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Introduction
Healthcare managers are forced to review their organisational practices to improve quality and productivity. Total Quality Management (TQM), as an organisational strategy, enhances organisational performance by providing high-quality products and services through team work, customer-driven quality and continuously improving inputs and processes (Mosadeghrad, 2006). TQM's success in manufacturing industry has encouraged many healthcare managers to examine whether it can also work in the health sector. Consequently, in the last 30 years, many healthcare organisations implemented TQM to improve service quality and efficiency. Healthcare organisations with mechanistic structure, functional designs, centralised decision making, rigid bureaucracies, strict rules, narrowly defined tasks, chain-of-command orientation and top-down communication are complicated, which may constrain TQM. In reality, several healthcare organisations have fallen short in implementing TQM programmes. Researchers mostly evaluated TQM success in healthcare organisations at a medium or low level (Buciuniene et al., 2006; Huq and Martin, 2000; Lee et al., 2002; Theodorakioglou and Tsiotras, 2000). Bureaucratic and hierarchical structure, professional autonomy, poor leadership, employee resistance to TQM implementation, inappropriate organisational culture, insufficient training and inadequate resources were the major health-sector TQM obstacles (Mosadeghrad, 2013). A TQM model has two components: values and principles (i.e. management support, employee involvement and team working) and techniques and tools (e.g. statistical process control). These are TQM's soft and hard dimensions. There is no consensus among TQM gurus, researchers and consultants about TQM basic principles and critical success factors (CSFs). Various quality gurus included different principles, practices and CSFs in their TQM models. Consequently, managers are confused where to start and what is required to implement TQM.
Aims
This study aims to fill this gap by developing a theoretically sound TQM model by identifying TQM CSFs. Understanding the factors that facilitate TQM implementation enables managers to develop more effective strategies for institutionalising TQM's principles.
Method
A systematic review of health sector TQM CSF studies was undertaken. Ten electronic databases were searched, including PubMed, Directory of Open Access Journals, Ebsco research databases, Elsevier science, Emerald, JSTOR, ScienceDirect, Social Science Citation Index, Social Science Research Network and Web of Knowledge. Keywords included “Total Quality Management”, “implementation”, “critical success factors” and “healthcare sector”. Selection was restricted to: those written in English; published between 1980 and 2012; examined healthcare TQM implementation; using an empirical...