The Influence of Teamwork in the Implementation of Total Quality Management (tqm) on Customer Satisfaction

Total Quality Management (TQM) is one of strategies that used to raise the caliber of healthcare services and customer satisfaction nowadays. Teamwork is the primary metric for TQM implementation. The major goals of this study are to examine current research on TQM teamwork in hospital health services and to determine how TQM teamwork is used. In this study, recent scientific articles that published between 2018 until 2023 were systematically summarized using inclusion and exclusion criteria. The conclusion of this journal article shows that teamwork is a crucial element of TQM since a strong team may boost independence, communication, and self-assurance while successfully attaining shared objectives.


INTRODUCTION
Hospital is a health institution that has an important role in providing health services to the community (Egan dkk., 2019).Hospitals as facilitators of medical services are obliged to ensure quality, efficient, fair, and safe services for patients by paying attention to professional and service standards, as well as the professional code of ethics.
Because the standard of living of the community is increasing, the demand for quality health services, especially in hospitals, is also increasing (Groopman dkk., 2019).This indirectly provides demands for health service providers, especially hospitals, to be able to improve the quality of their services so that they can be better (Lippi dkk., 2020).Hospitals should not only try to improve the quality of health services that are healing diseases, but carry out prevention or prevention to improve the quality of life and provide satisfaction for consumers, namely patients as users of health services.
The competitiveness of the hospital is influenced by how much the hospital is able to meet the wants and needs of patients (Liang dkk., 2020).Hospitals must be able to nurture the needs of each patient and continue to strive to improve their services to be of higher quality than their competitors, not only from the medical side but also including the entire service system offered.
The application of the concept of Integrated Quality Management (IQM) or Total Quality Management (TQM) is one of the efforts that can be made by hospitals in order to provide good quality health services in an integrated and planned manner (Slivnick & Lampert, 2019).TQM is a method in management to manage a business that aims to optimize the selling value of a company through continuous innovation in all aspects of it, such as labor, services, products, manufacturing methods, and the environment.
TQM has ten dimensions that can be used as a basis or benchmark for successful implementation in an effort to achieve customer satisfaction (Piva dkk., 2020).The elements of TQM according to Goetsch and Davis in Kurnaisih ( 2014) are a) Focus on the customer; b) Obsession with quality; c) Scientific approach; d) Long-term commitment; e) Teamwork; f) Continuous system improvement; g) Education and training; h) Controlled freedom; i) Unity of purpose; and j) The existence of a single goal.Unity of purpose; and j) Employee involvement and empowerment.
A team is a group of people who share a common goal (Jung dkk., 2020).Teamwork is one of the fundamental elements in the implementation of TQM that must be well established and fostered (Carr & Rowe, 2020).Organizations that implement TQM require teamwork, both among company employees and with the surrounding community, as well as the government so that institutional processes can run smoothly (Juharni, 2017).
Research on teamwork in TQM implementation that can affect patient satisfaction in hospitals is an interesting topic to discuss because teamwork in TQM is one of the techniques that is currently often utilized and practiced by health facilities in order to improve their performance (Guan dkk., 2020), which in turn is expected to increase patient satisfaction.

RESEARCH METHODOLOGY
This journal article uses the Systematic Literature Review (SLR) method, which is a systematic way to collect, critically evaluate, integrate and present findings from various research studies on research questions or topics of interest.As the name implies (Yao dkk., 2020), this method is carried out systematically or sequentially from the most basic to the most complex (Adams & Walls, 2020).Starting from collecting literature first, then continuing with reading, then evaluating.
The article search strategy uses the database available on e-resources with keywords in finding articles, namely Total Quality Management (TQM), Integrated Mutut Management (MMT) (Alatab dkk., 2020), teamwork and customer satisfaction.Inclusion data to determine the criteria for journal articles, namely: 1) Original articles from primary sources; 2) Research articles published from 2018 to 2023; and 3) Articles that display full text.The exclusion data are: 1) Articles outside the topic of strategic management; 2) Articles published above the last 5 years or before 2018; and 3) Articles only contain part of the abstract or part of text.

