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Quality improvement interpreted as a complex adaptive system : implications and opportunities : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand
(Massey University, 2024-11-01) Wilson, William
The effectiveness of quality improvement (QI) methods in healthcare has been challenged, especially under circumstances of high complexity. This thesis examines the implications for quality improvement if complex socio-technical systems such as healthcare are interpreted as complex adaptive systems (CAS). The research followed a mixed-method design. Informed by the complex systems and quality management literature, a conceptual model for quality improvement within CAS was developed — the complex quality improvement network (CQIN). An agent-based simulation model was then used to establish the plausibility and face validity of the model constructs and their interaction. Thematic analysis and crisp-set qualitative comparative analysis (QCA) were then used to examine the evidence for CQIN constructs within published quality improvement case studies. One applied case study was also conducted for deeper insight into the practical difficulties of interpreting a real-world quality improvement project as a CAS. Finally, the findings of the simulation modelling and the secondary data analysis were integrated into a Bayesian network model. Empirical evidence, in the form of consistency across cases and coverage within cases, was found for eleven of the twelve CQIN constructs. Multiple sets of sufficient conditions for reported improvement success were identified across cases. These sets were minimised to four strategies for successful quality improvement; i) strengthening agent network communication paths; ii) building shared understanding of problem and context amongst networked agents; iii) increasing problem-solving effectiveness; and iv) improved system signal integration. If the evolutionary foundations for CAS are in some way inhibited, the likelihood of quality improvement success is reduced. Healthcare quality improvement can be plausibly simulated using fundamental CAS principles. The first contribution to quality improvement discourse is the CQIN model, a CAS model of change applied specifically to quality improvement. A second contribution of this research is a complex quality improvement risk assessment model, the CQIN Bayesian Network. Practitioners can use this model to examine and test identified CAS-informed improvement strategies. The individual CQIN constructs make a third contribution by providing new categories of causal factors for the comparison of disparate quality improvement case studies.
The relationship between lean and performance measurement in service and manufacturing organisations in New Zealand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Accounting at Massey University, Manawatū, New Zealand
(Massey University, 2024-08-20) Roos, Christina Maria
This thesis examines the relationship between lean and performance measurement systems (PMSs) in New Zealand private and public organisations. There is a dearth of research on lean and PMSs, despite the importance of understanding this relationship. To provide insights and an understanding of this relationship, this study identifies and examines lean techniques and the corresponding performance measures applied to measure lean performance. The research data were analysed using Searcy’s (2004) framework of lean performance dimensions and the findings were informed by contingency theory. The research conclusions were drawn from qualitative interpretations of the data through thematic analysis. The research findings show that lean is still in an emergent state in New Zealand and that managers associate lean with reducing waste to reduce costs, promote continuous improvement, improve quality, and deliver customer value. This differs from the global perspective of providing customer value through continuous improvement (Thornton et al., 2019; Albzeirat et al., 2018). The lean techniques implemented by the lean organisations reflect the managers’ association of lean with reducing cost and promoting continuous improvement, with a marginal focus on improving customer value. Organisations that successfully use lean techniques remain in a ‘black hole’ between measuring lean performance and the inclusion of lean performance dimensions in the PMS. Less than half of the organisations adapted their PMSs to include lean performance, nor did they implement specific lean KPIs to measure and evaluate lean performance. In those organisations where managers had identified, implemented, and used critical lean success factors, they had concurrently modified their PMS to include lean KPIs. Nonetheless, dollars saved are still recognised as the most important lean contribution, subsequently, once dollar-related goals were reached, organisations restored their traditional PMSs. As such, lean performance was neglected, and the existing lean practices were not associated with PMS. Ultimately, most organisations did not adapt their PMSs sufficiently to accommodate lean, and consequently, the organisations’ PMSs did not adequately capture lean outcomes. The implications for organisations and CEOs are that they need to shift focus from cost savings and profits to lean techniques and map the correct key performance indicators to the PMS to fully measure and evaluate lean outcomes.
