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Organizational culture and total quality management practices: a Sri Lankan case
K.A.S.P. Kaluarachchi
Department of Management and Organization Studies, Faculty of Management and Finance, University of Colombo, Colombo, Sri Lanka
Abstract
Purpose The purpose of this paper is to identify the effect of organizational culture (OC) on the total quality management (TQM) practices of a Sri Lankan public sector hospital, which practices Japanese 5-S based TQM and has won several national quality awards. Design/methodology/approach The data are gathered through direct observations, short-time interviews, participative observations, in-depth interviews, and obtaining relevant documentary evidence by the employment of grounded theory. The director, divisional heads, doctors, nursing sisters and nurses, paramedical staff, midwifery staff, clerical staff, and support staff of the hospital are appropriately considered as the informants during the employment of the above data gathering techniques. The data are analyzed qualitatively in line with the research variables. Findings As cultural characteristics of the hospital, the study identied low power distance, low uncertainty avoidance, low individualism, and low masculinity. The study identied high senior management commitment, high staff commitment, high stakeholder focus, high integration of continuous improvement, high quality culture, high measurement and feedback, and high learning organization characteristics as TQM practices of the hospital. Moreover, the study found that the supportive culture of the hospital has positively impacted on its TQM practices. Research limitations/implications To overcome the limitations of the OC framework adopted in the present study, the paper invites future studies to examine the issue from a broader and new culture perspective. Originality/value Recently, many organizations in Sri Lanka irrespective of their category and industry have been practicing TQM in order to stay competitive in both domestic and international markets. But empirical studies on the topic are very limited in the Sri Lankan context. This study as a case of a Sri Lankan public sector hospital aims to ll that gap. Keywords Organizational culture, Sri Lanka, Public sector organizations, Total quality management, Hospitals Paper type Case study

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Received November 2007 Revised May 2009, August 2009 Accepted August 2009

Introduction Total quality management (TQM) has become a world-wide topic in the twenty-rst century. Having its roots partly in the USA and partly in Japan, it was primarily adopted by some Japanese companies in the decades immediately after World War II. With the greater successes of Japanese companies during the 1980s, companies all over the world found that it was necessary to have good quality management practices in order to stay competitive (Lagrosen, 2002; Stahl and Grigsby, 1997). But many approaches to quality management, including TQM hardly give long-term success to organizations. This is mainly because of the problematic nature of organizational culture (OC) within which managers nd it difcult to practice their

The TQM Journal Vol. 22 No. 1, 2010 pp. 41-55 q Emerald Group Publishing Limited 1754-2731 DOI 10.1108/17542731011009612

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TQM activities. Hence, understanding the effect of OC on the implementation of TQM practices in organizations is important (Dale, 1994; Kroslid, 1999; Kaye and Anderson, 1998; Kaye and Dyason, 1995; Padhi, 2000). Although quality management practices need to be adopted in Sri Lankan organizations in order to enhance their business performance, such efforts face an enormous challenge due to many negative reasons. The challenge is mainly due to the cultural and behavioural mismatch within Sri Lankan organizations when they try to practice quality management within their organizational boundaries (Nanayakkara, 1992). The issue is seen to be more critical in public sector organizations in Sri Lanka when they try to implement new management systems. It has been found that the reforms and innovative programmes introduced in public sector organizations in Sri Lanka are less compatible with the attitudes and skills of the organizational participants. Therefore, those innovative programs become simply technical, rather than managerially meaningful to the organizations (Samarathunga and Bennington, 2002). But by implementing new management systems, some Sri Lankan public sector organizations have achieved a certain degree of success. As a key example, the Sri Lankan public sector hospital, studied in this research, has won several national quality awards for being more responsive to the public demands through the implementation of Japanese 5-S based TQM activities. Hence, this study was motivated by the need of examining the TQM practices implemented by the said hospital within its cultural set up. Therefore, the purpose of the study reported in this paper was to identify the effect of OC on the TQM practices of the above mentioned Sri Lankan public sector hospital. However, the intended purpose was further divided into and specied by the following three questions: RQ1. What kind of culture is there in the hospital? RQ2. What kind of TQM practices are there in the hospital? RQ3. How has the culture of the hospital affected its TQM practices? Conceptual framework As in Tayeb (1988), researchers who adopt the cultural theory in business research attempt to follow two strands: ideational in which their attention is to attitudes and values expressed by organizational participants, and institutional or material in which they concentrate upon structural aspects such as division of labor, career, status, and reward structures of organizations. With the ideational culture perspective, this study used some Hofstedian cultural dimensions (Hofstede, 1991) to conceptualize the culture of the hospital: (1) Power distance (PD). In a decision-making situation in an organization, at least two types of power and authority scenarios are seen. In the rst scenario, a decision may be taken by one person or group and the order for its implementation is carried out by other persons or groups. This situation may lead to unequal power relationships in organizations. The situation is termed high PD. In the second scenario, the two actors take decisions and implement them together. This situation may lead to less unequal power relationships in

