TQM is a strategic management method that aims to improve healthcare, focusing on quality and care, in order to satisfy patients' needs. Despite having been implemented in the developed world, TQM is overlooked through a multitude of challenges when rolled out in post-conflict and poor, deprived nations such as Libya. This paper aims to investigate the barriers to implementing TQM in the Libyan healthcare system, through a case study of Gharyan Hospital as a model of secondary healthcare organizations. A comparison to the case of hospitals in Germany, Sweden, and France emphasizes the impacts of socio-political framework conditions, resource demands, and cultural contingencies on quality management activities. A mixed method design included in-depth interviews with 25 healthcare administrators and clinicians, a cross-sectional survey of 500 adult patients, and document analysis of quality manuals and performance indices. The numbers show a huge disparity in patient satisfaction, as 85% of shifty European hospitals compare with 65% at Gharyan Hospital. At Gharyan, the main bottlenecks were old infrastructure, a lack of trained staff, and broken information systems. Cultural issues might also have contributed, given Libyan patients' preference for being cared for in person rather than having proficient technicians.

The present study puts forward a Hybrid TQM model incorporating the EFQM (European Foundation for Quality Management) criteria and Libyan socio-cultural context with respect to phased implementation, management leadership dedication, and resources provision. The results offer some guidance for Libyan health care policy makers and hospitals’ top managers on how to enhance quality under the context of constraints.