Abstract
Quality is part of life in our rapidly changing world. In the final quarter of twentieth century, quality has been implemented with the strategic development of quality circles, statistical process control (SPC), culture change, customer service and benchmarking, continuous quality improvement (CQI), quality management (QM) and total quality management (TQM).
Although governments impose reduced public spending, the taxpayers' expectations from the public sector do not change accordingly. Therefore, the public sector has to adjust itself to be more effective and efficient at lower cost. In this direction, the purpose of this project is to identify perceived customer satisfaction level in TRNC public health services. For the purpose of this study, both the qualitative and quantitative methodologies were selected.
Paper concluded that up to now ın TRNC, the policies of public health care are aiming to provide a quality service. However the quality management systems and total quality management systems were not applied.
Acknowledgments
I would like to thank Dr. Fehiman Eminer, my research advisor for helping me to guide this thesis from conceptualization through to approval. Dr.Eminer went beyond the usual tasks of the advisor and contributed considerably to advise me all the time and give me the support to go forward with the successful research. This project would not have been possible without Dr. Fehiman’s tireless patience and support.
I would like to express my gratitude. Special recognition goes to Assc. Prof Dr. Erdal Güryay for his continued assitance , encouragement and support of the project.
A special note of thanks goes to Ministry of Health personnel and specially Head of ministry of Health Mrs. İsmet Salihlioğlu and Dr. Burhan Nalbantoğlu Hospital administrators. I would also like to thank the Near East University Instıtute of Nursing pesonnell specially Özden Nurluöz and Yeşim Kubilay for their moral support of the project.
Last, but not least, I wish to thank NEU Maritime Faculty Dean’s for permission to using their computer laboratory.
ABBREVIATIONS
ASQC: American Society for Quality Control BSI: British Standards Institute
CEOs: Chief executive officer
CQI: Continuous quality improvement CWQC: Company wide quality control:
ECJ: European Court of Justice GDP: Gross Domestic Product GNP: Gross National Product
ISO: International Quality Standardization Systems JIT: Just-in-time
KMO: Kaiser-Meyer-Olkin Measure of Sampling Adequacy.
MBO: Management by objectives OECD: Organization for Economic Cooperataion and Development
QFD: Quality Function deployment QM : Quality management
R&D: Research and Development ROI : Maximum return on investment SDEs: Small developing economies SPC: Statistical process control
SPSS: Statistical Analysis Software predictive TQC: Total quality control
TQM: Total quality management WHO: World Health Organization
LIST OF TABLES
Table 1: Examples of Cultural Changes Required………...29
Table 2: Basic continuous process improvement cycle………...41
Table 3: Health Status in TRNC………..81
Table 4: Health Spending % of GDP, (2003)...82
Table 5: Health Expenditure ratios to State Budget and GNP………...84
Table 6: Health Care Investment ratio to Total Investment and Budget………….85
Table 7: Number of Health Personnel………87
Table 8: Number of Public Health Personal ………..88
Table 9: Distribution of patients according to Gender………....96
Table 10: Distribution of patients according to age………..96
Table 11: Distribution of patients according to their level of education…………...97
Table 12: Distribution of patients according to their marital status………..97
Table 13: Distribution of the patient according to their M. treatment department…98 Table 14: Distribution of Factor analysis inpatient services……….98
Table 15: Distribution of values according to Varimax Rotation (inpatient)……...100
Table 16: Item-Total Statistics………..102
Table 17: Dis. of Correlations between the demographic and perceived Quality….104 Table 18: The reasons the patients preferring the hospital………....106
Table 19: Distribution of out patients according to Gender………..107
Table 20: Distribution of out patients according to age………107
Table 21: Distribution of out patients according to their level of education……….108
Table 22: Distribution of out patients according to their occupation………109
Table 23: Service quality evaluation scale principal component variable…………109
Table 24: Distribution of values according to Varimax Rotation (outpatient)……...110 Table 25: Item-Total Statistics for outpatient services………...111 Table 26: Dis. of Correlations between the demographics and perceived Quality…112
LIST OF FIGURE
Figure 1: Histogram………50
Figure 2: Run Chart………51
Figure 3: Pareto Chart……… 52
Figure 4: Fishbone Diagram………...53
Figure 5: Tree Diagram………...54
Figure 6: Flow Chart and Modeling Diagram……….55
Figure 7: Scatter Diagram...56
Figure 8: The Organizational Chart of Ministry of Health ………75
Figure 9: State Budget Health Expenditures % GNP 2000-2004………...81
Figure 10: Health spending % of GDP, 2003………...83
Figure 11: Health expenditures ratios % budget and % GNP………...84
Figure 12: Health Care Investment ratio to Total Investment % and Budget %...85
Figure 13: Percentage distribution of health sector personnel ……….87
Figure 14: Number of Public Health Personal………..88
TABLE OF CONTENTS
ABSTRACT...i
ACKNOWLEDGMENT...ii
ABBREVIATIONS...iii
LIST OF TABLE...iv
LIST OF FIGURE...vi
SECTION I...1
RESEARCH PROBLEM AND OBJECTIVES...1
1.1 Introduction...1
1.2 Problem statement...2
1.3 Purpose of the study...2
1.4 Research objectives...2
1.5 Need of statement...3
1.6 Methodology... 3
1.6.1 Research design...3
1.6.2 The Model of research...5
1.6.3 Data analysis...10
1.7 Limitations...11
1.8 Assumptions...11
SECTION II...12
A LITERATURE REVIEW...12
2.1 Introduction...12
2.2 History of Quality...12
2.3 Management Philosophy...17
2.4. Basic Quality Concept...18
2.4.1 Dimensions of quality...20
2.4.2 Quality in Services...21
2.5 Total Quality Management...23
2.5.1 TQM definition...24
2.5.2 Basic approach...25
2.5.3 Essence of TQM implementation...29
2.5.4 Benefit from applying TQM principles...48
2.5.5 Total Quality Management SPC tools...48
2.6 TQM implementation in Health sector... 56
2.7 ISO 9000 Standards... 60
SECTION III...62
TRNC PUBLIC SECTOR; TQM IN PUBLIC HEALTH SECTOR...62
3.1 Introduction...62
3.2 Common Economic Characteristic of Small Island Economy...62
3.3 Turkish Republic of Northern Cyprus Economy...64
3.3.1 History of TRNC...64
3.3.2 General economy and finance...66
3.4 Public Health Administration and Managemet in TRNC ...69
3.4.1 General Status of H.care system,management and role of government...72
3.4.2 Ministry of Health and its role in health system ...74
3.4.3 Health services in country profile ...75
3.4.3.1 Health services by public sector...76
3.4.3.2 The health services undertaken by the private sector...80
3.4.3.3 Health status...80
3.4.4 Health care Financinig and expenditures...83
3.4.5 Human resource data...86
3.5 TQM and Public health services...90
3.6 Conclusion...91
SECTION IV...95
FINDINGS ...95
4.1 Measuring findings ...95
4.2 The thypotheses of research ...95
4.3 Evaluation of inpatient’s percieved quality and customer satisfaction survey...96
4.4 Evaluation of outpatient’s perceived quality and customer satisfaction survey 107 4.5 Results of hypotheses...113
4.6 Recommendations for futurs study...114
4.7 Conclusion...118
References...123 Appendix I : Inpatient and Outpatient services evaluation Questionnaires
Appendix II : With Prior Permittion