Customer relationship management and QM maturity:

an examination of impacts in the health-care and

non-health-care setting
Wing M. Fok
Department of Management, Loyola University New Orleans, New Orleans,
Louisiana, USA
Jing Li
Department of Management, Loyola University New Orleans, New Orleans,
Louisiana, USA
Sandra J. Hartman
Department of Management, University of New Orleans, New Orleans,
Louisiana, USA
Lillian Y. Fok
Department of Management, University of New Orleans, New Orleans,
Louisiana, USA
Keywords well as the organization. As with QM,
Quality, Customer relationship, Introduction differences between health-care and non-
Customer service management,
Health services, In this research, we investigate the health-care organizations could impact these
Organizational culture, relationships between organizational adoption areas as well. In the discussion which
Organizational performance and extent of use of two widely-used follows, we begin by reviewing the QM and
organizational improvement programs: CRM literatures to develop a rationale for the
Abstract
Investigates the relationships quality management (QM) programs and relationships we expect.
between organizational adoption customer relationship management (CRM) in
and extent of use of quality
two different organizational settings ± health
management (QM) programs and
customer relationship care and non-health care. Specifically, we QM maturity
management systems (CRM) in contend, first, that systematic differences in Our interest in the idea of QM maturity had
health-care and non-health-care the two kinds of organizations may lead them
organizational settings. In referring
its origin in a review of recent literature
to QM, recognizes that there has
to vary considerably in what we term QM which has hailed the advent of the ``quality
been widespread adoption, across maturity. We have found that, across settings, movement,'' or total quality management
organizations generally, of some organizations appear to have adopted (TQM), as offering great potential as a
programs aimed at delivering
QM only superficially, giving more ``lip- solution for recent problems with
superior quality to the customer.
Focuses on this group of programs service'' than real use, while others have productivity and quality in US corporations.
when considering QM, and looks at bought far more fully into QM and its
In turn, declining quality and productivity
how adoption of QM may impact philosophies (Fok et al., 2000). We use the term
the CRM programs. Specifically, were offered as key offenders where US firms
contends that organizations from
QM maturity to describe organizations which were seen as losing competitive advantage,
the two settings may vary have adopted QM programs more fully and in especially to Japan (e.g. Bowen and Lawler,
considerably in QM maturity. ``better'' ways qualitatively. Such
Begins by considering whether
1992; Fuld, 1992; Lawler et al., 1992; Shearer,
organizations, we expect, will be different from
there are differences in the paths 1996). However, we noted other literature
which health-care and non-health- lower QM maturity organizations along
which has suggested that TQM programs, at
care organizations have used in several dimensions. We expect that they will
least as initially introduced in a number of US
approaching and implementing have developed organizational cultures which
QM. Finds no differences, however, organizations, have represented anything but
are supportive of the empowerment
in this research. Instead, finds that a panacea. Moreover, in at least some cases,
there were systematic changes accompanying QM, and that their performance
efforts to introduce quality programs have
which appeared to accompany will be seen as higher. If there are differences
higher-quality QM implementations in QM maturity in health care vs. non-health met with problems and failure (e.g. Choi and
in both health-care and non-health- Behling, 1997; Klein, 1991; Parker, 1991). With
care organizations. care, these areas should differ as well.
some organizations reporting successful
Moreover, and central to the issues
implementations while others reported
investigated in this study, we expect that
more QM-mature organizations will be failures, we felt that it would be important to
different in their adoption of CRM systems. examine why such differences in
Specifically, and based on both the literature organizations' experiences with quality
and our previous research, we expect more programs could have occurred. In recent
QM-mature organizations to have adopted research, we have shown that an important
underlying issue may involve the depth or
International Journal of Health CRM systems in ways which are seen by
Care Quality Assurance employees as benefiting their customers as qualitative aspects of the organization's
16/5 [2003] 234-247
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[ISSN 0952-6862]
[DOI 10.1108/09526860310486688] http://www.emeraldinsight.com/researchregister http://www.emeraldinsight.com/0952-6862.htm

