, there is a pressing need for a new approach in managing healthcare organisations to become more cost-effective in the delivery of high quality healthcare services. Quality management constitutes an appropriate response to these challenges. It is a potential way to improve systems and procedures as effectively as possible by using scientific methods to achieve an optimum outcome. Total quality management as a quality management strategy aims to enhance customer satisfaction and subsequently organisational performance by providing high quality products and services through the participation and collaboration of all stakeholders, teamwork, customer driven quality and continuously improving the performance of inputs and processes by applying quality management techniques and tools.
Total quality management (TQM) became one of the competitive strategies of choice during the 1990s. It has been widely implemented in various firms throughout the world for achieving greater profitability ([85] Mosadeghrad, 2005). There is a widespread consensus that a successful TQM implementation is related to economic and performance success ([18] Brah et al. , 2002; [44] Hansson and Eriksson, 2002; [50] Hendricks and Singhal, 2001; and [66] Kaynak, 2003). The success of TQM in industry has encouraged many healthcare managers to examine whether it works in the healthcare sector. As a result, in the last 30 years, many healthcare organisations increasingly adopted the TQM principles to improve the quality of outcomes and efficiency of healthcare services delivery. An effective TQM implementation enables healthcare organisations to identify clients' requirements to deliver appropriate care, benchmark for best practices and improve processes to reduce the frequency and severity of medical errors. These activities lead tohigh quality healthcare services, patient satisfaction, and increased productivity and profitability ([5] Alexander et al. , 2006; [76] Macinati, 2008).
Nevertheless, the application of TQM in practice involves many difficulties. Many healthcare organisations have found difficulties in implementing TQM successfully ([20] Bringelson and Basappa, 1998; [36] Ennis and Harrington, 1999; [53] Huq and Martin, 2000; [139] Zabada et al. , 1998). Although some quality improvement projects were successful ([25] Chattopadhyay and Szydlowski, 1999; [39] Francois et al. , 2003; [55] Jackson, 2001; [69] Klein et al. , 1998; [91] Motwani et al. , 1996), most of these...