Review of Literature

The health care industry, or medical industry, is a sector within the economic system that

provides goods and services to treat patients with curative, preventive, rehabilitative, and

palliative care. The modern health care sector is divided into many sub-sectors, and depends on

interdisciplinary teams of trained professionals and paraprofessionals to meet health needs of

individuals and populations.

The health care industry is one of the world's largest and fastest-growing industries. Consuming

over 10 percent of gross domestic product (GDP) of most developed nations, health care can

form an enormous part of a country's economy.

In today scenario we can see that patient’s expectations from health care is very high. They are

dissatisfied with the system of waiting in queue for long time and they are unhappy with the

hospitality they are getting in health care industry. So the patients ask why health services cannot

use quality methods like other industries to reduce the raising costs of healthcare. So there need

to have modern techniques instead of traditional approaches. Modern quality methods will make

it possible for professionals and managers to understand and develop the complex systems of

care. Costing methods are over complex where health managers try to keep finance separate

from quality. Relationship between quality and resources damages the credibility of many

quality activities.

In terms of Garvin (1984) quality aspects contains both the user based approach and the

manufacturer based approach. User based approach includes maintaining appointments with

patients, professional treatment and patient satisfaction. Manufacturing based approach includes:

carefulness and safety.

Modern marketers are rediscovering the ancient mantras for success in corporate world and

blending them with contemporary marketing practices. Long term survival and competitive

advantage can only be attained by establishing an emotional bond with the customers. A shift is

taking place from marketing to anonymous masses of customers to developing and managing

quality of service and gentile relationships with customers (Gronroos, 1994).

Customer Relationship and quality Management “are the core business strategies that integrate

internal processes and functions, and external networks, to create and deliver value to targeted

customers at a profit. It is grounded on high-quality customer data and enabled by IT” (Buttle,

2004). Quality management is a business strategy to identify, cultivate, and maintain long-term

profitable customer relationships. It requires developing a method to select your most profitable

customer relationships (or those with the most potential) and working to provide those customers

with service quality that exceeds their expectations. (McDonald, 2002).

An organization’s survival depends largely on harmonious relationships with its stakeholders in

the market. Customers provide the ‘life-blood’ to the organization in terms of competitive

advantage, revenue and profits. Managing relationships with customers is imperative for all types

and size of service organizations. A sound base of satisfied customers allows the organization to

move on the path of growth, enhance profitability, fight out competition and carve a niche in

the market place. Bennett (1996) described that quality management seeks to establish long term,

committed, trusting and cooperative relationship with customers, characterized by openness,

genuine concern for the delivery of high quality services, responsiveness to customer

suggestions, fair dealings and willingness to sacrifice short term advantage for long term gains.

Schneider and Bowen (1999) advocated that service business can retain customers and achieve

profitability by building reciprocal relationships founded on safeguarding and affirming

customer security, fairness and self esteem. It requires that companies view customers as people

first and consumers second. Trust, commitment, ethical practices, fulfillment of promises, mutual

exchange, emotional bonding, personalization and customer orientation have been reported to be

the key elements in the hospitality management (Levitt,1986; Gronroos, 1994; Morgan,1994;

Gummesson,1994; Bejou et al,1998 ).

Quality Management is a strategy that embodies the belief that the management process must

focus on integrating the customer – driven quality throughout an organisation (Stah, 2002). It

stresses continuous improvement of product quality and service delivery while taking into

cognisance the reality that in order to achieve this goal, employee relations needs to be equally

addressed, as the customer cannot get the satisfactory service delivery from ill- motivated

employees (Lewis, 2004).

The philosophy underlying the implementation of quality management strategy is to see

organizational customers and clients as the vital key to organizational success. Organisations

with hospitality and quality management strategy see their business through the eyes of their

customers and clients and then measure their organisations performance against customer/client

expectations (Fran, 2002). It therefore follows that organisations that want to be successful with

the implementation of quality management strategy must evaluate its operations through the eyes

of its customers by strengthening and exploring all avenues including the people (employees)that

make up the organisational structure(Stah,2002).

According to Balogun and Hope-Hailey (2008), strategy should be seen as a system/process, that

should be able to engender in the employees a culture of total commitment to the vision and

mission of the organisation, and thus, a functional strategy that embodies the collective

contribution of various components that make up the organisational hierarchy should be such

that complement each other in the implementation of a strategy. For a strategy to accomplish the

desired goals and objectives of an organisation, effective strategy implementation mechanisms

should be put in place and one of the most potent ways for achieving this is by exploiting the

internal capabilities of the organisation in the form of its employees as a veritable asset while

encompassing various HRM initiatives, such as recruitment and selection, training and

development, reward systems, performance appraisal , the need for enhanced employee voice

systems , employee engagement and greater line manager involvement with

management ,because they should be seen as a bridge between the employees and management

for enhanced psychological contract, which will in turn facilitate greater employee commitment

(Murphy et al, 2001).

Quality products or services need not only to conform to consumers requirements; the

product/service must be acceptable. Effective quality management strategy entails that the

product/service must go beyond acceptability for a given price range. For example, rather

leaving customers/clients satisfied that nothing went wrong with the product or service, a

product/service should give the customers/clients some delightful surprises, or provide

unexpected benefits (Collard, 2001). This means, therefore, that product/service quality

assurance requires more than just meeting customers/clients minimum standards. The level of

product quality is the degree, to which a product/service is equal to or greater than

customers/clients expectations,

Thus, for organisations who desire to have TQM strategy in place and make it work effectively,

should as a matter of principle endeavour to be positively disposed to the idea of quality

management philosophy in their organisation. According to Haigh and Morris (2002), quality

management is an ingredient towards adequate quality delivery to customers .Quality

management involves: management systems, delivery, quality, cost, technology and of course

the employees, because according to Donaldson, (2001), no matter how perfect a strategy might

be, it depends on people for implementation. All these various components of quality

management when effectively harnessed will result in customer satisfaction; where the intention

is not to stop at a point in the process of implementation, but rather a continuous improvement of

the mechanism for a sustainable competitive advantage (SCA), through the use of employees as

organisations effective internal assets for a successful implementation (Haigh and Morris, 2002).