organizations, and it is termed low PD. Using the ideational culture perspective, it is assumed that in organizations, there can be variations in the power and authority gaps between seniors and juniors, superiors and subordinates, and so on. (2) Uncertainty avoidance (UA). Most of the decisions in organizations involve a degree of uncertainty. More uncertainty of decisions leads to a greater degree of ambiguity, and vice-versa. There are at least two types of behavioural patterns of organizational participants behind this that can be identied. In the rst scenario, a higher degree of uncertainty tolerance behaviour can be shown by a participant, when he or she (a group as well) faces an uncertain situation. This is termed low UA or high-risk-taking behaviour. In the second scenario, a lower degree of uncertainty tolerance behaviour can be shown by a participant, when he or she (a group as well) faces an uncertain situation. This situation is termed high UA or low-risk-taking behaviour. Using the ideational culture perspective, it is assumed that in organizations, there can be variations in the ways that participants tolerate the uncertain situations they face. (3) Individualism (IND). Most of the reactions of organizational participants can be explained by their attachment to the organizational goals. At least two types of reactions can be seen pertaining to how organizational participants attach themselves to the organizational goals. In the rst scenario, they can display relatively a higher attachment to their own goals than the organizational goals. This situation is called IND. In the second scenario, they can display a relatively higher attachment to the organizational goals rather than to their own goals. This situation is called collectivism or low IND. Using the ideational culture perspective, it is assumed that in organizations, there can be variations in the ways that participants attach themselves to their personal goals over the organizational goals. (4) Masculinity (MAS). Most of the reactions of organizational participants can be explained using the way their gender roles appear in the workplace. There are at least two types of scenarios that can be seen in relation to this. In the rst scenario, the gender roles of the participants are distinguished as the male members focus more on material success than the female members. This situation is called MAS. On the other hand, gender roles of the participants overlap as both male and female participants tend to function interactively with each other. This situation is called femininity or low MAS. Using the ideational culture perspective, it is assumed that in organizations, there can be variations in the ways that gender roles of the participants appear in the workplace. Based on the grounded data and some existing literature on TQM (Deming, 1986; Juran, 1995; Crosby, 1979; Feigenbaum, 1991; Ishikawa, 1985; Dale, 1994; Kroslid, 1999; Kaye and Anderson, 1998; Kaye and Dyason, 1995; Padhi, 2000), the following variables were used to conceptualize TQM practices of the hospital: . senior management commitment (SMC); . staff commitment (SC); . stakeholder focus (SF); . integration of continuous improvement (ICI);

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. . .

quality culture (QC); measurement and feedback (MFB); and learning organization (LO).

