ABSTRACT Total quality management (TQM) is a combination of leadership, staff involvement, patient-focused care, process control and continuous improvement. The overall idea of the structured narrative review is to synthesise the evidence related to hospital TQM implementation, barriers and implications in the context of Sudan. The literature was identified using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar and official health-organization resources. Evidence was thematically synthesized and differentiated by integrated TQM, related quality approaches, or by contextual relevance. Studies conducted in hospitals mostly found links between TQM practices and the perceived quality of service or organizational performance. Leadership effects were dependent on context and there was a lack of consistency between provider assessments and patient experience. The evidence of the lean, laboratory quality-management systems and risk-management interventions guided specific improvement mechanisms, but did not establish the effectiveness of integrated TQM. Sudanese data showed low levels of professional involvement in quality improvement and organizational barriers, and no assessment of a hospital TQM program. A four-step process is suggested: a readiness assessment, standardization and training, pilot implementation, and evaluation with gradual expansion. The framework is a synthesis, which has not been tested, and is designed to provide a basis for future empirical study. While TQM could provide an organizational framework for improvement in Sudanese hospitals, further evaluation of the 'feasibility, effectiveness and sustainability' of TQM is needed at the local level