[ 234 ]
Wing M. Fok, Jing Li,
Sandra J. Hartman and
Lillian Y. Fok
Customer relationship
management and QM
maturity: an examination of
impacts in the health-care and organization has reported that it has been ``on
non-health-care setting
International Journal of Health
Care Quality Assurance
16/5 [2003] 234-247
experience with QM, a term to which we refer
to as QM maturity (Fok et al., 2000).
Specifically, we report that it is important to
distinguish between the length of time an
TQM'' and the quality of its implementation.
We have also contended that QM maturity
may be important in understanding the
impact upon related systems in organizations
differing in QM maturity. In terms of ideas
from socio-technical systems theory, for
example, we recognize that organizations
must be understood as being complex and
highly interconnected bodies of social and
technical systems. Moreover, changes to one
or more of the systems will cause change
throughout the systems comprising the
organization (Jacques, 1952; Trist and
Bamforth, 1952). From this perspective, it
appears likely that, under increasing QM
maturity, or as QM is implemented with
more depth (i.e. more comprehensively, in
ways which impact more parts of the
organization, and the like), we should expect
effects upon related systems. We have found
that QM maturity impacts individuals'
understanding of QM concepts, leads to
increased job enrichment, and affects
employees' assessments of the organization's
culture, as well as their assessments of how
the organization is performing (Fok et al.,
2000). We have recently shown that, as
organizations increase in QM maturity, their
adoption of information systems (IS) will be
more user-centered and participative (Fok et
al., 2000). In this research, we extend our
focus to examine QM maturity's impacts
upon CRM systems, a subset of IS.
Customer relationship
management (CRM) systems
As noted by Robinson (2000), there has been a
great deal of recent interest in CRM. This
interest, in turn, undoubtedly has its origin in
the quality movement's emphasis on a
customer-centered focus (Nelson, 1998).
Robinson points out that CRM is an inclusive
concept, referring to the applications
businesses can use to manage any and all
aspects of customer encounters. Included
under the CRM rubric, for Robinson, are a
wide range of applications, including those for
gathering data about customers to ones used
by customers, such as self-service Web sites
where customers can get information on or
purchase products. Many CRM applications
are oriented toward gaining a competitive
advantage by moving the customer more
quickly through the system. Time-savings
potentially represent an improvement from
the standpoint of both the organization and its
customers (Burgum, 2000). Systems which
help organizations better understand their
customers and meet their needs represent
another category of CRM systems. As
McDonald (2000) points out, knowledge of the
customer provided by such systems
represents another important potential
competitive advantage. Other applications
permit customers access to the organization's
records, as is the case when an airline lets
customers see current flight information on a
Web site, or provide higher quality service, as
when a delivery company tracks truck
locations by microwave and reroutes them as
needed via electronic messaging to better
serve customers (Girard, 1998; Seybold, 1996).
In ways which appear to be somewhat
analogous to the early days of the quality
movement, however, the full potential of CRM
may not be realized in many organizations.
Robinson (2000) points out that, as the
potential of CRM has gained recognition, a
wide variety of developers and vendors have
offered an equally extensive series of CRM
applications. An unfortunate result, in many
organizations, has been a lack of integration,
as systems are used in isolation, rather than
in a reciprocal fashion, where they could
potentially be used in concert to coordinate all
of the organization's multi-pronged dealings
with its customers. Moreover, as Meyers
(1994) shows, many of the applications, and
especially those designed to save time and
personnel costs, are not seen by consumers as
offering them any advantages. Instead, the
change to CRM may be viewed by the
customer as making the system more rigid,
more difficult to figure out, or more time-
consuming. In general, these reports suggest
that CRM has potential to impact customers
positively but, where systems are designed
without customer needs in mind, and where
they are used in isolation, much of the
potential may be lost.
What differences may exist in the
health-care setting?
There is widespread support for the premise
that health-care managers and executives are
struggling to cope with environmental
challenges in the health-care industry (Chase,
1994; Nichol, 1990; Sieveking and Wood, 1994;
Roemer, 1996; Smith et al., 1994; Smith et al.,
1998; Wooden, 1998). Zuckerman's (2000)
comments are typical of the discussion in the
literature, in pointing out that it is the
dynamic nature of the health care industry
[ 235 ]
Wing M. Fok, Jing Li,
Sandra J. Hartman and
Lillian Y. Fok
Customer relationship
management and QM
maturity: an examination of
impacts in the health-care and organizations continue to lag behind other
non-health-care setting
International Journal of Health
Care Quality Assurance
16/5 [2003] 234-247
[ 236 ]
which leads organizations to struggle to
survive in turbulent conditions. Moreover,
Zuckerman (2000) notes that the management
approaches used by many health-care
businesses in similar industries.
Of special significance to this research,
Rundle (2000) has recently suggested that the
health-care industry is falling behind in
issues of management, particularly with
respect to adopting and managing
automation and technology. The implication
is that managers and executives in health
care, compared with their counterparts in
other industries, do not have the business
knowledge and skills to utilize fully the
available automation and technology.
Interestingly, the broad scope of Rundle's
concerns suggests a belief that health care is
falling behind non-health-care organizations
in a broad range of industries, both service
and manufacturing. Murray (2000) has
recently made similar points when
considering the steps health care is taking
with respect to preparing to exchange data in
ways which will benefit patients. While
organizations from other industries, both in
service and in manufacturing, are searching
for ways to interconnect and exchange data,
Murray's comments suggest that health care
is far less ready to do so. What is perhaps
suggested is that health care may be lagging
behind at just the time when turbulence in
the industry should be moving health-care
organizations toward the development of
sophisticated IS systems and, notably, from
the perspective of this research, CRM may be
among the problem areas. Is it possible that
differences in the factors we have discussed,
and especially QM maturity, could be
underlying causes of the slow response?
QM-CRM and organizational
systems relationships and the issue
of health-care differences
We have pointed out that our earlier research
has suggested that a concept we term QM
maturity has impacts upon a number of the
subsystems comprising an organization.
Thus, we see potential that more QM-mature
organizations will approach CRM
implementation in qualitatively different
ways. We have shown that increasing QM
maturity appears to lead to changes in the
content of jobs, and specifically to higher
levels of job enrichment, a finding which is
clearly in line with the quality movement's
emphasis upon worker autonomy (Fok et al.,
2000). Similarly, the quality movement has
consistently, from Deming (1986) to current
advocates, focused upon the customer and
giving superb customer service. It seems
reasonable, therefore, to expect that
increasing QM maturity will lead to greater
emphasis upon meeting both internal and
external customer needs. In turn, CRM
potentially represents an important avenue
for organizations which are working to
improve customer service. Thus, as QM
maturity increases, so should degree or
extensiveness of use of CRM. However, the
high QM-mature organization should have
quality as a top priority and, as a result, we
should expect it to give emphasis to the
quality or effectiveness of its CRM
implementation. Thus, higher QM-mature
organizations should also have qualitatively
better CRM systems.
Moreover, as organizations become more
QM-mature and have adopted CRM more
extensively and effectively, our discussion of
systems theory leads us to expect additional
impacts. In line with our earlier (Fok et al.,
2000) findings, use of high quality CRM in
concert with mature QM programs should
lead those in organizations to report that the
organization's culture is supportive of the two
systems and, for example, that it is
empowering and participative. Note,
however, that the impacts between the culture
and the systems may move in two directions.
Specifically, as organizations become more
QM-mature and have more extensive and
effective CRM systems, we should see a move
toward a more empowered, employee-
centered, and customer-centered culture.
Additionally, however, a more QM-supportive
culture should lead to additional gains in QM
and CRM. Finally, where more extensive and
effective CRM and more mature QM systems
are in place, we expect that, overall, the
organization itself will be seen as ``doing
better''. Thus, QM and CRM will be seen as
having positive impacts upon organizational
outcomes. We have speculated, however, that
health-care may show differences from non-
health-care settings.
