The first goal of this investigation was to undertake a non-equivalent quasi-experimental design to test the effect of a total Quality management (TQM) approach to improve the appropriateness of clinical laboratory test utilisation in the management of early acute myocardial infarction (AMI). The study was conducted at 2 public hospitals in Sydney over a 30 month period, and in 2 stages- pre and post TQM intervention. Using specifically a Continuous Quality Improvement (CQI) FOCUS-PDCA model, a multidisciplinary team was empowered to make appropriate changes in order to improve a variety of problem areas that affected the total pathology service. Improvement was directed at the total system of pathology testing, not just test ordering. It was observed that the introduction of a TQM environment had provided a more committed, integrated and motivated clinical care effort towards improving the appropriateness of test ordering. Such team efforts were accompanied by demonstrated customer satisfaction at various aspects of the laboratory service and further benefits to patient care. Patient care benefited greatly from the highly significant changes towards more appropriate timing of blood collections for cardiac enzyme testing. Other improvements included overall improvements to the turnaround time of test results, reductions in specimen delivery delays, more appropriate use of clinical laboratory tests, a streamlined distribution of printed reports and marked improvements in communication between staff involved in the process of test ordering. Of major importance was the finding that CQI strategies resulted in substantial savings of 23.0% of the overall cost of pathology services. Adoption of the TQM approach appears to be a strategy worthy of exploration by laboratory directors and health administrators interested in improving patient care while at the same time reducing expenditure. / Doctor of Philosophy (PhD)

This Doctoral thesis has arisen from a developing interest in the synergy between leadership, culture and ethos in schools, and particularly how this is manifested in the generation of quality curriculum, effective school organization and excellent outcomes for students. It particularly explores how the leadership of the Principal can empower others to effect change. Early interest in the empowering role of leadership arose through experience at Head of Department level, extended by system contribution beyond the school. The conception of the interface between leadership, culture and ethos was cemented by appointment as Foundation Principal of a new Government high school. A passionate commitment to exploring the unique opportunities, and to attempting to resolve the very specific problems of a new school led to collaboration with other Foundation Principals. Subsequently, I undertook a review of the literature and research into the specific issues inherent in the establishment of a school. Data was collected in situ through visits to new schools, across four States in eastern Australia. This research led to positions of system leadership in new schooling, and to advocacy for a “new deal” for establishing schools. The research led to a growing portfolio of articles, two of which have been published in refereed journals. The desired outcome of the research and published papers was to document some initiatives which could be undertaken by leadership teams in schools as they sought to establish effective culture and ethos in the early years of their schools. My experience in schools identified the position of Head of Department as a critical, gatekeeping position for the cultivation or resistance of desired change in schools. Accordingly, I was part of a research study which employed a Grounded Theory methodology (Strauss and Corbin, 1990) and gathered data through telephone interviews. The research found Heads of Department typically distracted, by the sheer weight of tasks endemic to their role, from the major focus on curriculum and quality teaching and learning. Three refereed journal articles to which I contributed, one as lead author, sought to reconceptualise the role. Educational systems have shown considerable interest in this research. A focus on Heads of Department led fairly naturally to an attempt to identifying other agencies within a school which could lead to cultural change. Specifically, further research sought to identify initiatives available to the leadership team as it sought to enhance curriculum provision and student outcomes. This represented an attempt to apply the very considerable literature to develop some cutting edge initiatives, and led to further journal contributions, one of which was refereed. Other schools have shown considerable interest in these initiatives. A change of situation from the Government to the Independent schooling system provided a new practical and research challenge: how to undertake Christian education which was authentic, in the sense that it was truly educative and not indoctrinative, and was effective in transmitting Christian values. The literature in the field was not encouraging in terms of the efficacy of schools’ Christian education programs in effecting values change, or of the ethical integrity of their pedagogy. The apparent deficits in models of Christian education presented in schools, as revealed in the literature, gave rise to a number of research studies in my own school, which, as an outcome, has sought to reconceptualise the school’s approach to Christian education. This attempted reconceptualisation has been documented in a number of journal articles and publications, two co-authored and refereed, in an attempt to provide some exemplars which may be influential in other schools. The overall thesis of this dissertation is that when the Principal seeks to empower and mobilize other members of the school leadership team, including key teachers and parents, effective change can occur in the school’s culture and ethos. These changes in turn can feature a range of initiatives which substantially improve learning outcomes for students. / Doctor of Education (Ed.D)