RESULT AND DISCUSSION
Integrated Quality Management (MMT) or Total Quality Management (TQM) is a community or customer-oriented approach by introducing systematic management changes and continuous improvement of processes and services (Tjiptono and Diana, 2014).
TQM is an approach in the field of management in running a business to maximize the competitiveness of the company through continuous improvement of products, services, labor, processes and also the environment.TQM is a combination of all functions owned by a company that is built on the concepts of customer satisfaction, quality, productivity, and teamwork (Nasution, 2015).
From the previous discussion of the definition of TQM, it can be concluded that what is meant by TQM or MMT is a set of principles along with ways that can be done in managing organizational quality in an integrated manner, including respect for everyone, management based on facts, and continuous improvement with the aim of providing satisfaction for service users or customers.In applying the TQM concept, the company directly makes efforts to improve quality, starting from the organization as a whole, including suppliers to all customers.TQM emphasizes continuous management commitment to get the direction to be achieved, namely excellence in all aspects of products and services that are important to customers.
Basically, TQM has two main components, namely the 'what' and the 'how' the company carries it out.The 'how' component is what distinguishes the concept of TQM from other management approaches in running an organization.When examined further, from these components can be found ten main elements in the application of TQM, namely: a) Customer focus; b) Scientific approach; c) Long-term commitment; d) Teamwork; e) Obsession with quality; f) Education and training; g) Continuous improvement; h) Unity of purpose; i) Controlled freedom; and j) Involvement and empowerment of all employees.
The team is one of the factors in the success of the organization, teamwork can be interpreted as a form of group work that is committed to achieving a common mission that has been agreed upon beforehand by complementing each other's skills to achieve goals effectively and efficiently.In a team work, of course, there is a fusion of various individuals to achieve a common goal, so it is very necessary to have the willingness of each member to join hands in completing the work.The existence of good teamwork will result in good employee performance as well, this will ultimately increase customer satisfaction.An important component in the implementation of TQM is teamwork, where teamwork can basically improve and develop self, independence, and individual communication.Through teamwork, all members are encouraged to achieve goals by utilizing skills.Indicators of teamwork are complementary attitudes, transitional processes and actions, mutual encouragement, interaction, mutual trust, and responsibility.
Relationship building is said to be successful if the leader of the organization or company is able to create cooperation between members of the organization or human resources (HR) in it.Teamwork is very necessary in an organization or company, as for the reasons are as follows: a) Can provide more results; b) Provide enthusiasm, happiness and satisfaction for members; c) The ability of each individual can be utilized to improve organizational performance; d) Group success can be achieved through mutual assistance between members.
The definition of customer satisfaction basically includes the difference between expectations and perceived performance or results.Because customers are recipients and users of the results of the work of a person or organization, only customers can determine how the quality of a service or product is, and customers can also convey what and how their needs are.Organizations that apply the TQM concept must have a focus on customers, because customer satisfaction is the top priority of an organization (Tjiptono and Diana, 2014).
Customer-focused companies are outward-looking and customer satisfaction is a strategic priority for the organization and the company.There are three main success factors in shaping a focus on customer satisfaction, including: a) Making employees aware of the importance of customer satisfaction; b) Placing employees to interact with customers directly; c) Employees are given freedom of action to satisfy customers (Zulian Yamit, 2002;83).
It is undeniable that even though employees already have a good awareness of the importance of customer satisfaction, disappointment or complaints from customers will still appear, but we can use this as a reference topic in making continuous improvements.Many companies that focus on customer satisfaction experience success in developing their companies.And this customer satisfaction can be made by the company as the main basis for increasing employee compensation and promotion.
Several kinds of methods in measuring customer satisfaction according to Kotler in Tjiptono and Diana (2014), including: a. Criticism and suggestion system.Through this system, the company can provide opportunities for all its customers to convey all their suggestions and criticisms.One example is by providing suggestion boxes, comment cards, customer complaint services, and others.This information can provide good input for the company, and allow it to be able to react responsively and quickly in overcoming problems that occur.
b. Customer satisfaction surveys.There are many ways this can be done, including by post, telephone or in-person interviews.The main benefit of the survey is to provide a positive sign (signal) that the company pays more attention to its customers, besides that the company will also get responses and feedback (feedback) from customers.
In the approach using the TQM concept, the needs of customers are clearly identified as an important part of the development of business products and services.The company uses this approach with the aim of exceeding the expectations of each customer, not just meeting them.For this reason, it is necessary for the company to collect accurate information regarding the needs and desires of its customers for the products and services produced by the company, so that the company can understand its consumer behavior well.This can then guide the company in developing the right strategies and programs in order to take advantage of opportunities in the field, establish good relations with each customer, and outperform its competitors.
In identifying customer needs we can use an approach consisting of six steps, namely: a) Estimate the results; b) Develop an information collection plan; c) Process information collection; d) Analyze the results of the information obtained; e) Check the validity of conclusions; and f) Take action (Tjiptono and Diana, 2014).
The main key that can be used by companies in identifying customer needs is through continuous communication between company managers who are interrelated as individuals and also between business ventures that are interdependent as a unit.In every communication, all parties can convey their needs to the other party in the hope of creating mutual understanding and also forming good cooperation.
Total Quality Management (TQM) or also known as Integrated Quality Management (IQM) is an important matter that needs the attention of every organization, including health service providers such as hospitals.Through the application of the TQM concept, hospitals can implement a quality control system to obtain maximum quality for their patients.
Reinold Glory Masinambow and Merlyn Mourah Karuntu (2019) in their research suggested that the implementation of TQM at Siloam GMIM Sonder Hospital chose patient satisfaction as a quality standard, they conducted training for each workforce to improve service quality standards in their hospital.
Research conducted by Dedi Mulyani, Uus M. Fadli, and Fitriyani Cipta Kusuma Ningsih showed that the quality management of health services at the Karawang Islamic Hospital has a good management system in handling patients (Baabdullah dkk., 2019).There are five services that have been accredited, including: administrative and management services (Saha dkk., 2020), Emergency Room (IGD), medical record services, medical services and nursing services (Kumar dkk., 2019).From the results of the questionnaire filled out by patients, it shows that the services they do have met the standards of good health service quality management.But on the other hand there are still frequent complaints about delays in patient handling due to the limited number of health workers, so in this case the hospital still has obstacles in Human Resources (HR) management (Al-Ansi dkk., 2019).For the types of services available at the Karawang Islamic Hospital, there are still shortages, especially in outpatient services and the Karawang Islamic Hospital plans to add outpatient services for the eye clinic, ENT clinic and orthopedic clinic (Li dkk., 2021).Overall, the results showed that hospital employees, both nurses and doctors, have been dexterous and responsive in managing incoming patient complaints, therefore patients and their families are satisfied with the service or treatment provided (Hult dkk., 2019).Karawang Islamic Hospital employees are also considered to have a good attitude, friendly, polite and also polite in speech so that patients and families who accompany them feel satisfied without complaints.
The results of research on the implementation of TQM conducted at Yarsi Dental and Oral Hospital show that the dimension in TQM that has the greatest impact is teamwork (Pierce dkk., 2020).One of the policies formed by hospital leaders related to teamwork is the standard procedure in handling incoming patient complaints.Every patient complaint received must be resolved by all units in the hospital within a maximum of three days (Pfefferbaum & North, 2020).In practice in the field, although some patient complaints have been able to be resolved properly, there are still patient complaints that continue to occur repeatedly, such as for example regarding waiting times, patient queues, insurance processes, payments at the cashier and also hospital facilities that are relatively long.There are three elements that determine the success of teamwork that must be mastered by every hospital health worker in order to produce customer satisfaction, namely: a) Awareness of the importance of teamwork for customer satisfaction; b) Ability to communicate clearly and easily understandable both with other work teams and customers; c) Providing space for hospital functional staff to satisfy customers without violating the procedures and ethics of service in the hospital.

