Total Quality Management Boosters and Blockers in a Humanitarian Setting: An Exploratory Investigation

Utilizing qualitative techniques, this research is aimed at investigating total quality management (TQM) implementation practices within a humanitarian setting. The extensive survey instrument of professionals working for the United Nations (UN) organizations operating in the Middle East is used to reveal TQM use within international nongovernmental organizations (INGOs) that provide humanitarian relief. With the goal of helping organizations to address anticipated difficulties in implementing TQM practices that improve performance of humanitarian interventions, this study identifies and examines the boosters and blockers of successful implementation of the TQM practices. The most prominent themes that were identified relate to availability of funding, management commitment to quality, partnerships and communication channels, and knowledge sharing.


Introduction
There is a consensus among quality experts and scholars that for the pay received from their organizations, employees are responsible for the quality of products/services offered by their organizations. Such responsibility can be fulfilled through designing an effective and efficient system that ensures the superior quality of products. Such orientation toward quality excellence led to the emergence of a concept called total quality management (TQM). According to the U.S. Department of Defense DOD (cited in Goetsch & Davis, 2013, p. 5), total quality embraces the constant development of people, processes, products (including services), and environments. With total quality anything and everything that impacts quality is a target for continual improvement. When the total quality notion is effectively put into action, the end results can include organizational excellence, superior value, and global competitiveness. TQM is a systematic and participative approach that is intended to plan and implement a continuous improvement process that aims to exceed the expectations of the customer, spot the mistakes, and encourage the joint efforts toward decision making (Napierala, 2012).
TQM has gained a wide acceptance as a powerful performance-enhancing customer-focused management philosophy. With the benefits of TQM ranging from process improvements and higher quality, to increased employee engagement and continuous improvement, ultimately leading to organizational excellence, TQM is undeniably a powerful proven-to-work approach to attaining organizational excellence.
Nonetheless, much of the scholarly work on TQM has focused on the private sector. While numerous evidence links TQM in profit-driven organizations with improved corporate performance (e.g., Al-Dhaafri & Al-Swidi, 2016) and sustainable competitive advantage (e.g., Boateng-Okrah & Fening, 2012), significantly less is known about TQM's performance in nonprofit organizations, especially those involved in humanitarian relief efforts. The uniqueness of the relief works due to the sudden need to mobilize the resources for the intervention to take place when the disaster strikes imposes many constraints on the efficient and effective use of resources particularly from the long-term business viability perspective. Academic scholarship recognizes the importance of developing strategies to improve the impact of relief efforts on both beneficiaries and the organization delivering the intervention; however, there does not seem to be a consensus on what constitutes the best approach. To this extend, a study by Sweis et al. (2016) was among the first to conceptualize the TQM implementation practices in the humanitarian setting and as such was the first study to offer a multidimensional TQM performance-enhancing model that identified six dimensions of quality measures based on experiences of two international nongovernmental organizations (INGOs).
The nature of humanitarian sector revolves around people and scholars agree not only to identify beneficiary as a primary stakeholder in humanitarian setting (Wellens & Jegers, 2014), but to emphasize the importance of involving the beneficiary in the decision making, design, and delivery of the intervention, thus achieving quality via beneficiary's satisfaction (Griekspoor & Sondorp, 2001). The beneficiary's satisfaction in the humanitarian setting is largely dependent on organization's employees and their ability to deliver timely, efficient, and reliable relief. Thus, organization's internal stakeholders, the employees, should not only be aware of their impact on beneficiary's assessment of quality, but be deeply committed to quality. Such commitment can only be cultivated by the top management though appropriate leadership style and commitment to quality (Fonseca, 2015), thus reinforcing one of the key TQM principles that is equally applicable in private and nonprofit settings. A study by Analoui and Samour (2012) found strategic management of human resources particularly important for improving the strategic performance in nongovernmental organizations, while Ridder, Piening, and Baluch (2012) confirmed the increasing importance of human resource management in a nonprofit setting, particularly as a result of needing to serve multiple stakeholders while facing scarcity of resources.
