Paper 6

International Review of Management and Marketing

ISSN: 2146-4405

available at http: www.econjournals.com

International Review of Management and Marketing, 2016, 6(4), 790-797.

International Review of Management and Marketing | Vol 6 • Issue 4 • 2016790

The Moderating Role of Knowledge Management on the Relationship between Employees’ Commitment and Total Quality Management: A Study on the Public Healthcare Sector in Saudi Arabia

Abdulrahman Ahmad Al Ghamdi1*, Fadzli Shah Bin Abd. Aziz2, Rushami Zien Yusoff3, Munauwar Bin Mustafa4

1Ministry of Health Saudi Arabia and School of Business Management, College of Business, University Utara Malaysia, 06010 UUM, Kedah, Malaysia, 2School of Business Management, College of Business, University Utara Malaysia, 06010 UUM, Kedah, Malaysia, 3School of Business Management, College of Business, University Utara Malaysia, 06010 UUM, Kedah, Malaysia, 4School of Business Management, College of Business, University Utara Malaysia, 06010 UUM, Kedah, Malaysia. *Email: [email protected]

ABSTRACT

This current study investigated the relationship between employees’ commitment and total quality management (TQM) in the public healthcare sector of Saudi Arabia. Furthermore moderating effect of knowledge management (KM) on the relationship between employees’ commitment and TQM has been examined. The core of the paper showed the effectiveness of public health sectors employee’s commitment to improve the TQM. Quantitative methodology for data analyses were employed to test the hypothesized model. A total of 259 questionnaires were distributed among the respondents, out of which 165 questionnaires were returned and only 154 were found useful in sense of completeness and usefulness for further analysis. The results of the analyses confirmed that there is significant direct effect of employees’ commitment to improve the TQM and KM moderates the relationship between employees’ commitment and TQM.

Keywords: Total Quality Management, Employees’ Commitment, Knowledge Management, Partial Least Squares, Public Healthcare JEL Classifications: M1, M12

1. INTRODUCTION

All over the globe and in most countries whether developed countries or emerging countries, healthcare represented mainly by hospitals remains an important sector providing basic and advanced health services to the people (Al-Adham, 2004). Hospitals comprise the largest expenditure category of the health system in developing or emerging countries. Therefore, despite the idea that their roles are seen as integral part in the health system and these roles are very well-recognized, hospitals are often the target of improvement and reform in terms of quality, efficiency, equity and their service delivery to people (Santos et al., 2008). These factors led to an increase concern about the services delivered by the hospitals and more importantly the quality of the services offered.

Patel (2008) documented the fact that billions of dollars have been spent on the betterment of health sector worldwide. But irrespective of the money spent for improvement of the health it seems to be “ineffective, inefficient and inadequate.” This urges a need to carry out paradigm shift in the quality of the health sector services delivery by monitoring and sustaining the delivery of quality health services. This study proposed that the those institution which are quality conscious and committed to provide quality services with continuous improvement expected to gain more acceptance from the customers and in turn flourish on the expense of others. Patel (2008) suggested that total quality management (TQM) which aimed on improved customer satisfaction is an effective tool to enhance the quality services and consequently prospect of increased market share and profitability. In line with the above,

Ghamdi, et al.: The Moderating Role of Knowledge Management on the Relationship between Employees’ Commitment and Total Quality Management: A Study on the Public Healthcare Sector in Saudi Arabia

International Review of Management and Marketing | Vol 6 • Issue 4 • 2016 791

health sector institution especially the government sector should on their TQM practices improvement.

TQM has appeared in many definitions although there seems to be consensus among researchers of TQM that it is not easy to introduce a single definition for the construct of TQM (Santos- Vijande and Alvarez-Gonzalez, 2007). The researchers further elaborate that since the 1980s, when the (TQM) concept was firstly defined, researchers and practitioners alike have broadly reported a positive relationship between the construct of TQM and the overall effectiveness and performance of firms worldwide whether these firms produce products or deliver services.