The first goal of this investigation was to undertake a non-equivalent quasi-experimental design to test the effect of a total Quality management (TQM) approach to improve the appropriateness of clinical laboratory test utilisation in the management of early acute myocardial infarction (AMI). The study was conducted at 2 public hospitals in Sydney over a 30 month period, and in 2 stages- pre and post TQM intervention. Using specifically a Continuous Quality Improvement (CQI) FOCUS-PDCA model, a multidisciplinary team was empowered to make appropriate changes in order to improve a variety of problem areas that affected the total pathology service. Improvement was directed at the total system of pathology testing, not just test ordering. It was observed that the introduction of a TQM environment had provided a more committed, integrated and motivated clinical care effort towards improving the appropriateness of test ordering. Such team efforts were accompanied by demonstrated customer satisfaction at various aspects of the laboratory service and further benefits to patient care. Patient care benefited greatly from the highly significant changes towards more appropriate timing of blood collections for cardiac enzyme testing. Other improvements included overall improvements to the turnaround time of test results, reductions in specimen delivery delays, more appropriate use of clinical laboratory tests, a streamlined distribution of printed reports and marked improvements in communication between staff involved in the process of test ordering. Of major importance was the finding that CQI strategies resulted in substantial savings of 23.0% of the overall cost of pathology services. Adoption of the TQM approach appears to be a strategy worthy of exploration by laboratory directors and health administrators interested in improving patient care while at the same time reducing expenditure. / Doctor of Philosophy (PhD)

During the past decade, nurses in the clinical setting have began making a paradigm shift from Quality Assurance to Total Quality Management, or as it is commonly referred to within health care facililties, Continuous Quality Improvement.In contrast, scant attention has been paid to quality management practices in nursing in the higher education sector. This study provides an applied example of where it investigates quality management practices in the context of organisational culture and human resource management with the aim of developing a quality culture model for a school of nursing in higher education.The research study that was conducted produced several major findings from the views of nurse academics who participated in it. Several issues associated with nurse academics' opinions of quality management practices utilised in schools of nursing have been unravelled.The fundamental issue is that procedures and policies formulated for nurses in the hospital setting do not serve the needs of nursing education.The most crucial factor to be considered in policy developments and future research is that it needs to be contextualised in the culture of nursing in higher education.It has become imperative that a transparent quality culture reflects contemporary nursing in Australia and the proposed model in this thesis provides nurses with an opportunity to shape a quality system for the nursing profession. / Doctor of Philosophy (PhD)