Another aspect of TQM implementation that is an integral part of the TQM philosophy is process management and continuous improvement. Few scholars have focused specifically on nonprofit sector to raise awareness and gain insights on the importance of process improvement for nonprofits. The work by Lassiter (2007) advocated the need for integrating process improvement strategies into nonprofit sector and identified those strategies that are most appropriate within the setting of nonprofit organizations. Using case study, Cheng and Chang (2012) revealed how one particular process improvement approach, Lean Six Sigma, can improve the quality of humanitarian interventions, allowing organization to shorten the assistance delivery time despite being constrained by limited resources.
Another dimension of quality that is particularly important for humanitarian interventions is collaborative partnerships with a multitude of stakeholders. According to Jacobs (2011), humanitarian organizations embrace collaboration and cooperation with key stakeholders because of the positive impact such partnerships have on the quality of interventions. Among those key stakeholders are local communities, governmental officers, and private companies. Fitzpatrick and Molloy (2014) suggest the need for nonprofit organizations to enter into partnerships with local NGOs because those are better equipped to understand the intricacies of implementing humanitarian activities locally. Partnering has been shown to be crucial for resource sharing, as Rathi, Given, and Forcier's (2014) demonstrate that one of the critical benefits of collaborative partnership is mutual support via organizational resource sharing, including finance, staffing, experience, and information. In the age of technology, ability to share information among partners avoids overlapping and promotes cost savings while both partners achieve their common objectives in an effective and efficient fashion (Proulx, Hager, & Klein, 2014).
Despite an abundance of a healthy interest from the academic community toward finding ways to better understand the application of TQM within the nonprofit and more specifically within humanitarian relieve industry, most of such attempts remain as a few contextually and narrowly focused studies that need further investigation within a broader setting.
For the purpose of this study, INGOs are considered as humanitarian agencies that develop and deliver humanitarian relief in the international setting. For example, some INGOs that were surveyed for this study are the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), the World Food Programme (WFP), The Food and Agriculture Organization (FAO), the United Nations Office for Project Services (UNOPS), the Department of Safety and Security (UNDSS), the United Nations High Commissioner for Refugees (UNHCR), the United Nations Development Programme (UNDP), and the World Health Organization (WHO). This study represents a qualitative exploration of the plight of TQM implementation alongside with its boosters and blockers within the United Nations (UN) organizations operating in the Middle East.

Literature Review
Humanitarian agencies started exploring use of private sector proven management philosophies under the pressures created by the mainstream media and donors to optimize performance and improve accountability. Furthermore, the complexity of the environment INGOs operate in, where competition pressures for ever tighter funding and donor capital, has also generated the need for becoming more efficient and accountable regarding the delivery and execution of relief efforts. Therefore, NGOs are becoming more urged to look for techniques that have proved themselves effective in a for-profit setting.
In this context, many international initiatives have emerged (Griekspoor & Sondorp, 2001) and over time, as the number of humanitarian organizations has increased, numerous training courses were developed to raise awareness about relief work and improve organizational capacity so that TQM performance improves. Among such international initiatives are Emergency Capacity Building Project (ECB), Synergie Qualité, Humanitarian Accountability Partnership (HAP), the Inter-Agency Network for Education in Emergencies (INEE), Quality COMPAS, The Sphere Project, The Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP), and People in Aid.
