Quality management for sustainable health: methodologies, values and practices taken from Swedish organizations

(1)

LICENTIATE T H E S I S

Luleå University of Technology

Department of Business Administration and Social Sciences Quality & Environmental Management

2006:49

QUALITY MANAGEMENT FOR SUSTAINABLE HEALTH

Methodologies, Values and Practices taken from Swedish Organizations

Ingela Bäckström

(2)

(3)

LicentiateȱThesisȱNumberȱ31ȱ Qualityȱ&ȱEnvironmentalȱManagementȱ

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ

ȱ ȱ

QUALITYȱMANAGEMENTȱ FORȱSUSTAINABLEȱHEALTHȱȱ

ȱ

Methodologies,ȱValuesȱandȱPracticesȱtakenȱȱȱȱȱȱ fromȱSwedishȱOrganizationsȱ

ȱ ȱ ȱ ȱ ȱ ȱ

IngelaȱBäckströmȱ

ȱ ȱ ȱ ȱ ȱ ȱ ȱ

LuleåȱUniversityȱofȱTechnologyȱȱ

DepartmentȱofȱBusinessȱAdministrationȱandȱSocialȱSciencesȱ Qualityȱ&ȱEnvironmentalȱManagementȱ

(4)

(5)

ACKNOWLEDGEMENTȱ

Theȱresearchȱpresentedȱinȱthisȱthesisȱhasȱformallyȱbeenȱcarriedȱoutȱatȱtheȱ Divisionȱ ofȱ Qualityȱ &ȱ Environmentalȱ Management,ȱ Luleåȱ Universityȱ ofȱ Technology.ȱ Theȱ workȱ has,ȱ howeverȱ mostlyȱ beenȱ carriedȱ outȱ atȱ theȱ Departmentȱ ofȱ Engineering,ȱ Physicsȱ andȱ Mathematicsȱ atȱ Midȱ Swedenȱ Universityȱ inȱ Östersund.ȱ Duringȱ theȱ workȱ withȱ myȱ researchȱ Iȱ haveȱ receivedȱsupport,ȱhelpȱandȱguidanceȱfromȱaȱlotȱofȱpeopleȱtoȱwhomȱIȱamȱ veryȱgrateful.ȱȱȱȱȱ

ȱ

Iȱwouldȱfirstȱofȱallȱlikeȱtoȱthankȱmyȱsupervisors,ȱProfessorȱBengtȱKlefsjöȱ andȱ Professorȱ Håkanȱ Wiklundȱ forȱ yourȱ advice,ȱ supportȱ andȱ feedbackȱ duringȱ theȱ wholeȱ researchȱ journey.ȱ Thankȱ youȱ bothȱ forȱ sharingȱ yourȱ experienceȱandȱwisdomȱwithȱme.ȱManyȱthanksȱtoȱmyȱcolleaguesȱatȱbothȱ theȱDivisionȱofȱQualityȱ&ȱEnvironmentalȱManagementȱinȱLuleåȱandȱtheȱ DepartmentȱofȱEngineering,ȱPhysicsȱandȱMathematicsȱinȱÖstersundȱandȱ inȱ particularȱ toȱ Pernilla,ȱ Maria,ȱ Johan,ȱ Johanȱ andȱ Åsaȱ forȱ yourȱ supportȱ andȱ advice.ȱ Specialȱ thanksȱ toȱ Rolandȱ Harnesk,ȱ Karinȱ Schönȱ andȱ Johanȱ Larssonȱforȱfruitfulȱcollaboration.ȱ

ȱ

Iȱ wouldȱ alsoȱ likeȱ toȱ expressȱ myȱ gratitudeȱ toȱ Yvonneȱ Lagrosenȱ andȱ herȱ husbandȱ Stefanȱ forȱ yourȱ advice,ȱ support,ȱ generosityȱ andȱ fruitfulȱ collaboration.ȱ Manyȱ thanksȱ toȱ allȱ managersȱ andȱ coȬworkersȱ atȱ theȱ studiedȱorganizations,ȱforȱyourȱcooperationȱandȱforȱtakingȱyourȱtimeȱtoȱ answerȱ ourȱ questionsȱ andȱ fillȱ inȱ theȱ questionnaires.ȱ Toȱ Lindaȱ andȱ Johnȱ Aspinȱ forȱ rentingȱ theirȱ “Anchorage”ȱ toȱ meȱ andȱ myȱ familyȱ duringȱ ourȱ stayȱ inȱ Canadaȱ andȱ myȱ writingȱ period,ȱ theȱ lovelyȱ sceneryȱ atȱ Princeȱ EdwardȱIslandȱinspiredȱme.ȱȱ

ȱ

Last,ȱbutȱnotȱleast,ȱIȱwantȱtoȱexpressȱmyȱgreatȱgratitudeȱandȱloveȱtoȱmyȱ wholeȱfamilyȱandȱespeciallyȱtoȱmyȱchildrenȱAndreas,ȱMartinȱandȱAntonȱ forȱ helpingȱ meȱ realizeȱ thatȱ thereȱ isȱ moreȱ toȱ lifeȱ thanȱ workȱ andȱ inȱ particularȱtoȱmyȱbeloved,ȱLarsåkeȱforȱyourȱpatience,ȱunderstandingȱȱandȱ encouragement.ȱȱ

ȱ

Östersund,ȱAugustȱ2006ȱȱ IngelaȱBäckströmȱȱ

(6)

(7)

ABSTRACTȱ

Inȱ manyȱ Westernȱ countriesȱ today,ȱ notȱ leastȱ inȱ Sweden,ȱ thereȱ areȱ aȱ lotȱ ofȱ organizationsȱ thatȱ haveȱ greatȱ problemsȱ withȱ sicknessȱ absence.ȱ Theȱ costsȱ connectedȱ toȱ theȱ highȱ ratesȱ ofȱ sicknessȱ absenceȱ haveȱ alsoȱ risenȱ toȱ alarmingȱ levels.ȱ Healthyȱ coȬworkersȱ andȱ healthyȱ organizationsȱ areȱ obviousȱ goalsȱ forȱ manyȱleaders,ȱbutȱthisȱisȱnotȱalwaysȱsoȱeasyȱtoȱestablish.ȱWorkȱ practicesȱandȱ leadershipȱthatȱareȱbeneficialȱtoȱcoȬworkerȱhealthȱareȱthusȱvitalȱtoȱidentify.ȱȱ ȱ

Studiesȱ haveȱshownȱrelationshipsȱ betweenȱcompanyȬwideȱimplementationȱ ofȱ qualityȱ programsȱ andȱ improvedȱ coȬworkerȱ satisfactionȱ alongȱ withȱ lowȱ coȬ workerȱ turnȱ over;ȱ inȱ otherȱ words,ȱ coȬworkerȱ healthȱ alongȱ withȱ improvedȱ customerȱ satisfactionȱ andȱ financialȱ results.ȱ Despiteȱ theȱ greatȱ problemsȱ concerningȱsicknessȱabsence,ȱthereȱareȱorganizationsȱthatȱhaveȱbeenȱawardedȱ prizesȱforȱexcellenceȱinȱleadership,ȱinternalȱpartnership,ȱworkingȱenvironment,ȱ andȱprofitability.ȱ

ȱ

Theȱ overallȱ purposesȱ ofȱ theȱ researchȱ describedȱ inȱ thisȱ thesisȱ areȱ toȱ examineȱ andȱdescribeȱhowȱmanagementȱandȱleadershipȱcanȱestablishȱsustainableȱhealthȱ amongȱtheȱcoȬworkersȱandȱexamineȱhowȱtheȱleadershipȱforȱsustainableȱhealthȱ isȱrelatedȱtoȱQualityȱManagement.ȱTheȱinȬdepthȱpurposeȱisȱtoȱexamineȱwhichȱ aspectsȱ withinȱ theȱ valuesȱ derivedȱ fromȱ theȱ qualityȱ movementȱ areȱ thoseȱ thatȱ primarilyȱinfluenceȱtheȱcoȬworkers’ȱperceivedȱhealth.ȱȱ

ȱ

Theȱresultsȱpresentedȱcanȱbeȱdescribedȱinȱthreeȱpartsȱandȱareȱresultsȱfromȱfourȱ caseȱ studiesȱ carriedȱ outȱ inȱ fiveȱ differentȱ organizations.ȱ Threeȱ ofȱ theȱ organizationsȱ haveȱ receivedȱ awardsȱ forȱ establishingȱ goodȱ workingȱ environment,ȱ goodȱ financialȱ results,ȱ andȱ lowȱ sickȱ leavesȱ amongȱ theirȱ coȬ workers;ȱ theȱ fourthȱ receivedȱ anȱ awardȱ forȱ theȱ successfulȱ implementationȱ ofȱ qualityȱprograms.ȱȱ

ȱ

Theȱ firstȱ partȱ consistsȱ ofȱ resultsȱ fromȱ caseȱ studiesȱ inȱ threeȱ differentȱ organizationsȱ andȱ describesȱ howȱ organizationsȱ canȱ workȱ toȱ achieveȱ sustainableȱ healthȱ amongȱ theirȱ coȬworkers,ȱ withȱ practicalȱ examples.ȱ Theȱ resultsȱ areȱ methodologies,ȱ valuesȱ andȱ organizationalȱ structure,ȱ whichȱ itȱ isȱȱ consideredȱpossibleȱforȱotherȱorganizationsȱtoȱadoptȱinȱtheirȱeffortsȱtoȱachieveȱ goodȱworkingȱconditionsȱresultingȱinȱfewerȱsickȱleaves.ȱȱ

ȱ

Theȱsecondȱpartȱisȱanȱattemptȱtoȱinvestigateȱifȱleadershipȱforȱsustainableȱhealthȱ isȱ relatedȱ toȱ Qualityȱ Management.ȱ Methodologies,ȱ leadershipȱ values,ȱ

(8)

organizationalȱ structure,ȱ andȱ generalȱ valuesȱ foundȱ inȱ organizationsȱ whichȱ haveȱ achievedȱ sustainableȱ healthȱ areȱ analyzedȱ inȱ theȱ lightȱ ofȱ Deming’sȱ 14ȱ points,ȱandȱaȱcorrelationȱisȱindicated.ȱThereȱisȱalsoȱcorrelationȱfoundȱbetweenȱ theȱTQMȱvaluesȱandȱtheȱcoȬworkers’ȱperceptionȱofȱtheirȱhealth.ȱȱȱ

