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Nurses who directly took care of patients with at least B.Sc. degree and working fulltime in three working shifts of morning, afternoon and night in the mentioned hospitals at least for six months allowed to be recruited. The exclusion criterion was unwillingness for participation. The research environment included eight teaching, public and referral hospitals affiliated to the Tehran University of Medical Sciences, from which four performed organizational excellence plan (Jame Zanan Hospital with 118 beds, Roozbeh Psychiatric Hospital with 165 beds, Farabi Eye hospital with 199 beds and Hashemi Nejad Kidney and urinary tract hospital with 163 beds), and four did not perform the organizational excellence plan (Akbar Abadi Obstetrics and Gynecology Hospital with 267 beds, Iran Psychiatric hospital with 105 beds, Hazrat Rasool general hospital with 426 beds and Firoozgar general hospital with 192 beds) in 2013 (www.research.ac.ir). The hospitals performing the organizational excellence plan in this research implemented the EFQM model, and after evaluating by the Institute for Studies in Human Resource and Productivity, were selected as the best organizations ( ).
Although the European Foundation for Quality Management (EFQM) Excellence Model has been widely adopted throughout Europe, a thorough examination of the factors that contribute to the internalisation of the model (i.e. a substantive adoption) has been neglected in the literature. The purpose of this paper is to present a model that analyses the drivers of the real internalisation of the EFQM excellence model, with a focus on the role of motives for adoption, and appraisal and compensation systems.
Escrig-Tena, A.B., Garcia-Juan, B. and Segarra-Ciprés, M. (2019), \"Drivers and internalisation of the EFQM excellence model\", International Journal of Quality & Reliability Management, Vol. 36 No. 3, pp. 398-419. -08-2017-0161
To promote the adoption of the model, the EFQM launched a recognition scheme, through which organisations could be recognised by a way of an internal and external assessment based on the EFQM model criteria. Consequently, many organisations have been awarded an external recognition in accordance with the EFQM model, for which they must have offered proof that they have adopted a comprehensive range of management practices embedded within the criteria of the constituting model. The widespread adoption of the model amongst practitioners has aroused the interest of scholars, who have conducted interesting academic studies that evidence the benefits derived from the adoption of the EFQM model (e.g. Boulter et al., 2013).
In this context, although in the last decade the internalisation of management standards like ISO 9000 has been studied in the specialised literature (e.g. Nair and Prajogo, 2009; Tarí et al., 2013), little is known about what really allows the EFQM model to be internalised in the organisation (i.e. it is accepted by people as part of the way they think and behave, which means a substantive rather than symbolic adoption). However, as both ISO 9000 standards and the EFQM excellence model are used as frameworks to develop Quality Management (QM) practices, as faithful reflections of the principles and methods of QM (e.g. Kim et al., 2010; Bayo et al., 2011; Brown, 2013; Gómez et al., 2017; Suárez et al., 2017), analysis of the internalisation of the EFQM model can draw on the QM and quality standards internalisation literature. In fact, previous studies on the EFQM excellence model (e.g. Bou et al., 2009; Escrig and de Menezes 2015; Calvo et al., 2015; van Schoten et al., 2016; Suárez et al., 2016; Zárraga and Álvarez, 2016; Raharjo and Eriksson, 2017) have been developed under the wider umbrella of the QM literature.
By addressing this question, this paper contributes to the existing literature in several ways. First, to the best of our knowledge, this is the first study that focuses on the internalisation of the EFQM model; previous studies have focussed on the internalisation of ISO 9001 standards (e.g. Nair and Prajogo, 2009) or QM initiatives in general (e.g. Bello et al., 2014). Second, while previous studies have addressed internalisation by concentrating on the motivations for adoption, the present study introduces another variable that may explain the substantive adoption of the EFQM model, namely, the role of appraisal and compensation systems. Thus, this study brings together different perspectives to explain the internalisation of the EFQM model. Finally, the paper contributes to the debate about the strength of the EFQM model as a continuous improvement tool, since it unveils the factors that could foster the integration of the model within the organisational routines, instead of being just a management fad. In doing so, it helps to bridge the research gap identified by La Rotta and Pérez (2017) and Suárez et al. (2017), namely, the need for research into the reasons that lead to the adoption of excellence models from an institutional perspective, as well as the barriers that could prevent real adoption of the EFQM model.
