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Introduction
Improving the quality and safety of health services represents a major challenge in low- and middle-income countries (Harrison et al., 2015) where the exact magnitude of unsafe healthcare practices remains unclear. Wilson has reported that the rates of preventable harm and death are increasing, causing alarm amongst policy makers and healthcare providers (Wilson et al., 2012; World Health Organization, 2012). In response, many quality improvement (QI) initiatives have appeared in the health sectors of low- and middle-income countries in order to train healthcare providers in various QI approaches (Heiby, 2014; Aveling et al., 2015). Despite such efforts, quality and safety in healthcare remains a major challenge (World Health Organization, 2016).
Many studies have sought to understand this challenge, and some research has underscored the difficulty of creating a high-quality and safety culture among healthcare providers. Meanwhile, there is a dearth of research and information regarding quality and safety, a situation that is delaying the progress of interventions. Health facilities also face insufficient dissemination and sustainability of QI programs (World Health Organization, 2012; Elmontsri et al., 2017). Finally, some studies indicate that the shortage of health resources is a major factor affecting health workers’ performance as well as the quality and safety of health services (Mosadeghrad, 2014; Rowe et al., 2005).
In view of the above circumstances, QI approaches have shifted away from quality control (QC) or quality assurance to total quality management (TQM). Introduced into the health service industry in the late 1990s, this model seeks to improve productivity and to increase effectiveness, thus utilizing health resources to the fullest in order to achieve high quality medical services and patient safety. TQM activities currently are being implemented in many health care facilities in Asia, Europe and the USA (Chakravarty et al., 2001; Balasubramanian, 2016).
Background to the 5S-KAIZEN-TQM approach
Conceptually, TQM appears often in the health sector with some literature emphasizing the strong relationship between the TQM and KAIZEN approaches (Saleem et al., 2012; Janjić et al., 2018; Rouf et al., 2017). For instance, Andersson’s study concluded that lean management could be used to enhance the value of TQM (Anderson et al., 2006), while Saleem et al. (2012) concluded that KAIZEN is a...