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The possible relationship between the two types of research variables was conceptualized as shown in Figure 1. Methodology/approach The case method was employed as the strategy of this research. A Sri Lankan public sector hospital, which practices Japanese 5-S based TQM activities, was selected as the case. The director of the hospital was initially contacted to seek permission to conduct the empirical study. Once the permission was given, the empirical data were gathered through direct observations, short-time interviews, participative observations, in-depth interviews, and obtaining relevant documentary evidence following the grounded theory (Glaser and Strauss, 1967). The director, divisional heads, doctors, nursing sisters and nurses, paramedical staff, midwifery staff, clerical staff, and support staff of the hospital were appropriately interviewed as the informants. However, the extent of the interviews ranged from short-time interviews to in-depth interviews based on the data gathering requirements. The short-time interview sample consisted of 100 informants who represented the above staff categories. For the data gathering purpose, the OC and TQM variables were further specied into the indicators shown in Tables I and II, respectively. The indicators were used to develop data gathering schedules for the short-time and in-depth interviews. Two specic questions were asked for each indicator of OC and TQM variables in order to gather data through the short-time interviews. Moreover, ve in-depth interviews were carried out to see the effect of OC variables on the TQM variables. The in-depth interviews were carried out with the director, senior medical ofcer, administrative ofcer, accountant, and senior matron since they actively handle 5-S based TQM activities in the hospital.
TQM variables Senior management commitment (SMC) OC variables Staff commitment (SC) Power distance (PD) Stakeholder focus (SF) Uncertainty avoidance (UA) Individualism (IND) Masculinity (MAS) Integration of continuous improvement (ICI) Quality culture (QC) Measurement and feedback (MFB) Learning organization (LO)

Figure 1. Conceptual research framework

Variables (1) PD (2) UA (3) IND (4) MAS

Indicators 1.1 1.2 2.1 2.2 3.1 3.2 4.1 4.2 Degree of boss-subordinate positional gaps Degree of centralized decision making of the director Degree of employee strictness to rules and regulations Degree of employee resistance to possible changes taken place in the workplace Degree of employee performance evaluation using their individual work results Degree of employee willingness to work alone than work as teams Degree of staff distribution unequally between male and female categories Degree of male and female staff members willingness to work separately than work interactively

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Table I. OC variables and indicators

Variables (1) SMC (2) SC (3) SF (4) ICI (5) QC (6) MFB (7) LO

Indicators 1.1 1.2 2.1 2.2 3.1 3.2 4.1 4.2 5.1 5.2 6.1 6.2 7.1 7.2 Degree of directors two-way communication style Degree of directors involvement with the staff Degree of staff willingness to know about TQM Degree of staff involvement in TQM activities Clarity of continuous improvement oriented strategy formation Success of continuous improvement oriented strategy deployment Degree of vertical ICI Degree of horizontal ICI Degree of focus to initiate a QC Degree of maintenance of a QC Degree of adherence to service performance evaluation Degree of adherence to service performance feedback Degree of self-assessment of continuous improvement Degree of enhancing staff knowledge and skills

Table II. TQM variables and indicators

The data were analyzed qualitatively (Silverman, 2000). The OC and TQM variables were evaluated as low medium and high using the answers given to each question by the interviewees during the short-time interviews. Based on the short-time interview results, the analysis was further extended to see the effect of OC variables on the TQM variables. For this purpose, the contents and patterns of relationships between the OC and TQM variables were checked and veried using the in-depth interview results. The case discussion was completed following the results of the analysis. Some narratives of the respective informants taken down during the in-depth interviews were also highlighted in the discussion. OC and TQM The concept of OC has been dened by different scholars in different ways. Most of these scholars (Hofstede, 1991; Robbins, 2005; Peters and Waterman, 1982; Stahl and Grigsby, 1997) dene OC in a subjective or an ideational aspect. For them, OC is a system of shared values. But some other scholars (Schein, 1985; Johnson, 1988; Deal and Kennedy, 1982; Handy,1985)deneOCcombiningbothsubjectiveandobjectiveormaterialaspects.