Furthermore, an important gap in the previous work on TQM practices in the healthcare sector is that most of the previous studies attempted to examine the impact of a number of determinants on the implementation of TQM practices. However, scarce research seems to have been conducted on examining the moderating impact of some other factors that may influence the relationship between the antecedent determinants and TQM practices (Sadikog and Zehir, 2010). One of the important moderating factors that have been hypothesised to influence the relationship between the antecedent determinants and TQM practices is the construct of knowledge management (KM).

Another factor that emerged in the literature as an influential factor that affects an effective implementation of TQM practices is the construct of employees’ commitment. As far as healthcare is concerned, the availability of highly skilled doctors, nurses, administrators, and other staff is important in achieving outcomes of high quality (Argote et al., 2000). Brown and Duguid (2003) believe that hospitals ought to adopt policies which guarantee focus on recruiting and at the same time retaining top-level doctors and nurses. In the Saudi public hospitals, there seems to be a problem with the availability of highly skilled physicians, nurses, administrators, and ancillary staff keeping in mind that such skilled employees are mostly foreign workers who normally work in private hospitals (Bedu, 2008). In addition, when workers come from different countries and cultural backgrounds, this could affect the communication between these workers due to cultural and language barriers for example and this could in turn influence their service delivery to patients. This it is important that these workers receive good training on communication and cooperation. A recommendation to include employees’ capacity and training as determinant of effective implementation of TQM practices was given by Mukhalalati (2009) who conducted the study on TQM in the Qatari Healthcare Sector. Finally, this study aims to answer these questions does employees’ commitment affect TQM practices in the public hospitals in Saudi Arabia? And to what extent does KM moderate relationship between the employees’ commitment, and TQM practices in the public hospitals in Saudi Arabia?

1.1. TQM The concept of TQM is said to mean that organizations attempt to continuously strive to fulfill or surpass the desire and hopes of customer whether these customers are external or internal (Malek and Kanji, 2000; Oluwatoyin, 2008; Rönnbäck and Witell,

2008) in allm processes in which everyone is committed to their continuous improvement. The concept of TQM brings together the best features and traits of the of any organization and this is done through or by means of reducing fear and doing the service right at the first time. This can be done through removing error, and obtaining inventory control without waste. TQM was introduced as a means of fulfilling a purpose or a goal, which has been set at the strategic level of the organization.

Organizations worldwide strive to achieve their objectives so that they can improve their positions in the market. Keeping in mind that today’s market is highly competitive in nature where multiple companies produce the same product or deliver the same service, organizations strive to improve the quality of their products and services as to secure a good competitive advantage (Zhou et al., 2005). The researchers further elaborate that failing to do so would mean that these organizations are on the diminish track and there is a possibility that they would no longer be able to compete with other competitors. A number of research have highlighted the importance of quality management believing that it is the way to improve the quality of products and services provided to consumers which would in turn ensures a good competitive advantage in the market. In this context, Alharbi (2014, p. 23) argues that gaining a competitive advantage which is a paramount goal of all organizations will be achieved “when the organization has the conviction that implementing quality management can lead to enhanced quality.” From this basic principle appeared the concept of TQM.

From the principles of TQM, the successful implementation of TQM involves defining and deployment of several critical success factors (CSFs) (Seetharaman et al. 2006). Saraph et al. (1989) conducted one of the pioneer empirical study that attempts to identify TQM CSFs. Afterword, various studies have been conducted that analyses TQM CSFs that indicates those factors which are helpful in successful implementation of TQM practices. Among those factors top management commitment, training, supplier management, strategic quality planning, customer focus, employee involvement, product and service design, process management and quality culture are identified as more influential factors towards TQM. These factors are crucial to measures the TQM practices in an organization.

1.2. Employees’ Commitment Regardless of the type of organizations whether they produce products or deliver services, employees working in these organizations are regarded as their main resources and the roles these employees play is highly influential in achieving the objectives of the organizations they work in. A number of researchers support this view; Armstrong (2006) argues that employees who work in an organization are regarded as the organization’s most valued assets believing that these employees are the ones who individually and collectively contribute to the achievement of its objectives. The researcher goes on to elaborates that since an organization consist of people, the acquisition of these people, their development of different skills, their motivation for higher levels of achievements, as well as ensuring that their level of commitment are well maintained are all very important activities that have direct influence on the performance of any organization.