Figure 1 shows the linkages we expect and
relates linkages to the corresponding
research questions. Note that, since we have
speculated that health-care may show
differences from non-health-care settings, we
point to these differences as our first
research question. In our study, we believe
that more QM-mature organizations should
be more CRM-mature (Research Question 2
labeled as RQ2 in Figure 1). Additionally, as
organizations become more QM- and CRM-
mature, we should see a move toward a more
empowered, employee-centered, and
Wing M. Fok, Jing Li,
Sandra J. Hartman and
Lillian Y. Fok
Customer relationship
management and QM
maturity: an examination of
impacts in the health-care and
non-health-care setting
International Journal of Health
Care Quality Assurance
16/5 [2003] 234-247
Figure 1
Research model
customer-centered culture (Research
Questions 3 and 4 labeled as RQ3 and RQ4 in
Figure 1). Finally, where more mature CRM
and QM systems are in place, we expect that,
overall, the organization itself will be seen as
``doing better'' in general and in providing
service. Thus, QM and CRM maturity will be
seen as having positive impacts upon
organizational performance (Research
Questions 5 and 6 labeled as RQ5 and RQ6 in
Figure 1) and service quality (Research
Question 7 labeled as RQ7 in Figure 1):
RQ1. There will be no differences in the
health-care vs. non-health-care
samples with respect to culture, QM
maturity, CRM extensiveness and
effectiveness, service quality and
organizational success.
RQ2. Organizations which are described by
employees as higher in QM maturity
will also be described as having
implemented CRM more extensively
and effectively for the health-care and
non-health-care samples.
RQ3. Organizations which are described by
employees as higher in QM maturity
will also be described as having a
culture which is aligned with QM (i.e.
fostering employee growth and
empowerment) for the health-care
and non-health-care samples.
RQ4. Organizations which are described
by employees as having implemented
CRM more extensively and
effectively will also be described as
having a culture which fosters
employee growth and empowerment
for the health-care and non-health-
care samples.
RQ5. When employees describe their
organizations as higher in QM
maturity, they will also report more
positive feelings about the
organization's performance for the
health-care and non-health-care
samples.
RQ6. When employees describe their
organizations as having more
extensively and effectively
implemented CRM, they will also
report more positive feelings about
the organization's performance.
RQ7. When employees describe their
organizations as having more
extensively and effectively
implemented CRM, they will also
report more positive feelings about the
CRM's ability to provide high levels of
customer service for the health-care
and non-health-care samples.
Methodology
Subjects
Respondents in the health-care sample were
approximately 64 managers from health-care
organizations. The managers were roughly 65
per cent female, and the age range was from
the late 20s to mid-40s, with a median age of
approximately 32. Respondents in the
non-health-care sample were approximately
133 managers from a wide variety of primarily
service organizations operating outside the
health-care setting (e.g. banks and retailers).
We also included a number of
entrepreneurships in areas including
manufacturing and distribution. The
managers were roughly 35 percent female.
The age range was from the late 20s to early
50s, with a median age of approximately 35.
Both samples have 15 per cent minority, with
African-Americans the predominant minority
group represented. They were attending
graduate level management training
emphasizing QMat at two universities in a
large southern city and all indicated that their
organizations had at least a moderate interest
in the quality movement.
Data
QM maturity
In this study, QM maturity refers, in a
qualitative sense, to the degree of QM
implementation in an organization. We
suggest, and previous research has shown
(Ahire et al., 1996; Flynn et al., 1994; Fok
et al., 2000; Patti et al., 2001; Saraph et al., 1989)
that it can be measured by examining the
perceived use of QM programs. These ideas
assume that, if an organization has more
completely followed the QM philosophy, QM
programs should be used throughout the
organization and in various functional areas,
rather than in isolation. Moreover, if ``quality
is indeed everyone's job'', where QM is more
fully in place, employees should be aware of
the various QM tools and techniques which are
[ 237 ]
Wing M. Fok, Jing Li,
Sandra J. Hartman and
Lillian Y. Fok
Customer relationship
management and QM
maturity: an examination of
impacts in the health-care and
non-health-care setting
International Journal of Health developed dealt with perceived program use
Care Quality Assurance
16/5 [2003] 234-247
[ 238 ]
in use. If an organization, on the other hand,
has very little or no experience with QM, the
opposite is expected to occur. In a stream of
earlier research (Fok et al., 2000; Patti et al.,
2001), we began the process of developing a
measure of QM maturity. The instrument we
and asked respondents whether seven QM
programs are in use in the organization, with a
range from ``not used'' to ``high usage''.
In this study, consistent with our earlier
research, the QM maturity instrument was
used to gauge QM maturity. The items are
shown as Question 3 in the Appendix. We
conducted a factor analysis to identify the
underlying dimensionality. Three factors
emerged from the ``usage'' items. The first
factor appeared to include all the traditional
quality management programs and was
termed ``traditional QM programs''. The second
factor consists of people-oriented QM programs
and, therefore, is named ``people-oriented QM
programs''. The last factor was termed
``advanced QM programs'', which includes
programs like Black Belt training and Six
Sigma programs. Table I provides the items
and shows the results of our factor analysis.
Culture
Based on previous research (Fok et al., 2000),
we measured the organizational culture
construct with a series of paired opposite
items (Question 2 in the Appendix) which
asked whether the organization's climate
should be described as open vs. closed, soft vs.
tough, and the like. Table II provides the items
and shows the results of our factor analysis.
As Table II indicates, we obtained a
three-factor solution in the case of the culture
items. We have labeled Factor 1 as ``team
culture'', Factor 2 as ``accepting culture'', and
Factor 3 as ``decentralized culture''. The
results are generally in line with previous
findings (Fok et al., 2000).
Table I
Factor analysis on quality programs usage items
Traditional QM
Quality management program
Quality circle
Statistical process control
Employee suggestion channels
Employee quality training programs
Quality improvement seminars
Acceptance sampling
Six Sigma programs
Black Belt training
CRM extensiveness and CRM
effectiveness
Two measures of CRM systems
implementation were developed specifically
for this study. The first examined how
extensively five primary categories of CRM
systems were used in the organization (these
items are shown in the Appendix as the use
column of Question 1, Items n to r). The
second one asked how effectively the CRM
systems were used (these items are shown in
the Appendix as the effectiveness column of
Question 1, Items n to r).
Organizational performance
The organizational performance items were
primarily adapted from the Malcolm
Baldrige National Quality Award outcome
assessment measures. The Baldrige Awards
are designed to identify organizations which
are performing in an exceptional manner and
include criteria for identifying excellence.
We used the Baldrige criteria in the form of a
scale which asks respondents to provide their
perceptions about their organizations along
Baldrige lines. The resulting scale, shown at
Question 5, items a-k in the Appendix, has
been used and reported in our previous work
(Fok et al., 2000). As shown in the Appendix,
included are items such as ``overall, my
company is performing well'', ``overall,
morale in my company is high'', ``overall, I
am satisfied with the use of technology in my
company'', and the like. Factor analysis in
this study indicated that two factors were
present. We named Factor 1 as ``general
organizational success'' and Factor 2 as
``satisfaction with technology''.
Service quality
The service quality scale asked employees to
rate the impact of organizational systems on
improving customer service (see the
Appendix, Question 21, Items a to h). The
scale measured the eight service dimensions
± service time, promptness, comprehensive
service, courtesy, consistency, accessibility,
Rotated factor pattern
Factor 1 Factor 2 Factor 3
People-oriented QM Advanced QM
0.625 0.505 0.074
0.793 0.279 0.126
0.818 0.214 0.122
0.117 0.830 0.132
0.285 0.848 0.067
0.354 0.709 0.131
0.644 0.135 0.385
0.201 0.178 0.807
0.120 0.049 0.872
Wing M. Fok, Jing Li, Table II
Sandra J. Hartman and Factor analysis on organizational culture items
Lillian Y. Fok
Customer relationship Rotated factor pattern
management and QM
maturity: an examination of Factor 1 Factor 2 Factor 3
impacts in the health-care and Team culture Accepting culture Decentralized culture
non-health-care setting
International Journal of Health
Open 0.733 0.179 ±0.026
Care Quality Assurance Tough ±0.085 0.739 ±0.050
16/5 [2003] 234-247 Competitive ±0.006 0.819 ±0.035
Formal ±0.053 0.716 0.211
Team-oriented 0.719 ±0.012 ±0.204
Centralized 0.002 0.080 0.959
Participative 0.700 0.011 ±0.025
Quality-oriented 0.754 ±0.133 0.003
Innovative promoting 0.760 ±0.129 0.150
Proactive 0.681 ±0.209 0.091