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For them, OC is not only a system of shared values, but is also comprised of features of organizations like artifacts, symbols, and other structural elements. In his cross-cultural studies at IBM companies, Hofstede (1991) denes OC as the collective programming of the mind that distinguishes the members of one organization from another. For Hofstede, attitudes towards OC are partly affected by national culture elements. Using the national culture view, he recognizes PD, UA, IND vs collectivism, and MAS vs femininity as major characteristics common to the cultures of organizations. The concept of TQM has evolved with the quality gurus ideas (Deming, 1986; Juran, 1995; Crosby, 1979; Feigenbaum, 1991; Ishikawa, 1985). They recognize TQM with some requirements for organizational success. Most of the contemporary TQM researchers (Dale, 1994; Kroslid, 1999; Kaye and Anderson, 1998; Kaye and Dyason, 1995; Padhi, 2000) identify TQM with some key organizational practices. The case The Castle Street Hospital for Women was established in 1950 as a public sector maternity hospital in Sri Lanka. It was brought under the administrative control of the Committee of the Colombo Group Hospitals in 1958. In 1964, it became a teaching hospital of the Medical Faculty of Colombo. Presently it functions as the largest maternity hospital in Sri Lanka with a capacity of 450 beds providing maternal, gynecological, and neonatal care services for the public. The hospital also provides specialized neonatal intensive care and fertility services. There are 16,000 to 18,000 deliveries taking place annually with an average of 27 percent cesarean deliveries. It operates with ve maternal and gynecological units, and one neonatology unit. These units are supported by three operating theatres, two intensive care units, one blood bank, one laboratory, one Radiology Department, and some Paramedical units. The units work in harmony to ensure the essential and emergency care at tertiary levels. The vision, mission, values, goals, objectives, strategies, and quality policy of the hospital are presented as follows. The vision
A government hospital with a sense of quality.

The mission
Provision of quality maternal, gynecological, and neonatal care services and training of health personnel using current medical practices and the efcient use of resources in a friendly environment of good working relationship where the patient care needs will be of the highest priority.

The values The hospital highly values the responsiveness to the people. For this, it walks an extra miles to enhance the care of people with dignity and compassion. The goal
Healthy children to be born in the Castle Street Hospital for Women with a minimum disability to mothers who are cared for so they can be free of complications.

The objectives . To reduce the maternal mortality rate (MMR) of the hospital 25 percent below the national gures. . To reduce the neonatal mortality rate (NMR) by 5 percent annually. . To ensure there will be no preventable stillbirths. . To ensure safe delivery and surgical procedures free of complications. The strategies . Leadership development to improve health systems. . Human resource development and involvement for performance excellence. . Continuous improvement through productivity concepts. . Mistake proong. . Customer centered responsive service provision. The quality policy
We are committed to TQM. We practice continuous improvement in all aspects of our performance. We dedicate ourselves to satisfy our customers expectations.

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Since April 2000, the hospital has been practicing Japanese 5-S (5-S abbreviates the Japanese words Seiri (tidiness), Seiton (orderliness), Seiso (cleanliness), Seiketsu (standardization), and Shitsuke (training and self-discipline)) based TQM activities in order to deliver a better service to the public. It has won several national quality awards for its high quality sense and care of service. The Best 5-S Implementation Merit Award in 2001, the Sri Lankan National Quality Merit Award in 2002, and the National Productivity and Quality Award in 2003 are among the quality awards won by the hospital. Analysis and results The analysis addressed the three research questions which were already mentioned at the beginning of the paper. In order to ascertain the results of the OC variables, the selected informants were interviewed during the short-time interviews. The interview sample consisted of 100 informants who represented different staff categories of the hospital. Table III shows the interview results. The results were considered as the interviewee perception of the OC variables. A similar process was carried out to ascertain the results of the TQM variables. The interview results are shown in Table IV. The results were considered as the interviewee perception of the TQM variables.
Interviewee perception Low Medium High 112 124 142 116 56 36 34 52 32 40 24 32 Percentage Medium 28 18 17 26

Variables (1) (2) (3) (4) PD UA IND MAS

Low 56 62 71 58

High 16 20 12 16

Evaluation Low Low Low Low Table III. Interviewee perception of the OC variables

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Using the short-time interview results, the analysis was further extended to see the effect of OC variables on the TQM variables. For this purpose, ve in-depth interviews were carried out. The purpose of the in-depth interviews was to identify the possible effect of each OC indicator on the TQM indicators. The results are summarized in Table V. However, for greater clarity, the effect is shown in Figure 2. Discussion Culture of the hospital Low PD. The inequalities between the hierarchical positions have been minimized. Hence, the boss-subordinate positions and their relationships do not create unnecessary power gaps to discourage the teamwork behaviour of the employees. The subordinates respect the bosses and their competence. The bosses also like to see competence displayed by their subordinates. The management (the director represents the senior management and the Divisional Heads represent the middle management) encourages employees to take operational level decisions, while they are asked to

