“…This is especially the case with an ethically poor business environment. Therefore, the barriers such as the lack of quality support, poor TQM knowledge and TQM awareness, poor information sharing, temporary workers, overdependence on contract document, poor data collection measurement, undefined TQM roles and responsibilities, award to lowest bidder tendency, poor business environment, and corruption are common (Dilawo & Salimi, 2019). Looking at the health services sector, in addition to barriers that occur in other SME sectors, there are other obstacles: high employee turnover, resistance to change among employees, bureaucracy and hierarchical structure, professional autonomy, tensions between managers and professionals, and difficulties in evaluating health processes and outcomes (Alsughayir 2014;Mosadeghrad 2013).…”