PurposeConsumer expectations of quality have grown in recent years, forcing organisations, both service and manufacturing, to adopt total quality management (TQM) principles to satisfy customer demands efficiently. However, previous studies on the performance impacts of total quality management practices have mainly focused on the financial performance of firms in the manufacturing sector. This study focusses on the research questions: (1) What is the effect of TQM practices on operational performance? and (2) How do TQM practices combine to influence the operational performance of healthcare facilities?Design/methodology/approachUsing a sample of 154 health facilities (i.e. private hospitals, pharmacies, maternity clinics, and diagnostic centres), the authors applied symmetric (PLS-SEM) and asymmetric (fsQCA) data analysis approaches to examine how TQM practices influence the operational performance of health facilities in the Ashanti Region of Ghana.FindingsThe PLS-SEM results revealed that five out of the seven TQM practices investigated influenced operational performance. However, the fsQCA results identify five different complex combinations of TQM practices that lead to operational performance.Research limitations/implicationsLongitudinal studies can be conducted in the future to assess changes in the variables over time. A control variable, such as firm size, should be considered to assess the level of implementation of TQM practices based on firm size. A different performance measure, for instance, sustainability indicators or the balance score card, could be used to examine performance.Practical implicationsA proper and coordinated integration of the TQM practices is required for firms to be able to achieve operational performance. TQM practices vary in their sufficiency for operational outcomes; therefore, management needs to carefully consider their implementation as part of the organisation's strategy.Originality/valueThis research, by focussing on TQM practices from both symmetrical and asymmetrical perspectives, contributes to the understanding of the literature on TQM, thereby providing actionable insight on how to invest in the various TQM practices for improved operational performance.