Quality Systems in the Public Sector - Research Paper Example

Research Proposal - Quality Systems in the Public Sector Introduction: The Public Sector continues to operate in various fields of industry and service provision areas. The concepts of quality systems have been developed and adopted by private businesses to help generate efficiency and customer value in addition to answering the needs of their stakeholders and sustainability. This research proposes to examine the extent to which such quality initiatives are applicable and valid for adoption in the public sector and to what level these have been successfully assimilated in public sector organisations. This proposal briefly examines the different quality systems adopted by private enterprise and their applicability to public enterprise through a review of literature on the subject. This review is then used to arrive at the research objectives. The methods to be adopted to complete the research are discussed and laid out. This research is proposed to be limited to those areas of public sector enterprise where there is a direct interface between the enterprise and the public - the customers. The public sector provides an array of services such as housing, healthcare, policing, fire-fighting, water and sewage, national security and so on. While some initiatives have been taken to privatise some of these services, some, like healthcare remain within the ambit of public sector operation. We may consider approaching this subject from two sides. The first being from within the organisation, to understand the adoption of quality systems/ models, and the perceived effects and benefits to the organisation in terms of efficiency, productivity and costs. The second approach could be to research the quality systems and models adopted by the public sector and assess the impact these have had on the service user public. This proposal aims at adopting the latter approach. The importance of public opinion has been advocated as an important criterion to judge the impact of initiatives of the public sector in different policy documents (). Thus, in principle, this research will be divided into two parts: A. An appraisal of quality systems and models adopted by the selected public sector B. Collection, collation and analysis of public views of the impact of these initiatives. It is understood that, for this research to be meaningful, the information to be gathered must be scientifically defensible and actionable by the relevant policy makers and conclusive enough to convince the decision makers to use it. Literature Survey: The conservative party's victory in1979 was based on a manifesto that, among others, promised to 'roll back the State'. The party saw the welfare state as being morally indefensible because it promoted a culture of dependency, inefficiency and bureaucracy (Ahmad & Broussine, 2003). Accordingly, the government concentrated on the privatisation of state-owned industries and utilities and the deregulation of the financial services sector. Attention was then turned to apply the principles of modern management, as practiced in the private sector, to health, education and social care (Barlett et al., 1994). The response of public services to these pressures and changes were characterized as managerialist (Hood, 1991) and neo-Taylorist (Pollitt, 1993). Operations of the public sector have been criticised for their limited attitude toward target-setting and performance measurement (Hood, 1991). Pollitt (1993) noted that efforts for application of scientific management principles were the main drivers of change sought to be brought in by the public services in their response to the new challenges. Pollitt (1993) argued that the public sector considered the application of these principles as the panacea for all the ills that besieged them. However Clarke et al. (1994) argued against these concepts and noted that the changes 'represented a deeper ideological process that was transforming power relationships, culture, control and accountability' (ibid). The New Labour government was elected in May 1997. Its manifesto had promised the modernisation and reform of public services. They proposed to achieve this through a process of collaboration, partnership and inclusion. The public services responded by looking at ways to get rid of the images that described their operations. This was soon to change as progress slowed down and "we can now observe the onset of nearly as much disillusion as was noticeable during the Conservative administrations in the 1980s and 1990s" (Ahmad & Broussine, 2003). Concepts of total quality management (TQM) were founded by EW Deming in the US, but were more enthusiastically adopted by the Japanese, who went further to adapt these principles to develop systems like 'zero-error', the TPS, 'House of Quality', Six Sigma and a host of other related ideas. TQM was then adopted by such high profile corporations as General Motors, Motorola, and Xerox (Gabor, 1990) and demonstrated tremendous potential for improving the bottom line of corporations. It is a mistaken belief that TQM can also be applied to public sector organisations (Swiss, 1992). There is a need to modify and adapt TQM before it can have