Implementation of quality management is very important for hospitals to improve processes, solve problems, and reduce variations and errors in service, including through the implementation of popular Total Quality Management (TQM) and Six Sigma (SS) as new quality management strategies to increase profitability, effectiveness and efficiency of the organization's operations to meet customer’s needs. This study aims to develop an integrated hospital quality management model from the practice of TQM and SS to provide synergy in improving hospital performance. The study design was cross sectional through a survey using a questionnaire on 863 respondents, namely all employees ranging from doctors to administrative personnel at 8 hospitals. The TQM and SS practice integration model identified as “Quality Management Alliance Model (QMA)” consists of 6 variable constructs, namely: Management Practice (MP); TQM Infrastructure Practice (IPTQM); SS Infrastructure Practice (IPSS); Core Practice TQM (CPTQM); Core Practice SS (CPSS); and Hospital Performance (KRS) with 12 structural equations hypothesized. Data analysis are performed using Structural Equation Model through 2 tests, namely analysis of measurement models using confirmatory factor analysis (CFA) second order approach and structural model analysis. The results of the first order confirmatory factor analysis (CFA) analysis, after issuing invalid indicators (SLF≤0.5 and t≤1.96), obtained constructs of latent variables with models fit, valid, and reliable. Then in the second order CFA analysis on the overall model after being simplified through LVS (latent variable score) the study obtained construct model fit, valid and reliable. The results of the structural model analysis obtained a model fit with 11 structural equations that are positively and significantly related (t> 1.96). This study proves that the QMA model is feasible and can be applied to measure the implementation of hospital quality management. Hospital management is recommended to implement the QMA Model optimally to improve performance.

The purpose of this study is to measure the impact of institutional environment as government regulation and managers’ capabilities to maintain the relationship between the stakeholder networks and the entrepreneurial orientation within the context of the hospital industry in Indonesia. The results of data analysis from 105 small and medium private hospitals in the Jakarta city and surrounding areas show that the hospital entrepreneurial orientation was significantly influenced by government policies reflected by the legal certainty and bureaucratic attitudes that assist the implementation of the policies. Besides, it is proven that management capabilities to establish the relationships with many stakeholders, consisting of all existing partners and employees, also affect the growth of entrepreneurial orientation. Finally, the performance of the hospital is proven to be significantly influenced by the entrepreneurial orientation directly and also mediated by business model innovation. The results of this study become paradoxical because it is different from the opinion that the healthcare industry would not have accepted the concept of entrepreneurship.

Total Quality Management (TQM), a comprehensive and strategic management philosophy based on continuous quality improvement, strong customer relations, and involvement of the entire organization, has moved from its industrial roots to become the primary support of modern healthcare deliveries. The present article offers a thorough review of the literature that synthesizes 30 years of scientific work from all over the world and provides a critical analysis of the application, effectiveness, and evolution of TQM in the complicated context of hospitals. The analysis starts with the historical and theoretical foundations of TQM in healthcare, connecting basic quality frameworks to modern practices. It then assesses with great care the large volume of evidence proving TQM's positive effect on the most important hospital performance indicators such as patient safety, satisfaction, clinical outcomes, operational efficiency, and economic viability. The discussion devotes a considerable part to the strong challenges and barriers to TQM being successfully implemented, bringing in studies from both developed and developing countries to point out the hurdles that are common and the ones that are particular to a given context. Moreover, the review goes into the interaction between TQM and other process improvement approaches like Lean and Six Sigma. Lastly, it outlines the future path of quality management in the healthcare sector by looking into the alliance of TQM with digital transformation, AI, telemedicine, and innovation management. The paper wraps up by asserting that TQM is still a 'must-have' strategic option for hospitals but that it needs strong and determined leadership, a broad-based quality culture, and an adaptive to change technology and methodology for its successful running.