While the purpose of these well-established initiatives varies, the overall goal is to increase the level of quality of humanitarian assistance. Academic research has not produced a consensus on how to measure the quality of the humanitarian assistance. Many of the aforementioned initiatives have developed their own quality-measuring criteria. For example, Humanitarian Accountability Partnership (HAP, 2010) focuses on improving quality of interventions by increasing their effectiveness, efficiency, and accountability produced nine standards that are part of their Core Humanitarian Standard (CHS): (a) Relevance (b) Effectiveness and timeliness, (c) Humanitarian response empowerment, (d) Humanitarian response is based on communication, (e) Participation and feedback, (f) Complaints are encouraged and addressed, (g) Humanitarian response is coordinated and complementary, (h) Humanitarian actors continuously learn and improve, (i) Staff are supported to do their job effectively, and are treated fairly, while resources are managed and used responsibly for their purpose (The Core Humanitarian Standard, 2014). These standards underline the critical role that quality improvements and corporate accountability play for humanitarian actors to become more efficient in the deliveries of their interventions. In another effort, the European Foundation for Quality Management model (EFQM) has been used by humanitarian organizations to utilize nine criteria for evaluating the quality of humanitarian assistance. Among these criteria are leadership, policy, resource management, partnerships, processes, beneficiary satisfaction, the satisfaction of the human resources, impact on society, and performance results (Griekspoor & Sondorp, 2001). Sweis et al. (2016) proposed a conceptual framework postulating six dimensions of TQM based on extensive literature reviews of the for-profit economic sector as well as practical adoptions of TQM by two major INGOs located in Jourdan. We purposely omit the bulk of the literature review leading to the identification of each of the six dimensions because they are fully captured in the study by Sweis et al. (2016).
The suggested model was specifically aimed to assist INGOs to carry out their interventions effectively and efficiently and offered a six-dimensional construct for improving INGOs performance and satisfying donors and beneficiaries. The six dimensions presented in that model are (a) Leadership and Management Commitment; (b) Beneficiary Focus and Participation; (c) Partnership Quality Management for Sustainability; (d) Human Resource Focus; (e) Process management, Learning and Continuous Improvement; and (e) Use of Quality Information. That was followed by another research that empirically linked some of the TQM dimensions (i.e., Leadership and management commitment, Beneficiary focus and participation, Partnership management for sustainability, and Use of quality information) to the performance of the INGOs (Saleh, Sweis, Abdelqader, Abdallah, & Arafeh, 2017).
This exploratory investigation intends to shed additional light onto the issues of TQM implementation within humanitarian setting and offers qualitative insights on factors that act as boosters and blockers of TQM within humanitarian organizations involved in intervention deliveries.

Method
We constructed an online survey that contained, in relevance to this study, two sections. Section 1 consisted of a briefing of the respondents with the meaning of TQM alongside of two open-ended questions to generate the themes concerning the two main variables (i.e., TQM boosters and TQM blockers). The first open-ended question asked the respondents to list the blockers they believed their organization might have faced during its efforts to implement TQM. The second open-ended question asked the respondents to provide their views on what their organization might do to enhance its effectiveness of implementing TQM. We also added another open-ended question for the respondents to describe the likes of any practice that their organization displays toward quality aspects. We analyzed the narratives of the respondents to these two questions. Section 2 of the survey was comprised of questions related to the basic demographic traits of our sample. The data for this study were derived from a purposive sample of a larger dataset comprising of all professional members of staff of the UN organizations that had operations in Syria, Egypt, Cyprus, Palestinian Territories, Israel, Lebanon, Iran, Iraq, and Turkey. Of the 1,982 self-administered questionnaires distributed in 2017-2018, we had 739 returned responses prior to data analysis and purposively selected 188 responses that were used in the thematic analysis. The aforementioned procedures are well established in the literature and widely used by scholars in qualitative research (e.g., Mahmoud & Grigoriou, 2017). Profiling our respondents, most of our sample were males (55%), educated to a postgraduate level (61%), and had 5-to 10-year tenure in their current position (43%) and more than 10-year experience in the humanitarian sector. Finally, we ran a thematic analysis using NVIVO 12 Pro to identity the patterns/themes of both boosters and blockers regarding implementing TQM as well as any other patterns related to the quality of services within the surveyed organizations.

Boosters and Blockers of TQM Implementation
The two open-ended questions in the questionnaire allow us to gain additional insights on blockers that may be affecting TQM implementations and to better understand the motivational boosters supporting the use of TQM within the UN surveyed organizations. Because our results show that there are multiple blockers and boosters of the implementation of TQM, they should be identified to enable managers to create effective policies to overcome the obstacles and reinforce the opportunities (Jun, Cai, & Peterson, 2004).