any applicability in the public service sectors TQM in its current form can not be applied because it is a product of statistical quality control and industrial engineering, and almost all of its early applications were for assembly-line work and other routine processes. "In its unmodified or orthodox form, TQM is strikingly ill suited to the government environment" (ibid). Quality initiatives and performance measurement in private enterprises have developed as an art in themselves. Commercial enterprises have a specific output and a driving theme of profit maximisation - the bottom line. Quality, cost and improvements in such areas as logistics, after-sales service, purchasing, manufacturing etc. allow measurement readily. However, the public sector organizations are different in that there is no concept of a bottom line against which performance can be measured. Their revenues are generated from the State and they are more concerned about providing 'value for money', and more recently 'Quality Assurance' rather than being accountable to a set of stakeholders (Boland & Fowler, 2000). More than 15 years of use of excellence models in the public sector shows that the gains from the use of excellence models (be it through self-assessment or external assessment) are uncertain (Lffler, 2001). The need for performance measurement and appraisal in the public sector has been attracting attention for some time now and a new 'industry' has developed within the public sector which concerns itself with collecting, reporting and appraising organisational performance (Holloway, 1999; Rouse, 1999). Even then, most of the reporting of such performance is restricted to collection, collation and publishing of available data. Despite all the work that has gone into understanding and measuring performance since the 1980s it is still impossible to measure outcomes (Smith, 1995). It is important to remember a simple adage on quality perceptions "the only judge of quality is the customer". Research Issues This brings us to the research question: How can the performance of a public sector service be measured By and large, the services provided by such services like Education, Police, Health Services, Public Works and Roads, Fire services and so on would appear impossible to measure, for quality and effectiveness, especially where benchmarking is not possible against similar services provided by the 'commercial sector'. This research project therefore proposes to address the following issues: 1. The quality initiatives, systems and models, incorporated in the public sector in recent times. Understanding and appraisal of the steps taken. 2. Development of a structured system for the measurement of the effectiveness of the above as viewed from the 'customer' (the service user) viewpoint. The study would address the healthcare services and focus on two districts in Scotland, one where population is predominantly urban and the second where rural population predominates. Research Methodology Having formulated the thesis subject, the steps identified for achieving the desired results are proposed in the following passages. To reiterate, the objectives of this research are to identify the quality enhancement steps taken in the provision of healthcare and to develop a measure to evaluate the effectiveness of such steps from the point of view of the users/beneficiaries of the healthcare services. The objectives are summarised as: 1. To identify some of the important quality improvement initiatives taken by the public healthcare service. 2. To identify the research methodology that will allow for an accurate measurement of the public response as to the effectiveness of such initiatives. 3. To make an assessment of the validity of the research methods chosen 4. To develop a framework for simple and easy assessment of future quality improvement steps. 5. It is expected that as a result of the above research some areas of priority for future improvements will emerge. 6. The research will focus on health service provision in Scotland. 7. To identify limitations of the research and ethical issues impacting such a study. 8. To identify areas for future research. In order to achieve these objectives the following methodology is proposed to be adopted: a. Literature review: A methodical review of literature will be undertaken to identify the validity and reasoning behind different quality improvement measures that may be undertaken by a public sector enterprise, and the likely impact on the service users. b. Field study: Hospitals across the target area will be visited and the senior staff, administrators and policy makers will be interviewed to find details of the quality improvements made. Such steps will also be attempted to be categorised according to two criteria one whether the initiatives were top-down (required by higher/central authority) or bottom-up (local initiative) and second based on primary focus - cost or quality of service. This would be addressed with a positivist approach and statistical methods and procedures will be employed to interpret the data. c. A detailed survey will be carried out among a cross-section of the user public to collect data on their opinions of the effectiveness of