TQM Framework for Response Procedures in Military Hospitals During the 2023 Gaza War

Abstract

Background: Military medical institutions in the Palestinian territories, particularly in the Gaza Strip, operate under extreme pressure due to the ongoing blockade and recurrent armed conflicts, including the escalation that began in October 2023. These conditions have severely damaged healthcare infrastructure, overburdened staff, and caused critical resource shortages, thereby fundamentally challenging the delivery of high-quality patient care and effective crisis response. Objectives: This study aimed to guide military medical institutions in implementing a Total Quality Management (TQM) system and to develop a TQM framework that improves administrative, medical, and engineering processes, thereby enhancing crisis-response effectiveness in this challenging context. Methods: A qualitative research design was used, involving in-depth interviews with senior managers at military hospitals in the Gaza Strip. The study focused on Algerian Hospital and Kamal Adwan Hospital because their strategic locations near conflict zones and borders make them critical to emergency response. Results: The study developed a comprehensive TQM framework. Its implementation is expected to enhance crisis-response procedures, medical and administrative services, and technical operations. The study also identified essential engineering requirements and key factors influencing emergency response times, thereby providing an actionable roadmap for institutional improvement. Conclusions: Despite profound obstacles, including structural damage, strategic constraints, and human resource limitations, the pursuit of TQM remains vital to healthcare resilience in Gaza. The proposed framework provides a pathway for military medical institutions to systematically improve service quality and crisis management. Comprehensive quality systems are urgently needed to mitigate the effects of chronic and acute crises on healthcare delivery.