The Gap between Staff Expectations and Perceptions in Total Quality Management Elements in Zanjan Province Hospitals 2003-2004

Improving quality of hospital services helps to optimize resource utilization and promotes quality of care and community satisfaction. Since identification of staff perceptions and expectations leads to increased efficiency, improvement of organization products and fulfillment of customer's present and future needs, this research was conducted in order to analyse total quality management (TQM) elements in Zanjan's hospitals from 2003 through 2004. This descriptive study was carried out on 256 employees of different hospitals in Zanjan province who had been selected through stratified random sampling. Data collecting tool was questionnaire (Likert scale) including optimal situation (expectations) and present situation (perceptions) of TQM elements which was completed by research samples. The gap between expectations and perceptions was calculated by subtracting the perceptions scores from expectations score. The results were analysed through statistical test (Kroscal-Wallis Wilcoxon). The mean gap scores between optimal situation (expectations) and present situation (perceptions) were significant in all elements of TQM (P=0.01). The fair recognition and reward system was the most important dimension from employee's standpoint and scored the most negative (mean gap score= -3). Quality culture and staff empowerment were rated as the second and third most important dimensions. The results indicate that fair recognition and reward system, the initiative and creative culture and staff empowerment are the most important preconditions of effective implementation of TQM in hospitals. Thus, it is recommended that hospital managers establish fair reward system based on well-done performance and encourage creative work and quality culture.