Physicians in TQM: A Survey in Taiwan Fenghueih Huarng Department of Business Adm,Southern Taiwan Univ. of Technology Huei-min Hsei Center for Hospital Development, Kaohsiung Medical Univ.

Research Model  H 1 : A hospital-physician TQM relationship is positively related to physician’s personal medical quality.  H 1a : A hospital-physician TQM relationship is positively related to physician’s personal medical quality taking physician’s personal value as a moderating variable.  H 2 : An altruism physician has better personal medical quality than an egoism physician in TQM culture.  H 3 : Physician’s effort in advanced study is positively related to medical quality. Physician-hospital TQM relationship Physician’s professional advanced study Physician’s personal value Medical quality

Qualitative results —interviewing 22 doctors(most lasting at least 2 hours) NHI reimbursement rules Hospital cost policy Hospital payment policy about physicians Patients’ attitude The prevention of mal-practice suits Physicians’ professional ability Medical Quality Physician’s personal value

Literature Review  Some successful TQM cases in clinical Dept. (Hart & Masfeldt,1992, Dieter & Gentile,1993; Nathanson,1994; Healey,etc,1994)  Low acceptance in clinical Dept. for TQM (Zabada, Rivers & Munchus,1998; Lewis & Lamprey, 1992; Socha, 1993; Gerber,1992)  Building a supported and cooperation culture to physicians help (Johnson,1992; Nathanson,1994; Boerstler,etc,1996; Massarweh,1998)  Top management leadership help clinical involvement in TQM (Weiner,Shortell & Alexander,1997)  Physician-hospital relationship is emphasized (Berry,1999; Dahill & Kalman,2001; Budetti,etc,2002)

 Personal cooperative, organizational collectivistic values or organizational individualistic value contribute separately to cooperative behavior (Chatman & Barsade,1995)  Congruence between personal values and organizational culture outperform than either characteristic alone (Chatman,1991)  Factors on physician utilization, medical quality or length of stay: specialty, age, sex, experiences, type of training, years of practices (Eisenberg,1985;Salem-Schatz,Avorn & Soumerai,1993;Shi,1996; Ely,etc,1996) Literature Review

Research Method  Literature review and 22 physicians  302 copies sent to 11 hospitals ( 5 major hospital center, 5 regional, 1 local )  222 returned samples, 73.5% returned rate  21 items for physicians’ personal values (1:highly disagree, 3:indifferent, 5:highly agree)  24 items for physician-hospital TQM relationship (1:highly disagree, 3:indifferent, 5:highly agree)  13 items for physician’s effort on clinical medical quality in two years (1:highly disagree, 3:indifferent, 5:highly agree)  5 items for professional advanced study relative to other physicians (1:none, 2:low, 7:high)  99(chief) residences vs. 123 senior attendings

Results  Factor Analysis — Table11, physician’s personal values, 7 variables (Fsce1-Fsce7) — Table12, physician-hospital TQM relationship, 5 variables (Fshe1-Fshe5) — Table13, medical quality, 2 variables (Fsqe1-Fsqe2) — Table14, professional advanced study (Fsq141)

Results  Cluster Analysis — using factor scores of physician personal values — two groups: altruism vs. egoism

Fshe1-Fshe5 Fsq141 altruistic vs.egoism Fsqe1, Fsqe2  Linear Regression Analysis(stepwise) — One control variable: B70, years spending in senior attending — VIF is 1.3 for 1 cv & 6 indep. vars. — α=0.05 Results

 Altruism: Adj-R 2 Fsqe1 = *Fsq Fsqe2 = *Fshe *Fshe *Fshe  Egoism : Fsqe1 = *Fsq Fsqe2 = *Fshe *Fsq Results

Discussions & Conclusions  For both type doctors — advanced study (Fsq141) help preventing malpractice (Fsqe1)  For altruism doctors — hospital encourage physicians’ promoting medical skill with customer in mind (Fshe1), hospital actively communicating with physicians about medical quality (Fshe3), full empowering physicians in clinical decisions (Fshe5), help patients’ affirmation and treatment accuracy (Faqe2)  For egoism doctors — advanced study (Fsq141) & teamwork to elevating medical profession (Fshe4) help patients’ affirmation and treatment accuracy (Fsqe2)

 Building TQM relationship with physicians, hospitals can help in different ways. — for egoism, emphasizing team working can promote patient’s affirmation and treatment accuracy. — for altruism, emphasizing patient satisfaction, communicating about medical quality, fully empowering in clinical decisions can promote patients’ affirmation and treatment accuracy.  Physician’s advanced study(an indicator of physician’s profession ) help preventing mal-practice.  Confirm the interaction between personal value and organizational culture — Match of altruism doctors with TQM outperform in patient’s affirmation, treatment accuracy and preventing mal-practices.  Building physician-hospital TQM relationship helps all senior attending doctors. Discussions & Conclusions