This document summarizes a research study on factors influencing quality management in nursing services. The study used a descriptive research design and collected primary data through questionnaires from 150 nursing respondents. The study found that institutional profiles like adequate funding and facilities impacted quality. Challenges to quality included safety, workload, and lack of leadership. Factors influencing quality included supportive management, policies, and communication. The study also assessed hospital resources, staff development activities, and their impact on nursing quality.

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International Journal of Management (IJM)
Volume 11, Issue 11, November 2020, pp. 3846-3852, Article ID: IJM_11_11_380
Available online at https://iaeme.com/Home/issue/IJM?Volume=11&Issue=11
ISSN Print: 0976-6502 and ISSN Online: 0976-6510
DOI: https://doi.org/10.17605/OSF.IO/R6DYB
© IAEME Publication Scopus Indexed
A SURVEY ON FACTORS INFLUENCING
QUALITY MANAGEMENT WITH REFERENCE
TO NURSING SERVICES
Thomas Maliakkal
Full Time Research Scholar, PG and Research Department of Management,
Rajagiri Dawood Batcha College of Arts and Science,
Papanasam, Tamil Nadu, India.
Dr. G. Vani, Ph.D.
Assistant Professor and Research Advisor, PG and Research Department of Management,
Rajagiri Dawood Batcha College of Arts and Science,
Papanasam, Tamil Nadu, India
ABSTRACT
The present study consists of following to analyse the impact of Institutional profile
and care information provided to them on quality management. The research design is
descriptive in nature. Primary data is collected with the help of structured
questionnaire. The validity of research is based only on the data collected for the study.
The present research is based on primary as well as secondary data. Simple random
sampling method was used in selecting the respondents. The sample size is chosen for
data collection of 150 respondents in quality management with reference to nursing
services.
Key words: Quality management, Manpower, Government hospitals
Cite this Article: Thomas Maliakkal and G. Vani, A Survey on Factors Influencing
Quality Management with Reference to Nursing Services, International Journal of
Management (IJM), 11(11), 2020, pp. 3846-3852.
https://iaeme.com/Home/issue/IJM?Volume=11&Issue=11
1. INTRODUCTION
Even though leaps have been made regarding quality management in recent years and reports
of positive results due to quality control is evident in many parts of the world, this remains a
pipe dream in many of the developing countries. Factors like the extensive research and data
required for the upkeep, cost-efficiency and most important of all, lack of skilled individuals
who are just as good at managing their sectors from the background as caring for their patients
can be pointed out as the reasons for its poor results in these countries. However, as a matter of
fact, the biggest reasons behind the underutilization of TQM in developing countries have to be
attributed to cost: efficiency ratio. Discussions on quality management and cost control in

2. A Survey on Factors Influencing Quality Management with Reference to Nursing Services
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medical sector often take place independent of one another while in reality, each of these aspects
complements each other. With these factors, quality management struggles to find wiggle room
outside of textbook examples in these parts. Whereas, looking into the other parts of the world,
especially the developed ones, institutions employing TQM have pushed their personnel so far
that it resulted in the medical crew being exhausted, demoralized and simply put overworked.
The reason behind such failed experiments in these parts of the world can be logically
attributed to poor planning of their quality management models that include poor
communication within the personnel, lack of clear directives, mismanagement of resources and
lack of manpower.
Hence it is important that quality management in any institution has to be planned by taking
into consideration of both the economy and manpower. Another major criticism aimed at
quality management is that it’s not indicative of the actual care received by patients in medical
institutions. According to disputes, quality assurance in many institutions is just an after
thought, employed to inspect, repair and for damage control rather than to innovate and develop
the care received by the patients. It focuses on solving the problem rather than finding new
innovations to prevent it from occurring in the first place.
2. IMPACT OF INSTITUTIONAL PROFILE ON QUALITY
MANAGEMENT
The results of the research to compare the impact of institutional profiles in quality management
made it clear that there is a great difference in the impact of institutional profiles as the quality
parameters are better in the private hospitals in comparison with the public hospitals and hence
the patients choose private hospitals more for the treatments. Hence it is suggested that setting
up of a hospital should invariably take care to provide enough number of patient beds and other
patient supportive machineries. The fund sources should be adequate to provide support to
clinical research, well advanced medical technology and diagnostics, provision for both
curative as well as preventive health care facilities, qualified and professional doctors etc. The
government hospitals may consider fund raising from NGOs for better facilities. The cost of
the services may be kept at a reasonable price. However, since there is trend among the patients
to go for quality care even if the service coast is high, it is important to maintain the quality of
care services rather than cost reduction. Salary packages for the staff nurses may also be
considered as per the government rules which have to be followed up by the labour
commissions.
3. REVIEW OF LITERATURE
Jahromi et al., 2017 concluded for their study that teaching positive thinking has a positive
impact on work life of nurses and was on par with the findings50of Amponsah- Tawiah and
Mensah (2014) which revealed that factors such as increased self- efficacy, optimism, and
flexibility can improve the quality of work life of nurses.
Evans et al. (2006) are of the view point that tacit (skill) knowledge, or the ‘how to’
knowledge, is acquired primarily through experience which includes observational experiences,
preceptor ship learning opportunities and also by working with mentors.
Yaghoubi et al., (2013) states that the management must use their authority and influence
to ensure that their employees are working creatively to accomplish the goals for the
organization, which in the health sector would beto deliver the most effective and efficient
services to the patient by providing maximum support to their staffs. Managers need to promote
a staff who is competent and hard working as this is will directly affect the quality of work.