ȱ

Theȱ thirdȱ partȱ examinesȱ whichȱ ofȱ theȱ aspectsȱ withinȱ theȱ valuesȱ grownȱ fromȱ theȱ qualityȱ movementȱ areȱ thoseȱ thatȱ influenceȱ theȱ coȬworkersȱ perceivedȱ health.ȱTheȱresultsȱshowȱsignificantȱcorrelationȱbetweenȱtheȱvaluesȱandȱtheȱcoȬ workers’ȱ perceptionȱ ofȱ theirȱ health.ȱ Aspectsȱ foundȱ withinȱ theȱ valueȱ “Topȱ managementȱ commitment”ȱ wereȱ named;ȱ Empathy,ȱ Presenceȱ andȱ Communication,ȱ Integrity,ȱ andȱ Continuity.ȱ Withinȱ theȱ valueȱ “Letȱ everybodyȱ beȱcommitted”ȱtheȱaspects;ȱDevelopment,ȱInfluenceȱandȱBeingȱinformedȱwereȱ found.ȱ Theseȱ aspectsȱ areȱdescribedȱ inȱmoreȱdetailȱ andȱ alsoȱ inȱ oneȱ modelȱ perȱ value.ȱ

ȱ

Theȱ resultȱ impliesȱ thatȱ theȱ TQMȱ values;ȱ “Topȱ managementȱ commitment”,ȱ

“Improveȱ continuously”ȱ “Letȱ everybodyȱ beȱ Committed”ȱ andȱ “Focusȱ onȱ customers”ȱareȱimportantȱforȱachievingȱhealthyȱorganizationsȱandȱsustainableȱ healthȱamongȱcoȬworkers.ȱȱ

ȱ

(9)

SAMMANFATTNINGȱ

Iȱdagȱärȱdetȱmångaȱorganisationerȱiȱvästvärlden,ȱochȱinteȱminstȱiȱSverigeȱsomȱ harȱstoraȱproblemȱmedȱsjukfrånvaroȱochȱkostnadernaȱsomȱärȱkoppladeȱtillȱdenȱ högaȱsjukfrånvaronȱharȱstigitȱtillȱalarmerandeȱnivåer.ȱȱFriskaȱmedarbetareȱochȱ friskaȱorganisationerȱärȱtydligaȱmålȱförȱmångaȱledareȱmenȱdeȱärȱinteȱalltidȱsåȱ lättȱ attȱ etablera.ȱ Arbetssättȱ ochȱ ledarskapȱ somȱ ärȱ välgörandeȱ förȱ medarbetarnasȱhälsaȱärȱdärförȱvitalaȱattȱidentifiera.ȱȱ

ȱ

Studierȱ harȱ visatȱ påȱ relationȱ mellanȱ helhetsomfattandeȱ implementeringȱ avȱ kvalitetsprogramȱiȱföretagȱochȱökadȱmedarbetarȱnöjdhetȱtillsammansȱmedȱlågȱ medarbetarȱomsättning,ȱmedȱandraȱordȱmedarbetarnasȱhälsaȱtillsammansȱmedȱ förbättradȱ externȱ kundnöjdhetȱ ochȱ ökatȱ finansielltȱ resultat.ȱ Trotsȱ storaȱ problemȱ medȱ sjukfrånvaroȱ såȱ finnsȱ detȱ organisationerȱ somȱ fåttȱ prisȱ förȱ sinȱ utomordentlighetȱiȱledarskap,ȱinterntȱpartnerskap,ȱarbetsmiljöȱochȱlönsamhet.ȱȱ ȱ

Detȱ övergripandeȱ syftetȱ medȱ forskningenȱ somȱ beskrivsȱ iȱ denȱ härȱ avhandlingenȱärȱattȱundersökaȱochȱbeskrivaȱhurȱorganisationerȱkanȱarbetaȱförȱ attȱ åstadkommaȱ hållbarȱ hälsaȱ blandȱ medarbetarnaȱ ochȱ undersökaȱ hurȱ ledarskapetȱ förȱ hållbaraȱ hälsaȱ ärȱ relateratȱ tillȱ Kvalitetsutveckling.ȱ Detȱ underliggandeȱ syftetȱ ärȱ attȱ undersökaȱ vilkaȱ avȱ deȱ aspekterȱ inomȱ värderingarnaȱ somȱ vuxitȱ framȱ urȱ kvalitetsrörelsenȱ somȱ primärtȱ influerarȱ medarbetarnasȱupplevdaȱhälsa.ȱȱ

ȱ

Resultatetȱ somȱ presenterasȱ iȱ denȱ härȱ avhandlingenȱ kanȱ beskrivasȱ iȱ treȱ delarȱ ochȱ ärȱresultatetȱfrånȱ fyraȱfallȱstudierȱgenomfördaȱiȱfemȱolikaȱorganisationer.ȱ Treȱ avȱ organisationernaȱ harȱ fåttȱ prisȱ förȱ attȱ deȱ harȱ åstadkommitȱ godȱ arbetsmiljö,ȱ lönsamhetȱ ochȱ lågaȱ sjukskrivningstalȱ blandȱ medarbetarna,ȱ denȱ fjärdeȱ organisationenȱ harȱ fåttȱ prisȱ förȱ attȱ deȱ varitȱ framgångsrikaȱ medȱ attȱ implementeraȱkvalitetsprogram.ȱ

ȱ

Denȱ förstaȱ delenȱ innehållerȱ resultatȱ frånȱ fallstudierȱ iȱ treȱ olikaȱ organisationerȱ ochȱ beskriverȱ hurȱ organisationerȱ kanȱ arbetaȱ medȱ praktiskaȱ exempel,ȱ förȱ attȱ uppnåȱ hållbarȱ hälsaȱ blandȱ sinaȱ medarbetare.ȱ Resultatetȱ ärȱ arbetssätt,ȱ värderingarȱ ochȱ organisationsstrukturerȱ somȱ bedömtsȱ varaȱ överförbaraȱ tillȱ andraȱorganisationerȱiȱderasȱsträvanȱefterȱattȱåstadkommaȱbraȱarbetsmiljöȱsomȱ resulterarȱiȱfärreȱsjukskrivningar.ȱȱ

ȱ

Denȱandraȱdelenȱärȱettȱförsökȱtillȱattȱundersökaȱomȱledarskapȱförȱhållbarȱhälsaȱ ärȱ besläktatȱ medȱ kvalitetsutveckling.ȱ Deȱ arbetssätt,ȱ ledarskapsvärderingar,ȱ

(10)

organisationsstrukturȱochȱallmännaȱvärderingarȱsomȱhittadesȱiȱorganisationerȱ somȱ harȱ uppnåttȱ hållbarȱ hälsaȱ analyseradesȱ motȱ Demingsȱ 14ȱ punkterȱ ochȱ indikeradeȱkorrelation.ȱȱ

ȱ

Denȱtredjeȱdelenȱundersökerȱvilkaȱaspekterȱinomȱvärderingarnaȱsomȱvuxitȱurȱ kvalitetsrörelsenȱ ochȱ harȱ influeratȱ medarbetarnasȱ upplevdaȱ hälsa.ȱ Resultatetȱ visarȱ påȱ signifikantȱ korrelationȱ mellanȱ värderingarnaȱ ochȱ medarbetarnasȱ upplevdaȱ hälsa.ȱ Aspekternaȱ somȱ hittadesȱ inomȱ värderingenȱ ”Engageratȱ ledarskap”ȱ benämndes;ȱ empati,ȱ närvaroȱ ochȱ kommunikation,ȱ integritetȱ ochȱ kontinuitet.ȱ Inomȱ värderingenȱ ”ȱ Skapaȱ förutsättningarȱ förȱ delaktighet”ȱ hittadesȱ aspekterna;ȱ utveckling,ȱ påverkanȱ ochȱ attȱ bliȱ informerad.ȱ Dessaȱ aspekterȱärȱbeskrivnaȱmerȱiȱdetaljȱochȱmedȱenȱfigurȱförȱvarjeȱvärdering.ȱȱ

ȱ

Resultatenȱ antyderȱ attȱ TQMȱ värderingarna;ȱ ”Engageratȱ ledarskap”,ȱ ”Arbetaȱ ständigtȱmedȱförbättringar”,ȱ”Skapaȱförutsättningarȱförȱdelaktighet”ȱochȱ”Sättȱ kundernaȱiȱcentrum”ȱärȱviktigaȱförȱattȱuppnåȱfriskaȱorganisationerȱochȱhållbarȱ hälsaȱblandȱmedarbetarna.ȱȱ

ȱ

(11)

ȱTABLEȱOFȱCONTENTSȱ ȱ

PREFACE... 5

1 INTRODUCTION ... 9

1.1 B^ACKGROUND... 9

1.2 PROBLEMȱAREA... 11

1.3 PURPOSE... 11

1.4 RESEARCHȱQUESTIONS... 11

1.5 DELIMITATIONS... 12

1.6 THESISȱSTRUCTURE... 12

2 THEORETICALȱFRAMEȱOFȱREFERENCE ... 15

2.1 THEȱQUALITYȱCONCEPT... 15

2.2 THEȱQUALITYȱMOVEMENT... 16

2.3 TOTALȱQUALITYȱMANAGEMENT... 18

2.4 VALUESȱWITHINȱTQM ... 20

2.5 VITALȱFORȱSUCCEEDINGȱWITHȱQUALITYȱMANAGEMENTȱANDȱTQM.. 22

2.6 LEADERSHIPȱANDȱM^ANAGEMENT... 28

2.7 T^HEȱI^NTERNALȱPARTNERSHIPȱM^ODEL... 29

2.8 H^EALTH... 31

2.9 THEȱCONNECTIONȱBETWEENȱQUALITYȱMANAGEMENTȱANDȱHEALTH36 3 RESEARCHȱMETHODOLOGY ... 38

3.1 PURPOSEȱOFȱTHEȱRESEARCH... 38

3.2 R^ESEARCHȱA^PPROACH... 39

3.3 RESEARCHȱSTRATEGIES... 46

3.4 METHODOLOGICALȱCHOICESȱINȱTHEȱPERFORMEDȱCASEȱSTUDIES... 49

3.5 RELIABILITY,ȱVALIDITYȱANDȱGENERALIZABILITY... 63

4 SUMMARYȱOFȱAPPENDEDȱPAPERS... 66

4.1 PAPERA ... 66

4.2 P^APERȱB ... 68

4.3 PAPERȱC... 71

4.4 PAPERȱD... 76 ȱ

(12)

5 MAINȱFINDINGSȱANDȱCONCLUSIONS... 80

5.1 RECONNECTIONȱTOȱTHEȱRESEARCHȱQUESTIONS... 80

5.2 RECONNECTIONȱTOȱTHEȱPURPOSEȱANDȱTOȱTHEORY... 89

5.3 CONCLUSIONS... 93

6 DISCUSSIONSȱANDȱFURTHERȱRESEARCH ... 96

6.1 Q^UALITYȱMANAGEMENTȱFORȱSUSTAINABLEȱHEALTH... 96

6.2 FURTHERȱRESEARCH... 97

REFERENCES... 99 ȱ

APPENDEDȱPAPERSȱ ȱ

APPENDICES

(13)