accuracy, and responsiveness. Factor
analysis produced a single-factor solution
and we named it ``service quality.''
Results
Our first research question considered the
possibility that managers in different
settings (i.e. health care vs. non-health care)
might experience QM, CRM, culture,
organizational performance, and service
quality improvement somewhat differently.
Tables III and IV provide the MANOVA
results. The results fail to find sufficient
evidence to support the idea that managers
from the health-care vs. the non-health-care
settings have different experiences with QM,
CRM, culture, organizational performance,
and service quality improvement.
RQ2 held that QM maturity and CRM
maturity would be related and that
organizations which were seen as more QM-
mature would also be characterized as
having implemented CRM more extensively
and effectively. We used the QM maturity
scales shown in Table I and the extent and
effectiveness of CRM implementation scales
shown in the Appendix to examine the
relationships. Table V provides the results of
our correlation analysis for both the health-
care and the non-health-care samples.
The results of the health-care sample listed
at the top of Table V show three significant
pairs of relationships between CRM use and
three QM maturity factors ± use of traditional
QM tools, people-oriented QM tools, and use
of advanced QM tools. In the case of the
non-health-care sample, we found four
significant relationships among the factors
(see the bottom of Table V). The use and the

Table III
Multivariate tests ± CRM, QM, culture, organizational performance and service quality
Effect Value F Hypothesis df Error df Sig.
Wilks' Lambda 0.933 1.410 11.000 216.000 0.170