• • Funding limitations-There was a consensus among the respondents that limited resources are one of main barriers to providing aid (Cătălin, Bogdan, & Dimitrie, 2014). Respondents clarified that the scarcity of funds leads to limited human resources within the organization [. . . limited human resources due to the lack of fund . . . Staff promotions are not timely available due to budget restrictions]. Thus, organizational performance is affected. They also confirmed that poor planning (Cătălin et al., 2014) and poor management are obstacles impeding the quality achievement (Amar & Zain, 2002). For that, the respondents believe that good planning (Black & Porter, 1996) and strong human management reinforce the implementation of TQM (Karuppusami & Gandhinathan, 2006). They also stressed that employee selection in recruitment processes as well as consideration of the quality of work in the employee's appraisal are important for supporting the TQM implementation. Furthermore, the scarcity of funds negatively impacts the work environment since it leads to high staff turnover [. . . staff turnover is very high in the UN system due to limited budget] and an increased sense of job insecurity (Talib & Rahman, 2015). Due to the strong influence of funding, the respondents considered donor commitment and funding as two important boosters for the TQM [. . . increasing the fund and donor commitment]. • • Organizational commitment to quality-In addition, most of respondents viewed the paucity of necessary training for the staff members as a blocker to TQM implementation [. . . Training of the members of staff would fulfill the requirements of TQM . . . Providing training for the members of staff would support implementing TQM more effectively]. Hence, they confirmed that capacity building in terms of quality and TQM for both organizational staff and partner's staff is crucial for TQM success especially for newly hired staff members (Cătălin et al., 2014;Gherbal, Shabani, Saidani, & Sagoo, 2012). The respondents clarified that senior management plays a vital role in communicating the TQM concept among the staff [. . . decision makers should promote for the quality culture within the organization . . . motivating the staff to adopt TQM as an integral part of the organizational culture] (Soltani, Lai, & Gharneh, 2005). Respondents also confirmed that the absence of monitoring and controlling practices within organizations hinders continuous learning and therefore impedes the implementation of TQM [. . . Lacking a proper code of ethics and accountability within the organization negatively impact the implementation of TQM]. The respondents indicated that monitoring is imperative to collect the needed information related to the activities that enable the employees to explore the deviations in organizational processes and take corrective action during the implementation phase (Amar & Zain, 2002).

• • Partnerships and communications-Partnerships
with local organizations and the commitment to quality by senior management, both of the organization and of the partner organizations, are also necessary for TQM implementation (Ernest, Osseo-Asare, & Longbottom, 2002). If these matters are ignored, the quality of work is negatively affected [. . . poor partnership with local associations]. In addition, the respondents confirmed that modern technology, reward systems, and motivational approaches are the best practices to encourage employees' commitment to TQM (Black & Porter, 1996) [. . . The organization that I work for uses a modern technology in data collection which is helpful for an effective implementation of TQM]. Many of the respondents indicated that their organizations give priority to partner selection and share their quality standards and the accountability framework with those partners [. . . selecting partners is one of the key quality indicators]. As partnerships are crucial for the nonprofit organizations to secure funding, and to share the needed information that assists in risk mitigation (Proulx et al., 2014), empirical evidence suggests that organizations recognize the importance of partnerships. • • Organizational Culture-Respondents to our study stated that organizational culture, in terms of communication and teamwork, affects organizational performance because poor communication (Talib & Rahman, 2015) and absence of teamwork (Bayazit, 2003) have a negative impact on the quality of staff members' work [. . . poor communication channel between the top management and other members of staff]. In addition, the bureaucracy that stifles innovation, slow decision making, and the absence of process re-engineering were also identified as blockers [. . . bureaucracy and poor management].