APPENDEDȱPAPERSȱ

ȱ

PaperȱAȱ

Harnesk,ȱ R.,ȱ Schön,ȱ K.ȱ &ȱ Bäckström,ȱ I.ȱ (2005).ȱ Howȱ successfulȱ Swedishȱ organizationsȱ achieveȱ sustainableȱ health.ȱ Internationalȱ Journalȱ ofȱ ManagementȱPractice,ȱVol.ȱ1,ȱNo.ȱ3,ȱppȱ233Ȭ250.ȱȱ

ȱ

PaperȱBȱ

Lagrosen,ȱ Y.,ȱ Bäckström,ȱ I.ȱ &ȱ Lagrosen,ȱ S.ȱ (2007).ȱ Qualityȱ Managementȱ andȱ Healthȱ aȱ doubleȱ connection.ȱ Forthcomingȱ inȱ Internationalȱ Journalȱ ofȱ QualityȱandȱReliabilityȱManagement,ȱVol.ȱ24,ȱIssueȱ1.ȱȱ

Anȱ earlierȱ versionȱ ofȱ theȱ paperȱ wasȱ presentedȱ atȱ andȱ publishedȱ inȱ theȱ Proceedingsȱofȱ7^thȱToulonȬVeronaȱConference,ȱQualityȱinȱServices,ȱSeptember,ȱ 2004,ȱToulon,ȱFrance.ȱ

ȱ

PaperȱCȱ

Lagrosen,ȱ Y.,ȱ Bäckström,ȱ I.ȱ &ȱ Lagrosen,ȱ S.ȱ (2005).ȱ Healthȱ effectsȱ ofȱ Qualityȱ Managementȱ Ȭȱ theȱ roleȱ ofȱ leadershipȱ andȱ participation.ȱ Submittedȱforȱpublication.ȱ

Anȱ earlierȱ versionȱ ofȱ theȱ paperȱ wasȱ presentedȱ atȱ andȱ publishedȱ inȱ theȱ Proceedingsȱ ofȱ 8^thȱ QMODȱ Internationalȱ Conference,ȱ Qualityȱ Managementȱ &ȱ OrganizationalȱDevelopment,ȱJune,ȱ2005,ȱPalermo.ȱ

ȱ

PaperȱDȱ

Bäckström,ȱ I.,ȱ Larsson,ȱ J.ȱ &ȱ Wiklund,ȱ H.ȱ (2006)ȱ Leadershipȱ andȱ Workplaceȱ Healthȱ Promotionȱ Ȭȱ Successfulȱ organizationsȱ fromȱ aȱ TQMȱ perspective.ȱSubmittedȱforȱpublication.ȱȱ

ȱ ȱ

APPENDICESȱ

ȱ

x Descriptionsȱofȱtheȱ5ȱstudiedȱorganizationsȱȱ x Questionnaireȱ

ȱ

(14)

(15)

PREFACEȱ

Iȱ willȱ firstȱ giveȱ aȱ shortȱ descriptionȱ ofȱ myȱ backgroundȱ asȱ theȱ authorȱ ofȱ thisȱ thesisȱ sinceȱ myȱ background,ȱ educationȱ andȱ experienceȱ haveȱ influencedȱ theȱ choiceȱ ofȱ approachesȱ inȱ differentȱ decisionsȱ duringȱ theȱ wholeȱresearchȱprocess.ȱItȱisȱmyȱintentionȱthatȱthisȱintroductionȱwillȱhelpȱ you,ȱ asȱ aȱ readerȱ ofȱ theȱ thesis,ȱ toȱ understandȱ myȱ pointȱ ofȱ viewȱ andȱ toȱ followȱmeȱthroughȱmyȱresearch.ȱȱ

ȱ

Workingȱ asȱ anȱ accountantȱ forȱ manyȱ yearsȱ Iȱ visitedȱ manyȱ differentȱ organizationsȱinȱdifferentȱfieldsȱandȱofȱdifferentȱsizes.ȱEvenȱthoughȱthereȱ areȱdifferencesȱbetweenȱallȱorganizationsȱthereȱareȱmanyȱthingsȱthatȱareȱ commonȱ toȱ allȱ organizations.ȱ Allȱ organizationsȱ haveȱ coȬworkersȱ andȱ managers,ȱ allȱ organizationsȱ haveȱ someȱ kindȱ ofȱ administration.ȱ Atȱ thatȱ timeȱIȱlearnedȱthatȱtheȱsameȱroutineȱworkȱandȱtheȱsameȱsetȱofȱproblemsȱ couldȱ beȱ solvedȱ inȱ manyȱ ways,ȱ withȱ differentȱ methodologies.ȱ Iȱ alsoȱ learnedȱ thatȱ itȱ dependsȱ onȱ theȱ leaders’ȱ andȱ theȱ managers’ȱ wayȱ ofȱ leading,ȱasȱtoȱhowȱtheȱcoȬworkersȱgetȱalongȱwithȱeachȱotherȱandȱhowȱtheȱ workȱsituationsȱare.ȱOnȱmyȱfirstȱvisitȱtoȱanȱorganization,ȱIȱcouldȱalreadyȱ tellȱ byȱ theȱ morningȱ coffeeȱ break,ȱ whatȱ kindȱ ofȱ workȱ situationȱ theȱ coȬ workersȱ had:ȱ ifȱ theyȱ enjoyedȱ workingȱ there,ȱ ifȱ theyȱ likedȱ workingȱ togetherȱ withȱ eachȱ other,ȱ ifȱ theyȱ likedȱ theirȱ managerȱ orȱ not.ȱ Atȱ someȱ organizationsȱtheyȱhadȱsoȱmuchȱfunȱatȱtheȱcoffeeȱbreaksȱthatȱtheyȱwereȱ laughingȱtheirȱheadsȱoff,ȱinȱotherȱorganizationsȱtheyȱdidȱnotȱevenȱtalkȱtoȱ eachȱ other.ȱ Thisȱ reallyȱ fascinatedȱ meȱ butȱ studyingȱ theȱ coȬworkersȱ andȱ theȱleadersȱwasȱnotȱwhatȱIȱwasȱthereȱtoȱdo.ȱȱ

ȱ

Asȱ youȱ mightȱ alreadyȱ haveȱ figuredȱ out,ȱ myȱ workȱ asȱ anȱ accountantȱ didȱ notȱappealȱtoȱme.ȱIȱlikedȱtheȱcontactȱwithȱpeopleȱinȱtheȱorganizationsȱandȱ myȱcolleaguesȱbutȱnotȱtheȱworkȱIȱhadȱtoȱdo.ȱAfterȱworkingȱsevenȱyearsȱIȱ decidedȱ toȱ endȱ myȱ careerȱ inȱ accountancyȱ andȱ finishedȱ myȱ businessȱ studiesȱandȱIȱalsoȱstartedȱtoȱstudyȱpedagogics.ȱMyȱaimȱwasȱtoȱbecomeȱaȱ teacherȱ atȱ upperȱ secondaryȱ schoolȱ inȱ economicsȱ andȱ business,ȱ butȱ sometimesȱ lifeȱ doesȱ notȱ turnȱ outȱ asȱ youȱ expectedȱ butȱ thisȱ isȱ notȱ necessarilyȱ aȱ badȱ thing.ȱ Whenȱ Iȱ hadȱ studiedȱ forȱ aȱ year,ȱ Ericssonȱ advertisedȱ forȱ peopleȱ withȱ businessȱ qualifications.ȱ Iȱ appliedȱ andȱ gotȱ aȱ jobȱ asȱ aȱ teamȱ leaderȱ atȱ theȱ accountsȱ department.ȱ Iȱ likedȱ workingȱ withȱ

(16)

peopleȱ andȱ improvingȱ procedures.ȱ Afterȱ aȱ while,ȱ Iȱ startedȱ toȱ lookȱ forȱ otherȱ responsibilitiesȱ withinȱ theȱ organizationȱ andȱ asȱ theȱ organizationȱ wasȱbig,ȱaboutȱ1000ȱcoȬworkers,ȱthereȱwereȱaȱlotȱofȱopportunities.ȱIȱgotȱaȱ jobȱasȱaȱprojectȱleaderȱworkingȱonȱaȱprojectȱtoȱdevelopȱqualityȱtoolsȱthatȱ wereȱtoȱbeȱmadeȱmoreȱeasilyȱavailableȱforȱtheȱcoȬworkers.ȱAtȱthatȱtimeȱIȱ realizedȱ thatȱ Iȱ hadȱ beenȱ involvedȱ inȱ qualityȱ workȱ atȱ theȱ accountingȱ companyȱasȱwell,ȱalthoughȱweȱdidȱnotȱcallȱitȱqualityȱwork.ȱIȱandȱanotherȱ coȬworkerȱhadȱdevelopedȱaȱstandardȱforȱtheȱauditsȱinȱsmallȱcompanies.ȱȱȱ ȱ

