Influence of Total Quality Management Practices Implementation on the Strategic Competitiveness of Selected Diagnostic Laboratories in Nakuru County

Abstract

Abstract Diagnostic medical laboratories are integral to health systems globally, underpinning clinical decision-making and public health surveillance. In Kenya, however, increasing incidences of false-positive and false-negative results have raised concerns about laboratory effectiveness and quality assurance. Within Nakuru County, limited documentation exists on the adoption and strategic value of Total Quality Management (TQM) practices in enhancing competitiveness and sustainability. This study investigated the influence of TQM implementation on the strategic competitiveness of selected diagnostic laboratories in Nakuru County. The study was anchored in strategic quality frameworks, including the Six Sigma Theory, Juran’s Trilogy of Quality Management, and Kaoru Ishikawa’s Theory of Total Quality Control. A convergent parallel mixed-methods design was applied, using expert and homogeneous sampling to recruit 48 participants. Quantitative data were collected using standardized questionnaires, while qualitative insights were obtained through key informant interviews. Ethical clearance was obtained from Kabarak University Research Ethics Committee (KUREC), and NACOSTI issued a research license. The study found that 61.9% of participants were laboratory technologists or technicians, 47.6% had over a decade of experience, and 57.1% possessed bachelor’s degrees. Private laboratories accounted for the most significant proportion (47.6%), with 61.9% holding KENAS accreditation. Resource availability was moderately constrained (57.1%). Strategic human resource variables such as job role and experience were statistically significant in influencing revenue diversification (p = 0.021) and the adoption of staff training and personalized service strategies (p = 0.011). Higher educational attainment was associated with stronger financial performance (p = 0.007), highlighting the role of human capital in strategic execution. TQM structures were formally documented in 90.5% of the laboratories, with 47.6% having defined performance metrics across all processes. Strong correlations were observed between the use of performance metrics and measurement frequency (r = .726) and between the use of performance metrics and process improvement initiatives (r = .645). Familiarity with the PDCA cycle significantly influenced both its practical application (r = .917) and participation in continuous improvement practices such as Kaizen (r = .646). Root-cause analysis, particularly the "5 Whys" method (52.4%), was reported by 42.9% of laboratories. Financial performance was rated as stable by 61.9% of respondents, and ISO 15189 compliance was seen as enhancing training and internal feedback systems. Notably, frequent data visualization and the use of performance analytics were associated with higher profit margins and improved service quality. In conclusion, the study demonstrates that effective TQM implementation serves as a critical strategic lever for enhancing operational efficiency, service quality, and competitive positioning in the diagnostic laboratory sector. Nonetheless, persistent challenges such as resource limitations and inconsistent adherence to standard operating procedures (SOPs) limit the full realization of strategic benefits. To sustain competitiveness, laboratory managers should prioritize strategic investments in resource mobilization, institutionalization of TQM practices, and capacity development.