Table IV
Multivariate test ± individual ANOVAs
Dependent variable
Source Type III sum of squares df Mean square F Sig.
Traditional QM tools 1.608 1 1.608 1.617 0.205
People-oriented QM tools 0.029 1 0.029 0.030 0.862
Advanced QM tools 0.144 1 0.144 0.127 0.722
Team culture 0.768 1 0.768 0.849 0.358
Accepting culture 3.041 1 3.041 3.269 0.072
Decentralized culture 0.182 1 0.182 0.179 0.672
Overall organizational success 0.179 1 0.179 0.178 0.674
Satisfaction with technology 2.801 1 2.801 2.803 0.095
Service quality 1.598 1 1.598 1.687 0.195
CRM effectiveness 0.064 1 0.064 0.065 0.799
CRM use 5.632 1 5.632 3.263 0.072

[ 239 ]
Wing M. Fok, Jing Li, effectiveness of CRM are related to the use of
Sandra J. Hartman and traditional tools and people-oriented tools.
Lillian Y. Fok
Customer relationship The results provide some support for RQ2.
management and QM The results suggest that both health-care and
maturity: an examination of non-health-care organizations which are
impacts in the health-care and
non-health-care setting characterized as more QM-mature are also
International Journal of Health characterized as having implemented CRM
Care Quality Assurance more effectively and extensively.
16/5 [2003] 234-247 RQ3 and RQ4 suggested that there would be
relationships between QM maturity
(measured by the traditional QM programs,
people-oriented QM programs, and advanced
QM programs (Table I)), CRM maturity, and
the organization's culture (the three culture
factors shown in Table II). Specifically, we
speculated that, as organizations were seen
as more QM-mature and CRM-mature, they
would also be seen as having cultures which
were higher in the employee and
empowerment-centered aspects emphasized
by the quality movement. We have noted that
our factor analysis of the culture instrument
shown in Table II revealed three factors
which we labeled team culture, accepting
culture, and decentralized culture. Tables V
and VI provide the results of our correlation
analyses with these factors.
Table V reveals that, for the health-care
sample, there are three significant
relationships. Accepting culture is
negatively related to QM maturity ± use of
traditional QM programs and people-oriented
QM programs. While our research questions
had argued for a relationship between QM
maturity and culture, we had expected that
the relationship would be positive, rather
than the negative finding for the health-care
sample. In the Discussion section which
follows, we will suggest some possible
reasons why this finding may have occurred.
The other significant relationship is more in
line with our speculations and is between
team culture and the use of people-oriented
QM programs. The non-health-care sample
shows a significant relationship between the
people-oriented QM programs factors and the
team culture.
As for the relationship between CRM
implementation and organizational culture,
Table VI shows two significant relationships for
the health-care sample. In line with the
previously noted relationship but unexpectedly,
the accepting culture is negatively correlated
with the use of CRM, while, and more in line
with our speculations, the team culture is
positively correlated with CRM effectiveness.
Moreover, and again unexpectedly, the
non-health-care sample also shows a negative

Table V
Pearson's correlation matrix showing correlation between QM, CRM, culture and organizational performance
Overall Satisfaction
CRM CRM Team Accepting Decentralized organizational with
effectiveness use culture culture culture performance technology
Health
Traditional QM tools ±0.144 0.313** 0.018 ±0.417** 0.005 ±0.120 0.136
People-oriented QM tools 0.057 0.314** 0.381** ±0.214* ±0.039 0.242* 0.244*
Advanced QM tools ±0.061 0.193** 0.064 ±0.084 0.126 ±0.018 0.071
Non-health
Traditional QM tools 0.262** 0.300** 0.100 ±0.063 0.003 0.019 0.084
People-oriented QM tools 0.218** 0.276** 0.340** 0.058 ±0.127 0.244** 0.091
Advanced QM tools 0.030 ±0.006 0.034 ±0.082 0.205* ±0.087 0.129
Notes: * Correlation is significant at the 0.05 level; ** Correlation is significant at the 0.01 level

Table VI
Pearson's correlation matrix showing correlation between culture, organizational performance
and CRM
Overall
Team Accepting Decentralized organizational Satisfaction
culture culture culture performance with technology
Health
CRM effectiveness 0.189* 0.024 0.031 0.188 ±0.083
CRM use 0.068 ±0.246** 0.051 ±0.025 0.272**
Non-health
CRM effectiveness 0.198** ±0.023 ±0.011 0.148 0.211*
CRM use 0.082 ±0.170* ±0.027 0.061 0.144
Notes: * Correlation is significant at the 0.05 level; ** Correlation is significant at the 0.01 level

