Drivers of perceived healthcare service quality among healthcare workers in TQM-implementing hospitals in conflict-affected yemen: a cross-sectional study
- 1Department of Business Administration, Sana’a University, Sana’a, Yemen
- 221 September University for Medical and Applied Sciences, Sana’a, Yemen
- 3Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
Abstract
Background Healthcare quality in Yemen's conflict-affected health system is a critical challenge. In 2021, the Ministry of Public Health mandated the implementation of Total Quality Management (TQM). This study provides a comprehensive evaluation of TQM's impact on service quality with a focus on fragile frontline healthcare professionals. Methods This cross-sectional analytical study included 410 healthcare professionals from four purposively selected hospitals in Sana'a. Data were collected using a validated questionnaire that measured five TQM dimensions (based on the EFQM model) and five health service quality dimensions (based on the SERVQUAL model). The relationships were analyzed using multiple linear regression. Results Despite the challenging context, TQM was implemented to a high degree (mean = 5.44 on a 7-point scale). TQM implementation was a powerful predictor of health service quality, explaining 64.8% of the variance (R² = 0.648, F(5, 404) = 148.73, p < .001). "Systematic Processes" (β = 0.468) and "Policy & Strategy" (β = 0.305) were the strongest drivers of quality. Paradoxically, "Leadership Commitment" was the highest-rated dimension by staff but had no significant predictive power (β = 0.009, p = 0.742). Furthermore, "Human Resources" was a non-significant predictor and the lowest-rated TQM dimension, highlighting a critical implementation gap. Conclusions TQM can be effectively implemented to improve healthcare quality, even in conflict zones. However, success is driven primarily by robust systems and policies rather than perceived leadership commitment. Addressing profound human resource challenges related to workforce well-being is fundamental to the sustainability of quality improvements in such settings. Trial Registration Not applicable.
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BibTeX
@article{alsalit2026drivers,
title = {{Drivers of perceived healthcare service quality among healthcare workers in TQM-implementing hospitals in conflict-affected yemen: a cross-sectional study}},
author = {Gobran Mohammed Alsalit and Muneer Musleh Al-Wesabi and Haitham Mohammed Jowah},
journal = {Conflict and Health},
year = {2026},
month = sep,
doi = {10.1186/s13031-026-00839-5},
url = {https://doi.org/10.1186/s13031-026-00839-5},
note = {CC BY},
}
RIS
TY - JOUR
TI - Drivers of perceived healthcare service quality among healthcare workers in TQM-implementing hospitals in conflict-affected yemen: a cross-sectional study
AU - Gobran Mohammed Alsalit
AU - Muneer Musleh Al-Wesabi
AU - Haitham Mohammed Jowah
PY - 2026
DA - 2026/09/17
JO - Conflict and Health
DO - 10.1186/s13031-026-00839-5
UR - https://doi.org/10.1186/s13031-026-00839-5
AB - Background Healthcare quality in Yemen's conflict-affected health system is a critical challenge. In 2021, the Ministry of Public Health mandated the implementation of Total Quality Management (TQM). This study provides a comprehensive evaluation of TQM's impact on service quality with a focus on fragile frontline healthcare professionals. Methods This cross-sectional analytical study included 410 healthcare professionals from four purposively selected hospitals in Sana'a. Data were collected using a validated questionnaire that measured five TQM dimensions (based on the EFQM model) and five health service quality dimensions (based on the SERVQUAL model). The relationships were analyzed using multiple linear regression. Results Despite the challenging context, TQM was implemented to a high degree (mean = 5.44 on a 7-point scale). TQM implementation was a powerful predictor of health service quality, explaining 64.8% of the variance (R² = 0.648, F(5, 404) = 148.73, p < .001). "Systematic Processes" (β = 0.468) and "Policy & Strategy" (β = 0.305) were the strongest drivers of quality. Paradoxically, "Leadership Commitment" was the highest-rated dimension by staff but had no significant predictive power (β = 0.009, p = 0.742). Furthermore, "Human Resources" was a non-significant predictor and the lowest-rated TQM dimension, highlighting a critical implementation gap. Conclusions TQM can be effectively implemented to improve healthcare quality, even in conflict zones. However, success is driven primarily by robust systems and policies rather than perceived leadership commitment. Addressing profound human resource challenges related to workforce well-being is fundamental to the sustainability of quality improvements in such settings. Trial Registration Not applicable.
SN - 1752-1505
ER -