Determinants of quality management systems implementation in hospitals.
OBJECTIVE
To identify the problems and facilitating factors in the implementation of quality management system (QMS) in hospitals through a systematic review.


METHODS
A search strategy was performed on the Medline database for articles written in English published between 1992 and early 2006. Using the thesaurus terms 'Total Quality Management' and 'Quality Assurance Health Care', combined with the term 'hospital' and 'implement*', we identified 533 publications. The screening process was based on empirical articles describing organization-wide QMS implementation. Fourteen empirical articles fulfilled the inclusion criteria and were reviewed in this paper.


RESULTS
An organization culture emphasizing standards and values associated with affiliation, teamwork and innovation, assumption of change and risk taking, play as the key success factor in QMS implementation. This culture needs to be supported by sufficient technical competence to apply a scientific problem-solving approach. A clear distribution of QMS function within the organizational structure is more important than establishing a formal quality structure. In addition to management leadership, physician involvement also plays an important role in implementing QMS.


CONCLUSIONS
Six supporting and limiting factors determining QMS implementation are identified in this review. These are the organization culture, design, leadership for quality, physician involvement, quality structure and technical competence.
Wardhani
Viera
V
Department of Public Health, Faculty of Medicine, University of Brawijaya, Malang, Indonesia.
Utarini
Adi
A
van Dijk
Jitse Pieter
JP
Post
Doeke
D
Groothoff
Johan Willem
JW