[ 240 ]
Wing M. Fok, Jing Li,
Sandra J. Hartman and
Lillian Y. Fok
Customer relationship
management and QM
maturity: an examination of
impacts in the health-care and
non-health-care setting
International Journal of Health
Care Quality Assurance
16/5 [2003] 234-247
significant relationship between accepting
culture and use of CRM. In general, what is
suggested is that there does seem to be a pattern
of relationships among organization culture
and the use of QM and CRM programs, but that
the pattern is not necessarily in line with our
initial speculations. In the Discussion section
which follows we will attempt to develop a
rationale for these findings and their support
for RQ3 and RQ4.
RQ5 suggested that, in line with our prior
arguments, we would observe positive
relationships among our respondents' beliefs
that, where their organizations were more
QM-mature (measured by the use of general
QM programs and advanced QM programs
(Table I)), those in the organization would
report improved organizational performance
(measured by the scale shown in the
Appendix, Question 5, Items a to k). Factor
analysis (Table VII), indicated that
organizational performance comprises two
factors ± overall organizational performance/
success and satisfaction with technology.
Similarly, RQ6 indicated that more extensive
and effective implementation of CRM would
also be related to improved organizational
performance. Finally, RQ7 indicated that,
where employees perceive that the
organization has more extensively and
effectively implemented CRM in general
throughout the organization, they will also
report more positive feelings about the
organization's service quality. Tables V-VIII
provide the results of our correlation analysis.
For the health-care sample, the significant
relationships are between the use of people-
oriented QM tools and the two success
factors ± overall organizational
performance/success and satisfaction with
technology (see Table V). CRM use is
Table VII
Factor analysis on organizational success
Overall, my company is performing well
Overall, morale in my company is high
Overall, my company is productive
My overall job satisfaction is high
Overall, the use of IS has affected my job positively
In general, my co-workers are happy and proud of working for my company
In general, our company has good relationships with our customers
Relative to our competitors, my company's customers are satisfied with our
products/services
Overall, my company uses an appropriate level of technology
Overall, I am satisfied with the use of technology in my company
Overall, I have confidence in the technology being used in my company
correlated with satisfaction with technology
and service quality (see Tables VI and VIII).
As for the non-health care sample, there is a
significant relationship between the use of
people-oriented QM tools and overall
organizational performance/success (see
Table V). The CRM effectiveness is correlated
with satisfaction with technology (see
Table VI), and both CRM use and effectiveness
are correlated with service quality (see Table
VIII). These findings provide support for our
final research questions.
Discussion and conclusions
In this paper, we have reported the results of
exploratory research into a series of
proposed relationships between two
important systems for enhancing
organizational competitiveness. We have
examined QM and CRM systems, and have
considered whether differences emerge when
these systems are implemented in the health-
care vs. the non-health care-setting. Our
concerns about implementation in health
care arose from reports that health care may
be lagging behind other, non-health-care
settings in implementation of technology
(Murray, 2000; Rundle, 2000). Basically, we
proposed that, where QM is implemented in a
high-quality manner, there should be
impacts which resonate throughout the
organization. Specifically, the organization's
culture will be aligned to fit the requirements
of QM for an empowered, participative
workforce, and workers should feel that the
organization is more effective. Moreover,
QM's concerns for quality and customer
service should extend to the extensiveness
Rotated factor pattern
Factor 1 Factor 2
General Satisfaction
organizational with
success technology
0.765 0.182
0.791 0.088
0.796 0.232
0.767 0.197
0.388 0.420
0.794 0.171
0.764 0.196
0.750 0.246
0.140 0.914
0.147 0.917
0.260 0.846
[ 241 ]
Wing M. Fok, Jing Li,
Sandra J. Hartman and
Lillian Y. Fok
Customer relationship
management and QM
maturity: an examination of
impacts in the health-care and
non-health-care setting
International Journal of Health
Care Quality Assurance
16/5 [2003] 234-247
[ 242 ]
Table VIII
Pearson's correlation matrix showing correlation between QM, CRM, and service quality
Traditional QM People-oriented
tools
Health
Service quality 0.016
Non-health
Service quality 0.240**
Notes: * Correlation is significant at the 0.05 level; ** Correlation is significant at the 0.01 level
and effectiveness of CRM system
development. Specifically, we expect that,
with QM maturity, CRM will be used more
effectively and extensively.
Our results from this exploratory study
offer some support for the sorts of
relationships we have suggested.
Surprisingly, and contrary to reports
expressing concern about technology
implementation in health care, our analysis
did not detect significant differences in QM
maturity in health-care vs. non-health-care
settings. What is suggested is that health care
and non-health-care organizations are no
different in QM maturity and that increasing
QM maturity does appear to be related to at
least some of the changes in CRM we had
speculated would occur.
Also notable is the pattern of unexpected
results we found in the negative relationship
between the accepting culture and QM
maturity and CRM extensiveness and
effectiveness. While this relationship is
especially notable in health-care
organizations, we found some evidence that a
negative relationship between CRM and the
accepting culture is occurring in non-health
care as well. Certainly, the literature leads to
the expectation that QM maturity and CRM
extensiveness and effectiveness would be
associated with more ``positive'' and
supportive cultures. Yet these results suggest
that, as CRM and perhaps QM maturity
increases, cultures become less accepting,
especially in health care. Could it be that, with
increasing QM maturity, the culture becomes
less tolerant of poor work, errors, and excuses
and more focused upon creation of a quality