Background: Many innovative ideas have been proposed to manage and improve the quality and cost of clinical care. For many innovations, like Total Quality Management (TQM), the &quotblack box&quot of implementation process is not well understood. Empirical work on the process of innovation implementation in health care is limited. Objective: This study was designed to explore how one organisation, Intermountain Health Care (IHC), an acute and primary health care provider in the USA, innovates in implementing TQM organisation-wide to improve and manage clinical quality. More broadly, the study aims to identify factors that contribute to innovation implementation in health care for clinical quality improvement, and to generate a model of innovation implementation in health care for clinical quality improvement. Method: This thesis takes a case study approach using multiple research methods. The main methods used comprise interviews with key personnel, assessment of organisational documents and a survey of clinicians' and managers' attitudes and beliefs. Findings: The main finding of the research is that innovation implementation at IHC was a journey, not a destination. Embedded in the journey were five periods and many actions and interactions, grouped into eleven elements. The five periods were: exposing to an innovative idea, embracing the idea, extending knowledge and experience on the idea, emerging of strategies to implement the idea organisation-wide, and enacting and adapting the strategies. The eleven elements were: gestation, shocks, plan, proliferation, fluid participation, setbacks, criteria shift, top executive involvement, relationships and infrastructure building, and adoption. To implement TQM organization-wide, integrated structures and systems were being instituted. The study found that resistance to change came from not only some physicians but also hospital administrators. The study also found that supportive environments played a critical role in the journey. While the TQM implementation at IHC resulted in some cost savings and some behavioural changes including clinical practice change, cultural change at the level of values and beliefs had yet to occur. Conclusion: A process-oriented integrative model of clinical service management is proposed. The elements of an innovation, the temporal change processes, lead to formation and changes of the ongoing organisational processes, which in turn evaluate and improve the important clinical processes. These processes integrate TQM with other quality improvement approaches; also ensure that quality is part of the dialogue between key stakeholders who are responsible for managing and improving clinical quality and costs. These processes also are capable of dealing with dilemmas faced in health care and the constantly created managerial ideas and clinical knowledge. Key Words: Innovation, Clinical Outcomes, Knowledge, Quality and Costs, TQM Management

The aim of this thesis is to assist industry leaders in Australia understand the nature of employee empowerment by identifying the characteristics of employee empowerment, the leadership strategies required to guide employee behaviour changes and the interaction between the two concepts. This thesis argues that in the 1990's the role of leadership needs to change in order to address the threat of increasing competition. The role of leadership needs to focus on employee development and enhancing their ability to adapt to change, be innovative, creative and committed to achieving the goals of the organisation. Effective leadership is therefore reflected in the behaviour of employees. A characteristic identified as employee empowerment. The research for this study had two components. First was the development of the model to investigate the relationship between leadership strategies and employee empowerment behaviour in a workplace setting. The second research component of the study was testing the model. Testing required the development of a multi-component workplace survey instrument. A range of validation methodologies supported the survey instrument. The case study site was a government organisation. Results provided answers to each of the research questions. Among other findings, it was found that factors other than leadership could also moderate empowerment behaviours. The results of the study, if replicated, have important significance to Australian industry. Serious questions are raised concerning the direction of previous leadership research. Furthermore a new focus is provided to explain why TQM fails in organisations. Another key point highlighted in the study was the importance of using practical models that can be tested in the workplace. / Doctor of Philosophy (PhD)

This thesis investigated the relationship between Total Quality Management (TQM) practice and hospital performance from 1997 t0 2001 in a Taiwan public hospital. In Taiwan, previous research focused on TQM practice and hospital performance in the manufacturing sector. Earlier research relevant to hospitals emphasised outcomes, such as hospital efficiency. The current study differs from the previous hospital research by examining comprehensive organisational performance, including financial and non-financial performance. The objective was to gain insights into ways in which the managers of hospitals might use the findings to enhance the hospital performance levels. The Malcolm Baldrige National Quality Award (MBNQA) 2001 health care criteria for performance excellence were used as a research instrument to measure TQM practice and hospital performance. Data were collected using triangulation method, that is a self-assessment questionnaire, focus group interviews and documentation that is Government Annual Reports. Multivariate Analysis of Variance (MANOVA) and Multiple Regression Analysis were utilised to analyse data from questionnaires. Findings from focus group interviews were coded and categorised. Findings from documentation were used to verify and validate the progress of hospital performance. The quantitative findings indicated that the demographic characteristics of employees had no significant impact on TQM practice, nor on hospital performance. Elements of TQM, however, were important determinants of overall hospital performance, the more committed the TQM practice, the better the hospital performance. The qualitative findings indicated that, for Hospital A, effective TQM would be accomplished through incremental organisational change. This research makes a contribution to both academic knowledge and hospital practice. It bridges the research gap in the relationship between TQM practice and hospital performance and also offers a solid foundation for future academic research. The study also provides short and long-term recommendations about quality improvement to both the manager and hospital A.

