Leadership Enhancing Employee Morale: The Missing Link in the Quality Management of a Sub-Saharan African Public Hospital

This study examines the role of leadership support in enhancing employee morale and strengthening Total Quality Management (TQM) implementation within a Sub-Saharan African public hospital context. Public hospitals in the region continue to experience service delivery challenges despite formal commitments to quality improvement, suggesting a persistent gap between quality management policy and operational practice. Guided by the Resource-Based View (RBV), the study conceptualizes leadership capability, employee morale, resources, and process management as strategic organizational resources that influence healthcare service delivery. A deductive, quantitative, cross-sectional survey design was adopted. Structured questionnaires were administered to 150 hospital staff members and 250 clients at the hospital of study, with response rates of 65.3% and 79.6%, respectively. Data were analysed using descriptive statistics, correlation analysis, and multiple regression analysis. The findings indicate that leadership support for TQM, resource adequacy, and managerial task execution were generally perceived as low to moderate. Regression results further revealed that TQM Leadership and TQM Process were the only dimensions that significantly and positively influenced employee morale. These findings suggest that leadership is not merely one dimension of TQM, but the strategic capability that activates other TQM dimensions by mobilizing resources, supporting employees, and aligning processes with quality objectives. The study concludes that leadership-enhanced employee morale represents a critical missing link between TQM implementation and improved healthcare service delivery. It recommends leadership development, stronger resource commitment, employee engagement, process improvement, and institutionalisation of a TQM-oriented culture in public healthcare settings.