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Variables (1) (2) (3) (4) (5) (6) (7) SMC SC SF ICI QC MFB LO

Interviewee perception Low Medium High 4 28 16 30 10 36 34 14 30 38 36 22 48 58 182 142 146 134 168 116 108

Low 2 14 8 15 5 18 17

Percentage Medium 7 15 19 18 11 24 29

High 91 71 73 67 84 58 54

Evaluation High High High High High High High

Table IV. Interviewee perception of the TQM variables

OC indicators Low PD 1.1 Low PD 1.2 Low UA 2.1 Low UA 2.2 Low IND 3.1 Low IND 3.2 Low MAS 4.1 Table V. Summary of the in-depth interview results Low MAS 4.2

Affected TQM indicators High SMC 1.2, High SC 2.1, High SC 2.2, High ICI 4.1, High ICI 4.2, High QC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High ICI 4.1, High ICI 4.2, High QC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2, High ICI 4.1, High ICI 4.2, High QC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2 High SMC 1.1, High SMC 1.2, High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2, High ICI 4.1, High ICI 4.2, High QC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2 High SC 2.2, High SF 3.1, High SF 3.2, High ICI 4.1, High ICI 4.2, High QC 5.2, High MFB 6.2 High SC 2.1, High SC 2.2, High SF 3.1, High SF 3.2, High ICI 4.1, High ICI 4.2, High QC 5.1, High QC 5.2, High MFB 6.1, High MFB 6.2, High LO 7.1, High LO 7.2

OC variables

TQM variables

OC and TQM practices

High SMC Low PD

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High SC

Low UA High SF

High ICI Low IND

High QC

Low MAS High MFB

High LO

Figure 2. Demonstrating the effect of OC variables on TQM variables

implement strategic decisions taken by the management. This is because the director follows a decentralized decision-making policy. The director, addressing the point, replied that:
We like to see the competence of our people and they are welcome anytime to display their talents.

The organizational chart of the hospital (Figure 3) reects its exible decision-making and reporting structure. The exible decision-making and reporting structure has helped the director to employ his decentralized decision-making policy at the stake of the continuous improvement. According to the short-time interview results, the low PD variable accounted for 56 percent of interviewee perception. Low UA. The hospital has to follow the formal rules, circulars, procedures, and performance indicators set by the Ministry of Health. But the management has introduced systematic and relatively exible goals, objectives, strategies, and quality policy in line with their vision and mission. The systematic and exible environment has motivated staff members to the work. Hence, they are most often punctual at work. Moreover, the managers and staff members tolerate possible changes that take place in the hospital. They like to be exposed to the new changes in order to enhance the productivity of the hospital. For example, the Japanese 5-S based TQM activities have

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Doctors Senior medical officer

Director

Matrons

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Administrative officer

Accountant

Chief pharmacist

Nursing sisters and nurses Clerical staff (medical and non-medical) Support staff (medical and non-medical) Clerks (finance)

Paramedical staff

Midwives

Figure 3. Organizational chart of the hospital

Support staff (paramedical)

been adopted in the hospital without substantial resistance by the staff. Addressing this point, the Administrative Ofcer said that:
The management and our employees instead of avoiding risks, like to accept the risks encountered in the workplace.

The interviewee perception of low UA dimension accounted for 62 percent. Low IND. The management recognizes the overall performance of the hospital considering both teamwork and individual work results of the employees. Each worker is encouraged to perform his or her job to the utmost. At the same time, they are encouraged to function as work teams. The Accountant responded favourably to this:
We appreciate both teamwork results and individual worker results, because both are necessary to quality improvement in the hospital (the Senior Matron also had a similar opinion to this).

