International Journal of Business and Management; Vol. 11, No. 2; 2016 ISSN 1833-3850 E-ISSN 1833-8119 Published by Canadian Center of Science and Education 232 Staff Perceptions of Obstacles to Quality Management Systems in Low- and High- Performing Hospitals in Jordan Ashraf A’aqoulah 1 , Ahmed Bawa Kuyini 2 , Musa T. Ajlouni 1 , Naser Saif 1 & Atef Al-Raoush 1 1 Faculty of Administrative and Financial Sciences, Philadelphia University, Amman, Jordan 2 School of Health, University of New England, Armidale, NSW, Australia Correspondence: Ashraf A’aqoulah, Faculty of Administrative and Financial Sciences, Philadelphia University, Amman, Jordan. E-mail: aabuaaqoulah@philadelphia.edu.jo Received: December 1, 2015 Accepted: December 28, 2015 Online Published: January 23, 2016 doi:10.5539/ijbm.v11n2p232 URL: http://dx.doi.org/10.5539/ijbm.v11n2p232 Abstract Implementing a quality management system (QMS) is important for hospitals to deliver high-quality services. Hospitals in Jordan vary greatly in terms of the quality of their services. This study aimed to explore QMS obstacles in low- and high-performing hospitals in Jordan. The study employed a Mixed Method-Sequential Exploratory design. A questionnaire was used to explore the QMS obstacles. The study population was drawn from six public and private hospitals considered low- and high-performing. A total of 908 participants who worked in the six hospitals completed the questionnaire. The questionnaire contained 23 items and was rated using 5-points Likert Scale. The data was analysed using quantitative tools as Descriptive statistics, General Liner Model (Univariate analysis) to determine the major QMS obstacles in low- and high-performing hospitals and to explore the relationship between participants’ background variables. The study found that low-performing hospitals faced six major obstacles: lack of rewards for hospital staff, inadequate material resources, lack of training programmes in sufficient staff motivation, insufficient budget for a QMS, and inadequate authority delegation. Whereas, the high-performing hospitals faced three major obstacles: lack of rewards for hospital staff, inadequate authority delegation, and shortage of staff. The results showed that there were significant differences between low- and high-performance hospitals in terms of the QMS obstacles. The study also provides recommendations for improving the implementation of QMS in Jordanian hospitals. Keywords: obstacles, quality management system (QMS), low- and high-performing hospitals 1. Introduction A hospital’s Quality Management System (QMS) is defined as the ‘procedures explicitly designed to monitor, assess and improve the quality of care in a hospital’ (Wagner, Gulacsi, Takacs, & Outinen, 2006, p. 2). Implementing a QMS, which is an essential component in the development of a contemporary approach to quality management, can help hospitals create and implement procedures that improve patient and employee satisfaction. The World Health Organisation (WHO) (WHO, 2008a) asserts that QMSs enhance management, allow more effective organisation, improve quality of services, increase staff satisfaction and commitment to the organisation, enhance co-operation among employees and management, and improve patients’ satisfaction. For these reasons, hospitals in most countries including Jordan are constantly trying to improve their QMSs. Maintaining quality requires that every hospital should have a QMS that covers domains such as leadership and management, resource management, quality improvement, and organisational culture (Lin & Jang, 2008; Pongpirul, et al. 2006). In the past, most hospitals had their own criteria for a QMS. However, in recent times the Joint Commission on Accreditation of Health Care Organisations (JCAHO) and the International Organisation for Standardization (ISO) have started using specific standards for a QMS as a basis for accreditation. The main providers of care services in Jordan are Ministry of Health, Army Medical Services, university hospitals and the private sector. The Ministry of Health (MOH) is the major provider of health care services for all population. There are 31 hospitals owned and operated by the ministry (MOH, 2010). The Army Medical Services offers medical services for army personnel and their families through 11 hospitals. There are two university hospitals that provide services to students, university staff, and the public. The private sector plays a