product? Note that our findings for QM
maturity occur in health care, where it seems
reasonable to expect that traditionally the
culture has been more people-centered and
perhaps ``accepting'' than in non-health-care
organizations. Perhaps embracing QM leads
to a less ``personal'', more results-oriented
focus and the change has been felt most
strongly in health care because the implied
contrast has been greater.
But what are we to make of the negative
relationships between CRM and the
Advanced QM CRM CRM
QM tools tools effectiveness use
0.316** 0.173 0.078 0.230*
0.223** 0.032 0.185* 0.358**
accepting culture found in both health care
and non-health care? Is it possible that these
results suggest continuing ambivalence by
employees about whether the systems are, in
fact, effective in improving customer service?
Perhaps they are being seen as working in
opposition to the accepting culture by
``de-personalizing'' the employees' ability to
provide service directly, for example.
Obviously, considerable future research will
be needed to permit understanding of what is
occurring and what the implications are for
organizations.
Note, however, that, in considering our
findings, it is important to recognize that this
research is, in fact, exploratory. We were
attempting to get a preliminary ``handle'' on
whether the constructs involved could be
related and how they operated in the health-
care vs. non-health-care setting. In effect, we
asked a sample of managers for their
perceptions and beliefs about the constructs,
asking, for example, how extensively the
managers believed that the programs were
used, how well the organization was
performing, and what the culture was like.
Reliance on respondent perceptions,
however, can potentially introduce single
source measurement bias, and as a next step
it will be important to attempt to confirm our
findings with more independent and
observable measures. Thus, this study should
be regarded simply as exploratory work,
which suggests that it may be worthwhile to
examine our proposed relationships in a
more sophisticated manner.
Moreover, the correlation analysis which
we used in this study is, of course, inadequate
to reveal issues of causation. Did
organizations first become QM-mature and
then go on to establish more extensive and
effective CRM systems? Do QM maturity and
adoption of high quality CRM systems lead to
high organizational outcomes, or are high-
performing organizations simply more
capable of implementing virtually any
program in a high-quality manner? Clearly
considerable additional, and probably
longitudinal, study will be needed to tease out
the directionality of the possible relationships.
Wing M. Fok, Jing Li,
Sandra J. Hartman and
Lillian Y. Fok
Customer relationship
management and QM
maturity: an examination of
impacts in the health-care and
non-health-care setting
International Journal of Health non-health care. We suspect that
Care Quality Assurance
16/5 [2003] 234-247
Finally, are there differences between
health-care and other types of organizations?
Our MANOVA did not detect differences in
QM maturity, but we may have seen
differences in the way QM maturity impacted
CRM and the culture in health care vs
considerable additional study will be
required if we are to gain an understanding
of what is occurring. One likely possibility is
that the distinction ``health care vs.
non-health care'' is simply too broad. Perhaps
health care should be contrasted with
specific industry types in health-care-related
areas, such as in service, health care vs.
insurance agencies or, in manufacturing,
health care vs. pharmaceuticals, for example,
to see what differences emerge.
Alternatively, additional investigation could
consider our speculation that relative lack of
sophistication in health care may be limiting
the way QM maturity impacts other systems.
From our perspective, what is notable is
that QM maturity and CRM extensiveness
and effectiveness are potentially important
ideas for organizations searching for ways to
improve their effectiveness. This research
suggests an intriguing series of relationships
between the constructs and, we believe,
indicates that further study could lead to an
understanding of the impacts which could be
helpful to managers seeking competitiveness
and researchers hoping to learn more about
organizations and quality.
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Customer relationship
management and QM
maturity: an examination of
impacts in the health-care and
non-health-care setting
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Wing M. Fok, Jing Li,
Sandra J. Hartman and Appendix
Lillian Y. Fok
Customer relationship
management and QM Table AI
maturity: an examination of Information systems and customer relationship management survey
impacts in the health-care and
non-health-care setting If used, level of
International Journal of Health Extent of use effectiveness
Care Quality Assurance No, but Don't Extremely Extremely
16/5 [2003] 234-247
Yes will be No know low high
1. Please indicate (CIRCLE) the extent of use and effectiveness (only if that technology is being used) of the
following technologies in your organization:
a) Computer-based human resource systems Y NW N DK 1 2 3 4 5
b) Computer-based payroll systems Y NW N DK 1 2 3 4 5
c) Computer-based accounting systems Y NW N DK 1 2 3 4 5
d) Computer-based order-processing systems Y NW N DK 1 2 3 4 5
e) Computer-based purchasing systems Y NW N DK 1 2 3 4 5
f) Database management systems Y NW N DK 1 2 3 4 5
g) Decision support systems Y NW N DK 1 2 3 4 5
h) Expert systems Y NW N DK 1 2 3 4 5
i) Intranet Y NW N DK 1 2 3 4 5
j) Extranet Y NW N DK 1 2 3 4 5
k) Company Web sites Y NW N DK 1 2 3 4 5
l) Electronic data interchange systems Y NW N DK 1 2 3 4 5
m) Enterprise resource planning (ERP) systems Y NW N DK 1 2 3 4 5
n) Computer-based customer relationship management Y NW N DK 1 2 3 4 5
systems
o) Web sites providing specific product/service Y NW N DK 1 2 3 4 5
information
p) Web sites allowing customers to purchase Y NW N DK 1 2 3 4 5
q) IS gathering information about customer preferences Y NW N DK 1 2 3 4 5
r) IS supporting the work of customer service employees Y NW N DK 1 2 3 4 5
s) Electronic payment systems Y NW N DK 1 2 3 4 5
t) E-mail systems Y NW N DK 1 2 3 4 5
u) Supply chain management systems Y NW N DK 1 2 3 4 5
v) Flexible manufacturing systems Y NW N DK 1 2 3 4 5
w) Computer-aided design software Y NW N DK 1 2 3 4 5
x) Computer-aided manufacturing technology Y NW N DK 1 2 3 4 5