A work team comprises of a small group which belongs to a particular division. For example, the administrative work team consists of the administrative ofcer, clerks, and the support staff members. The work team of the nursing staff consists of the matrons (Nursing Ofcers Special Grade I), nursing sisters (Nursing Ofcers Grade I), nurses (Nursing Ofcers Grades II A and II B), midwives, and the support staff members. Likewise, other divisions also have their own work teams. Each work team forwards their quality-related problems (e.g. the tidiness, orderliness, and cleanliness of the wards and ofces) to the assembly meetings through their representatives. They also engage in small group activities: the work improvement teams (WIT), quality control circles (QCC), and suggestion systems (SS). This environment has facilitated employees to enjoy their intergroup activities within the hospital. The management and staff members like this team environment, because it gives them a chance to share ideas, feelings, and emotions in relation to both their work life and family life. Consequently, the employees have given more priority to achieve the objectives of the hospital. Hence, according to the interview results (i.e. 71 percent of interviewee

perception), low IND (i.e. high teamwork) was evidenced as the core cultural characteristic of the hospital. Low MAS. The work force of the hospital consists of its director, administrative ofcer, accountant, senior medical ofcer, doctors, matrons, nursing sisters and nurses, midwifery staff, chief pharmacist, paramedical staff, and other clerical and support staff members. The overall work force is reasonably represented by both male and female employees. The key job positions have also been reasonably distributed among the male and female staff members. Addressing this issue, the senior medical ofcer replied that:
There is no difference between the male and female employees in the hospital, but they enjoy working interactively and giving a better service to the patients.

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The interaction between the male and female staff members was clearly seen when they engaged in the small group activities. For example, both male and female members contributed interactively to continuous improvement through the WIT, QCC, and SS. The low MAS dimension accounted for 58 percent of the interviewee perception. TQM practices of the hospital High SMC. The director has introduced a two-way communication system in which both top-down and bottom-up information ows are in effect. This two-way communication facilitates an open communication environment in which the vision, mission, goals, objectives, strategies, and quality policy of the hospital are well communicated and deployed to the other divisions. For example, the director usually discusses progress of the 5-S activities with the administrative ofcer. In addition to this, he discusses the progress with the senior medical ofcer, doctors, matrons, nursing sisters and nurses, accountant, chief pharmacist, and other staff members at the periodical meetings. Within this supportive communication environment, the director has introduced the 5-S based TQM system which consists of the WIT, QCC, and SS. According to the interview results (91 percent of interviewee perception), the directors commitment was evidenced as the core TQM practice of the hospital. High SC. The staff members of each division obtain information about their work targets from the respective heads. Further, they obtain new information about the continuous improvement programmes during their periodical meetings. The staff members forward their ideas and suggestions during the periodical meetings and when they engage in small group activities. There, the management becomes conversant with the weak points of the day-to-day activities. The operational level staff members usually provide such operational information to their heads. This provides the staff members a greater chance to become actively involved in the continuous improvement activities. High SF. The focus of the management to meet the expectations of the employees and patients of the hospital is well expressed by its mission, goals, values, objectives, strategies, and quality policy. The divisional heads (i.e. the administrative ofcer, accountant, senior medical ofcer, matrons, and chief pharmacist) and their staff have been given reasonable freedom to participate in the decision-making process. This is achieved mainly through the small group activities in which staff members are empowered to come out with new ideas and suggestions. In addition to this, periodical seminars, lectures, and training programs are conducted to develop staff skills.