The key factors driving successful improvement in primary care : a mixed methods investigation of the determinants of quality improvement success in Aotearoa New Zealand : a thesis with publication presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, Aotearoa New Zealand
(Massey University, 2023-11-30) Cullen, Jane
Primary care is where the population receives most of their health care and where successful quality improvement (QI) can have the biggest impact on health, wellbeing, equity, and health system performance. A better understanding of the factors that influence QI in primary care is urgently needed to support a high-performing primary healthcare system. Most prior studies into the determinants of effective QI have focused on secondary care organisations and large-scale collaborative efforts. Primary care services such as general practice present a different set of challenges. Various key contextual factors have been identified in the literature, but few studies explain how they relate to each other and QI success. This study sought to answer the following questions: 1. What are the contextual factors influencing primary care improvement interventions? 2. How do the contextual factors, improvement content (topic and planned changes) and the implementation process influence each other and the improvement outcomes in primary care? 3. How applicable for primary care assessment is the Model for Understanding Success in Quality (MUSIQ), a tool for assessing modifiable contextual factors developed in secondary care? This research was an explanatory sequential mixed methods study based in the Aotearoa, New Zealand (NZ) primary care setting of general practice and Primary Health Organisations (PHOs). Amulti-case mixed methods approach was followed in the first stage. Mainly qualitative data were collected from primary care interviews guided by the Consolidated Framework for Implementation Research (CFIR). This was compared with quantitative data from the MUSIQ survey. The second stage consisted of a national survey where emerging theory was tested by partial least squares structural equation modelling (PLS-SEM). The findings revealed that most teams did not use formal QI methods, instead relying on their people-centred relationship skills and networks to drive QI via distributed leadership. Teams were intrinsically motivated by community and patient need and drew on strengths developed within the complexity and uncertainty of the primary care settings to drive QI. The collaborative skills which are increasingly required in the modern primary care setting support the shared social processes of sensemaking for enacting change. The key success factors driving QI in primary care are identified and how they relate to each other explained. A primary care adaptation of MUSIQ has been proposed that may aid improvement practitioners and researchers to assess primary care contexts. The key strengths should be developed and supported across primary care services and capability, capacity and resources supported centrally to increase the ability of primary care to improve services more easily and effectively.
A global study on how the national business excellence (BE) custodians design BE frameworks and promote, facilitate, and award BE in their countries : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Engineering at Massey University, Manawatu Campus, New Zealand
(Massey University, 2021) Ghafoor, Saad
Business Excellence (BE) is a philosophy and a collection of BE Frameworks (BEFs) for organisations to follow to achieve excellence in strategies, business practices, and stakeholder-related performance results, to ultimately become the best they possibly can be. This research aimed to investigate the current state of and best practices in designing BEFs and deploying (promoting, facilitating, and awarding) BE on a national and/or regional level. The aim of this research was met through first conducting a systematic review of BE literature followed by collecting data directly from BECs. A mixed methodology and pragmatic philosophy were used in this research, thus collecting and analysing both quantitative and qualitative data. With regards to the participants of the research, 29 BECs from 26 countries undertook a 46-question survey. Of the survey participants, 13 BECs also undertook optional follow-up online structured interviews. It was found that while the BE literature comprises of 415 journal papers, no research covers how BECs support BE in their countries. There are 74 countries and four regions with BE Custodians (BECs) that promote BE within their countries, of which 57 actively hold BE Awards (BEA) with their last award held in 2018 or after. A key finding of this research is that BECs focus more on their BEA activities than their BE promotion and facilitation activities and report low levels of BE awareness and usage levels. A general framework for designing and reviewing a BEF is provided along with recommendations for BECs to improve their BE promotion, facilitation, and award activities. The findings of this research will help the national BECs to better understand their strengths and opportunities for improvement and to learn from other BECs’ practices. This will assist the BECs to better foster a culture of BE in their countries’ organisations that follow or aim to undertake a BE journey (of using a BE and adopting outstanding practices to achieve results) to ultimately benefit all of their stakeholders and lead to improved economic and societal benefits at a national level.
TQM implementation : a conceptual study of the impact of implementation on two companies : a comparative investigation about the understanding of and impact of Total Quality Management programmes within Post Haste Couriers, Palmerston North and Rayonier New Zealand, Wellington : a thesis presented in partial fulfilment of the requirements of the degree of Master of Business Studies at Massey University
(Massey University, 1996) Fowler, Richard John
Much has been written about the concepts associated with TQM, but little exists on the impact of TQM implementation in New Zealand companies. This paper is a comparative study on the understandings and impact of TQM within two New Zealand companies, Post Haste Couriers Palmerston North and Rayonier New Zealand, Wellington. Semi structured interviews were carried out and the data compared with a variety of theoretical approaches. The findings show that TQM means different things to different levels in a companies hierarchy and its successful implementation depends on the management style, company resourcing and the amount of control that can be exercised over the business environment.