In the literature about the adoption of meta-standards such as ISO 9001, some scholars have been interested in the concept of internalisation (e.g. Naveh and Marcus, 2004; Nair and Prajogo, 2009; Heras, 2011; Tarí et al., 2013; Ataseven et al., 2014). For instance, Nair and Prajogo (2009) and Ataseven et al. (2014) point out that internalisation involves the active daily use of the practices associated with the ISO 9001 standard, with the intention of modifying behaviour and decision making, and fostering continuous improvement. In the same vein, Tarí et al. (2013) consider internalisation as a process in which procedures and practices contained in the standards have become anchored in the beliefs of the organisation. In the wider QM literature, some scholars, such as Ford (2011), warn that organisations could make a genuine effort to adopt QM practices but in some contexts the adoption may be less authentic and would not be performance enhancing. In this second context, the adoption is more ceremonial and does not foster internalisation. Transferring the words of Ataseven et al. (2014) to the EFQM model, internalisation needs to be distinguished from the fact of having an EFQM recognition in place. In fact, Dubey (2016) caution that some organisations focus more on attaining recognition than on identifying improvement opportunities and learning from the EFQM model assessment process.
In addition, Sekiguchi (2013) suggests that for appraisal and compensation systems to be effective in employee motivation, they should be designed in a consistent way, i.e., practices increasing the wage differential should be accompanied by fair assessment systems. In this vein, some authors (e.g. Jiménez and Martínez, 2009; Escrig et al., 2016) describe the performance appraisal and compensation systems that could be more consistent with QM and the EFQM model: employees are involved in the design of the system, which strikes a balance between individual and group assessment and recognition; performance appraisal is oriented towards giving feedback and helping people to improve their skills and performance; and rewards and recognitions are linked to the appraisal and based on skills and collective performance. Since such practices are effectively promoting commitment to and employee involvement in excellence, they could contribute to the effective internalisation of the EFQM model in the organisation.
To assess the performance appraisal and compensation systems, the items proposed by Jiménez and Sanz (2013) were used to analyse the degree of adoption of human resource management practices consistent with the EFQM model (see Table II) using a five-point semantic differential scale. From these items, different types of performance appraisal and compensation practices were identified by means of cluster analysis.
Third, studies dedicated to the internalisation of QM have focussed above all on the influence of reasons for adoption as antecedents of internalisation (e.g. Nair and Prajogo, 2009). Our work unveils motivational practices regarding performance evaluation and compensation systems as another important factor to facilitate the internalisation of the EFQM excellence model. Organisations that use these systems to support and foster the commitment of employees by developing their abilities achieve a more substantive adoption of the EFQM model. In contrast, organisations that have a system focussed on meeting targets and neglect regular evaluations for skills development and variable remuneration, seem to obtain lower levels of internalisation. Having the sole concern of achieving goals seems to lead to a poorer internalisation of the EFQM model. Overall, given that there are no significant differences in the internalisation level between organisations that differ in the compensation system employed, the results suggest that the type of compensation system is not relevant in the achievement of the internalisation. It seems that what makes the difference is the appraisal system. Thus, the study shows that a performance appraisal system-oriented towards the development of employees encourages further internalisation of the practices embedded in the EFQM model, compared with a system that is more centred on achieving objectives. This again brings to the fore the relevance of the human factor for successful EFQM model internalisation, and, specifically, highlights the importance of intrinsic motivation in organisations, according to self-determination theory (Deci and Ryan, 2000).
The present study has some limitations, which indicate avenues for further research. First, we analysed Spanish organisations, as representatives of one country where the use of the EFQM model is widespread. However, this focus on only one country would restrict the generalisation of results, and future studies should be proposed to study an international sample of recognised organisations. Second, we focus on motives and appraisal and compensation systems as antecedents of the internalisation of the EFQM model. Future research would need to be developed to look deeper into the role that other human resource management practices could play in internalising the use of the EFQM model. Moreover, we intend to examine the findings obtained through a qualitative study in organisations adopting the EFQM model, which should allow us to complement the analysis of the data obtained from the survey. Finally, an open line of research involves the study of the consequences that the use of these performance appraisal and compensation systems has on the behaviour and attitudes of employees. These future lines of research will enable us to gain a better understanding of the reality of the organisations that have embarked upon a path towards excellence. 153554b96e