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Archives of Business Research – Vol. 9, No. 7
Publication Date: July 25, 2021
DOI:10.14738/abr.97.9847. Pondaag, J. J., Kindangen, P., Tawas, H. N., & Sumarauw, J. S. B. (2021). Implementation of Total Quality Management: The Effect
on Patient Safety Culture, Service Quality, and its Impact on Patient Satisfaction and Private Hospital Performance in Manado City.
Archives of Business Research, 9(7). 44-58.
Services for Science and Education – United Kingdom
Implementation of Total Quality Management: The Effect on
Patient Safety Culture, Service Quality, and its Impact on Patient
Satisfaction and Private Hospital Performance in Manado City
Jessy Jousina Pondaag
Sam Ratulangi University, Faculty of Economics and Business
Management Department, Management Science Doctoral Program
95115 Manado, North Sulawesi, Indonesia
Paulus Kindangen
Sam Ratulangi University, Faculty of Economics and Business
Management Department, Management Science Doctoral Program
95115 Manado, North Sulawesi, Indonesia
Hendra Novi Tawas
Sam Ratulangi University, Faculty of Economics and Business
Management Department, Management Science Doctoral Program
95115 Manado, North Sulawesi, Indonesia
Jacky Sigfried Beatrix Sumarauw
Sam Ratulangi University, Faculty of Economics and Business
Management Department, Management Science Doctoral Program
95115 Manado, North Sulawesi, Indonesia
ABSTRACT
The purpose of this research is to determine the effect of implementation of Total
Quality Management (TQM) on patient safety culture, service quality, patient
satisfaction, and hospital performance. This research conducted in private
hospitals in Manado City which are: GMIM Pancaran Kasih Hospital, Advent
Hospital, Sitti Maryam Hospital, and Siloam Hospital. The research approach used
in this research is quantitative approach. The population in this research is the
inpatients. Data collection technique conducted by questionnaires, documentation
and observation. The sampling technique used in this research is saturated
sampling (census). Data analysis conducted by using path analysis with the using
SPSS ver. 25. The result of this research shows that the implementation of Total
Quality Management impacted positively significantly on patient safety culture, the
implementation of Total Quality Management impacted positively significantly on
hospital service quality, the implementation of Total Quality Management impacted
insignificantly on patient satisfaction, the implementation of Total Quality
Management impacted positively significantly on hospital performance, Patient
Safety Culture impacted positively significantly on patient satisfaction, Patient
Safety Culture impacted positively significantly on hospital performance, Service
Quality impacted positively significantly on hospital performance, Hospital
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Pondaag, J. J., Kindangen, P., Tawas, H. N., & Sumarauw, J. S. B. (2021). Implementation of Total Quality Management: The Effect on Patient Safety
Culture, Service Quality, and its Impact on Patient Satisfaction and Private Hospital Performance in Manado City. Archives of Business Research, 9(7).
44-58.
URL: http://dx.doi.org/10.14738/abr.97.9847
Performance impacted positively significantly on hospital performance, and
Patient Satisfaction impacted positively significantly on hospital performance.
Keywords: total quality management, patient safety culture, service quality, patient
satisfaction, hospital porformance, organizational performance.
INTRODUCTION
The Background of Research Problem
In this industrial revolution 4.0, every sector entering an era of change and massive
competition. Industrial revolution 4.0 pushes technological innovations and service that
provide disruption effect or fundamental change to social life. This condition creates challenge
for industrial world even for hospital. Resulted from this industrial revolution 4.0, there is a
fierce competition in hospital industry, that then push hospital management to make changes
and innovations in every field in responding to the demands and needs of consumer and/or
patients. This condition encourages the owner or hospital management especially private
hospital to manage their hospital well, noticing the service efficiency and effectiveness that
focusing on service quality that safe for every patient. If this isn’t happened, hospital will be
disrupted with any changes. This is the reason why hospital needs to reduce any error or fail
level in provide their service to the patient so that the hospital can be reference hospital in
health service or personal recovery.
Hospital is a service provider that has an important role in social life especially in health sector.
As a place that has complexity such as pharmaceuticals, hundred of tests, and procedures, a lot
of equipment and technology, also a lot of jobs in services for 24 hours everyday, make hospital
should be manage well so it won’t cause any adverse events that threatening the safety of
patients (DepKes, 2008).