An investigation into the use of quality management techniques in NZ IT projects : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Information Systems at Massey University
(Massey University, 2006) Xu, RuiLin
The risks in an IT project are very high both because of its complexity and also because the context of rapidly-developing technology leads to a high degree of uncertainty. IT projects should have comprehensive formal quality management fully integrated within all aspects of project management. A review of the quality management in IT project literature suggests, customer-focused TQM is now synonymous with good management. TQM combines the use of computerised data collection and statistical experimentation with a focus on teamwork, group participation and a culture of continuous improvement in operating systems (Robert. 1993). Using the survey methodology and through two case studies, qualitative data was gathered to develop a model of quality management implementation process in New Zealand. Key words: Quality. Total Quality Management (TQM), Quality Control (QC), Quality Assurance (QA), Quality Model.
The integrated continuous improvement project : a thesis presented in fulfilment of the requirements for a Masters of Philosophy in Quality Systems at Massey University
(Massey University, 2005) Burton, Penelope Susan
This thesis represents the outcome of a research project undertaken to enhance the continuous improvement aspect of quality management in an engineering services company. The solution proposed involved creating an electronic reminder system to encourage colleagues to follow through on suggested improvements. This thesis describes the preparation, process, learning achieved and pitfalls encountered in the process of attempting to create such a system. The proposed system was to be a robust, effective electronic system, which allows continuous improvement efforts (including their outcomes) to be visible from a central place; be intuitive to use; have facilities to report progress - at different levels and within different groups; create effective reporting to interested parties; and enable analysis and evaluation of nature and status of suggested improvements. This thesis includes a review of literature relating to the Plan-Do-Check-Act (PDCA) cycle, continuous improvement, systems thinking, total systems intervention, and learning organisations, which were read in order to gain a clearer understanding of the shape of future continuous improvement systems. The thesis describes the project methodology followed for the idea conception, design, and specification of the system, assessment of suppliers and of their proposed solutions. Organisational influences that affected the project are discussed using five key filters - mechanical, organic, cultural, political and cybernetic - suggested in systems thinking literature, and project and thesis outcomes are described.
An examination of kaizen drift in Japanese genba : implications for business in the anglosphere : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Business and Administration at Massey University, Manawatu, New Zealand
(Massey University, 2013) Macpherson, Wayne Gordon
In attempting to decode the industrial competitive success of Japan, researchers in the Anglosphere have predominantly identified with the highly visible tools and methods of the quality management philosophy of kaizen. However, due to data collection methodologies and significant cross-cultural limitations kaizen appears to have been largely misinterpreted and misunderstood. This ‘gap’ has resulted in literature riddled with deterministic models of mechanical methodologies promoted to pursue business excellence. Further, there has been a plethora of attempts at transplanting Japan-centric tools and techniques, with little – if any – regard for the country’s individual and indigenous social characteristics. To deepen understanding of kaizen a phenomenological study was conducted in middle-to-large sized industrial companies in Japan to investigate Japanese workers’ perspectives of kaizen. Two parallel and complementary philosophies of the pursuit of business excellence were identified. The Japanese thread explored how Japanese workers acknowledge and exercise kaizen; and, the Anglosphere thread examined how workers in the Anglosphere attempt to adopt and practise kaizen. In the Japanese context, society is identified as being highly bounded with little opportunity for individual creativity. Many Japanese industrial organisations, being active kaizen environments, channel worker creativity and expressions of individuality into bounded environments, or kaizen audiences, providing a counter-point to social and cultural requirements. In addition to Japanese-style management, this has resulted in the production of tangible kaizen tools and methods, as easily identified by Anglosphere researchers and practitioners. The primary contribution to knowledge this research presents is the development of understanding of the utility of the kaizen phenomenon. Kaizen in industrial settings in Japan is found to be both culturally bounded and contextually dependent, and far beyond continuous improvement; differences in the perceptions of older and younger workers are seen to exist as kaizen drifts across generational boundaries; active programmes are maintained to ensure that kaizen remains embedded in both the individual and the organisation; and, the simplistic diffusion of kaizen to Anglosphere organisations is observed to be an unlikely guarantee to sustainable business excellence over the longer term, as it has in Japan. This research reports that the only likely viable means to sustainably diffuse kaizen in Anglosphere domains is for business leaders to return to square one and instil an implicit, comprehensive understanding and appreciation of kaizen; and, acquire and develop recipient-organisation-centric tools and methods. Such a new approach could provide practitioners in the Anglosphere the means to adopt and sustain kaizen thinking and practice, and a gateway to sustainable competitive advantage.
