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The chronic conflict in the Occupied Palestinian Territory poses additional challenges to the access and delivery of healthcare services. The intrusion of politics is reflected on the operations of all the Palestinian institutions. Governmental Hospitals in Palestine operate above the limits of their design capacity. This state of work to cope with high demand leaves behind adaptive responses and practices that negatively affect the quality of care. This cross sectional study assesses patient satisfaction as hospital outcome and applies process analysis approach to achieve the research objective in an attempt to improve quality in Palestinian hospitals.