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  • Total quality management- TQMis called as the conceptual framework that is used in business entities for the purpose of improving quality standards. The method came into existence first in Japan, and slowly it spread all over the world (Shalley and Gilson, 2016). TQM also include service users based practices, whose main aim is to enhance the quality and the care services towards promoting the process improvement.
  • Health care sector- The health care sector of the UK mainly concern towards the medical and health care services. Along with this, the health care industry also focuses on the integrating services that is used to serve the pateints with different curative, rehabiliative and other care services so that it may enhance the well  being of the patients. It is also consider as one of the fastest growing industry whose key aim is to meet the all healthcare needs anjd requirement of the individuals (Helo, Gunasekaran and Rymaszewska, 2017).
  • Patients satisfaction- Within the health care sector, the key emphasis is placed over patients satisfaction. The strategies of health care organization that is West Middlesex University Hospital designed them in such a way that it could fulfil the demands as well as meeicfal requirement of the service users and it also offer then quality sercvices.
  • SERVQUAL model- SERVQUAL model is the most efficient model in the quality process. This model is mainly used for assessing the expectations as well as patients perception towards the medical services. This model helps in measuring the service quality that is rendered by the University Hospital through evaluating gap among the perceived and expected services.


  • The current investigation is carried out on  West Middlesex University Hospital which is a part of NHS hospital operating practices with Chelsea and Westminster Hospital NHS Foundation Trust.It serves the beset services to the patients and the entire service provision is concerned with quality dimensions(Roth, Singhal, Singhal and Tang, 2016). The hospital has availability of more than 400 beds and it also offers all of the services that are associated with a district hospital. Chiefly, it believes to deliver appropriate services in the area of Accident and Emergency. Apart from this, a appropriate matter has been developed with regards to areas such as Scotland, Wales and England. Majorly, the entire process of funding is managed by government entities along with private and voluntary provision.
  • It has been noticed that NHS is holding high ratio of market in the UK and offering high range of services. It also provides an high ratio of contribution to the healthcare sector. There is specific purpose behind the formation of institution such asdelivering the best healthcare services to the clients (Schönsleben, 2016). However, the number of changes in environmental aspects has been witnessed but NHS remains to deliver proper care to the clients which is being funded with an assistance of taxes and national income.  Heath care and health policy for England is mainly framed by the UK administration because it is one of key responsibility of central government;whereas in Scotland, Wales and Northern Ireland, it is the accountability of the respective devolved government. At the same time, this also aids in managing proper contribution to all the diverse activities. NHS has its own systematic structure and organizational values so it must be referred in appropriate manner but overall it is not dissimilar to health systems (Coughlan, Draaijer, Godsell and Boer, 2016). The ordinarily residents of England are also attracted towards the services of sector because it available at low cost. NHS provides an great opportunity to the overall development of health care sector.  For residents of other nation the health care services are free from the government side in case of emergency situation. They should lie under the category such as visitors, illegal immigrants and etc.
  • Most of the private hospital care are largely involved in elective conditions that is financed through supplementary private voluntary health insurance. From the country statistics, it has been ascertained that total expenditure on healthcare was £179.4 bn in the year 2014 which is 4.2% higher than in 2013. Along with this, the total expenditure on health care in 2014 was worth 9.9% of GDP and this remains to be the same in 2013 and 2014. In the year 2014, 56.6% of health care expenditure was funded curative and rehabilitative care while on the other hand, health care expenditure was on long term care (Robinson, Fallon, Cameron and Crotts, 2016).
  • It was the year 2003 when a brand new building of West Middlesx University was opened with an objective  to form a compact hospital.This has helped in developing a health care entity that prominently works for better customer care services (Adebanjo, Laosirihongthong and Samaranayake, 2016). Earlier, the hospital is a teaching hospital of Imperial College School of Medicine which has active participation in volunteering programs. It has been also observed that the total sum of money which was invested on areas such as health care was approximately 8.5% of the total GDP.The total expenditure on health care as a proportion of GDP in 2013 was 8.5% below the OECD average of 8.9% and considerably it is less than comparable economies such as France, Germany, Netherland and the As compared to other nations in EU, the percentage of money invested on health care is very high.  
  • The hospitals then provide more specialist services including care for patients who have diverse healthcare problems.At the same time, community pharmacies are privately owned by the same entity; but they have developed appropriate contact in order to manage supply of drugs.Moreover, it has also been analysed that the public healthcare system also provides free of cost services including ambulance and emergency services (Roth, Singhal, Singhal and Tang, 2016). This is delivered at the time when patients need the specialist transport; thus this is the most important factor that helps the customers to promote the health care services on higher extent.


