Purpose The purpose of this paper is to analyze the operations of the quality management systems (QMS) in multinational companies, and develop a framework for classifying the QMS features based on the global operational and marketing structures arising from their expansion process. This paper is based on doctoral research conducted at the Department of Statistics, University of Haifa, Israel in 2007–2015. Design/methodology/approach This study used the innovative approach of adopting a systems perspective in analyzing the operation of a global QMS. In total 18 multinational companies at different levels of global expansion were studied in depth using observations, longitudinal studies, content analyses and depth interviews. Findings The result of this study is the global hierarchical model (GHM) that presents a classification of representative global operational and marketing structures deriving from the expansion process of multinational companies, and the extrapolated features of the respective global QMS. Practical implications This classification serves as a diagnostic tool for identifying the proper globalization level of a QMS, thereby helping plan global quality strategy and identifying the steps necessary for its effective implementation. Originality/value This research seeks to fill a lacuna in the field of global quality system development with regard to modes of competition and challenge. Integration of strategic, operational and marketing rationales into the QMS’s processes augments the functional level of management and supports the development of a strategy for global quality management that is derived from and supports the company’s global strategy.

Present medical practice encourages management according to written guidelines, protocols, and structured procedures (GPPs). Daily medical practice includes instances in which “leaping” from one patient management routine to another is a must. We define “frozen patient management”, when patient management leaping was required but was not performed. Frozen patient management may cause significant damage to patient safety and health and the treatment quality. This paper discusses the advantages and disadvantages of GPP-guided medical practice and gives an explanation of the problem of frozen patient management in light of quality engineering, control engineering, and learning processes. Our analysis of frozen patient management is based on consideration of medical care as a process. By considering medical care processes as a closed-loop control process, it is possible to explain why, when an indication for deviation from the expected occurs, it does not necessarily attract the medical teams’ attention, thereby preventing the realization that leaping to an alternative patient management is needed. We suggest that working according to GPPs intensifies the frozen patient management problem since working according to GPPs relates to “exploitation learning behavior”, while leaping to new patient management relates to “exploration learning behavior”. We indicate practice routines to be incorporated into GPP-guided medical care, to reduce frozen patient management.

While the importance of timely leaping from one patient management routine to another is emphasized in the training of physicians, medical teams too often fail to do so. The de-Freezing-protocol inexpensively encourages the consideration of a leap beyond what is evoked by the involvement of an external team. The protocol is applicable to all medical processes and should be incorporated into medical practice and education.

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