Maria João Major

Key success factors for quality management implementation: evidence from the public sector

The purpose of this paper is to identify the crucial factors for the successful implementation of a quality management/total quality management (TQM) process, particularly in the public sector. The paper adopts an explanatory longitudinal case study, using case research design to support the investigation. The case study consists of three government agencies where the results and outcomes of a quality management programme differed. This programme was launched by a specific ministry in Portugal, linked to organisational change and delivering excellence. The study was built on quality management literature, highlighting the contributions of J. S. Oakland [(2004). Oakland on quality management. Oxford: Elsevier Butterworth-Heinemann] and J. Oakland [(2011). Leadership and policy deployment: The backbone of TQM. Total Quality Management & Business Excellence, 22(5), 517–534]. The key findings of the paper show that the main items delivering excellence, identified in the ‘Oakland TQM model’ (the 4Ps and the 4Cs), primarily explain the different perceptions of results and outcomes. The investigation also identified other factors that can help account for successful implementation of quality management, such as ‘power’ and ‘collective involvement’. Consequently, a refined ‘Oakland TQM model’ is proposed, as well as a visualisation of the interaction of the items/factors involved in an input/output perspective.

When institutional entrepreneurship failed: The case of a responsibility centre in a Portuguese hospital

The purpose of this paper is to demonstrate the role of power relations in initiating and blocking accounting change that involves increased “responsibilisation” and “incentivisation”, and to understand how institutional entrepreneurship is steered by power strategies.,An in-depth case study was carried out between 2010 and 2015 in a cardiothoracic surgery service (CSS) where a responsibility centre was introduced.,Introducing a responsibility centre within a CSS led to a change process, despite pressures for stability. The institutionalisation of change was conditioned by entrepreneurship that flowed through three circuits of power. Strategies were adapted according to changes in exogenous environmental contingencies and alterations in the actors’ relationships.,The contributions of the paper are several: first, it demonstrates that the existing literature discussing the implementation of responsibility centres cannot be isolated from power issues; second, it expands understanding of the power dynamics and processes of institutional entrepreneurship when implementing accounting change; third, it shows how change introduced by exogenous political economic events structured organisational circuits of power and blocked the introduction of the change initiative.

Challenges of the New Public Management in a Public Hospital

In recent years the Portuguese national healthcare service (NHS) underwent a large reform, with the corporatization of 34 public hospitals in 2002 as a milestone in this process. The main goal of reform was to fight wastefulness and to encourage the best use of resources.