The applicability of 'voice of the customer' tools to an indigenous organisation in a developing country : a thesis submitted to Massey University in partial fulfilment for the degree of Masters in Philosophy (Quality Systems), Massey University of Manawatu, Palmerston North, New Zealand
(Massey University, 2012) Lewis, Janice Ann
The value and applicability of western management theories and practices to the developing world is rarely discussed within the current rush to globalise the world economies, capture untapped wealth and seek to establish businesses within indigenous societies. This is especially relevant to the use of Voice of the Customer (VOC) methods and tools when applied to indigenous peoples and service organisations, where customer information is used to design or improve services. There has been limited concentration and much debate as to whether VOC tools are as effective as anticipated, and can solve the unique problems that appear when used in unfamiliar diverse cultures in developing countries. A risk when using a particular method or management technique is the desire and expectation that it will be transferable for use in similar businesses in other countries. Service quality is reliant on what the customer feels and often cannot be measured easily. This can be compounded in a developing nation scenario, by the fact that methods are usually developed, implemented, interpreted and validated through a western ‘lens’. Armstrong and Pont et al (2011, page 6 -7) describe these issues succinctly when they state… ‘a survey of the leading academic journals suggest that well over 90% of the articles published are concerned with establishing basic causality behind certain phenomena. Very few studies investigate whether a certain method used by management is effective or not …. as practitioners we are more interested in what works than the intricacies of causality’. This research specifically explored the use of VOC tools in the Bougainville Village Court (VC) to identify service elements customers considered important to the functioning of the VC in their village communities. Tools that were used included quantitative measurement tools - a combined Garvin–SERVQUAL tool, the RATER model, and Quality Function Deployment (QFD) principles, and the more qualitative New Zealand Business Excellence Criteria (NZBEC). The research demonstrated that the quantitative VOC methods used did not fully fit, or account for some service elements important to the customer in this particular context, where societal trust and continuous contact are important service elements. The methods used were thus, unable to completely capture the full humanistic elements and contributing causal factors. In this research study cultural context in the form of history, environment, tradition, community relationships and structures, played a vital role in determining what the customer considered were important service elements. It was found that these elements were more easily captured through use of the more qualitative NZBEC as it enabled collection of more diverse perspectives through its open question structure. Generic VOC ‘western developed’ quantitative tools did gather VOC information. However, they were only effective after adaptation to each VC location and after cultural input. Cultural analysis from indigenous people to interpret the data is recommended as a prerequisite and standard part of VOC methodology in a developing country scenario. This research suggests assessment and analysis based solely on ‘western’ VOC methods and statistics will not capture the VOC fully and could lead to misinterpretation or fail to acknowledge the real voice of the customer and the causal and contextual factors contributing to customer responses.
Development of a guidance model for the selection of organisational improvement initiatives : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Engineering and Industrial Management at Massey University, Palmerston North, New Zealand
(Massey University, 2012) Mohammad, Musli Bin
research aims to develop a guidance model for selecting organisational improvement initiatives. The final guidance model was developed using the acronym ‘GUIDE’ which represents the five key steps to select improvement initiatives: (1) Goal setting, (2) Understanding relevant improvement initiatives, (3) Identifying decision criteria, (4) Deciding on the appropriate initiative, and (5) Evaluating the decision. This research used mixed methods approach, whereby qualitative data was used more dominantly than quantitative data. Two research phases were involved: (1) Development, evaluation and refinement of a conceptual model; and (2) Development, evaluation and refinement of a guidance model. This research incorporated multiphase concurrent and sequential data collection, which comprises an extensive literature review, a document review, a global exploratory survey, an evaluation survey and seventeen semi-structured interviews conducted in New Zealand, Singapore and Malaysia. Semi-structured interviews and an evaluation survey were used as primary sources of data. The proposed multilayer guidance model is one of the first to focus on the holistic processes to be used in selecting improvement initiatives whereby its contents are explicitly aligned to the Business Excellence Models (BEMs), such as Baldrige Criteria for Performance Excellence and European Foundation for Quality Management (EFQM) Excellence Model. Systems and contingency approaches were incorporated in the development of this model so that multiple perspectives and contexts (e.g. current maturity level of an organisation, benefit of implementing the initiative, ability to gain top management commitment and support) are considered when selecting an initiative. Part of the guidance model also consists of a framework that shows the main improvement initiatives that can be adopted towards business excellence (BE), which can help organisations to choose appropriate improvement initiatives by narrowing down the options according to the areas of implementation and BE maturity. This framework also indicates that the BEM can be used as an overarching framework for selecting and managing multiple improvement initiatives. In addition, this research identified that there were 94 national Quality / BE Awards used in 83 countries in year 2010 and revealed one of the latest and comprehensive list of the Quality / BE Awards worldwide.

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