Furthermore, as stated in Undang-Undang 23 Tahun 1992 about health, it is explained that
health service is a citizen right available that given with quality, affordable for every citizen. So,
it is important for the government in this case the Health Department as the official holder in
handling health problem in Indonesia, as well as hospital management, to be cautious with the
needs and wants, and also the expectation from the citizen who wants a good service.
In Indonesia, the growth of hospital based on the data until April 2018 shows in the Picture 1.1
as follows:
Picture 1.1 Hospital Growth in Indonesia until April 2018
Source:http://sirs.yankes.kemkes.go.id/rsonline/report/
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Archives of Business Research (ABR) Vol. 9, Issue 7, July-2021
Services for Science and Education – United Kingdom
LITERATURE REVIEW
Literature Review
This section explaining about the concept and theories underlying this research, which are:
Organizational Performance as the grand theory, Hospital Performance as the applied theory,
Quality Theory as the middle theory, Total Quality Management, Service Quality, Patient Safety
Culture, and Consumer (Patient) Satisfaction, as the applied theory as well as the related
previous research as the references.
Organizational Performance
Based on Gavrea et al. (2012) there is no universally accepted defition of organizational
performance. There are several ideas describing the concept of organizational performance,
such as: 1) Performance is a financial and non-financial device that provide information on
whether the purpose and the result met. 2) Performance is a dynamic, it is needed to have a
judgment and interpretation, 3) Performance is illustrated by using a quality model that explain
how an action affecting the future result, 4) Performance understood in several different way
depending on the person involved in organizational performance appraisal, 5) Concept of work
needs the knowledge on the characteristics of every elements in every accountability, 6) For
the report of organizational performance level, it is needed to have the ability to quantify the
result.
Definition of Hospital
Hospital is a form of organization providing invididual health service in general. Inside its
organization there is a lot of activities, that conducted by the officer from a lot of type of
profession, whether medical profession, paramedic or non-medic. Based on Permenkes No. 147
Tahun 2010 on hospital licensing that: Hospital is an institution of health services provider that
conducting individual health service plenary that provide inpatient service, outpatient service,
and emergencies.
Quality Theory
Quality is defined varies from the conventional way up to the more strategic point of view. The
conventional definition of quality usually depicting a direct characteristic of certain product
such as: performance, reliability, ease of use, esthetic, and so on. The strategic definition of
quality based on Gasperz (2005) is anything that is able in meeting the wants and needs of
customers.
Total Quality Management
There is a lot of definition of TQM, but each one of the experts have their own ideas in
formulating the definition of TQM. According to Tjiptono and Anastasia (2003), “TQM is an
approach in performing effort in order to maximize the organizational competitiveness by
continuous improvement on product, service, people, processes, and its
environment”.According to Gaspersz (2011), “TQM define as a way of continuous performance
improvement on every level of operation or process, in every functional area of organization,
by using every human resource and capital available”. On the other hand, Purnama (2006)
stated,” TQM is a structural system with a set of equipment, technique, and philosophy designed
to create organizational behavior focusing on consumer, involve the employee actively, and
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Pondaag, J. J., Kindangen, P., Tawas, H. N., & Sumarauw, J. S. B. (2021). Implementation of Total Quality Management: The Effect on Patient Safety
Culture, Service Quality, and its Impact on Patient Satisfaction and Private Hospital Performance in Manado City. Archives of Business Research, 9(7).
44-58.
URL: http://dx.doi.org/10.14738/abr.97.9847
continuous quality improvement in order to appropriately suit consumer needs (Nursya’bani
Purnama, 2006).
Quality Management, Global Perspective, First Edition, Ekonisia Fakultas Ekonomi, stated “TQM
is a managerial innovation that emphasizing on the total organizational commitment to the
consumer and continuously improve their quality on every process using problem-solving
approach, stirred by data, based on group empowerment and employee’s teams.
Service Quality
According to Tjiptono and Chandra (2011), the concept of quality determined as the level of
perfection of product or service that consist of design quality and conformance quality. Design
quality is a specific function of a product or service, conformance quality is a measurement on
how much the level of conformity between a product or service with the requirement or
specification quality set. That’s why quality is a condition in which several factors met the
consumer needs as stated by Goetsh and Davis in Tjiptono and Chandra (2011) considering the
quality, which is,” The dynamic condition related to product, service, human resource, process,
and environment that met or exceed the expectation”.