Whenȱ Iȱ workedȱ inȱ theȱ projectȱ atȱ Ericsson,ȱ Iȱ realizedȱ howȱ peopleȱ withȱ differentȱ skillsȱ andȱ backgroundsȱ couldȱ complementȱ eachȱ other.ȱ Asȱ theȱ leaderȱforȱtheȱproject,ȱIȱwantedȱtoȱmoveȱonȱandȱachieveȱresultsȱbutȱinȱtheȱ groupȱthereȱwereȱsomeȱpeopleȱthatȱhadȱexperiencedȱaȱprojectȱcrashȱandȱ wereȱ reallyȱ afraidȱ ofȱ makingȱ mistakes.ȱ Weȱ madeȱ aȱ reallyȱ goodȱ teamȱ togetherȱ sinceȱ weȱ madeȱ useȱ ofȱ allȱ theȱ teamȱ members’ȱ differentȱ qualifications.ȱ Weȱ madeȱ oneȱ toolboxȱ onȱ theȱ intranetȱ andȱ oneȱ physicalȱ toolȱboxȱthatȱcoȬworkersȱinȱtheȱorganizationȱcouldȱuseȱinȱworkshopsȱandȱ whenȱtheyȱwereȱworkingȱwithȱimprovements.ȱIȱdidȱnotȱwantȱtoȱgoȱbackȱ toȱmyȱjobȱatȱtheȱaccountsȱdepartmentȱwhenȱtheȱprojectȱwasȱfinished.ȱTheȱ Americanȱ companyȱ Solectronȱ hadȱ boughtȱ theȱ Ericssonȱ plantȱ andȱ thatȱ createdȱnewȱopportunities.ȱIȱstartedȱtoȱworkȱasȱaȱmemberȱofȱaȱCustomerȱ Focusȱ Team,ȱ whereȱ weȱ firstȱ documentedȱ ourȱ customers’ȱ expectationsȱ togetherȱwithȱtheȱcustomerȱandȱthenȱweȱstartedȱtoȱmeasureȱtheȱCustomerȱ Satisfactionȱ Index.ȱ Thatȱ isȱ aȱ processȱ byȱ whichȱ everyȱ Solectronȱ plantȱ isȱ evaluated.ȱ Thatȱ wasȱ anȱ enjoyableȱ butȱ frustratingȱ job.ȱ Weȱ hadȱ aȱ closeȱ relationshipȱwithȱtheȱcustomerȱandȱweȱknewȱwhatȱtheyȱwantedȱbutȱweȱ didȱ notȱ haveȱ theȱ authority,ȱ theȱ resources,ȱ orȱ theȱ powerȱ toȱ satisfyȱ themȱ andȱ theȱ manufacturingȱ managersȱ didȱ notȱ alwaysȱ understandȱ usȱ orȱ theȱ customer.ȱ Sometimesȱ theȱ managersȱ didȱ notȱ wantȱ toȱ makeȱ changesȱ thatȱ hadȱ toȱ beȱ made.ȱ Afterȱ aȱ whileȱ Iȱ gotȱ theȱ opportunityȱ toȱ workȱ withȱ theȱ improvementsȱ insideȱ theȱ plantȱ andȱ Iȱ thoughtȱ thatȱ thisȱ isȱ whereȱ Iȱ canȱ reallyȱmakeȱtheȱchangesȱthatȱhaveȱtoȱbeȱmadeȱinȱtheȱorganization.ȱIȱthenȱ realizedȱthatȱtheȱtopȱmanagersȱdidȱnotȱunderstandȱwhatȱreallyȱhadȱtoȱbeȱ doneȱandȱsometimesȱtheyȱdidȱnotȱwantȱtoȱmakeȱtoughȱdecisionsȱandȱriskȱ theirȱownȱposition.ȱByȱthisȱtime,ȱIȱhadȱrealizedȱthatȱitȱwasȱtimeȱforȱmeȱtoȱ moveȱonȱandȱatȱtheȱsameȱtime,ȱtheȱorderȱintakeȱstartedȱtoȱdropȱandȱtheȱ companyȱ hadȱ toȱ giveȱ peopleȱ notice.ȱ Iȱ volunteeredȱ toȱ leaveȱ soȱ thatȱ

(17)

anotherȱ coȬworkerȱ couldȱ haveȱ myȱ job.ȱ Iȱ nowȱ understoodȱ thatȱ itȱ wasȱ qualityȱthatȱwasȱimportantȱandȱIȱhadȱtakenȱoneȱcourseȱatȱtheȱuniversityȱ duringȱ myȱ employmentȱ atȱ Ericsson.ȱ Asȱ ifȱ itȱ wereȱ meantȱ toȱ be,ȱ someȱ weeksȱafterȱIȱhadȱdecidedȱtoȱleaveȱthereȱwasȱaȱjobȱadvertisementȱinȱtheȱ newspaperȱ forȱ aȱ lecturerȱ andȱ researcherȱ inȱ Qualityȱ Technologyȱ andȱ ManagementȱatȱMidȱSwedenȱUniversity!ȱ

ȱ

Thatȱ wasȱ fourȱ yearsȱ ago,ȱ andȱ now,ȱ Iȱ haveȱ theȱ opportunityȱ toȱ teachȱ theȱ studentsȱbasedȱonȱmyȱexperienceȱandȱwhatȱIȱthinkȱisȱcriticalȱforȱsuccess.ȱIȱ alsoȱ haveȱ theȱ opportunityȱ toȱ studyȱ andȱ enterȱ deeplyȱ intoȱ thisȱ excitingȱ andȱ importantȱ subject.ȱ Duringȱ myȱ researchȱ educationȱ Iȱ haveȱ becomeȱ evenȱ surerȱ ofȱ theȱ importanceȱ ofȱ Qualityȱ Managementȱ andȱ managementȱ commitment.ȱȱȱ

ȱ

(18)

(19)

1 INTRODUCTIONȱ

Theȱ purposeȱ ofȱ thisȱ firstȱ chapterȱ isȱ toȱ giveȱ theȱ readerȱ anȱ introductionȱ andȱ backgroundȱtoȱtheȱresearchȱareaȱandȱtoȱdescribeȱtheȱproblemȱandȱtheȱpurposeȱofȱ theȱresearchȱpresentedȱinȱthisȱlicentiateȱthesis.ȱTheȱstructureȱofȱtheȱthesisȱisȱalsoȱ presented.ȱ

ȱ

1.1 Backgroundȱ

Severalȱ countriesȱ inȱ Europeȱ haveȱ problemsȱ withȱ highȱ absenceȱ rates;ȱ amongȱtheseȱareȱtheȱNetherlands,ȱtheȱUK,ȱSweden,ȱNorway,ȱandȱIcelandȱ (Bonatoȱ &ȱ Lusinyan,ȱ 2004).ȱ Swedenȱ hasȱ displayedȱ anȱ upwardȱ trendȱ inȱ recentȱ yearsȱ (ibid)ȱ andȱ thisȱ trendȱ isȱ especiallyȱ clearȱ whenȱ itȱ comesȱ toȱ longȬtermȱ sicknessȱ absence,ȱ whichȱ hasȱ increasedȱ byȱ 30ȱ %ȱ betweenȱ 1997ȱ andȱ 2002ȱ (Riksförsäkringsverketȱ (Swedishȱ Socialȱ Insuranceȱ Administration,ȱ 2002).ȱ Manyȱ peopleȱ withȱ aȱ backgroundȱ ofȱ longȬtermȱ sicknessȱabsenceȱwillȱneverȱgetȱhealthyȱenoughȱtoȱworkȱagain.ȱThisȱcanȱ beȱ seenȱ byȱ readingȱ theȱ earlyȱ retirementȱ ratesȱ inȱ Swedenȱ whichȱ haveȱ increasedȱbyȱ15ȱ%ȱbetweenȱ2002ȱandȱ2004ȱ(Lindberg,ȱ2006).ȱAccordingȱtoȱ Janssenȱ etȱ al.ȱ (2003),ȱ theȱ occurrenceȱ andȱ causesȱ ofȱ sicknessȱ absenceȱ areȱ affectedȱbyȱseveralȱfactors,ȱincludingȱsocial,ȱworkȬrelated,ȱorganizational,ȱ andȱ individualȱ factorsȱ whichȱ makeȱ sicknessȱ absenceȱ intoȱ aȱ complexȱ phenomenon.ȱ Accordingȱ toȱ Lindbergȱ (2006),ȱ thereȱ wouldȱ beȱ considerableȱgainsȱforȱindividuals,ȱworkplaces,ȱandȱsocietyȱifȱtheȱnumberȱ ofȱ coȬworkersȱ sufferingȱ formȱ physicalȱ andȱ mentalȱ disordersȱ couldȱ beȱ reduced.ȱȱ

ȱ

DaubasȬLetourneuxȱ &ȱ ThébaudȬMony,ȱ (2003)ȱ maintainȱ thatȱ healthȱ atȱ workȱshouldȱbeȱgivenȱhighȱpriorityȱbyȱtheȱmanagementȱandȱotherȱactors,ȱ becauseȱ havingȱ peopleȱ absentȱ fromȱ workȱ resultsȱ inȱ considerableȱ expensesȱ forȱ companies.ȱ Besidesȱ immenseȱ costs,ȱ sickȱ absenceȱ hasȱ manyȱ consequencesȱ forȱ individuals,ȱ workplacesȱ andȱ societiesȱ seeȱ e.g.ȱ (Bonatoȱ

&ȱLusinyan,ȱ2004).ȱUnhealthyȱstressȱisȱoneȱcauseȱofȱsicknessȱandȱsicknessȱ absence.ȱ Accordingȱ toȱ Arnetzȱ (2002),ȱ theȱ researchȱ onȱ stress,ȱ efficiencyȱ andȱ renewalȱ seenȱ fromȱ theȱ perspectiveȱ ofȱ organizations,ȱ providesȱ aȱ numberȱofȱinterestingȱcluesȱtoȱmanagementȱandȱcoȬworkersȱonȱhowȱtheȱ operationȱcanȱbeȱrenewedȱandȱhowȱunhealthyȱstressȱmayȱbeȱprevented.ȱ

(20)

Heȱ alsoȱ statesȱ thatȱ itȱ takesȱ aȱ seriesȱ ofȱ effortsȱ withinȱ bothȱ softȱ andȱ hardȱ areasȱ inȱ orderȱ toȱ achieveȱ aȱ sustainableȱ organizationȱ andȱ coȬworkerȱ health.ȱFurthermore,ȱDolbierȱetȱal.ȱ(2001)ȱandȱYrkesinspektionen,ȱÖrebroȱ distriktȱ (Labourȱ Inspectorate,ȱ Örebroȱ Division),ȱ (2000)ȱ amongȱ others,ȱ haveȱ documentedȱ theȱ connectionȱ betweenȱ aȱ highȱ frequencyȱ ofȱ sicknessȱ absenceȱandȱaȱpsychologicallyȱunsatisfactoryȱworkȱenvironment.ȱ

ȱ

Comparedȱ toȱ otherȱ OECDȱ countries,ȱ theȱ coȬworkersȱ inȱ Swedenȱ haveȱ reportedȱtheȱlargestȱdecreaseȱinȱjobȱsatisfactionȱfromȱ1995ȱtoȱ2000ȱOeijȱ&ȱ Wiezer,ȱ (2002).ȱ Despiteȱ theȱ highȱ sicknessȱ absenceȱ ratesȱ andȱ theȱ lowȱ jobȱ satisfactionȱ inȱ Sweden,ȱ thereȱ areȱ Swedishȱ organizationsȱ thatȱ haveȱ reducedȱ theirȱ sicknessȱ absenceȱ andȱ achievedȱ sustainableȱ healthȱ amongȱ theirȱ coȬworkersȱ andȱ theyȱ canȱ alsoȱ bearȱ witnessȱ toȱ anȱ increasedȱ organizationalȱ performance,ȱ see,ȱ forȱ instance,ȱ (Harneskȱ etȱ al.ȱ 2005)ȱ Accordingȱ toȱ Waddockȱ &ȱ Graves,ȱ (1997),ȱ socialȱ andȱ financialȱ performanceȱ canȱ beȱ likeȱ aȱ virtuousȱ circle:ȱ socialȱ performanceȱ andȱ financialȱperformanceȱfeedȱandȱreinforceȱeachȱother.ȱȱ