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Watters (2009) suggested that a shared governance model is a preliminary footstep on the
road to professional nursing brilliance that can confirm a way for achieving elevated quality
and performance of the staff.
Barden et al. (2011) interested in examining nurse empowerment in relation to nurse
perceptions of shared governance conducted a descriptive co relational study of 158 nurses
working in a large tertiary care hospital in Queens, NewYork. This study supported the notion
that shared governance provides a communication and decisional infrastructure to empower
nurses in clinical practice.
4. OBJECTIVES OF THE STUDY
The present study consists of following objectives
• To analyse the impact of Institutional profile and care information provided to them on
quality management.
5. RESEARCH METHODOLOGY
The research design is descriptive in nature. Primary data is collected with the help of structured
questionnaire. The validity of research is based only on the data collected for the study. The
present research is based on primary as well as secondary data. Simple random sampling
method was used in selecting the respondents. The sample size is chosen for data collection of
150 respondents in quality management with reference to nursing services
Table 1 Institutional Profile
Sl. No. Particulars No. of Respondents Percentage
1
The hospital has enough rooms or
beds for patients.
15 10
2
Hospital has adequate finance to support the
clinical research.
24 16
3
There is a provision for both curative and
preventive health measures.
8 5.34
4 The hospital services are costly. 12 8
5
Qualified and professional doctors visit the
hospital if medically demanded.
11 7.34
6
The management level employees are well
educated and run the entire nursing care
system efficiently.
6 4
7
Ratio of nurse to patient is low and it puts a lot
of workload on you.
5 3.34
8
The fixed and low salary of nurses affects the
overall quality of services.
10 6.67
9
Medical technology and diagnostic centres are
well advanced.
12 8
10
The hospital has large facilities such as
cafeteria, parking space, pharmacy etc...
21 14
11
Training and development activities are
inadequate.
16 10.67
12
The benefits for nurses such as salary,
pension, training etc...Are inadequate.
4 2.67
13
There is a need to improve the medical
amenities and services in the hospital.
6 4
Total 150 100
Sources: Primary data 2020.
The above table shows the institutional profile of respondents. Out of 150 respondents 15
respondents report that the hospital has enough rooms and beds for patient.24 respondents says

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that hospital has adequate finance to support the clinical research.8 respondents says that there
is a provision for both curative and preventive health measures.12 respondents feels that the
hospital services are costly.11respondents says that qualified and professional doctors visit the
hospital if medically demanded.6 respondents has the opinion that the management level
employees are well educated and run the entire nursing care system efficiently.5 respondents
says that the ratio of nurse to patient is low and I puts a lot of workload to nurse.10rrspndents
feel that the fixed and low salary of nurses affects the overall quality of services.12 respondents
says that medical technology and diagnostic centres are well advanced. 21 respondents happy
that the hospital has large facilities such as cafeteria, parking space, pharmacy etc.16
respondents feel sad that training and development activities are inadequate. 4 respondents feel
that the benefits for nurses such as salary, pension, training etc. are inadequate. 6 respondents
suggests that there is a need to improve the medial amenities and services in the hospital.
Table 2 Challenges in quality management of nursing
Sl. No. Particulars No of Respondents Percentage
1 Ensuring safety and security of the nurses during day
and night shift is a challenge for the management for
better nursing care.
22 14.67
2 Without nurses’ agreement, night shift rotation is a
challenge to maintain the number of required nurses in
various departments.
15 10
3 Lack of leadership and orientation develops a negative
attitude in nurses.
36 24
4 Efficient planning is required with respect to nurses’
long working hours and work load.
7 4.67
5 Patients and relatives lack of trust in nurses’
knowledge and skill to provide medical care pose a
challenge to quality care.
11 7.34
6 Frequent friction and lack of cooperation between
nurses and physician needs attention.
15 10
7 Inadequate facilities can challenge nurses’
engagement.
44 29.34
Total 150 100
Sources: Primary data 2020.
The above table gives clear data about the quality management of nursing in the hospital.
Out of 150 respondents, 22 respondents says that ensuring safety and security of the nurses
during day and night shift is a challenge for the management for better nursing care, 15
respondents says that shift rotation is a challenge to maintain he number of required nurses in
various departments, 36 says that lack of leadership and orientation develops a negative attitude
in nurses. 7 respondents think that efficient planning is required with long working hours and
work load, 11 respondents says that patients and relatives has lack of trust in nurses knowledge
and skill to provide medical care is a challenge to quality care, 15 respondents says that frequent
friction and lack of between nurses and physician, majority of 44 respondents report that
inadequate facilities is a great challenge for the nurse for active engagement.