Patient Satisfaction
The word satisfaction comes from Latin “satis” which means good or suffice and “facio” which
means do or create. Satisfaction can be defined as “An effort to fulfill something” or “make
something sufficient”. According to Kotler cited by Tjiptono and Chandra (2011), consumer
satisfaction is a level of personal perception after comparing the performance or result to the
perceived expectation.
RESEARCH METHOD
This chapter explaining the steps that will be conducted in analyzing the model developed in
the previous chapter. These steps that will be explained are as follows: research design,
research location, population and sample, type and source of data, data collection method, data
analyzing technique, and variable and its measurements.
Research Design
This research uses quantitative approach with associative research as the level of explanation,
which is a research that explaining the influence between variables in research model.
Research Location
The location of this research is every general hospital with private ownership (non
government-owned) in Manado City which are: Pancaran Kasih Hospital, Advent Manado
Hospital, Sitti Maryam Hospital, Siloam Hospital Manado.
Population and Sample
Population
Population is generalization area consist of object and subject that are becoming the quantity
and certain characteristics set by the researcher to be studied and then concluded (Sugiyono,
2016). The population in this research is inpatient in every private-owned hospital in Pancaran
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Pondaag, J. J., Kindangen, P., Tawas, H. N., & Sumarauw, J. S. B. (2021). Implementation of Total Quality Management: The Effect on Patient Safety
Culture, Service Quality, and its Impact on Patient Satisfaction and Private Hospital Performance in Manado City. Archives of Business Research, 9(7).
44-58.
URL: http://dx.doi.org/10.14738/abr.97.9847
Hospital is a health facility that play an important role in giving health service to every party
needed such as patients, citizens, social organization, health service profession, health
department, and local government. Providing health service in hospital always closely relate to
health facility, where a comprehensive health service required a comprehensive facility. In
making sure the availability of health service to citizen, a nation makes national health system
by noticing comprehensive quality management and a good service quality to that the citizens
can fulfill the appropriate service.
Ahmad, M. (2011) in his research stated that in order to improve the service quality of general
hospital, the management should make an effort to create and synergize the TQM in hospital
based on the available equipment and medical tools that supported by a good medical officer.
TQM is already considered as a strategic and operational tool to get competitive advantage.
Based on Kozak et al., (2007) TQM can help to overcome any changes like technological
advancement and medical system information, service system, health plan, partnership,
alliance, and a better patient understanding regarding to service quality. The availability of
good TQM will increase the hospital service quality. The importance of service quality reviewed
from the operational management point of view can be an important policy in improving
competitiveness in providing an equal or more than the expectation level of customer needs.
The Influence of Implementation of Total Quality Management on Patient Satisfaction
The result of this research shows that the implementation of TQM in private-owned hospital in
Manado not significantly influence on patient satisfaction. This means that patient satisfaction
in private-owned hospital in Manado obtained not by the implementation of TQM conducted.
This result is different from the research conducted by Mulyadi et. al. (2013), but in line with
the research from Mahmud et. al. (2019).
This result indicated that the implementation of TQM in private-owned hospital in Manado
from the point of view of patient, must be improve to be better. In the past, the fuction of
hospital is just to treat the sick people, but as it develops, nowadays the hospital has become
the health center. Hospital is an organization in which the professional medical officer
organized as well as a permanent medical equipment conducting doctoral service, continuous
nursing care, diagnostics and disease treatment for patient. Hospital became the pedestal of
medical references, especially in treatment problem and individual health recovery. To increase
the equalization of equipment and infrastructure of health service to be appropriate with the
citizen needs, it is important to understand consumer wants and need, in this case the patient,
is the important thing that influence patient satisfaction. A satisfy patient is an important asset
because a satisfy patient will continuously use the suitable service, on the other hand, patient
who’s not satisfy will tell other people about the negative experience twice more than what
actually happened.
To create patient satisfaction, hospital must create and manage a system to obtain more patient
as well as their own ability to keep the patient. Consumer or patient usually will evaluate
thouroughly on every service they receive not only in a matter of service, to say if they are
satisfied or not satisfied. Hospital must continuously improve its quality with focusing on
patient satisfaction by paying attention on what suggested by patient.