ȱ

Thereȱ areȱ someȱ studiesȱ thatȱ haveȱ shownȱ relationshipsȱ betweenȱ aȱ companyȬwideȱ implementationȱ ofȱ qualityȱ programsȱ andȱ coȬworkerȱ healthȱ inȱ theȱ mannerȱ ofȱ improvedȱ coȬworkerȱ satisfactionȱ andȱ lowȱ coȬ workerȱturnȱover,ȱinȱadditionȱtoȱimprovedȱexternalȱcustomerȱsatisfactionȱ andȱ financialȱ resultsȱ (Dahlgaardȱ &ȱ Parkȱ ,ȱ 2003aȱ andȱ 2003b).ȱ Theȱ connectionȱ betweenȱ Totalȱ Qualityȱ Managementȱ (TQM)ȱ andȱ financialȱ performanceȱ hasȱ alsoȱ beenȱ exploredȱ inȱ manyȱ investigations.ȱ Accordingȱ toȱ Hendricksȱ &ȱ Singhalȱ (1999),ȱ theȱ linkȱ betweenȱ TQMȱ andȱ financialȱ performanceȱ isȱ clear.ȱ Hanssonȱ &ȱ Erikssonȱ (2002)ȱ foundȱ inȱ theirȱ investigationȱ thatȱ organizationsȱ thatȱ hadȱ implementedȱ TQMȱ alsoȱ hadȱ significantlyȱhigherȱreturnȱofȱassetsȱthanȱcomparableȱorganizations.ȱInȱaȱ studyȱ byȱ Sebastianelliȱ &ȱ Tamimiȱ (2003)ȱ itȱ isȱ pointedȱ outȱ thatȱ mostȱ obstaclesȱ toȱ TQMȱ canȱ beȱ linkedȱ directlyȱ toȱ ineffectiveȱ changeȱ management.ȱAccordingȱtoȱRahmanȱ(2004),ȱtheȱsofterȱ‘dimensions’,ȱoftenȱ calledȱ‘values’ȱofȱTQM,ȱareȱmuchȱtheȱsameȱasȱtheȱvaluesȱinȱmanagementȱ theory.ȱ Demingȱ (1986)ȱ describesȱ howȱ topȱ managementȱ canȱ provideȱ aȱ chainȱ orȱ aȱ connectionȱ whichȱ meansȱ thatȱ improvedȱ qualityȱ nurturesȱ effectiveȱandȱprofitableȱorganizations.ȱȱ

ȱ

(21)

1.2 ProblemȱAreaȱ

Inȱ spiteȱ ofȱ aȱ lotȱ ofȱ research,ȱ literature,ȱ andȱ knowȬhowȱ aroundȱ howȱ toȱ conductȱ organizations,ȱ theȱ bestȱ wayȱ seemȱ toȱ beȱ veryȱ difficultȱ toȱ carryȱ out;ȱthatȱis,ȱhowȱtoȱtransformȱknowledgeȱintoȱaction.ȱThereȱare,ȱhowever,ȱ someȱ organizationsȱ thatȱ haveȱ actuallyȱ succeededȱ inȱ achievingȱ sustainableȱ healthȱ amongȱ theirȱ coȬworkersȱ throughȱ theirȱ qualityȱ workȱ andȱ theirȱ leadership.ȱ Theyȱ haveȱ alsoȱ decreasedȱ theȱ sickȱ absenceȱ amongȱ theirȱ coȬworkersȱ andȱ increasedȱ theirȱ organization’sȱ profitability.ȱ Howȱ didȱ theyȱ workȱ inȱ orderȱ toȱ achieveȱ sustainableȱ healthȱ amongȱ theirȱ coȬ workers?ȱ Isȱ itȱ possibleȱ thatȱ otherȱ organizationsȱ canȱ learnȱ fromȱ theseȱ successfulȱ organizationsȱ andȱ throughȱ thatȱ achieveȱ sustainableȱ healthȱ amongȱtheirȱcoȬworkers?ȱ

ȱ

1.3 Purposeȱ

Theȱoverallȱpurposeȱofȱtheȱresearchȱdescribedȱinȱthisȱthesisȱisȱtoȱexamineȱ andȱdescribeȱhowȱleadershipȱcanȱestablishȱsustainableȱhealthȱamongȱtheȱ coȬworkersȱ andȱ examineȱ howȱ theȱ leadershipȱ forȱ sustainableȱ healthȱ isȱ relatedȱ toȱ Qualityȱ Management.ȱ Theȱ inȬdepthȱ purposeȱ isȱ toȱ examineȱ whichȱ aspectsȱ withinȱ theȱ valuesȱ grownȱ fromȱ theȱ qualityȱ movementȱ areȱ thoseȱ thatȱ primarilyȱ influenceȱ theȱ coȬworkers’ȱ perceivedȱ health.ȱ Theȱ underlyingȱ assumptionȱ isȱ thatȱ theȱ resultsȱ inȱ thisȱ researchȱ couldȱ helpȱ otherȱ organizationȱ toȱ establishȱ sustainableȱ healthȱ amongȱ theirȱ coȬ workers.ȱ

ȱ

1.4 ResearchȱQuestionsȱ

Toȱ fulfilȱ theȱ purpose,ȱ theȱ followingȱ threeȱ researchȱ questionsȱ haveȱ beenȱ formulated:ȱ

ȱȱ

1. Howȱ areȱ organizations,ȱ whichȱ haveȱ achievedȱ sustainableȱ healthȱ amongȱtheirȱcoȬworkers,ȱworkingȱinȱpractice?ȱȱ

2. Toȱwhatȱextentȱdoȱorganizations,ȱwhichȱhaveȱachievedȱsustainableȱ healthȱ amongȱ coȬworkers,ȱ workȱ accordingȱ toȱ Qualityȱ Management?ȱ

3. Whatȱaspectsȱwithinȱtheȱvaluesȱgrownȱfromȱtheȱqualityȱmovementȱ areȱofȱimportanceȱforȱtheȱcoȬworkers’ȱperceptionȱofȱtheirȱhealth?ȱ ȱ

(22)

1.5 Delimitationsȱ

Theȱpurposeȱandȱtheȱresearchȱquestionsȱinȱthisȱthesisȱwillȱbeȱrestrictedȱtoȱ Swedishȱ organizations.ȱ Culture,ȱ structure,ȱ andȱ otherȱ differencesȱ inȱ organizationsȱ inȱ otherȱ countriesȱ mightȱ influenceȱ theȱ possibilityȱ andȱ theȱ effectȱofȱtheirȱwayȱofȱworking.ȱȱȱ

ȱ

1.6 ThesisȱStructureȱ

Theȱ bodyȱ ofȱ theȱ thesisȱ consistsȱ ofȱ sixȱ chapters,ȱ plusȱ fourȱ papersȱ andȱ appendices.ȱ Theȱ structureȱ isȱ presentedȱ inȱ Figureȱ 1Ȭ1ȱ below.ȱ Theȱ firstȱ chapterȱisȱmeantȱtoȱgiveȱanȱintroductionȱandȱbackgroundȱtoȱtheȱresearchȱ areaȱ andȱ itȱ alsoȱ describesȱ theȱ problemȱ areaȱ andȱ theȱ purposesȱ ofȱ theȱ researchȱ presentedȱ inȱ thisȱ licentiateȱ thesis.ȱ Theȱ theoreticalȱ frameworkȱ relevantȱtoȱtheȱresearchȱpresentedȱinȱthisȱthesisȱisȱthenȱgivenȱinȱChapterȱ 2,ȱalongȱwithȱreferencesȱtoȱotherȱauthors’ȱworkȱinȱthisȱfieldȱofȱresearch.ȱ Chapterȱ3ȱhasȱaȱpresentationȱofȱtheȱchosenȱmethodologyȱandȱincludesȱaȱ discussionȱ ofȱ aspectsȱ relatedȱ toȱ theȱ chosenȱ researchȱ approachȱ andȱ strategyȱ inȱ orderȱ toȱ fulfilȱ theȱ purpose.ȱ Chapterȱ 3ȱ alsoȱ containsȱ aȱ discussionȱ concerningȱ validity,ȱ reliabilityȱ andȱ generalizability.ȱ Inȱ Chapterȱ4,ȱtheȱfourȱappendedȱpapersȱareȱshortlyȱsummarizedȱandȱinȱtheȱ fifthȱchapterȱofȱtheȱbody,ȱtheȱfindingsȱandȱconclusionsȱareȱpresentedȱandȱ suggestionsȱ givenȱ toȱ organizationsȱ andȱ leadersȱ whoȱ wishȱ toȱ achieveȱ healthyȱ coȬworkers.ȱ Inȱ theȱ lastȱ chapterȱ theȱ resultsȱ areȱ discussedȱ andȱ ideasȱforȱfurtherȱresearchȱareȱalsoȱpresented.ȱ

ȱ

Theȱ relationsȱ betweenȱ theȱ appendedȱ papersȱ andȱ theȱ researchȱ questionsȱ presentedȱinȱthisȱthesisȱareȱshownȱinȱFigureȱ1Ȭ2.ȱ

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ

(23)

ȱ ȱ

Chapterȱ1

Introduction

Paperȱ A

Chapterȱ2

Theoreticalȱframeȱ ofȱreference

Chapterȱ3

Researchȱ methodology

Chapterȱ5

Mainȱfindings andȱconclusions Paperȱ

B

Paperȱ C

Paperȱ D

Appended papers

Appendices Chapterȱ4

Summaryȱofȱappendedȱpapers

Chapterȱ6

Discussionsȱandȱ furtherȱresearch ȱ

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ

Figureȱ1Ȭ1ȱTheȱstructureȱofȱthisȱthesisȱȱ

(24)

ȱ

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ

ResearchȱQuestionȱ1 Howȱareȱorganizations,ȱ whichȱhaveȱachievedȱ sustainableȱhealthȱ amongȱtheirȱcoȬ workers,ȱworkingȱinȱ practice ?ȱ

ResearchȱQuestionȱ2 Toȱwhatȱextent do organizations,ȱwhich

haveȱachievedȱ sustainableȱhealth amongȱcoȬworkers, workȱaccordingȱtoȱ QualityȱManagement?

ResearchȱQuestionȱ3 Whatȱaspectsȱwithinȱthe valuesȱgrownȱfromȱthe qualityȱmovementȱareȱ ofȱimportanceȱforȱtheȱ coȬworkers’ perceptionȱ ofȱtheirȱhealth?