the quality initiatives and their impact on: Probable health gains Clinical effectiveness Impartiality of access to all sections (economic, colour, gender and health status) Quality of service This survey would be used for collecting qualitative data using the phenomenological methods and data generated through interviews. The field study will be carried out using a questionnaire-based survey methodology using a choice-based conjoint analysis and 'allocation of points' technique. Selection of possible respondents shall cover people who have used the health service facilities in the past, people who have used the facility more than once, patients under treatment and some who have not used the facility at all. The selection shall also strive to cover a broad cross-section of the demographic profile of the public with regard to the sections identified above. If required, the questionnaire will be followed up by a telephonic interview to seek clarifications and/ or to fill identified gaps in the information collected. There is no single technique to evaluate public opinion. The method to be used must be carefully chosen and scrupulously carried out in order to accommodate the question being asked (Ryan et al, 2001). Simple ranking techniques are of limited use and 'qualitative discriminant' method found too difficult to implement and use in the present context. The conjoint technique is chosen since it allows for meeting all quantitative techniques criteria, which are: validity, reproducibility, internal consistency and acceptability to respondents. This technique may be used within the constraints of cost and resources and is backed by a solid foundation of theory. It offers constrained choices while offering strength of preference measure. Rating scales were considered and evaluated. The analogue scale was not found adequate as it does not provide constrained choice and does not give a clear measure of strength of choice. Similarly, Likert scales, Guttman scales and semantic differential techniques were also not found to provide a measure of strength of preference. As against these conjoint analysis scales were found to be preferable for carrying out the intended survey. For seeking qualitative information, one may approach individuals or seek opinions in group scenarios such as focus groups, public meetings, consensus panels etc. However, individual one-on-one were found to be the proper choice for the first part of the field survey because it would be logistically more convenient to seek interviews with one person at a time. The problem of objectivity in such a format will be covered through the use of a pre-determined and structured format. Limitations Resource and time constraints require the study to be limited to a single public sector service. This study can then provide a guiding path for further research and extrapolation of the results to other sectors of public enterprise. This study proposes to cover health services, with special focus on health services in Scotland. In addition to the above, the second limitation of this study is seen as the lack of benchmarking against similar service provided by private hospitals clinics and private practitioners. This benchmarking is possible in the service chosen, but will not be undertaken in the present study. References Ahmad, Y. and Broussine, M. (2003): The UK public sector modernization agenda, Public Management Review, 5(1), pp 45-62 Barlett.W., Propper, C, Wilson, W. and Le Grand, J. (1994) Quasi-Markets in the Welfare State, Bristol: SAUS Publications. Boland, T. and Fowler, A. (2000): A systems perspective of performance management in public sector organisations, The International Journal of Public Sector Management, 13(5) , pp. 417-446. Clarke, J., Cochrane, A., McLaughlin, E. (eds.) (1994) Managing Social Policy, London: Sage Publications. Gabor, Andrea, 1990. The Man Who Discovered Quality: How W. Edwards Deming Brought the Quality Revolution to America. New York: Times' Books. Holloway, J. (1999): Managing performance, in Rose, A. and Lawton, A. (Eds), Public Services Management, Financial Times/Prentice-Hall, Harlow, Chapter 12, pp. 238-59. Hood, C. (1991): A Public Management for All Seasons, Public Administration, 69 Spring , pp 3-19. Lffler, E. (2001): Quality Awards as a Public Sector Benchmarking Concept in OECD Member Countries. Some Guidelines for Quality Award Organizers', Public Administration and Development 21(1): 27-40. Pollitt, C. (1993): Managerialism and the Public Service (2nd edn.), Oxford: Blackwell. Rouse, J. (1999): Performance management, quality management, and contracts, in Horton, S. and Farnham, D. (Eds), Public Management in Britain, Macmillan, Basingstoke, Chapter 5, pp. 76-93. Ryan, M.; Scott, D.A.; Reeves, C.; Bate, A.; van Teijlingen, E.R.; Russell, E.M.; Napper, M.; and Robb, C.M. (2001): Eliciting public preferences for healthcare: a systematic review of techniques, Health Technology Assessment; Vol. 5: No. 5 Smith, P. (1995a): Performance indicators and outcomes in the public sector, Public Money & Management, 15(4), pp. 13-16. Swiss, J.E. (1992): Adapting Total Quality Management (TQM) to Government, Public Administration Review, July/August 1992, Vol. 52, No. 4 Read More