The purpose of this analytical study is to determine the degree of application of Total Quality Management (TQM) philosophy and practices in the industrial corporations in Jordan. Through detailed examination of primary and secondary empirical data from these corporations, the study examines the link between TQM and labour productivity. The population of the study consists of all Jordanian shareholding corporations listed under the industrial category in Amman Stock Exchange. In late 1998, this consisted of a total of 90 companies. Both quantitative and qualitative data were collected and analysed in investigating the relationship between TQM implementation and labour productivity. Detailed survey responses from 76 participating companies were classified into two groups: high-level TQM implementation and low-level TQM implementation. About 60% of these companies were classified as companies with high-level TQM. Descriptive analysis of the survey responses plus company report data found that mean labour productivity measurements for companies with high-level TQM were significantly higher than for those with low-level TQM over the years (1993-1998). Also mean growth rates of labour productivity measurements for companies with high-level TQM were higher than for those with low-level of TQM during this period. Regression analysis demonstrated a statistically significant positive relationship between TQM and labour productivity. This relationship showed a high positive slope in companies with ISO 9000 certification, and considerably lower (but still positive) slope in companies without ISO 9000 certification. / Doctor of Philosophy (PhD)

This thesis reports on a study which explored the experiences of teachers working at Gilmore Primary School in the Australian Capital Territory as they initiated the management philosophy known as Total Quality Management (TQM). The teachers' perceptions of key TQM ideas were obtained from staff meeting notes, interviews and a variety of questionnaires. The teachers' perceptions constituted the data for the study. The study utilised ethnographic methodology incorporating aspects interpretive and critical approaches. Participants in the study were actively engaged in the initiation project and as such were taking part, with the researcher, in a co-operative experiential enquiry. Key TQM ideas provided the themes for this study. These themes were; continuous improvement, shared vision, customer and process focus, teamwork, outrageous goals and systematic data gathering. Teachers' perceptions regarding each of these themes or key ideas were analysed by considering the effect on them of two sets of factors. The first set consisted of factors in educational change while the second was comprised of factors in the culture of teaching. TQM history, principles and practices as well as the two sets of factors related to educational change and the culture of teaching were discussed in a review of literature. From the analysis of teachers' perceptions a series of recommendations were developed for implementing TQM at Gilmore Primary School and for more general application of theory and practice.

Si la gestion de l'entreprise industrielle a continuellement subi des mutations philosophiques et technologiques importantes (production en Juste-à-Temps, Total Quality Management, robotique, nouvelles technologies de l'information, etc.), les systèmes d'évaluation de la performance qui sont supposés jouer un rôle d'assistance et d'aide à la décision managériale doivent régulièrement accompagner ces mutations. Dans le présent travail, nous proposons une méthodologie conceptuelle d'évaluation de la performance globale d'une entreprise qui opère sous l'optique du Total Quality Management. Le besoin en modélisation du phénomène de la performance est pour clarifier une relation floue et contradictoire entre la performance et le TQM puisque la littérature managériale n'a pas aboutit à une conclusion ferme sur la nature de cette relation. A ce propos, la littérature nous offre trois situations typiques. La première stipule une relation statistiquement positive entre la performance globale et le TQM. Une deuxième situation avec un effet neutre. Enfin, la troisième situation peut mener des conséquences négatives sur l'entreprise. En effet, un modèle conceptuel liant les pratiques critiques du TQM et la performance globale a été développé. Suite à une méthodologie claire basée sur une étude exploratoire auprès de 102 entreprises opérantes dans le secteur Textile-Habillement nous a permis d'identifier la nature de cette relation. A ce propos, une analyse en composantes principales en premier lieu et une analyse de relations structurelles entre les différentes variables en second lieu ont dévoilée se lien entre le TQM-performance globale.