1. Review of Literature
The health care industry, or medical industry, is a sector within the economic system that
provides goods and services to treat patients with curative, preventive, rehabilitative, and
palliative care. The modern health care sector is divided into many sub-sectors, and depends on
interdisciplinary teams of trained professionals and paraprofessionals to meet health needs of
individuals and populations.
The health care industry is one of the world's largest and fastest-growing industries. Consuming
over 10 percent of gross domestic product (GDP) of most developed nations, health care can
form an enormous part of a country's economy.
In today scenario we can see that patient‟s expectations from health care is very high. They are
dissatisfied with the system of waiting in queue for long time and they are unhappy with the
hospitality they are getting in health care industry. So the patients ask why health services cannot
use quality methods like other industries to reduce the raising costs of healthcare. So there need
to have modern techniques instead of traditional approaches. Modern quality methods will make
it possible for professionals and managers to understand and develop the complex systems of
care. Costing methods are over complex where health managers try to keep finance separate
from quality. Relationship between quality and resources damages the credibility of many
quality activities.
In terms of Garvin (1984) quality aspects contains both the user based approach and the
manufacturer based approach. User based approach includes maintaining appointments with
patients, professional treatment and patient satisfaction. Manufacturing based approach includes:
carefulness and safety.
Modern marketers are rediscovering the ancient mantras for success in corporate world and
blending them with contemporary marketing practices. Long term survival and competitive
advantage can only be attained by establishing an emotional bond with the customers. A shift is
taking place from marketing to anonymous masses of customers to developing and managing
quality of service and gentile relationships with customers (Gronroos, 1994).

2. Customer Relationship and quality Management “are the core business strategies that integrate
internal processes and functions, and external networks, to create and deliver value to targeted
customers at a profit. It is grounded on high-quality customer data and enabled by IT” (Buttle,
2004). Quality management is a business strategy to identify, cultivate, and maintain long-term
profitable customer relationships. It requires developing a method to select your most profitable
customer relationships (or those with the most potential) and working to provide those customers
with service quality that exceeds their expectations. (McDonald, 2002).
An organization‟s survival depends largely on harmonious relationships with its stakeholders in
the market. Customers provide the „life-blood‟ to the organization in terms of competitive
advantage, revenue and profits. Managing relationships with customers is imperative for all types
and size of service organizations. A sound base of satisfied customers allows the organization to
move on the path of growth, enhance profitability, fight out competition and carve a niche in
the market place. Bennett (1996) described that quality management seeks to establish long term,
committed, trusting and cooperative relationship with customers, characterized by openness,
genuine concern for the delivery of high quality services, responsiveness to customer
suggestions, fair dealings and willingness to sacrifice short term advantage for long term gains.
Schneider and Bowen (1999) advocated that service business can retain customers and achieve
profitability by building reciprocal relationships founded on safeguarding and affirming
customer security, fairness and self esteem. It requires that companies view customers as people
first and consumers second. Trust, commitment, ethical practices, fulfillment of promises, mutual
exchange, emotional bonding, personalization and customer orientation have been reported to be
the key elements in the hospitality management (Levitt,1986; Gronroos, 1994; Morgan,1994;
Gummesson,1994; Bejou et al,1998 ).
Quality Management is a strategy that embodies the belief that the management process must
focus on integrating the customer – driven quality throughout an organisation (Stah, 2002). It
stresses continuous improvement of product quality and service delivery while taking into
cognisance the reality that in order to achieve this goal, employee relations needs to be equally
addressed, as the customer cannot get the satisfactory service delivery from ill- motivated
employees (Lewis, 2004).

3. The philosophy underlying the implementation of quality management strategy is to see
organizational customers and clients as the vital key to organizational success. Organisations
with hospitality and quality management strategy see their business through the eyes of their
customers and clients and then measure their organisations performance against customer/client
expectations (Fran, 2002). It therefore follows that organisations that want to be successful with
the implementation of quality management strategy must evaluate its operations through the eyes
of its customers by strengthening and exploring all avenues including the people (employees)that
make up the organisational structure(Stah,2002).
According to Balogun and Hope-Hailey (2008), strategy should be seen as a system/process, that
should be able to engender in the employees a culture of total commitment to the vision and
mission of the organisation, and thus, a functional strategy that embodies the collective
contribution of various components that make up the organisational hierarchy should be such
that complement each other in the implementation of a strategy. For a strategy to accomplish the
desired goals and objectives of an organisation, effective strategy implementation mechanisms
should be put in place and one of the most potent ways for achieving this is by exploiting the
internal capabilities of the organisation in the form of its employees as a veritable asset while
encompassing various HRM initiatives, such as recruitment and selection, training and
development, reward systems, performance appraisal , the need for enhanced employee voice
systems , employee engagement and greater line manager involvement with management
,because they should be seen as a bridge between the employees and management for enhanced
psychological contract, which will in turn facilitate greater employee commitment (Murphy et al,
2001).
Quality products or services need not only to conform to consumers requirements; the
product/service must be acceptable. Effective quality management strategy entails that the
product/service must go beyond acceptability for a given price range. For example, rather
leaving customers/clients satisfied that nothing went wrong with the product or service, a
product/service should give the customers/clients some delightful surprises, or provide
unexpected benefits (Collard, 2001). This means, therefore, that product/service quality
assurance requires more than just meeting customers/clients minimum standards. The level of

4. product quality is the degree, to which a product/service is equal to or greater than
customers/clients expectations,
Thus, for organisations who desire to have TQM strategy in place and make it work effectively,
should as a matter of principle endeavour to be positively disposed to the idea of quality
management philosophy in their organisation. According to Haigh and Morris (2002), quality
management is an ingredient towards adequate quality delivery to customers .Quality
management involves: management systems, delivery, quality, cost, technology and of course
the employees, because according to Donaldson, (2001), no matter how perfect a strategy might
be, it depends on people for implementation. All these various components of quality
management when effectively harnessed will result in customer satisfaction; where the intention
is not to stop at a point in the process of implementation, but rather a continuous improvement of
the mechanism for a sustainable competitive advantage (SCA), through the use of employees as
organisations effective internal assets for a successful implementation (Haigh and Morris, 2002).