Ghamdi, et al.: The Moderating Role of Knowledge Management on the Relationship between Employees’ Commitment and Total Quality Management: A Study on the Public Healthcare Sector in Saudi Arabia

International Review of Management and Marketing | Vol 6 • Issue 4 • 2016792

Consequently, the commitment of these employees and their willingness to accept and strive to achieve the objectives of the organization and also work on a collaborative nature are essential elements that employees should have in any given organization (Munizu, 2013). Other earlier researchers seem to support what Armstrong and Munizu believed in about the influential roles of employees in healthcare sector. In this context, Plek (1998) argues that that if every hospital employee sees himself or herself as crucial to the quality of health service delivered the attitude of the health workers (employees) will change significantly which would in turn leave a great impact on carrying out the objectives of the hospital.

1.3. KM KM is the methodology that refers to social affairs, controlling and communicating workers’ learning capital through association. Learning in this way helps organizations to improve current authoritative business practices and procedures, bring efficient and more powerful procedures and methods to uproot excess methods. KM acts as an optimised and community oriented which synchronize the way of creation, foster the process of learning by effective utilization of an endeavour’s learning resources. In organisation KM has become a standard need irrespective of size and growth. Catching an organization’s most important knowledge (resource) and dispersing it viably over the undertaking is a business discriminating issue for some help work area, client backing and IT divisions. KM is not only defining knowledge technology aspects. KM act as a tool that empower and lead the resources to achieve business goals. The authoritative flotsam and jetsam from fizzled endeavors to force new specialized frameworks that are either improper to their workplaces, or where individuals are not eager to impart learning is adequate proof. Consequently the need of KM activity emerges to end up answer for such issues, which unites individuals, process and innovation and helps corporate to accomplish its objectives and vision. Information administration arrangements are presently the most imperative vital advancements for substantial organizations, as indicated by another report and overview of European officials by the Economist Intelligence Unit (EIU.com, 2005), supported by Tata Consultancy Services. In the study, 67% of organizations refer to information administration/business discernment arrangements as essential to accomplishing their key objectives throughout the following 3 years. KM used as moderation factor between employees commitment and TQM.

1.4. Research Framework and Hypothesis Based on the literature review discussed in this paper, the model proposed for test in this study is presented in the Figure 1 below:

1.5. Employees’ Commitment and TQM TQM is a managerial philosophy and thus, its deployment does not only rely on the top management but also every employee of a firm (Hietschold et al. 2014). To that effect, commitment reflects the support and involvement of quality by individuals across all spectrum of an organisational hierarchy (Grover et al., 2006). That is to say, committed employees are thought to attain clear understanding of the organisational values, strategies, and policies. Additionally, they are believed to have clear vision regarding the utilisation of available resources, along the value chain Grover et al. 2006). Hence, employees’ commitment fosters their involvement, eliciting quality culture as a determinant of strategic deployment of TQM (Nair, 2006). Guided by the previous discussion and in line with Barney’s (1991) resources-based view, the research proposes the following hypothesis.

H1: There is a positive significant effect of employees’ commitment on total quality management.

1.6. The Moderating Influence of KM KM, generally, is viewed in terms of process-oriented perspective; which in turn, is the manifestation of a set of strategies that are designated to create or acquire knowledge from internal and external sources; and then, access, assess, store, and share and apply that knowledge within the organisation (Lee and Choi, 2003; Alavi and Leidner, 2001; Sabatier, et al., 2005). In the pursuit of establishing the moderating role of KM over the previously outlined hypotheses and in line with Uhlaner et al. (2007) assessment, the current paper posit that KM the set of the aforementioned strategies and processes. To that effect, it is noteworthy that in reconciliation with resources-based view (Barney, 1991), it is believed that for a firm to improve the implementation of TQM, it needs to effectively manage acquired knowledge (Penrose, 1995). That said, theoretically, a firm might acquire such knowledge through internal and external sources. Hence, KM performance might improve both the levels of commitment and support of TQM practices through KM promotion of supportive activities in the pursuit of knowledge- sharing (Frank and Andreas, 2011). Motivating by this discussion, the following hypothesis is inferred.

