Implementation of TQM in Healthcare Laboratory Services: Shifting from Compliance Towards a Systems Quality Improvement Approach

Owino, Benard (2023) Implementation of TQM in Healthcare Laboratory Services: Shifting from Compliance Towards a Systems Quality Improvement Approach. Doctor of Business Administration thesis, University of Liverpool.

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Abstract

This thesis explores quality improvement (QI) by providing insights into real-world laboratory problems and then suggests temporal and contextual change interventions. The laboratory under study plays a significant role in public health by providing data for use at the national, regional, and global levels. This role notwithstanding, the stakeholder and regulatory authorities cast doubt on laboratory service quality, prompting QI efforts. This multi-method qualitative research combines grounded theory and ethnography and employs critical realism and social constructivism philosophical approaches. The study utilizes participatory action research (PAR) models in interactive problem identification, action planning, implementation, and evaluation. I address the specific research objectives (1) build a contextualized evidence-based integrated framework for laboratory systems quality improvement; (2) understand macro-processes for institutionalizing quality improvement and (3) explore the role of knowledge management within a research community in the realization of Total Quality Management (TQM). This research addresses the question: What exists between TQM knowledge and implementation in a real context of action? The study involved eleven participants identified through purposive and convenience sampling. Participants completed two cycles of extensive actions in the specific laboratory setting for 21 months. The research cycle, iterative in design, takes an inductive-subjective-contextual approach. It yields researcher mindset paradigmatic shifts, drawing on pragmatist accounts and reflexivity. I locate manifestation of institutional change in institutional entrepreneurship as laboratory practitioners leverage actions, extending value for the patients and the stakeholders, following improved work and knowledge-sharing practices. The findings suggest the permeability of quality frameworks to social interaction, enabling practitioners to conceptualize what works in temporal settings. As social entrepreneurs, participants decide modalities for staging, framing, and propagating change. Participant connections to intersubjective realities, innovative engagement, and collaborative inquiry provide legitimacy in the process. Finally, I reflect on my experiences in conducting an empirical qualitative study from scholarship and practice contexts.

Item Type:	Thesis (Doctor of Business Administration)
Divisions:	Faculty of Humanities and Social Sciences > School of Management
Depositing User:	Symplectic Admin
Date Deposited:	30 Jan 2024 14:09
Last Modified:	30 Jan 2024 14:09
DOI:	10.17638/03173570
Supervisors:	Borah, Dhruba
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3173570