2. I feel that the climate in my organization is: (Circle the number on each scale)
a) Open 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Closed
b) Tough 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Soft
c) Competitive 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Collaborative
d) Formal 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Informal
e) Confrontational 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Cooperative
f) Team-oriented 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Individualistic
g) Impersonal 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Personal
h) Centralized 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Decentralized
i) Participative 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Directive
j) Quality-oriented 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Quality-lacking
k) Innovation-promoting 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Innovation-lacking
l) Proactive 3ÐÐÐÐ2ÐÐÐÐ1ÐÐÐÐ0ÐÐÐÐ1ÐÐÐÐ2ÐÐÐÐ3 Reactive

Not
used Low High
3. Indicate the levels of use of the following quality programs in your organization
a) Quality management (QM) program 0 1 2 3 4 5
b) Quality circles 0 1 2 3 4 5
c) Statistical process control 0 1 2 3 4 5
d) Employee suggestion channels 0 1 2 3 4 5
e) Employee quality training programs 0 1 2 3 4 5
(continued)

[ 245 ]
Wing M. Fok, Jing Li, f) Quality improvement seminars 0 1 2 3 4 5
Sandra J. Hartman and
Lillian Y. Fok g) Acceptance sampling 0 1 2 3 4 5
Customer relationship h) Six Sigma programs 0 1 2 3 4 5
management and QM i) Black Belt training 0 1 2 3 4 5
maturity: an examination of
impacts in the health-care and
non-health-care setting 4. As far as you know, the IS people in your organization believe that system users are:
International Journal of Health a) Responsible 3Ð2Ð1Ð0Ð1Ð2Ð3 Irresponsible
Care Quality Assurance b) Creative 3Ð2Ð1Ð0Ð1Ð2Ð3 Imitative
16/5 [2003] 234-247
c) Active 3Ð2Ð1Ð0Ð1Ð2Ð3 Passive
d) Able to control work situation 3Ð2Ð1Ð0Ð1Ð2Ð3 Unable to control work situation
e) Able to work without close supervision 3Ð2Ð1Ð0Ð1Ð2Ð3 Unable to work without close supervision
f) Imaginative 3Ð2Ð1Ð0Ð1Ð2Ð3 Dull
g) Powerful 3Ð2Ð1Ð0Ð1Ð2Ð3 Powerless
h) Future-oriented 3Ð2Ð1Ð0Ð1Ð2Ð3 Current-oriented
i) Concerned with quality 3Ð2Ð1Ð0Ð1Ð2Ð3 Not concerned with quality

Strongly Strongly
agree disagree
5. Give us your general reaction to your organization:
a) Overall, my company is performing well 1 2 3 4 5
b) Overall, morale in my company is high 1 2 3 4 5
c) Overall, my company is productive 1 2 3 4 5
d) My overall job satisfaction is high 1 2 3 4 5
e) Overall, the use of IS has affected my job positively 1 2 3 4 5
f) In general, my co-workers are happy and proud of working for my 1 2 3 4 5
company
g) In general, our company has good relationships with our customers 1 2 3 4 5
h) Relative to our competitors, my company's customers are satisfied with 1 2 3 4 5
our products/services
i) Overall, my company uses an appropriate level of technology 1 2 3 4 5
j) Overall, I am satisfied with the use of technology in my company 1 2 3 4 5
k) Overall, I have confidence in the technology being used in my company 1 2 3 4 5

For Questions 6-20, please circle the number on the descriptive scale based on your own experience and feelings
6. Your relationship with the IS staff during the development of various systems
Rough 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Smooth
7. Processing of requests for changes to various systems
Fast 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Slow
8. Extent of training provided to users for new or upgraded systems
Complete 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Incomplete
9. Quality of training provided to users for various systems
Low quality 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 High quality
10. Documentation and manuals of various systems for the users
Good 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Bad
11. Your understanding of various systems
Insufficient 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Sufficient
12. Your feelings of your participation in developing various systems
Positive 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Negative
13. Attitude of the IS staff who worked on various system projects
Cooperative 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Uncooperative
14. Reliability of output information from various systems
High 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Low
15. Relevancy of the system's output information to your needs
Relevant 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Irrelevant
16. Validity and accuracy of output information from various systems
Low 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 High
17. Precision of output information from various systems
Low 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 High
18. Completeness of output information from various systems
Adequate 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Inadequate
(continued)

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Wing M. Fok, Jing Li, 19. Your communication with the IS staff who worked on various system projects
Sandra J. Hartman and
Lillian Y. Fok Difficult 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Easy
Customer relationship 20. Time given for the development of various systems
management and QM Unreasonable 3ÐÐÐ2ÐÐÐ1ÐÐÐ0ÐÐÐ1ÐÐÐ2ÐÐÐ3 Reasonable
maturity: an examination of
impacts in the health-care and
non-health-care setting Low High
International Journal of Health 21. Please provide your reactions to the impact of various
Care Quality Assurance systems on customer service. To what extent does the
16/5 [2003] 234-247
use of IS and technology allow your organization to:
a) Offer service on a broad range of times 1 2 3 4 5
b) Give service in a timely/prompt manner 1 2 3 4 5
c) Give complete/comprehensive service 1 2 3 4 5
d) Give courteous service 1 2 3 4 5
e) Give consistent service 1 2 3 4 5
f) Provide accessibility/convenience 1 2 3 4 5
g) Give service in an accurate (do-it-right the first time) manner 1 2 3 4 5
h) Be responsive to customers' changing needs? 1 2 3 4 5

Strongly Strongly
agree disagree
22. Overall, I am satisfied with my organization's use of technology:
a) to support customer relationship management 1 2 3 4 5
b) to improve the quality of products/services 1 2 3 4 5
c) to improve productivity in my organization 1 2 3 4 5

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