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The hospital enhances its service responsiveness to patients mainly through the committed (the directors commitment is at the core) and participative staff engaged in continuous improvement activities. High ICI. The ICI activities within the hospital is mainly done through inter-group interactions. Initially, the small groups belonging to each division discuss what they need to improve in their divisions. Later, the suggestions are forwarded by each divisional head to the management meetings. The respective decisions taken in the management meetings are conveyed to the staff members by each divisional head. Thus, the Divisional Heads function as intermediaries of the continuous improvement activities. In addition to this, the common meetings and notice boards also convey messages to the staff members. High QC. The director has initiated a continuous improvement oriented infrastructure in the hospital by clearly dening its mission, goals, values, objectives, strategies, and quality policy. They are communicated to the operational level staff members through the divisional heads. However, the continuous improvement activities are carried out in small groups (i.e. WIT, QCC, and SS). Overall, this small group based teamwork environment creates and maintains a QC that helps continuous improvement. High MFB. The management evaluates service performance of the hospital using some service outcome rates. For this purpose, MMR, NMR, still birth rate, and perinatal mortality rate are determined and evaluated annually. The annual rates are compared with the historical, national, and global gures and possible variances are identied. The variances are discussed in the management and staff meetings and relevant action is taken in order to continuously improve the service performance. For example, death reviews and near death reviews are done in order to overcome the future deaths of the patients. High LO. The hospital practices Japanese 5-S based TQM activities as its self-assessment techniques for continuous improvement. The TQM activities are practiced through the small group activities: WIT, QCC, and SS. The small group activities and other staff development programs such as periodical meetings, seminars, lectures and staff training facilitate knowledge sharing and skills development of the staff members. Overall, all these activities have created a strong learning culture in the hospital. The effect of the culture of the hospital on its TQM practices The nal results of the analysis suggested that each culture variable has positively impacted on the respective TQM variables. For example, low UA has positively impacted on high SMC, high SC, high SF, high MFB, and high LO. However, low IND has positively impacted on all TQM variables conceptualized in the study. Hence, based on the OC and TQM conceptualization, it was suggested that overall, the supportive culture of the hospital has positively impacted on its TQM practices. Findings Addressing the three research questions, the ndings of the study are summarized as follows. The adopted cultural dimensions (Hofstede, 1991) were evidenced with low PD, low UA, low IND, and low MAS. They characterized the supportive culture of the hospital. However, low IND (i.e. high teamwork) was evidenced as the core cultural characteristic of the hospital.

The adopted TQM variables based on the TQM literature (Deming, 1986; Juran, 1995; Crosby, 1979; Feigenbaum, 1991; Ishikawa, 1985; Dale, 1994; Kroslid, 1999; Kaye and Anderson, 1998; Kaye and Dyason, 1995; Padhi, 2000) were evidenced with high SMC, high SC, high SF, high ICI, high QC, high MFB, and high LO. They characterized TQM practices of the hospital. However, high SMC (i.e. high commitment of the director) was evidenced as the core TQM practice of the hospital. Moreover, it was found that each cultural characteristic of the hospital has positively impacted on its TQM practices. However, the low IND cultural characteristic of the hospital has positively impacted on all its TQM practices. Thus, overall, the supportive culture of the hospital has positively impacted on its TQM practices. Managerial implications The present study found that the supportive culture of the hospital has positively impacted on its TQM practices. In other words, the success of TQM practice of the hospital has been achieved through its supportive culture. Thus, the ndings may be useful to managers of the hospital so they could concentrate upon its supportive culture in order to sustain the success of its TQM practice in the future. The ndings may also be useful to public sector healthcare managers and administrators in Sri Lanka to successfully practice TQM within a supportive OC. Conclusions At the beginning of the paper, it was mentioned that Sri Lankan organizations face a quality management challenge due their cultural and behavioural mismatch. Moreover, it was mentioned that the reforms and innovative programs introduced in public sector organizations in Sri Lanka are less compatible with the attitudes and skills of the employees. However, the Sri Lankan public sector hospital under study has been practicing Japanese 5-S based TQM activities successfully since 2000. Further, it has won several national quality awards for being more responsive to public demands through TQM implementation. The present study based on its ndings suggests that the quality management achievements of the hospital are mainly due to its supportive culture which has positively impacted on its TQM practices. Thus, the ndings of the present study reinterpret the previous research evidence (Nanayakkara, 1992; Samarathunga and Bennington, 2002). Research limitations This study conceptualized the concept of OC adopting some Hofstedian cultural dimensions (Hofstede, 1991) with an ideational perspective in order to identify the effect of OC on TQM practices. More specically, the study conceptualized the culture of the hospital adopting PD, UA, IND, and MAS variables in order to identify their effect on TQM practices. Thus, to overcome the limitations of the OC framework adopted in the present study, the paper invites future studies to examine the issue from a broader and new culture perspective. Originality/value Recently, many organizations in Sri Lanka irrespective of their category and industry have been practicing TQM in order to stay competitive in both domestic and