PaperȱA

Howȱsuccessfulȱ Swedishȱ

organisationsȱ achieveȱsustainableȱ health

PaperȱB

Qualityȱmanagementȱ andȱhealth,ȱaȱdoubleȱ connection

PaperȱC

Healthȱeffectsȱofȱ qualityȱmanagement,ȱ theȱroleȱofȱleadershipȱ andȱparticipation

PaperȱD

Leadershipȱandȱ WorkplaceȱHealthȱ Promotionȱ

Ȭ Successfulȱ

organisationsȱfromȱaȱ TQMȱperspective

Figureȱ1Ȭ2ȱTheȱconnectionȱbetweenȱtheȱresearchȱquestionsȱandȱtheȱappendedȱpapersȱofȱ thisȱthesis.ȱ

ȱȱ

Figureȱ 1.2ȱ illustratesȱ theȱ mainȱ relationsȱ betweenȱ theȱ researchȱ questionsȱ andȱtheȱappendedȱpapers.ȱTheȱrelationsȱareȱcomplexȱandȱitȱcanȱbeȱnotedȱ thatȱ threeȱ papersȱ areȱ relatedȱ toȱ twoȱ researchȱ questionsȱ each.ȱ Researchȱ Questionsȱ 1ȱ andȱ 3ȱ areȱ answeredȱ throughȱ twoȱ papersȱ each,ȱ whileȱ theȱ answerȱtoȱResearchȱQuestionȱ2ȱisȱfoundȱinȱthreeȱpapers.ȱȱȱ

(25)

ȱ

2 THEORETICALȱFRAMEȱOFȱREFERENCEȱ

Inȱ thisȱ chapter,ȱ theȱ theoreticalȱ frameworkȱ relevantȱ toȱ theȱ researchȱ describedȱ inȱ thisȱ thesisȱ isȱ presented.ȱ Theȱ chapterȱ givesȱ referencesȱ toȱ otherȱ authors’ȱ workȱ inȱ theȱareaȱrelatedȱtoȱtheȱresearchȱpresentedȱinȱthisȱthesis.ȱȱȱ

ȱ

2.1 TheȱQualityȱConceptȱ

Qualityȱ hasȱ beenȱ givenȱ differentȱ definitionsȱ atȱ differentȱ times;ȱ seeȱ forȱ exampleȱ(Juran,ȱ1951)ȱwhoȱdefinesȱqualityȱasȱ“fitnessȱforȱuse”.ȱAccordingȱ toȱ Demingȱ (1986),ȱ qualityȱ shouldȱ beȱ “aimedȱ atȱ theȱ needsȱ ofȱ theȱ customer,ȱ presentȱ andȱ future”.ȱ ȱ Theȱ factȱ thatȱ theȱ qualityȱ conceptȱ shouldȱ originateȱ fromȱ theȱ needsȱ andȱ wantsȱ ofȱ theȱ customersȱ wasȱ somethingȱ thatȱ theȱ Japaneseȱ managersȱ soonȱ becameȱ awareȱ ofȱ (Bergmanȱ &ȱ Klefsjö,ȱ 2003).ȱ Bergmanȱ &ȱ Klefsjöȱ (2003)ȱ haveȱ definedȱ qualityȱ inȱ aȱ widerȱ concept;ȱ

“qualityȱ isȱ toȱ satisfy,ȱ andȱ preferablyȱ exceed,ȱ theȱ needsȱ andȱ expectationsȱ ofȱ theȱ customers”.ȱ Qualityȱ inȱ theȱ researchȱ describedȱ inȱ thisȱ thesisȱ isȱ definedȱ asȱ theȱwiderȱconceptȱofȱBergmanȱ&ȱKlefsjöȱ(2003).ȱȱ

ȱ

Sinceȱ qualityȱ isȱ judgedȱ byȱ theȱ customer,ȱ workȱ thatȱ aimsȱ toȱ increaseȱ qualityȱ withinȱ organizationsȱ hasȱ toȱ startȱ byȱ identifyingȱ theȱ customers.ȱ Differentȱ organizationsȱ haveȱ differentȱ kindsȱ ofȱ customers,ȱ althoughȱ someȱ organizationsȱ doȱ notȱ referȱ toȱ themȱ asȱ customers,ȱ andȱ mostȱ organizationsȱ haveȱ bothȱ externalȱ andȱ internalȱ customers.ȱ Theȱ meaningȱ andȱtheȱdefinitionȱofȱtheȱconceptȱofȱcustomerȱvary.ȱFromȱasȱnarrowȱasȱinȱ theȱ ISOȱ 9000:2000ȱ standardȱ “anȱ organizationȱ orȱ personȱ thatȱ receivesȱ aȱ product”ȱandȱ Demingȱ (1986)ȱ “thoseȱ whoȱ judgeȱ theȱ quality”ȱ toȱ theȱ widerȱ Bergmanȱ&ȱKlefsjöȱ(2003)ȱ“thoseȱweȱwantȱtoȱcreateȱvalueȱto”ȱandȱtheȱevenȱ wider,ȱ(Juranȱ&ȱGryna,ȱ1988)ȱ“anyoneȱwhoȱisȱaffectedȱbyȱtheȱproductȱorȱbyȱtheȱ processȱ usedȱ toȱ produceȱ theȱ product”.ȱInȱ theȱ researchȱ presentedȱ inȱ thisȱ thesis,ȱ customerȱ isȱ definedȱ byȱ theȱ widerȱ approachȱ usedȱ byȱ Bergmanȱ &ȱ Klefsjöȱ (2003);ȱ thatȱ definitionȱ alsoȱ includesȱ internalȱ customers.ȱ CoȬ workersȱ areȱ consideredȱ asȱ internalȱ customersȱ andȱ thereȱ areȱ investigationsȱ thatȱ demonstrateȱ aȱ linkȱ betweenȱ internalȱ customerȱ satisfaction,ȱexternalȱcustomerȱsatisfaction,ȱandȱproductivityȱ(Gronholdtȱ

&ȱMartensen,ȱ2001).ȱ ȱȱ

(26)

2.2 Theȱqualityȱmovementȱ

Theȱ qualityȱ movementȱ asȱ aȱ theoreticalȱ conceptȱ isȱ youngȱ comparedȱ toȱ traditionalȱ sciences,ȱ althoughȱ highȱ qualityȱ hasȱ probablyȱ alwaysȱ beenȱ aȱ matterȱofȱconcernȱinȱhumanȱactivities.ȱWalterȱA.ȱShewhartȱtogetherȱwithȱ W.ȱEdwardsȱDemingȱandȱJosephȱM.ȱJuran,ȱareȱseenȱasȱmainȱcontributorsȱ toȱtheȱqualityȱmovement,ȱsee,ȱforȱinstance,ȱ(Garvin,ȱ1988)ȱandȱ(Sitkinȱetȱ al.,ȱ1994).ȱȱ

ȱ

Theȱ comprehensionȱ ofȱ theȱ evolutionȱ ofȱ theȱ qualityȱ movementȱ differsȱ betweenȱ authors.ȱ Oneȱ commonȱ descriptionȱ ofȱ theȱ developmentȱ ofȱ Qualityȱ Managementȱ isȱ theȱ fourȱ phaseȱ modelȱ towardsȱ theȱ conceptȱ ofȱ Totalȱ Qualityȱ Managementȱ see,ȱ forȱ instance,ȱ Garvinȱ (1988)ȱ andȱ (Dale,ȱ 2003).ȱ Accordingȱ toȱ thisȱ model,ȱ theȱ developmentȱ startsȱ withȱ theȱ phaseȱ QualityȱInspectionȱaroundȱ1910ȱatȱFordȱMotorȱCompanyȱwhenȱtheȱfocusȱ stillȱwasȱonȱinspectionȱ(Dahlgaardȱetȱa.,ȱ1998).ȱTheȱnextȱstageȱisȱdescribedȱ byȱ Bergmanȱ &ȱ Klefsjöȱ (2003),ȱ asȱ theȱ Qualityȱ Controlȱ phaseȱ andȱ wasȱ developedȱ byȱ Walterȱ A.ȱ Shewhart.ȱ Qualityȱ Assurance,ȱ considersȱ theȱ wholeȱproductionȱchainȱfromȱdesignȱtoȱmarket,ȱ(Dahlgaardȱetȱal.,ȱ1998).ȱ TheȱcurrentȱstageȱisȱTotalȱQualityȱManagement;ȱitȱcoversȱunderstandingȱ andȱimplementationȱofȱQualityȱManagementȱprinciplesȱandȱconceptsȱinȱ everyȱaspectȱofȱbusinessȱandȱitȱhasȱaȱclearȱsystemȱapproachȱ(Bergmanȱ&ȱ Klefsjö,ȱ2003).ȱThisȱdevelopmentȱcanȱbeȱdescribedȱasȱinȱFigureȱ2Ȭ1.ȱȱ

ȱ

Anotherȱ comprehensionȱ ofȱ theȱ evolutionȱ ofȱ Qualityȱ Managementȱ isȱ basedȱ onȱ twoȱ differentȱ parallelȱ schools;ȱ theȱ Deterministicȱ Schoolȱ ofȱ Thoughtȱ andȱ theȱ Continuousȱ Improvementȱ Schoolȱ (Kroslid,ȱ 1999).ȱ Systematizedȱ Qualityȱ Managementȱ withȱ theȱ beliefȱ inȱ theȱ continuousȱ improvementȱ schoolȱ isȱ generallyȱ seenȱ asȱ originatingȱ fromȱ theȱ worksȱ ofȱ Walterȱ A.ȱ Shewhart,ȱ (Garvin,ȱ 1988)ȱ andȱ Kroslidȱ (1999)ȱ whileȱ theȱ Deterministicȱ Schoolȱ ofȱ Thought,ȱ originatesȱ fromȱ Taylorism.ȱ Taylor’sȱ ideasȱwereȱthenȱfurtherȱdevelopedȱinȱtheȱformȱofȱmilitaryȱstandardsȱandȱ becameȱ laterȱ theȱ baseȱ forȱ theȱ internationalȱ systemȱ ISOȱ 9000ȱ ofȱ Qualityȱ Managementȱ(ibid).ȱȱ

ȱ

(27)

Qualityȱ Inspectionȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ …afterȱ productionȱ

QualityȱControlȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ…duringȱproductionȱ QualityȱAssuranceȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ…beforeȱproductionȱ TotalȱQualityȱManagement …continuousȱimprovementsȱȱ

before,ȱduringȱandȱafterȱprod.ȱ

ȱ Figureȱ2Ȭ1ȱIllustrationȱofȱtheȱconceptsȱofȱqualityȱinspection,ȱqualityȱcontrol,ȱqualityȱ assuranceȱ andȱ totalȱ Qualityȱ Management.ȱ Theȱ diagramȱ showsȱ oneȱ commonȱ descriptionȱofȱtheȱevolutionȱofȱQualityȱManagement.ȱ(Bergmanȱ&ȱKlefsjö,ȱ2003).ȱ ȱ

Aȱ thirdȱ comprehensionȱ isȱ thatȱ Qualityȱ Managementȱ isȱ developedȱ throughȱ aȱ continuousȱ process.ȱ (Dahlgaard,ȱ 2001).ȱ Sheȱ seesȱ TQMȱ asȱ anȱ evolutionȱoutȱofȱWesternȱtheoriesȱandȱEasternȱpractices;ȱtheȱrationalȱandȱ logicalȱ fromȱ Westȱ andȱ theȱ practiceȱ fromȱ Eastȱ includingȱ theȱ successfulȱ Japaneseȱworkȱpractice.ȱȱ

