Impact of Total Quality Management on Healthcare Service Quality in Yemeni Hospitals: A Cross-Sectional Study

Background: Healthcare quality is a critical challenge in Yemen's conflict-affected health system. In response, the Ministry of Public Health and Population mandated the implementation of Total Quality Management (TQM) in 2021. This study provides a comprehensive evaluation of the impact of TQM on healthcare service quality, with a focus on frontline nursing and healthcare professionals. Methods: This cross-sectional analytical study included 410 healthcare professionals from four purposively selected hospitals (three public and one private) in Sana'a. Data were collected using a validated questionnaire that measured five TQM dimensions (Leadership Commitment, Human Resources, Policy & Strategy, Partnerships & Resources, Processes) and five dimensions of health service quality. Data were analyzed using descriptive statistics, correlations, and multiple linear regression. Results: The results indicated a high level of TQM implementation (mean = 5.44, 7-point scale). TQM implementation was a strong and significant predictor of health service quality, explaining 64.8% of the variance (R² = 0.648, F(5, 404) = 148.73, p < .001). The "Processes" dimension had the largest positive impact (β = 0.468), followed by "Policy & Strategy" (β = 0.305). Notably, the "Human Resources" dimension was not a significant predictor, and its low descriptive scores suggest it remains a key implementation challenge. Conclusions: TQM implementation significantly enhances healthcare service quality in Yemeni hospitals, demonstrating its effectiveness even in a fragile state. The findings reveal that systematic processes and strategic policies are primary drivers of quality improvement. However, the success of these programs is contingent on addressing the critical human resource challenges related to staff satisfaction and support. Healthcare leaders should prioritize both process optimization and workforce well-being to achieve sustainable quality improvements. Trial Registration: Not applicable.