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international markets. But empirical studies on the topic are very limited in the Sri Lankan context. This study performed as a case of a Sri Lankan public sector hospital aims to ll that gap.
References Crosby, P.B. (1979), Quality is Free: The Art of Making Quality Certain, McGraw-Hill, New York, NY. Dale, B.G. (1994), Managing Quality, Prentice-Hall, London. Deal, T.E. and Kennedy, A.A. (1982), Corporate Cultures, the Rights and Rituals of Corporate Life, Addison-Wesley, Reading, MA. Deming, W.E. (1986), Out of the Crisis, Cambridge University Press, Cambridge. Feigenbaum, A.V. (1991), Total Quality Control, McGraw-Hill, New York, NY. Glaser, B.G. and Strauss, A.L. (1967), The Discovery of Grounded Theory, Strategies for Qualitative Research, Aldine, Chicago, IL. Handy, C.B. (1985), Understanding Organizations, Penguin Books, New York, NY. Hofstede, G. (1991), Cultures and Organizations, Software of the Mind, McGraw-Hill, London. Ishikawa, K. (1985), What is Total Quality Control, the Japanese Way, Prentice-Hall, Englewood Cliffs, NJ. Johnson, G. (1988), Rethinking incrementalism, Strategic Management Journal, Vol. 9 No. 1, pp. 75-91. Juran, J.M. (1995), The History of Managing for Quality, the Evolution Trends and Future Directions of Managing for Quality, Quality Press, Milwaukee, WI. Kaye, M. and Anderson, R. (1998), Continuous improvements: the ten essential criteria, International Journal of Quality & Reliability Management, Vol. 16 No. 5, pp. 485-506. Kaye, M.M. and Dyason, M.D. (1995), The fth era, The TQM Magazine, Vol. 7 No. 1, pp. 33-7. Kroslid, D. (1999), In Search of Quality Management-Rethinking and Reinterpreting, Institute of Technology, Linkoping University, Linkoping. Lagrosen, S. (2002), Quality management in Europe: a cultural perspective, The TQM Magazine, Vol. 14 No. 5, pp. 275-83. Nanayakkara, G. (1992), Can Sri Lankans Take the Quality Challenge? A Cultural Analysis, Postgraduate Institute of Management, Colombo. Padhi, N. (2000), The eight elements of TQM, available at: www.isixsigma.com/library/content/ c021230a.asp Peters, T.J. and Waterman, R.H. (1982), In Search of Excellence, Lessons from Americas Best Run Companies, Harper & Row, New York, NY. Robbins, S.P. (2005), Organizational Behavior, Prentice-Hall, New Delhi. Samarathunga, R. and Bennington, L. (2002), New public management: challenge for Sri Lanka, Asian Journal of Public Administration, Vol. 24 No. 1, pp. 87-109. Schein, E. (1985), Organizational Culture and Leadership, Josses-Bass, San Francisco, CA. Silverman, D. (2000), Doing Qualitative Research: A Practical Hand Book, Sage, London. Stahl, M.J. and Grigsby, D.W. (1997), Strategic Management, Total Quality and Global Competition, Blackwell, Cambridge, MA. Tayeb, M.H. (1988), Organizations and National Culture: A Comparative Analysis, Sage, London.

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About the author K.A.S.P. Kaluarachchi obtained his Bachelor of Commerce (special) degree (with a second class upper division pass) from the Faculty of Management Studies and Commerce, University of Sri Jayewardenepura, Sri Lanka in 1998. In 2004, he obtained his Master of Business Administration degree from the Faculty of Graduate Studies, University of Colombo, Sri Lanka. He is a member of the Association of Accounting Technicians of Sri Lanka and a licentiate member of the Institute of Chartered Accountants of Sri Lanka. He has worked as a marketing manager at the Direct Marketing International (Pvt) Ltd in Sri Lanka and as an accounts trainee at the KPMG Ford, Rhodes, Thornton and Co. in Sri Lanka. Presently, he works as a Lecturer at the Faculty of Management and Finance, University of Colombo, Sri Lanka (on study leave) and a PhD candidate at the Graduate School of Business Administration, Hosei University, Japan. He has written and published several text books and research papers in relation to the eld of management and organizational studies prior to this paper. His specic research interests belong to OC, OC and managerial behaviour, and OC and TQM practices. K.A.S.P. Kaluarachchi can be contacted at: samankalu@yahoo.com

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