ȱ

Irrespectiveȱ ofȱ theȱ factȱ thatȱ theȱ comprehensionȱ ofȱ theȱ developmentȱ ofȱ Qualityȱ Managementȱ differs,ȱ Totalȱ Qualityȱ Managementȱ (TQM)ȱ originatesȱ fromȱ Qualityȱ Managementȱ evenȱ thoughȱ Deming,ȱ oneȱ ofȱ theȱ gurus, avoidedȱthisȱtermȱhimselfȱ(MartínezȬLorenteȱetȱal.,ȱ1998).ȱThereȱisȱ notȱ aȱ clearȱ orȱ anȱ agreedȱ differenceȱ betweenȱ Qualityȱ Managementȱ andȱ Totalȱ Qualityȱ Managementȱandȱ theȱdefinitionsȱ ofȱ theȱ twoȱ termsȱ differs.ȱ Inȱtheȱresearchȱpresentedȱinȱthisȱthesis,ȱQualityȱManagementȱisȱusedȱasȱ theȱtermȱforȱtheȱdevelopmentȱofȱtheȱqualityȱmovementȱdescribedȱaboveȱ andȱtherebyȱanȱoverarchingȱterm,ȱwhereinȱTQMȱisȱincludedȱ¹.ȱȱ

ȱ

MaybeȱasȱaȱresultȱofȱtheȱdifferencesȱinȱtheȱcomprehensionȱofȱtheȱQualityȱ Managementȱ development,ȱ thereȱ areȱ manyȱ differentȱ viewsȱ onȱ whatȱ isȱ includedȱinȱTQMȱandȱthereȱisȱstillȱanȱongoingȱdiscussionȱasȱtoȱwhetherȱ workingȱwithȱTQMȱcontributesȱtoȱorganizationalȱperformanceȱorȱnot.ȱȱ

1 It should be noticed that, in Paper D has the term TQM been used when Quality Management should have been used.

(28)

ȱ

2.3 TotalȱQualityȱManagement

Totalȱ Qualityȱ Management,ȱ TQM,ȱ hasȱ beenȱ describedȱ andȱ presentedȱ inȱ differentȱ waysȱ overȱ theȱ years,ȱ seeȱ forȱ instance,ȱ (Dahlgaardȱ etȱ al.,ȱ 1998)ȱ andȱ(Dale,ȱ2003).ȱDahlgaardȱ(1998)ȱdescribeȱTQMȱasȱaȱcorporateȱcultureȱ characterizedȱ byȱ increasedȱ customerȱ satisfactionȱ throughȱ continuousȱ improvementȱ inȱ whichȱ allȱ coȬworkersȱ inȱ theȱ organizationȱ participateȱ actively.ȱAccordingȱtoȱHellstenȱ&ȱKlefsjöȱ(2000),ȱTQMȱisȱ“aȱcontinuouslyȱ evolvingȱ managementȱ systemȱ consistingȱ ofȱ values,ȱ methodologiesȱ andȱ tools”.ȱ Theȱ valuesȱ areȱ fixedȱ butȱ theȱ methodologiesȱ andȱ toolsȱ areȱ justȱ examplesȱ andȱcanȱdifferȱdependingȱonȱtheȱvalueȱitȱisȱsupposedȱtoȱsupport,ȱ(ibid).ȱ Daleȱ (2003)ȱ definesȱ TQMȱ asȱ “aȱ managementȱ approachȱ ofȱ anȱ organization,ȱ centredȱonȱquality,ȱbasedȱonȱtheȱparticipationȱofȱallȱitsȱmembersȱandȱaimingȱatȱ longȬtermȱsuccessȱthroughȱcustomerȱsatisfaction,ȱandȱbenefitsȱtoȱallȱmembersȱofȱ theȱorganizationȱandȱsociety”.ȱTheȱdefinitionȱbyȱ(Shiba,ȱetȱal.,ȱ1993),ȱisȱ“anȱ evolvingȱ system,ȱ consistingȱ ofȱ practices,ȱ toolsȱ andȱ trainingȱ methodsȱ forȱ managingȱ organizationsȱ inȱ aȱ rapidlyȱ changingȱ context”ȱisȱ similarȱ toȱ theȱ definitionȱ byȱ Hellstenȱ &ȱ Klefsjöȱ (2000)ȱ accordingȱ toȱ system.ȱ Inȱ thisȱ researchȱtheȱtermȱTQMȱisȱdefinedȱsimilarlyȱtoȱHellstenȱ&ȱKlefsjös’ȱ(2000)ȱ andȱShibaȱetȱal.’sȱ(1993)ȱdefinition;ȱasȱaȱmanagementȱsystemȱwithȱvalues,ȱ methodologiesȱ andȱ tools.ȱ ȱ Hellstenȱ &ȱ Klefsjöȱ (2000)ȱ alsoȱ statesȱ thatȱ theȱ aimȱofȱtheȱsystemȱisȱtoȱ“createȱincreasedȱexternalȱandȱinternalȱcustomerȱ satisfactionȱwithȱaȱreducedȱamountȱofȱresources,ȱseeȱȱFigureȱ2Ȭ2.ȱ

ȱ

(29)

Values

Improve Continuously

Focus on Customers

Base Decisions on Fact

Let Everybody be Committed

Focus on Processes Top Management

Commitment

Methodologies

Bench- marking

Quality Function Deployment

Employee Development Quality

Circles

Process Management

Supplier Partnership

Design of Experiment Self-

assessment Policy Deployment

Aim: Increase external and internal customer satisfaction with a reduced amount of resources

Total Quality Management

Tools

Control Charts

Ishikawa Diagram

Tree Diagram Relation

Diagram

Process Maps

Criteria of MBNQA Factorial

Design

ISO 9000

ȱ Figureȱ2Ȭ2ȱTotalȱQualityȱManagementȱcanȱbeȱseenȱasȱaȱmanagementȱsystemȱmadeȱupȱ ofȱvalues,ȱmethodologiesȱandȱtools,ȱ(Hellstenȱ&ȱKlefsjö,ȱ2000).ȱ

ȱ

Bergmanȱ&ȱKlefsjöȱ(2003)ȱmaintainȱthatȱinȱorderȱtoȱhaveȱanȱimpact,ȱtheȱ coreȱvaluesȱofȱTQMȱmustȱbeȱsupportedȱbyȱtheȱtopȱmanagementȱandȱhaveȱ toȱ includeȱ “qualityȱ aspectsȱ inȱ theȱ companyȱ vision,ȱ andȱ supportȱ activitiesȱ regardingȱ qualityȱ financially,ȱ morallyȱ andȱ withȱ managementȱ resources”.ȱ Inȱ Hellstenȱ &ȱ Klefsjö’sȱ (2000)ȱ modelȱ seeȱ Figureȱ 2Ȭ2ȱ theȱ valuesȱ areȱ theȱ baseȱ onȱ whichȱ aȱ cultureȱ forȱ successfulȱ qualityȱ improvementȱ areȱ built.ȱ Theȱ valuesȱ areȱ inȱ turnȱ basedȱ onȱ topȱ managementȱ commitment.ȱ Withȱ thisȱ approach,ȱ TQMȱ becomesȱ aȱ managementȱ systemȱ withȱ differentȱ units,ȱ whereȱ theȱ valuesȱareȱ theȱ base.ȱ (Deming,ȱ 1994)ȱhasȱaȱ similarȱ viewȱ whenȱ heȱ talksȱ ofȱ aȱ systemȱ asȱ aȱ networkȱ ofȱ dependentȱ unitsȱ withȱ aȱ jointȱ goal.ȱ MoreȱofȱDeming’sȱthoughtsȱareȱdescribedȱinȱSectionȱ2.5ȱandȱ2.5.1.ȱȱ

ȱ

Inȱ theȱ researchȱ describedȱ inȱ thisȱ thesis,ȱ valuesȱ areȱ definedȱ asȱ howȱ coȬ workersȱ andȱ leadersȱ work,ȱ act,ȱ andȱ solveȱ problemsȱ butȱ itȱ isȱ alsoȱ fundamentalȱassumptionsȱsoȱdeeplyȱrootedȱthatȱnobodyȱgivesȱthemȱanyȱ thought.ȱ Inȱ thatȱ way,ȱ theȱ coreȱ valuesȱ withinȱ theȱ organizationsȱ establishȱ theȱ cultureȱ ofȱ theȱ organizations;ȱ thoseȱ practicalȱ valuesȱ areȱ calledȱ attitudesȱinȱPaperȱAȱandȱD.ȱAȱfurtherȱpresentationȱofȱcoreȱvaluesȱcanȱbeȱ foundȱinȱSectionȱ2.7.1.ȱ

ȱ

(30)

Accordingȱ toȱ Hellstenȱ &ȱ Klefsjöȱ (2000),ȱ methodologiesȱ areȱ neededȱ toȱ supportȱtheȱcoreȱvaluesȱofȱtheȱorganization.ȱTheȱestablishedȱEnglishȱtermȱ forȱ anȱ organization’sȱ approach,ȱ itsȱ wayȱ ofȱ working,ȱ orȱ itsȱ workȱ procedureȱ inȱ TQMȱ literatureȱ isȱ methodology.ȱ Thisȱ definitionȱ ofȱ methodology,ȱ aȱ moreȱ practicalȱ wayȱ ofȱ workingȱ thanȱ values,ȱ isȱ usedȱ inȱ thisȱthesisȱandȱtheȱresearchȱrelatedȱtoȱit.ȱȱ

ȱ

2.4 ValuesȱwithinȱTQMȱ

Theȱ baseȱ inȱ TQMȱ isȱ referredȱ toȱ inȱ differentȱ waysȱ byȱ differentȱ authors.ȱ Differentȱtermsȱusedȱare,ȱforȱinstance,ȱfactors,ȱkeyȱelements,ȱvalues,ȱcoreȱ stones,ȱ orȱ principlesȱ (Foster,ȱ 2004),ȱ (Dale,ȱ 2003),ȱ (Bergmanȱ &ȱ Klefsjö,ȱ 2003)ȱ andȱ (Silaȱ &ȱ Ebrahimpour,ȱ 2002).ȱ Thereȱ isȱ notȱ aȱ consensusȱ onȱ thisȱ issue.ȱ ȱ Anȱ investigationȱ ofȱ 347ȱ TQMȱ articlesȱ writtenȱ betweenȱ 1989ȱ andȱ 2000ȱsummarizesȱtheȱmostȱfrequentȱTQMȱfactorsȱas;ȱcustomerȱfocusȱandȱ satisfaction,ȱ employeeȱ training,ȱ leadershipȱ andȱ topȱ managementȱ commitment,ȱ teamwork,ȱ employeeȱ involvement,ȱ continuousȱ improvementȱandȱinnovation,ȱandȱqualityȱinformationȱandȱperformanceȱ measurementȱ (Silaȱ &ȱ Ebrahimpour,ȱ 2002).ȱ Accordingȱ toȱ Bergmanȱ &ȱ Klefsjöȱ (2003),ȱ theȱ baseȱ withinȱ TQMȱ areȱ theȱ coreȱ valuesȱ andȱ theyȱ listȱ themȱas;ȱfocusȱonȱcustomers,ȱimproveȱcontinuously,ȱfocusȱonȱprocesses,ȱ baseȱdecisionsȱonȱfact,ȱletȱeverybodyȱbeȱcommittedȱandȱtopȱmanagementȱ commitment.ȱ Thoseȱ coreȱ valuesȱ seemȱ toȱ beȱ theȱ valuesȱ thatȱ manyȱ inȱ theȱ qualityȱ movementȱ agreeȱ on,ȱ see,ȱ forȱ instance,ȱ Lagrosenȱ (2003)ȱ andȱ theyȱ areȱbrieflyȱdescribedȱfurtherȱbelow.ȱȱ

