<![CDATA[General Background Modern healthcare organizations operate in high-stakes environments where quality management is vital for survival. Specific Background Implementing Total Quality Management requires embedding quality principles into routine bedside practices. Knowledge Gap However, a significant disconnect persists between organizational intent and practical service delivery in hospital environments. Aims This study investigates the impact of Total Quality Management dimensions on clinical efficiency, service quality, and patient safety. Results Structural equation modeling of 384 medical staff and patient responses confirms that Quality Culture is the strongest predictor of Patient Safety ($\beta = 0.52, p < 0.001$), while Service Quality strongly correlates with patient satisfaction ($\beta = 0.63, p < 0.001$). A ServQual gap analysis reveals a severe negative magnitude ($-0.77$), with Empathy exhibiting the largest deficit ($-1.10$). Novelty The research validates an integrated structural framework combining industrial Lean Six Sigma and ServQual concepts within healthcare. Implications Hospital leadership must prioritize soft-skills training and culture transformation over purely technical protocol enforcement. Key Findings Highlights Quality culture serves as the primary predictor for patient safety outcomes. Frontline staff demonstrate strong professional resilience despite moderate administrative support. Patient satisfaction gaps are heavily driven by deficits in empathy and responsiveness. Keywords Total Quality Management, Healthcare Service Quality, Patient Safety, Servqual Model, Organizational Culture]]>
