The study reported in this paper was carried out to examine how TQM implementation is accomplished, when culture change of a Sri Lankan public sector hospital is attempted in particular, on history of its TQM implementation efforts. Drawing from a Habermasian critical perspective, some ethnographic methods were employed as the methodology. The paper reports some findings and implications of the study as follows. Culture of the hospital has been changed from non-cohesive status to the cohesive status as a result of the Japanese 5-S based TQM activities implemented in 2000. However, TQM practices of the hospital have reinforced its culture change effort. Cohesive culture of the hospital was evidenced with positive teamwork, change oriented risk recognition, long-term orientation, incremental technology, and transferable visible. The TQM practices were evidenced with managerial commitment, non-managerial commitment, strategic focus, customer focus, human resource focus, process management, managing supplier relations, managing employee relations, and global focus. The positive teamwork appeared as the core cultural value, which was seen with managerial and non-managerial commitment to continuous improvement. The positive teamwork value has reinforced the other cultural values. The managerial and non-managerial commitment has reinforced the other TQM practices. Therefore, TQM practices of the hospital were seen with its cultural integration as both managerial (i.e., the director and Divisional Heads) and non-managerial (i.e., the doctors, Nursing Sisters & nurses, Technical Staff, Midwifery Staff, Clerical Staff, and Support & Auxiliary Staff) employees have shared those practices collectively. The hospital as a health care service provider has improved its service outcomes/performance combining both clinical and TQM oriented activities together. The hospital as a public sector organization in Sri Lanka has improved its service outcomes/performance through the Japanese 5-S based TQM activities implemented in 2000 as its modernization/innovative program. As a result, it has been awarded with several national level quality awards for the success and being more responsive to the public demands. Presently the hospital functions as a model public hospital in Sri Lanka. The findings reinterpret the existing understanding about public sector organizations in Sri Lanka that their innovative programs mostly mismatch with the attitudes and skills of the participants. In overall, performance of the hospital reinterprets the existing understanding about public hospitals in Sri Lanka that their rigid administrative environment discourages the efforts of enhancing their quality of service. As implications, the findings may be useful to public sector organizations particularly, public health care service providers in Sri Lanka and other developing countries to be more responsive to public demands through successful integration of TQM implementation. To overcome the limitations of this single case study, future studies on the topic need to be conducted as comparative cases and survey research, including private sector hospitals in Sri Lanka.
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