H2: KM has a moderating effect on the relationship between employees’ commitment and TQM.

2. RESEARCH METHODOLOGY AND STATISTICAL DATA ANALYSIS

2.1. Measurement and Instrumentation The measurement of the constructs were selected after review of extensive literature. Especifically, the scale of employees’ commitment were taken from Albdour and Altarawneh (2014) as associated researches. Moreover, TQM measurements were taken from Demirbag et al. (2006). Finally, KM measurements adapted from Zheng et al. (2010) and Kamran and Sabir’s (2012).

2.2. Population and Sample The population of the current study consists of the total number of hospitals in Saudi Arabia were 259, Health Statistical Year

Figure 1: The research framework

Source : Ghamdi; et al.; (2016)

Ghamdi, et al.: The Moderating Role of Knowledge Management on the Relationship between Employees’ Commitment and Total Quality Management: A Study on the Public Healthcare Sector in Saudi Arabia

International Review of Management and Marketing | Vol 6 • Issue 4 • 2016 793

Book (2012). In order to test the proposed research model and hypothesized relationship, the data was obtained using a simple random sampling technique to select the hospital from the list of hospitals operating in Saudi Arabia. There were 259 questionnaire distributed among the respondent out of which 165 questionnaire were returned. After the screening process only 154 questionnaire were found useable for further analysis on the basis of completeness and usefulness. To test the empirical relationship of proposed research model, partial least squares structural equation modeling (PLS-SEM) was employed with the help of Smart PLS package 2.0. The detail of the analysis is given in the following section.

2.3. The Measurement Model In the first step of the analysis, the validity and reliability of the measurement model was tested following prescribed ways of PLS-SEM and Smart PLS 2.0 package were used.

In order to test the hypothesis, the measurement model was assessed using PLS-SEM before actual hypothesis testing. In order to ensure goodness fit of the model, two steps were following. In this process, construct validity and discriminant validity was assessed. Construct validity includes factor loadings, composite reliability, Cronbach’s alpha and convergent validity. Fornell and Larcker (1981) criterion was used to examined and confirm the discriminant validity.

2.3.1. Construct validity of the measurements Construct validity is the ability of the items generated to measure some constructs appropriate enough to serve the purpose of measuring the concept for which it was designed (Hair et al., 2010). In addition to that, the items designed to measure specific construct should have higher loadings on their respective constructs rather than on other construct. In this current study to ensure that there should be no issue of validity, a comprehensive literature have been reviewed to select the item that have already tested and reported with high level of validity by previous researchers. The items were assigned correctly to their respective constructs on the basis of factor analysis results. The items of the constructs showing higher loadings on the specific constructs and all items were significantly loaded on their respective constructs (Chow and Chan, 2008).

2.3.2. Convergent validity of the measurements Composite reliability of the constructs used in the current study are ranges from 0.944 to 0.817 (As showed in Figures 4 and 5). The values calculated in this current study are higher than recommended benchmark of 0.70 given by Fornell and Larcker (1981); Hair et al., (2010). The values of the average variance extracted (AVE) ranges between 0.809 and 0.535, which indicates a good and appropriate level of construct validity for the measures used in the current study (Barclay et al., 1995). The results of convergent validity of constructs in current study assures the convergent validity of the outer model. The details are shown in Table 1.

2.3.3. Discriminant validity of the measures In order to test the discriminent validity for the measurement tool employed in this current study, method developed by Fornell and Larcker (1981) has been used. The square root of AVE of all

constructs is placed on the diagonal of the correlation matrix. As the diagonal values of the elements were higher other elements in the rows and columns in which they are located, this process ensures that the discriminant validity of the outer model. The details of the AVE is given in Table 2 .

