Assessment of the quality of independent nursing practice in Indonesia based on total quality management indicators


total quality management
nursing services
personnel management
independent nursing practice

How to Cite

Sahputra, D., Lumbantobing, P., & Tuppal, C. P. (2021). Assessment of the quality of independent nursing practice in Indonesia based on total quality management indicators. Belitung Nursing Journal, 7(4), 294–303.
Google Scholar

Link to Google Scholar

Accepted for publication: 2021-07-09
Peer reviewed: Yes

Related articles in

Search Relations - Article by Author(s)

Share this article on:


Background: The quality of management has become a problem and significant issue of the late decade in Indonesia's professional nursing practice. By implementing total quality management (TQM), the organization would identify a health organization system's performance to improve patient satisfaction and patient safety for independent nursing practice services. 

Objective: This study aimed to assess the quality of independent nursing practice in Indonesia based on TQM indicators.

Methods: This study employed a sequential explanatory mixed methods design. Participants were 105 Chief Executive Officers (CEOs) of independent nursing practices who answered a TQM survey using The Malcolm Baldrige Criteria for Performance Excellence (MBCfPE). The quantitative responses were analyzed using SmartPLS version 3.0. For qualitative data, selected six participants from total respondents were interviewed to explore the participants' understanding of TQM. All the responses were transcribed and uploaded using NVIVO ver. 11 for thematic analysis.

Results: Leadership positively influenced strategic planning, customer attention, assessment analysis, and information management (focusing on personnel process management and efficiency) (p <0.001). In addition, process management indicated a positive influence on performance results (<0.001). Interview transcriptions concentrated on the following themes that emerged, such as quality focus, service focus, human resource focus, performance result, leadership, service system design, strategic planning, and information system.

Conclusion: TQM with the adaptation of MBCfPE criteria improves the organization's performance and serves as a strategic component in assessing and implementing sustainability change. The findings of this study can be used by CEOs of independent nursing practices for continuous improvement. In addition, the results serve as a basis for the ministry of health for accreditation to ensure the high quality of health care services.


Copyright (c) 2021 Devi Sahputra, Paul Lumbantobing, Cyruz P. Tuppal

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Article Metrics

Total views 1710 [Abstract: 1032 | PDF: 677 | XML: 1 ]


Download data is not yet available.

PlumX Metrics


Alolayyan, M. N., Ali, K. A. M., & Idris, F. (2011). The influence of total quality management (TQM) on operational flexibility in Jordanian hospitals: Medical workers' perspectives. Asian Journal on Quality, 12(2), 204-222.

Andreoli, K. (1992). Total quality management--a new culture. Journal of Professional Nursing, 8(2), 72.

Balasubramanian, M. (2016). Total quality management [TQM] in the healthcare industry–challenges, barriers and implementation developing a framework for TQM implementation in a healthcare setup. Science Journal of Public Health, 4(4), 271.

Berglund, M., Laarhoven, P. v., Sharman, G., & Wandel, S. (1999). Third-party logistics: Is there a future? The International Journal of Logistics Management, 10(1), 59-70.

Creswell, J. W. (2012). Educational research: Planning, conducting, and evaluating quantitative and qualitative research. Boston, MA: Pearson.

Government of Indonesia. (2014). Indonesian Nursing Law (Law No. 38 of 2014) Retrieved from

Gunawan, J., Aungsuroch, Y., & Fisher, M. L. (2019). Competence‐based human resource management in nursing: A literature review. Nursing Forum, 54(1), 91-101.

Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2-24.

Kaluarachchi, K. (2010). Organizational culture and total quality management practices: A Sri Lankan case. The TQM Journal.

Lauring, J., & Selmer, J. (2012). Knowledge sharing in diverse organisations. Human Resource Management Journal, 22(1), 89-105.

Manghani, K. (2011). Quality assurance: Importance of systems and standard operating procedures. Perspectives in Clinical Research, 2(1), 34.

Manurung, J. M., Oktamiati, P., Bachtiar, A., Junadi, P., Rijadi, S., & Muhammad, S. (2017). Kajian implementasi mutu dengan pendekatan integrasi six sigma dan TQM melalui penilaian Malcolm Baldridge di rumah sakit Charitas Palembang [Integration six sigma and TQM through Malcolm Baldrige assesment in Charitas Palembang Hospital]. Jurnal ARSI (Administrasi Rumah Sakit Indonesia), 3(2), 127-138.

Mun, T. W., Ghani, A., & Faizal, M. (2013). Continuous improvement in nursing education through Total Quality Management (TQM). Journal of Education and Learning, 7(4), 193-198.

Musker, K. (2011). Nursing theory-based independent nursing practice: A personal experience of closing the theory-practice gap. Advances in Nursing Science, 34(1), 67-77.

National Institute of Standard and Technology (NIST). (2020). Baldrige excellence framework: Proven leadership and management practices for high performance. USA: NIST Publication.

Porter, M. E., & Lee, T. H. (2021). Integrated practice units: A playbook for health care leaders. NEJM Catalyst Innovations in Care Delivery, 2(1).

Sadikoglu, E., & Olcay, H. (2014). The effects of total quality management practices on performance and the reasons of and the barriers to TQM practices in Turkey. Advances in Decision Sciences, 2014, 537605.

Sintari, M. N., & Novitasari, A. W. (2020). Hospital’s performance measurement with Malcolm Baldrige method. Journal of Public Health Research and Community Health Development, 3(2), 108-119.

Sugandini, D., & Wendry, B. (2017). Influence of quality relationship and satisfaction on loyalty: Study on supplier in Indonesia. Journal of Business & Retail Management Research, 11(4), 46-51.

Talib, F., Rahman, Z., & Azam, M. (2011). Best practices of total quality management implementation in health care settings. Health Marketing Quarterly, 28(3), 232-252.

Wang, K. Y., Chou, C. C., & Lai, J. C. Y. (2019). A structural model of total quality management, work values, job satisfaction and patient‐safety‐culture attitude among nurses. Journal of Nursing Management, 27(2), 225-232.

Wocare. (2020). Report of Wocare care clinician 2020. Retrieved from

Readers are able to give us their valuable feedbacks here. The comments will be reviewed by the editors and then published here. Important Note: The "Comments" related to the Galley Proof PDF must NOT be submitted via this form. Authors should submit their comments on their galley proofs only via system