CONCLUSION
Total Quality Management (TQM) is an approach to management that is customer-oriented and involves continuous improvement of the organization's products, services, workforce, processes, and environment.The focus of TQM is on maximizing customer satisfaction and achieving excellence in all aspects that matter to customers.TQM has ten key elements which include customer focus, obsession with quality, scientific approach, long-term commitment, teamwork, continuous system improvement, education and training, controlled freedom, unity of purpose, and employee involvement and empowerment.
Teamwork is an important component in TQM, because a well-functioning team can increase confidence, communication, and independence in achieving common goals effectively and efficiently.
The definition of customer satisfaction is the difference between expectations and performance or results felt by customers.Organizations that focus on customer satisfaction will prioritize customers as a key strategy and ensure all employees interact directly with customers to understand their needs and wants.
Methods that can be used to measure customer satisfaction include through a criticism and suggestion system, as well as customer satisfaction surveys that can be conducted through various media.Information from customers is valuable in helping organizations respond quickly and appropriately to problems that arise.
Identifying customer needs can be done using six steps, namely estimating results, developing a plan to collect information, the process of collecting information, analyzing results, checking the validity of conclusions, and taking action.Continuous communication between managers and relevant parties is essential to understanding internal customer needs.
By implementing TQM and improving teamwork, as well as prioritizing customer satisfaction, healthcare organizations such as hospitals can achieve excellence in service, meet customer expectations, and create a better working environment.