2.3.4. Prediction relevance of the model The results that indicates the prediction ability of the tested model are given in Table 3, indicating that the cross-validated redundancy of TQM is 0.241 while the cross-validated community is 0.52. As per the criterion of Fornell and Cha (1994) the values >0 indicates that an adequate predictivity of the tested model.

2.3.5. Hypotheses testing Hypothesized relationship were tested after assuring the goodness of fit of the model. The hypothesized model was tested using Smart PLS2.0 software and running PLS algorithm for empirical testing. The path coefficients were then generated, as illustrated in Figures 2 and 3.

As illustrated in Figures 2 and 3 and Table 4 the Employees’ Commitment has a positive and significant effect on TQM at the 0.001 level of significance (β = 0.473, t = 6.907, P < 0.001) and KM has a positive and significant effect on TQM at the 0.001 level of significance (β = 0.368, t = 5.120, P < 0.001). Finally, KM has negative moderation effect on the relationship between employees’ commitment and TQM at the 0.001 level of significance (β = −124, t = 2.344, P < 0.01). The results of the analysis of the collected data supports the proposed hypothesis H1, H2 and H3 of the current study. This finding indicated the importance of employees’

Figure 2: The research framework

Figure 3: Path model results

Ghamdi, et al.: The Moderating Role of Knowledge Management on the Relationship between Employees’ Commitment and Total Quality Management: A Study on the Public Healthcare Sector in Saudi Arabia

International Review of Management and Marketing | Vol 6 • Issue 4 • 2016794

commitment and KM on TQM of the public healthcare sector in Saudi Arabia.

3. DISCUSSION AND CONCLUSIONS

The core aim of this study was to investigate the effects of employees’ commitment on TQM of the public healthcare sector

in Saudi as well as the moderation effect of KM in the mentioned direction.

The public healthcare sector in Saudi Arabia has been experiencing many challenges in the quality of the services provided. In this context, the RNCOS report (2009) stated that despite being amongst the most lucrative markets in the world, the Saudi

Table 1: Loading convergent validity Variables Items Loading AVE Composite reliability Cronbachs alpha Customer focus CF1 0.806 0.565 0.885 0.846

CF2 0.681 CF3 0.646 CF4 0.754 CF5 0.802 CF6 0.803

Continuous improvement CI1 0.886 0.781 0.914 0.859 CI2 0.893 CI3 0.871

Employees’ commitment EC10 0.842 0.535 0.818 0.710 EC3 0.553 EC8 0.740 EC9 0.760

Information and analysis IA1 0.836 0.701 0.933 0.914 IA2 0.871 IA3 0.886 IA4 0.855 IA5 0.826 IA6 0.741

Knowledge management KM1 0.760 0.592 0.941 0.931 KM10 0.707 KM11 0.767 KM2 0.803 KM3 0.741 KM4 0.756 KM5 0.761 KM6 0.762 KM7 0.740 KM8 0.766 KM9 0.886

Process management PM2 0.835 0.596 0.898 0.864 PM3 0.774 PM4 0.784 PM5 0.659 PM6 0.771

Role of the quality department RD1 0.849 0.625 0.892 0.849 RD2 0.860 RD4 0.821 RD5 0.758

Strategic quality planning SP1 0.796 0.622 0.919 0.896 SP2 0.896 SP3 0.835 SP4 0.889 SP5 0.786 SP6 0.599 SP7 0.673

Training and education TE1 0.926 0.809 0.944 0.921 TE2 0.890 TE3 0.908 TE4 0.872

Teamwork and involvement TI1 0.515 0.535 0.817 0.710 TI2 0.813 TI3 0.764 TI4 0.794

“aComposite reliability (CR) = (Σ factor loading)2/{Σ (factor loading)2+Σ (variance of error)}. bAverage variance extracted (AVE) = Σ (factor loading)2/{Σ (factor loading)2+Σ (variance of error)}”