SERVQUAL model is the most efficient model in the quality process. This model is mainly used for assessing the medical demand as well as perception of patients towards services that are delivered by the staff within health care organization (Gómez-Expósito, Conejo and Cañizares, 2016). This model helps in measuring the service quality through evaluating gap among the perceived and expected services. In one of the studies developed by Watanabe and, (2016), mentions that the word “service” holds various meanings that lead towards certain conceptions in diverse ways and that is explained to the service management. Here, amenities develops performance in the health care industry and output in the process of while offering (Cachon, 2016).

It has been also assessed that there are different factors existing within the health care industry that results in influencing the delivering of quality care to the patients. It has also stated that there is significance of quality patient care for the overall economy as well as for the success of West Middlesex University in the health care industry. As per the view of Harvey, Heineke and Lewis (2016) there are different quality transformation efforts that are used by the institution of the health care it mainly include independent performance audit, internal audit, survey on patients satisfaction etc. it has also assessed that highly effective managers within the hospital mainly ensure proper commitment of them towards the improvement within the quality care and treatment so that it might results in enhancing the well-being of the individual (Heizer, Render and Munson, 2016)

Dobrzykowski, McFadden and Vonderembse (2016), mentioned that SERVQUAL model that is also referred as the multi-item scale, helped in developing the range for the purpose of assessing the perception of patients and their family members towards service quality within the West Middlesex University hospital. This scale tries to decompose the service quality perception in around five constructs such as empathy, tangibles, assurance, as well as responsiveness. It also relies on capturing the gap existing among expectations of patients and experience that are both negative and positive, in case expectations are higher as compared to experience is less or either equal to the experience (Radnor and Bateman, 2016).

The SERVPERF model, which is developed by Newman (2001), was highly derived through the SERVQUAL model through removing the expectations and then measuring the perception towards service quality, just through evaluating the patients views towards medical service (Cachon, 2016). There are around four equations in this process:

SERVQUAL= Performance –expectations

Weighted SERVQUAL= significance of X (performance- expectations)

SERVPERF= performance

Weighted SERFPERF= significance of X (performance)


Indirectly, the model of SERVPERF also tries to assess the experience of patients that relies on the attributes, because SERVQUAL conforms in close relation with the attitude and implications of satisfaction. Gómez-Expósito, Conejo and Cañizares (2016), had tried to develop the performance model evaluation for the purpose of overcoming the issues related to the conceptualization of gaps among perceived performance as well as the actual amount of patients expectations features (Watanabe and, 2016). It is also argued that this examination cover up the framework of perception-expectation, that’s questionable because definitional issues include the expectation definition, along with theoretical explanations of perception- expectation framework, as well as expectation measurement. It is also revised that measures related to expectations, clearly specify the quality literature with the actual figures of service attributes (Santibanez-Gonzalez and, 2016).

Total quality management as the theory is referred as the body of quality improvement methodologies, which is based on the perception and requirement of patients and are service oriented. Total quality management was developed in Japan, and slowly it spread all over the world. However, it is noted that while TQM might include customer based practices, whose main aim will be to enhance the quality and work towards promoting the process improvement within West Middlesex University hospital, there exist various theories at work that precisely guide the total quality management practices.

The EFQM framework- This framework is an important model relies on around nine quality control criteria (Santos-Vijande and Alvarez-Gonzalez 2007). It also includes five enablers as well as for outcomes. The result in the model refrains through consulting the methodology, and it also identifies the quality management diversity and method (Hitt, Xu and Carnes, 2016). The nine criteria are explained through the model of EFQM:

Emphasise on results- it tries to please the stakeholders of the health care organization by giving them results, as achieving the trust of stakeholders is the key aim of health care organization.

Emphasis on service users those who are preferring their services- it is important that quality management practices of the health care sector should lead towards satisfying the different requirement of patients (Singhal, Malhotra, Ployhart and Shang, 2016).

Facts and process the management focus- management of West Middlesex University hospital often break down things in the process, systems and effects that could be monitored easily (Mendelson and Moon, 2016).

Training and including care practitioners staff- The care practitioners staff that are rendering services within the West Middlesex University hospital should attain opportunities of professional development and are also driven to remain within the West Middlesex University hospital and deliver the quality care services to different requirement patients.

Continuous improvement and learning- every care practitioners and staff is offered with the effective opportunities to learn through the job so that they can easily deliver the quality care and medical treatment to their patient with different requirement (Chard and, 2016).

Developing partnerships- it is vital to initiate the partnerships within the West Middlesex University hospital, as it mainly add value towards the improvement process of the health care organization.

Corporation social responsibility- It is significant that corporations should act in the manner, where responsibility is placed towards society and environment (Shalley and Gilson, 2016).


TQM is the major aspect through which quality facets from organizational point of view can be encouraged and this can also increase the value of service provision. Since, the present case is describing about West Middlesex University Hospital; therefore it is crucial for the health care entity to focus chiefly on those forces which could increase the value of service provision. Considering on the same aspect, it is clear that the technique is crucial for enhancing the service facets and it can also aid in acquiring appropriate outcomes against the service types.