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Table 3 Factors influencing nursing quality
Sl. No. Particulars No of Respondents Percentage
1 There is a lack of strategies and policy to develop the
nursing quality care
22 14.67
2 Low nursing care quality can be due to an inadequate
policy on work culture for the hospital employees.
14 9.34
3 Non supportive management affects the nursing care
performance.
31 20.67
4 Managerial staff is always approachable and visible in
professional as well as personal needs
7 4.67
5 Conflicts between the clinical team members are
effectively handled by the management.
12 8
6 The hospital management is in regular and periodic
contact with nurses.
64 42.67
Total 150 100
Sources: Primary data 2020.
The table gives information about factors influencing nursing quality in hospital
management. From 150 respondents, majority of 64 respondents says that the hospital
management is in regular and periodic contact with nurses, 31 respondents says that non
supportive management affects the nursing care performance, 22 respondents report that there
is lack of strategies and policy to develop the nursing quality care, 14 respondents suggest that
low nursing care quality can be due to an inadequate policy on work culture for the hospital
employees, 7 respondents says that managerial staff is always approachable and visible in
professional as well as personal needs, 12 respondents says that any kind of conflicts between
the clinical team members are effectively handled by the management.
Table 4 Hospital Facilities and Resources for the Quality of Nursing
Sl. No. Particulars No of Respondents Percentage
1 Insufficient resources, poor infrastructure, lack of
modern equipment in the hospital affect the quality
of nursing care.
15 10
2 Lack of safety and security measures in the
hospital affects the nurses’ quality of services.
18 12
3 Unattended medical equipment repairs reduce
nurses’ work efficiency
36 24
4 Good food and water supplies to the nursing staff
can improve the work efficiency in hospital
42 28
5 External funded projects and research facilities in
hospitals helps to improve nursing skills and self-
confidence and thereby
8 5.34
6 Proper and hygienic house keeping facilities at
hospital encourage nurses to work better
31 20.67
Total 150 100
Sources: Primary data 2020
The above table clearly shows the facilities and resources for the quality of nursing at the
hospital. Out of 150 respondents, majority of 42 respondents are satisfied with the good food
and water supplies to the nursing staff which lead to the better work efficiency,36 respondents
report that unattended medical equipment’s repairs reduces nurses work efficiency, 31
respondents says that proper and hygienic housekeeping facilities at hospital encourages nurses
to work better, 18 respondents says that lack of safety and security measures in the hospital

6. A Survey on Factors Influencing Quality Management with Reference to Nursing Services
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affects the nurses quality of services, 15 respondents report that inefficient resources, poor
infrastructure, lack of modern equipment in the hospital affect the quality of nursing, 8
respondents suggests that extended funded projects and research facilities in hospitals helps to
improve nursing skills and self-confidence.
Table 5 Staff development activities
Sl. No. Particulars No of Respondents Percentage
1 Nurses should be updated about various innovations and
developments in clinical field for providing more patient
centered care.
22 14.67
2 Continuous nursing staff education should be a
mandatory objective of all the hospital organizations for
quality improvement
18 12
3 Nurses should be given opportunities to attend in service
training programmes by the organizations so as to
improve the quality of care provided by them
31 20.67
4 Workshops, online classes, seminars etc… are part of
quality improvement programmes implemented at the
hospital.
19 12.67
5 Personality development programmes are conducted
periodically and helps to improve
The personal skills
25 16.67
6 Nursing staff with high academic excellence may be
given incentives and encouraged to go for higher studies
which will help them to improve their working quality.
35 23.34
Total 150 100
Sources: Primary data 2020.
The table gives the data about the various activities for staff development in the hospital.
35 respondents report that hospital gives nursing staff with higher academic excellence may be
given incentives and encouraged to go for higher studies which will help them to improve their
working quality, 31 respondents says that nurses should be given opportunities to attend in-
service training programme by the organization so as to improve the quality of care provided
by them, 25 respondents says that personality development programmes are conducted
periodically and helps to improve the personal skills, 22 respondents has the opinion that nurses
should be updated about various innovations and development in clinical field,19 respondents
attend workshop, online classes, seminars etc., are part of quality improvement programmes in
the hospital, 18 respondents suggests that continuous nursing staff education should be
mandatory objective of all the hospital organization for quality improvement.
6. CONCLUSION
To conclude the current research, in a simple statement it could be stated that the research
entitled “a study on factors influencing quality management with reference to nursing services”
was an attempt to understand the nursing quality management scenario in the Indian context
with special reference to Tamil Nadu. With various objectives stated, the current study
identified the factors affecting nursing quality management, the challenges faced in the process
of nursing quality management, impact of different management strategies used in improving
nursing quality management, impact of institutional profile and care information on quality
management, knowledge and skill set requirement of nurses, awareness level of nurses about
the novel approaches in nursing care 186 and the effectiveness of task and patient allocation in
nursing quality management. While analyzing and understanding these aspects, it was studied

7. Thomas Maliakkal and G. Vani
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under both public and private sector hospitals. The major conclusions drawn from the current
research is as follows.
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