Ghamdi, et al.: The Moderating Role of Knowledge Management on the Relationship between Employees’ Commitment and Total Quality Management: A Study on the Public Healthcare Sector in Saudi Arabia

International Review of Management and Marketing | Vol 6 • Issue 4 • 2016 795

of foreign origin and have a very high turnover rate. The report also addressed other challenges that included the lack of skilled workers in the Saudi public healthcare sector, bureaucracy, being practiced in the Saudi public healthcare providers. Due to the importance of employees’ commitment on TQM of the public healthcare sector in Saudi, hypothesis H1 was tested and the results of analysis supported proposed hypothesis. These results clearly indicates the important of employees’ commitment in the public healthcare sector in Saudi is considered to be one of the most factor determinants of TQM. It is noteworthy that findings of various studies that utilised different methodologies (e.g. Chen et al., 2002; Lakhal et al., 2006) suggest that employees’ commitment is among the most critical forces for the implementation of TQM. The results of the current study are align with results of previous research studies such as, Zhang et al. (2000), Brah et al. (2002), (Nair, 2006). Hence, employees’ commitment fosters their involvement, eliciting quality culture as a determinant of strategic deployment of TQM (Nair, 2006). Guided by the previous discussion and in line with Barney’s (1991) resources-based view, the research proposes the following hypothesis.

The moderating effect of KM on the relationship between employees’ commitments on TQM of the public healthcare sector in Saudi, the results supported the relationship proposed in H2. KM strengthen the relationship between the two constructs (Rahman et al. 2013). Guided by this review and in line with the contingency theory (Schuler, 2000) and resources-based view (Barney, 1991). This result of the current study implied that in the situation of high level of KM lead to high level of employees’ commitment then the TQM will be achieved.

The result of current study can be used by the academicians and public healthcare centres that aims to focus about compatibility and success of the healthcare sector and those factors that can be potential influence on the relationship between individual and partners.

REFERENCES

Al-Adham, M.A.R. (2004), Determine the quality of service perceived health in Palestinian hospitals. MPhil, Najah University, Palestine.

Alavi, M., Leidner, D.E. (2001), Review: Knowledge management and knowledge management systems: Conceptual foundations and research Issues. MIS Quarterly, 25(1), 107-136.

Albdour A.A., Altarawneh, I.I. (2014), Employee engagement and organizational commitment: Evidence from Jordan. International

Table 2: Discriminant validity Constructs CF CI EC IA KM PM RD SP TE TI Customer Focus 0.751 Continuous improvement 0.751 0.883 Employees’ commitment 0.664 0.705 0.732 Information and analysis 0.766 0.737 0.588 0.837 Knowledge management 0.662 0.707 0.644 0.574 0.769 Process management 0.758 0.761 0.731 0.772 0.649 0.772 Role of the quality department 0.682 0.620 0.644 0.637 0.583 0.761 0.790 Strategic quality planning 0.812 0.797 0.693 0.825 0.645 0.800 0.661 0.789 Training and education 0.703 0.714 0.606 0.742 0.634 0.751 0.531 0.853 0.899 Teamwork and involvement 0.716 0.573 0.465 0.535 0.434 0.491 0.630 0.603 0.521 0.731

Table 3: Prediction relevance of the model Constructs R square Cross-validated

redundancy Cross-validated communality

TQM 0.641 0.241 0.502

Table 4: Hypotheses testing Hypotheses Path

coefficient Standard

error (STERR)

T value P value Decision

EC≥TQM 0.437 0.063 6.907 0.000 Support KM≥TQM 0.386 0.075 5.120 0.000 Support EC*KM≥TQM −0.124 0.053 2.344 0.010 Support

Figure 5: Moderating effect of knowledge management on the relationship between employees’ commitment and total quality

management

Figure 4: Path model significance results

healthcare market faces a number of challenges. One of the biggest challenges is the lack of human resources. Around 80% physicians and more than 79% nurses working in the country are

Ghamdi, et al.: The Moderating Role of Knowledge Management on the Relationship between Employees’ Commitment and Total Quality Management: A Study on the Public Healthcare Sector in Saudi Arabia

International Review of Management and Marketing | Vol 6 • Issue 4 • 2016796

Journal of Business, 19(2), 192-212. Alharbi, M.N. (2014), Identifying the Factors That Influence the Quality

of Health Care Services in the Public Hospitals in Saudi Arabia. Unpublished Thesis, UUM, Malaysia.

