Assessing the implementation of total quality management in the Palestinian healthcare sector : Lessons and recommendations for the future development of the Palestinian quality improvement effort.

The characteristics of the Palestinian Healthcare sector has led to a poor quality of care being provided which in turn pushed the Ministry of Heath (MOH) to initiate the Quality Improvement Project ( QIP ). That project was held responsible for improving the quality of healthcare provided through implementing Total Quality Management. This study assesses the process of TQM implementation in the Palestinian Healthcare sector. The central thrust of this study involves the identification of: The main pitfalls and obstacles to TQM which impede its implementation. The process of TQM implementation in the Palestinian healthcare sector. The main driving and restraining forces while implementing Total Quality Management in the Palestinian healthcare sector. The main lessons and recommendations for the future development of quality improvement. Case study methodology will be used in this thesis as it is unique in its ability to deal with a full variety of evidence through the use of documents, interviews and observations. The data that will be produced cannot be generalised. To overcome this disadvantage in the case study approach, a multi- method approach will be used in this thesis. A postal questionnaire survey, as part of the evaluation study, will be also used. The use of multiple cases and questionnaire surveys will justify the validity and reliability of the data .The multimethod approach in collecting the data in this thesis shows that the Quality Improvement Project (QIP) was not methodology - bound when implementing TQM. In the first cycle of improvement, the PDCA cycle was used as a model for implementation. In the second cycle of improvement, the Tom Noland model was used as basis for implementation. In seeking to improve the quality ofhealthcare, the QIP utilised no single scientific methodology for the improvement of the quality of healthcare but combination of more than one methodology that could assist in achieving the best results possible.The thesis also shows that the Quality Improvement Project Team (QIPT) dealt with many driving forces during their attempts to implement quality improvement such as team work, planning, a well defined and a scientific methodology, the use of a simple quality improvement model, a new management system, enthusiasm of the team leaders for quality improvement, and strong coordination. Furthermore, the QIPT faced many obstacles during implementing quality improvement such as the turbulent external environment, internal problems and difficulties inside the subject organisations, lack of monitoring and follow - up systems, resistant to change, centralisation, poor communication, and the dissatisfaction of health personnel. The QIPT learnt many lessons and drew many conclusions from their efforts to implement quality management in the Palestinian healthcare sector; such as the importance of the commitment of macro level managers to quality improvement. Quality improvement in Palestine is possible and has the potential to be successfully introduced into the current professional and technical internal environment. Consumer (internal & external) views about the health services is very important to consider when seeking any improvement in the health sector, and of maintaining a cintinous pattern of consolidation for the gains made in quality provision. In particular, there is a need to note the importance of conducting improvement processes within the selected organisations in response to the annual improvement needs plan within those organisations, of meeting the demand of the MOH and the importance of providing the financial and staff support that quality improvementprocesses needed if they are to be brought to a successful conclusion are recognised and recommendations offered.