Risk Culture and the Integration of Risk Management in Zambia’s Public Health Sector: Evidence from Ronald Ross General Hospital

This study examined the influence of risk culture on the integration of risk management within Zambia’s public health sector using Ronald Ross General Hospital as a case study. The study was motivated by concerns regarding weak institutional risk management practices, operational inefficiencies, and the limited integration of risk management systems within public sector institutions despite the existence of regulatory frameworks such as the Public Finance Management Act No. 1 of 2018 and the Government of the Republic of Zambia Risk Management Framework. Although enterprise risk management has received growing scholarly attention globally, limited empirical evidence exists on the relationship between risk culture and risk management integration within Zambia’s public health sector. The study therefore sought to address this contextual gap by examining how organisational risk culture influences effective risk management integration within a public health institution. The study adopted a mixed methods research design grounded in the critical realism paradigm. Primary data was collected through structured questionnaires and semi structured interviews involving management and operational staff at the hospital. Quantitative data was analysed using descriptive and inferential statistics, while qualitative data was analysed thematically. The findings revealed that the hospital had moderately established risk management structures, including risk profiling mechanisms, governance structures, and continuous learning initiatives. However, the integration of risk management into institutional decision-making and operational processes remained limited due to weaknesses in organisational risk culture. The study further established that risk management practices were largely compliance driven rather than fully embedded within institutional operations. The study contributes to public sector governance and enterprise risk management literature by demonstrating that risk culture is a critical institutional capability influencing effective risk management integration within public health institutions. The study concludes that strengthening organisational risk culture is essential for enhancing integrated risk management within public sector health institutions. It recommends stronger leadership commitment, continuous risk management training, institutional accountability mechanisms, and the mainstreaming of risk management into strategic and operational processes.