Argote, L., Ingram, P., Levine, J.M., Moreland, R.L. (2000), Knowledge transfer in organizations: Learning from the experience of others. Organizational Behavior and Human Decision Processes, 82, 1-8.

Armstrong, M. (2006), A Handbook of Human Resource Management Practice. 10th ed. London: Kogan Page Publishing.

Barclay, D., Higgins, C., Thompson, R. (1995), The partial least squares (PLS) approach to causal modeling: Personal computer adoption and use as an illustration. Technology Studies, 2(2), 285-309.

Barney, J.B. (1991), Firm resources and sustained competitive advantage. Journal of Management, 17, 99-120.

Bedu. (2008), Saudi Arabia: Private Versus Public Hospitals. Available from: http://www.americanbedu.com/2008/06/26/saudi-arabia- private-versus-public-government-hospitals/. [Last retrieved on 2009 Oct 01].

Brah, S.A., Tee, S.L., Rao, B.M. (2002), Relationship between TQM and performance of Singapore companies. International Journal of Quality and Reliability Management, 19(4), 356-379.

Brown, J.S., Duguid, P. (2003), Organizational Learning and Communities of Practice. Amsterdam: Butterworth Heinemann.

Chen, Z.X., Tsui, A.S., Farh, J.L. (2002), Loyalty to supervisor vs. organizational commitment: Relationships to employee performance in China. Journal of Occupational and Organizational Psychology, 75, 339-356.

Chow, W.S., Chan, L.S. (2008), Social network, social trust and shared goals in organizational knowledge sharing. Information and Management, 45(7), 458-465.

Demirbag, M., Tatoglu, E., Tekinkus, M., Zaim, S. (2006), An analysis of the relationship between TQM 30 Rouhollah Mojtahedzadeh, Veeri Chettiar Arumugam implementation and organizational performance: Evidence from Turkish SMEs. Journal of Manufacturing Technology Management, 17(6), 829-847.

EIU.com. (2005), Know how: Managing knowledge for competitive advantage. Available from: http://www.eiu.com/KnowHow.

Fornell, C., Larcker, D.F. (1981), Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39-50.

Fornell, C., Cha, J. (1994), Partial least squares. In: Bagozzi, R.P., editor. Advanced Methods in Marketing Research. Cambridge: Blackwell. p52-78.

Grover, S., Agrawal, V.P., Khan, I.A. (2006), Role of human factors in TQM: A graph theoretic approach. Benchmarking: An International Journal, 13, 447-468.

Hair, J.F., Anderson, R.E., Tatham, R.L., Black, W.C. (2010), Multivariate Data Analysis. 7th ed. USA: Prentice Hall.

Hietschold, N., Reinhardt, R., Gurtner, S. (2014), Measuring critical success factors of TQM implementation successfully - A systematic literature review. International Journal of Production Research, DOI: 10.1080/00207543.2014.918288.

Kamran, M.R., Sabir, F. (2012), Knowledge management a gate way to analyze effective organizational performance. Far East Journal of Marketing and Management, 2(1), 53-68.

Lakhal, L., Pasin, F., Limam, M. (2006), Quality management practice and their impact on performance. International Journal of Quality and Reliability Management, 23(6), 625-646.

Lee, H., Choi, B. (2003), Knowledge management enablers, processes, and organizational performance: An integrative view and empirical examination. Journal of Management Information System, 20, 179-228.

Frank, L., Andreas, W. (2011), Success factors of knowledge management

in temporary organizations. International Journal of Project Management, 29, 877-888.