ȱ

2.4.1 FocusȱonȱCustomersȱ

Qualityȱhasȱtoȱbeȱvaluedȱbyȱtheȱcustomerȱandȱitȱhasȱtoȱbeȱrelatedȱtoȱtheirȱ needsȱandȱexpectationsȱ(Bergmanȱ&ȱKlefsjö,ȱ2003).ȱCustomerȱsatisfactionȱ isȱ theȱ measureȱ ofȱ qualityȱ andȱ itȱ isȱ importantȱ toȱ listenȱ toȱ theȱ customers’ȱ experienceȱofȱhowȱtheȱorganizationȱhasȱperformedȱ(ibid).ȱDemingȱ(1986)ȱ maintainsȱ theȱ importanceȱ thatȱ allȱ effortsȱ inȱ theȱ organizationȱ shouldȱ beȱ linkedȱ toȱ fulfillingȱ theȱ needsȱ andȱ wantsȱ ofȱ theȱ customer.ȱ Bothȱ externalȱ andȱ internalȱ customersȱ areȱ hereȱ includedȱ inȱ theȱ conceptȱ ofȱ customer.ȱ Internalȱ customersȱ are,ȱ forȱ instance,ȱ differentȱ departmentsȱ withinȱ theȱ organization,ȱ theȱ coȬworkersȱ asȱ aȱ group,ȱ orȱ theȱ coȬworkersȱ asȱ individuals.ȱ

(31)

2.4.2 ImproveȱContinuouslyȱ

Continuousȱ improvementȱ isȱ aȱ necessaryȱ valueȱ inȱ theȱ workȱ toȱ increaseȱ customerȱ satisfaction,ȱ (Bergmanȱ &ȱ Klefsjö,ȱ 2003).ȱ Thisȱ isȱ oftenȱ conceptualizedȱinȱtheȱuseȱofȱtheȱDemingȱcycleȱtoȱimproveȱsystematicallyȱ throughȱ fourȱ stages:ȱ Plan,ȱ Do,ȱ Studyȱ andȱ Actȱ (PDSAȱ cycle)ȱ (Deming,ȱ 1986).ȱ Demingȱ (1986)ȱ describesȱ continuousȱ improvementsȱ inȱ hisȱ 14th^ȱ point,ȱseeȱalsoȱ2.5.1,ȱandȱheȱstatesȱthatȱtheȱcycleȱwasȱoriginallyȱconceivedȱ byȱ Walterȱ A.ȱ Shewhart.ȱ Everyȱ processȱ inȱ theȱ organizationȱ mustȱ workȱ withȱ continuousȱ improvementsȱ andȱ inȱ orderȱ toȱ doȱ this,ȱ theȱ humanȱ resourcesȱhaveȱtoȱbeȱusedȱinȱaȱmoreȱeffectiveȱwayȱ(ibid).ȱ

ȱ

2.4.3 FocusȱonȱProcessesȱ

Aȱ processȱ isȱ “aȱ repetitiveȱ networkȱ ofȱ activitiesȱ andȱ itsȱ goalȱ isȱ toȱ satisfyȱ itsȱ customers”,ȱ (Bergmanȱ &ȱ Klefsjö,ȱ 2003).ȱ Focusȱ onȱ processesȱ isȱ interconnectedȱwithȱtheȱotherȱvaluesȱinȱTQMȱ(Rentzhog,ȱ1996).ȱTheȱmainȱ differenceȱ betweenȱ anȱ organizationȱ workingȱ asȱ anȱ processȱ organizationȱ andȱaȱtraditionalȱfunctionȱorganizationȱisȱtheȱholisticȱviewȱ(Ljungbergȱ&ȱ Larsson,ȱ2001).ȱAccordingȱtoȱDemingȱ(1986),ȱtheȱmanagement’sȱtaskȱisȱtoȱ focusȱonȱtheȱprocessesȱandȱnotȱonȱtheȱoutcome.ȱȱ

ȱ

2.4.4 BaseȱDecisionsȱonȱFactsȱ

Inȱ TQM,ȱ itȱ isȱ importantȱ toȱ baseȱ decisionsȱ onȱ factsȱ andȱ notȱ letȱ randomȱ factorsȱruleȱtheȱwayȱdecisionsȱareȱmadeȱ(Bergmanȱ&ȱKlefsjö,ȱ2003).ȱDataȱ ofȱbothȱaȱnumericalȱandȱverbalȱcharacterȱisȱneededȱasȱwellȱasȱsystematicȱ toolsȱ forȱ theȱ structureȱ andȱ analysisȱ ofȱ theseȱ dataȱ (ibid).ȱ Deming,ȱ (1994)ȱ recommendsȱ theȱ useȱ ofȱ simpleȱ statisticalȱ toolsȱ toȱ ensureȱ thatȱ processesȱ areȱunderȱstatisticalȱcontrolȱandȱforȱgathering,ȱstructuringȱandȱanalyzingȱ numericalȱdata.ȱSevenȱQualityȱControlȱToolsȱandȱtheȱSevenȱManagementȱ Toolsȱareȱrecommendedȱforȱdataȱcollectionȱinȱorderȱtoȱbaseȱtheȱdecisionsȱ onȱfactsȱ(Mizuno,ȱ1988)ȱandȱ(Bergmanȱ&ȱKlefsjö,ȱ2003).ȱȱ

ȱ

2.4.5 LetȱeverybodyȱbeȱCommittedȱ

Thisȱvalueȱisȱachievedȱthroughȱmethodologiesȱbasedȱonȱcommunication,ȱ delegation,ȱ andȱ training,ȱ (Bergmanȱ &ȱ Klefsjö,ȱ 2003).ȱ Theȱ aimȱ ofȱ theseȱ

(32)

methodologiesȱisȱtoȱgiveȱtheȱcoȬworkersȱknowledgeȱaboutȱtheirȱplaceȱinȱ theȱorganization,ȱwhereȱtheȱorganizationȱisȱgoing,ȱandȱtheirȱcapabilityȱtoȱ carryȱ outȱ necessaryȱ improvements.ȱ Everybody’sȱ participationȱ andȱ commitmentȱ areȱ alsoȱ inȱ accordanceȱ withȱ theȱ ideasȱ ofȱ Theoryȱ Y,ȱ asȱ describedȱbyȱMcGregorȱ(1960),ȱwhereȱcoȬworkersȱareȱregardedȱasȱbeingsȱ whoȱ likeȱ toȱ workȱ andȱ regardȱ workȱ asȱ theȱ opportunityȱ toȱ developȱ themselves.ȱ ȱ Demingȱ (1986)ȱ stressesȱ thatȱ qualityȱ shouldȱ beȱ anȱ issueȱ forȱ everybodyȱ inȱ theȱ organizationȱ andȱ notȱ justȱ theȱ qualityȱ department:ȱ everybody’sȱcommitmentȱisȱessential.ȱȱ

ȱ

2.4.6 TopȱManagementȱCommitmentȱȱ

TopȱManagementȱCommitmentȱisȱoneȱofȱtheȱvaluesȱinȱTQMȱ(Dale,ȱ2003)ȱ andȱ(Bergmanȱ&ȱKlefsjö,ȱ2003).ȱFosterȱ(2004)ȱandȱDemingȱ(1986),ȱamongȱ others,ȱ stressȱ thatȱ Managementȱ Commitmentȱ isȱ aȱ criticalȱ factorȱ forȱ successȱ withȱ theȱ qualityȱ work.ȱ Alsoȱ (Kotter,ȱ 1996)ȱ emphasizesȱ theȱ importanceȱ thatȱ theȱ managementȱ hasȱ forȱ qualityȱ improvementsȱ andȱ organizationalȱ change.ȱ Accordingȱ toȱ Bergmanȱ &ȱ Klefsjöȱ (2003),ȱ Josephȱ Juranȱhasȱsaid,ȱ“toȱmyȱknowledge,ȱnoȱcompanyȱhasȱattainedȱworldȱclassȱqualityȱ withoutȱ upperȱ managementȱ leadership”.ȱ (Martin,ȱ 1993)ȱ alsoȱ claimsȱ thatȱ managementȱ commitmentȱ isȱ aȱ necessaryȱ foundationȱ forȱ succeedingȱ inȱ implementingȱ andȱ workingȱ withȱ TQMȱ althoughȱ heȱ isȱ referringȱ specificallyȱ toȱ theȱ humanȱ serviceȱ area.ȱ Demingȱ (1986,ȱ 1994)ȱ talksȱ aboutȱ 14ȱ pointsȱ forȱ managementȱ transformationȱ andȱ explainsȱ howȱ theseȱ 14ȱ pointsȱ areȱ basedȱ onȱ whatȱ heȱ callsȱ “profoundȱ knowledge”.ȱ Profoundȱ knowledgeȱ isȱ inȱ turnȱ basedȱ onȱ fourȱ elements:ȱ appreciationȱ ofȱ aȱ system,ȱ knowledgeȱ aboutȱ variation,ȱ theoryȱ ofȱ knowledge,ȱ andȱ psychology;ȱ seeȱ alsoȱSectionȱ2.5.1ȱaboutȱDeming’sȱ14ȱpointsȱandȱbelow,ȱSectionȱ2.5,ȱwhereȱ managementȱ commitmentȱ andȱ Qualityȱ Managementȱ areȱ furtherȱ discussed.ȱȱ

ȱ ȱ

2.5 VitalȱforȱSucceedingȱwithȱQualityȱManagementȱandȱTQM

Montgomery,ȱ (2005)ȱ isȱ ofȱ theȱ opinionȱ thatȱ effectiveȱ managementȱ ofȱ qualityȱ isȱ theȱ successfulȱ executionȱ ofȱ theȱ followingȱ activities:ȱ qualityȱ planning,ȱ qualityȱ assurance,ȱ qualityȱ controlȱ andȱ qualityȱ improvement.ȱ Heȱ describesȱ qualityȱ planningȱ asȱ oneȱ ofȱ theȱ strategicȱ activitiesȱ thatȱ isȱ