Hence, in this respect West Middlesex University Hospital should try out to meet all the requirements of health care policy so that patient satisfaction aspects can be managed (Helo, Gunasekaran and Rymaszewska, 2017). This is yet another way through which quality dimensions in the service provision can be maintained. Further, feedback should also be acquired from the patients so that they can assist West Middlesex University Hospital to adopt new tools for development and improvement. This is the appropriate way through which service delivery capability can be increased (Roth, Singhal, Singhal and Tang, 2016). Therefore, total quality management could be explained as the way towards attaining the excellence in all business functions, for the purpose of preventing the possibilities of making any mistake and for creating the optimal satisfaction of customers.

While providing services to the patients, West Middlesex University Hospital needs to ensure that they are adopting all the dimensions of quality process. Similarly, West Middlesex University Hospital is also required to focus on reducing all the errors through facilitating direct monitoring and observation aspects. Therefore, it can be said that with the help of Total Quality Management, West Middlesex University Hospital can enhnace the value of services and at the same time, it can also increase customer satisfaction facets (Adebanjo, Laosirihongthong and Samaranayake, 2016).  Along with the same technique, West Middlesex University Hospital also needs to ensure that all the resources are utilized in the best possible manner as that can only improve health care standards.

Further, employee opinion and views should be used in decision making process so that they can contribute more in enhancing the quality dimensions. This is also vital for underpinning the service capabilities of West Middlesex University Hospital. Therefore, it can be said that with the help of quality dimensions, issues and constraints related to patients can be avoided and services can be promoted on higher extent (Robinson, Fallon, Cameron and Crotts, 2016). Along with this, Six Sigma and other techniques can also be utilized for improving the quality dimensions and this can also assist in adopting new standards for service dimension.


In the current scenario, people are getting more concerned about quality facets because the trends and preferences are changing. At the same time, health care services are also getting more specific; hence clients are demanding for quality concerned services. There are several measures that are used to assess and compare the quality of health care organizations and that should be based on the demands of customers. There are various reasons that creates issues in the health care sector and chiefly constraints are concerned with quality services and amenities (Coughlan, Draaijer, Godsell and Boer, 2016). It is essential for the organization to consider the changing trends and preferences so that customer satisfaction ratio can be enhanced. Meeting the needs of customers is essential for the purpose of enhancing the scope of growth and profitability. In health care sector, quality dimensions are required to be considered so that mortality ratio can be declined. Since, it is related to health aspects of patients; therefore it is crucial for the entity to meet all the important facets of quality procedure. Moreover, it has also been observed that to manage quality facets, West Middlesex University Hospital needs to acquire feedback and opinion from the patients so that suitable changes can be made accordingly.

On the other hand, quality processes can be maintained with the help of conducting direct observation and monitoring and through this, the areas of improvements can be ascertained accordingly. It is also vital for West Middlesex University Hospital to adopt new measures and terms for quality management so that services can be delivered with zero defects. In this respect, West Middlesex University Hospital should opt for Total quality management which is the way of attaining the excellence in all tasks of business for the purpose of preventing the error possibilities and met the optimal satisfaction of customers.

Maintaining quality dimensions can also assist the West Middlesex University Hospital to enhance customer loyalty and satisfaction aspects and at the same time, it can also aid in promoting the services to other segments. West Middlesex University Hospital should also involve all the employees in decision making process so that they can give their valuable suggestions for enhancing the value of service dimension. This will also assist in enhancing the decision making process of the health care entity and at the same time, competitive edge can be created accordingly (Schönsleben, 2016). Involvement of employees can also aid in enhancing the service capability and at the same time, thee opportunities of issues and constraints can be eradicated.  Hence, in order to set up quality process, every staff of functional management tries to attend the meeting each day, which is based on total quality management and quality leadership among functions to attain the set objectives.

Similarly, West Middlesex University Hospital should include certain principles, which are mainly operated to ensure quality in meeting the needs of customers and their satisfaction. Nonetheless, it will assist to reduce the opportunities of errors and defects; thus suitable techniques are required to be adopted precisely to meet the aims and objectives. It is also recommended to West Middlesex University Hospital to focus more on the concept of leadership who have thorough idea about organizational practices and functions (Reim, Parida and Sjödin, 2016). This is also essential for the purpose of facilitating new changes and aspects in the health care services; henceforth dimensions related to leadership should be strengthened accordingly. Thus, in terms of suggestions, it can be said that West Middlesex University Hospital should focus more on evolving trends so that new procedure and practices can be adopted for overall service management. Further, continuous monitoring should also be facilitated so that the areas of development can be identified.


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