• • Knowledge and information sharing-Our results
show that exchanging experiences among the organizations (Chowdhury, Paul, & Das, 2007), sharing information and communicating effectively (Mahmoud, Delrosario, Reisel, & Pantsios, 2018) with the internal and external stakeholders, and establishing quality unit within the organization empower the application of TQM [. . . poor communication among the employees within the organization, as well as, between the organization itself and its partners . . . understanding of the concept TQM sometimes poses a challenge to the implementation process]. Most of the surveyed organizations have documented and approved Standard Operating Procedures (SOP) [. . . we insure that SOPs are well documented, approved, communicated and agreed on]. Those help to lessen the delays and reduce the rework (Yong & Wilkinson, 2001) by streamlining the work and explaining to the employees how to perform the tasks (Vorster, 2011). Our respondents indicate that most of the organizations conduct internal reflections and audits and share the results of monitoring and evaluation with their partners, who are the implementing parties [. . . we conduct internal inspections on a frequent basis]. These practices improve the quality performance because they provide a feedback mechanism for the staff to learn from the mistakes that occurred in the past. Another recurrent theme was technology related, as many respondents indicated that their organizations utilize modern technology for collecting timely and accurate data. Furthermore, the organizations collect data concerning interventions on a regular basis to monitor and evaluate quality performance, which is considered a crucial practice for continuous improvement (White, 2013) [. . . The use of information is run in a timely and an accurate manner . . . we provide information using advanced technologies]. • • Leadership-Some respondents to our survey indicated that the leadership of their organizations exhibits a strong commitment to quality, which further indicates that they recognize the importance of the top management commitment to quality (Kutlu & Kadaifci, 2014) [. . . the commitment of top management to the quality]. Moreover, quality within the organization and quality of beneficiary care have been reported to be included in the organizations' mission and vision [. . . To consider TQM as one of the strategic goals]. The accountability to beneficiaries, donors, and other stakeholders has also been mentioned as being integrated in the overall mission [. . . lacking monitoring and ignoring the importance of the feedback from beneficiaries]. There is an indication of favorability regarding the fact that quality services and continuous improvement are becoming a bigger part of the organizational culture [. . . to enhance the services quality offered by the organization . . . at the organization I work for, providing quality services is an integral part of the organizational culture], which incorporates focus on improving the beneficiaries' care for better performance and success of strategies (Kanji, 2012).

Conclusion and Implications and Limitations
This study explores the implementations of TQM practices as well as their boosters and blockers within the UN organizations operating in the Middle East. With the help of the survey and following a qualitative approach via conducting thematic analyses, this study identified factors that boost the effectiveness of the TQM implementation in humanitarian settings as well as pointed to blockers preventing successful implementation of TQM by humanitarian actors. Those insights should help the nongovernment organizations operating in the challenging setting of delivering humanitarian relief to address the anticipated difficulties and reinforce the potential opportunities. It is clear that limited resources in the form of scarce funds and challenged human resources are at the route of most reported blockers of successful TQM implementations. From the lack of training to high turnover, from subpar managerial planning to poor communications, from the lack of monitoring to slow decision making, this study has been able to not only identify those factors that limit the ability of the humanitarian actors to become more effective and efficient in the delivery of their relief but also point out those areas where improvements would lead to the overall boost in organizational performance. Evidence suggests that while many of the important quality measure dimensions previously discussed in the academic literature are being already incorporated by many of the humanitarian actors, our study identified areas where more attention is needed to support a healthy TQM implementation. Areas within human resources where job security, employee selection and healthy appraisal system have been linked to promoting TQM support from employees via improved rewards and motivation, as well as areas related to stronger partnership relations, have been identified as being critical in our study.
While this study relied on inputs from INGOs performing interventions mostly in Middle East region, similar surveys should be conducted in other parts of the world to further understand the extend of the TQM implementation similarities and differences across cultures. There is a room to further fine-tune our survey tool by breaking it down into more detailed survey questions of closed-ended nature to solicit input on some of the individual areas mentioned above.
Furthermore, the results of our survey could be used to suggest a new theoretical model that would construct a measure of TQM implementation performance and as such could be tested quantitatively in the future research.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.