Malek, A., Kanji, G. (2000), TQM in Malaysian Higher Education Institutions. Sinergie Rapporti di Ricerca N. 9/2000.

Mukhalalati, B.A. (2009), The implementation of TQM in the Qatari healthcare sector. Journal of Accounting-Business and Management, 16(2), 1-14.

Munizu, M. (2013), The Impact of Total Quality Management Practices towards Competitive Advantage and Organizational Performance: Case of Fishery Industry in South Sulawesi Province of Indonesia. Pakistan Journal of Commerce and Social Sciences, 7(1), 70-79.

Nair, A. (2006), Meta-analysis of the relationship between quality management and firm performance: Implications for quality management development. Journal of Operations Management, 24, 948-975.

Oluwatoyin, A. (2008), Total Quality Management. A test of the Effect of TQM on Performance and Stakeholder Satisfaction. Blekinge Institute of Technology, School of Management.

Patel, G. (2009), Total quality management in healthcare. The Midas Journal, ss.1-4.

Penrose, E. (1995), Theory of the Growth of the Firm. New York: Oxford University Press.

Plek, P.E. (1998), Techniques for managing quality. Hospital and Health Services Administration, 40, 118-201.

Rahman, A.A., Ng, S.I., Sambasivan, M., Wong, F. (2013), Training and organizational effectiveness: Moderating role of knowledge management process. European Journal of Training and Development, 37(5), 472-488.

Rönnbäck, Å., Witell, L. (2008), A review of empirical investigations comparing quality initiatives and manufacturing and service organizations. Managing Service Quality, 18(6), 577-593.

Sabatier, R., Nelson, A., Nelson, W. (2005), Toward an understanding of global entrepreneurial knowledge management (EKM) practices: A preliminary investigation of EKM in France and the U.S.’, Paper Presented at RENT XIX, Research in Entrepreneurship and Small Business, Naples, Italy.

Sadikog, E., Zehir, C. (2010), Investigating the effects of innovation and employee performance on the relationship between total quality management practices and firm performance: An empirical study of Turkish firms. International Journal of Production Economics, 127, 13-26.

Santos, S., Murphy, G., Baxter, K., Robinson, K. (2008), Organizational factors affecting the quality of hospital clinics. Health Information Management Journal, 37(1), 25-37.

Santos-Vijande, M.L., Alvarez-Gonzalez, L.I. (2007), TQM and firms performance: An EFQM excellence model research based survey. Journal of Business Science and Applied Management, 2(2), 21-41.

Saraph, J.V., Benson, P.G., Shroeder, R.G. (1989), An instrument for measuring the critical factors of quality management. Decision Sciences, 20, 810-829.

Schuler, R.S. (2000), The internationalization of human resource management. Journal of International Management, 56(3), 178-191.

Seetharaman, A., Sreenivasan, J., Boon, P.L. (2006), Critical success factors of total quality management. Quality and Quantity, 40, 675-695.

Uhlaner, L., van Stel, A., Meijaard, J., Folkeringa, M. (2007), The Relationship Between Knowledge Management, Innovation and Firm Performance: Evidence from Dutch SMEs. Scientific Analysis of Entrepreneurship and SMEs.

Zhang, Z.H., Waszink, A.B., Wijngaard, J. (2000), An instrument for measuring TQM implementation for Chinese manufacturing companies. International Journal of Quality and Reliability

Ghamdi, et al.: The Moderating Role of Knowledge Management on the Relationship between Employees’ Commitment and Total Quality Management: A Study on the Public Healthcare Sector in Saudi Arabia

International Review of Management and Marketing | Vol 6 • Issue 4 • 2016 797

Management, 17(7), 730-755. Zheng, W., Yang, B.Y., McLean, G.N. (2010), Linking organizational

culture, structure, strategy, and organizational effectiveness: Mediating role of knowledge management. Journal of Business

Research, 63(7), 763-771. Zhou, K.Z., Yim, C.K., Tse, D.K. (2005), The effects of strategic

orientations on technology - and market-based breakthrough innovations. Journal of Marketing, 69(2), 42-60.