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.

Risk Culture, Risk Management Integration, Public Sector Governance, Enterprise Risk Management, Public Health Institutions, Zambia

1. Agarwal, V., & Kallapur, S. (2023). Organisational culture and enterprise risk management effectiveness. Journal of Risk Research, 26(4), 521–540. [Google Scholar] [Crossref]

2. Arena, M., Arnaboldi, M., & Azzone, G. (2010). The organizational dynamics of enterprise risk management. Accounting, Organizations and Society, 35(7), 659–675. [Google Scholar] [Crossref]

3. Asenova, D., Bailey, S., & McCann, C. (2015). Public sector risk management and the implications for Scottish local government. International Journal of Public Sector Management, 28(7), 562–578. [Google Scholar] [Crossref]

4. Office of the Auditor General. (2022). Report of the Auditor General on the Accounts of the Republic of Zambia for the Financial Year Ended 31 December 2022. Office of the Auditor General, Lusaka, Zambia. [Google Scholar] [Crossref]

5. Aziz, N. A. A., & Manab, N. A. (2020). Risk culture and sustainable business performance: The moderating role of enterprise risk management. International Journal of Business Continuity and Risk Management, 10(3), 230–247. [Google Scholar] [Crossref]

6. Barafort, B., Mesquida, A. L., & Mas, A. (2017). Integrating risk management in IT settings from ISO standards and management systems perspectives. Computer Standards & Interfaces, 54, 176–185. [Google Scholar] [Crossref]

7. Bhaskar, R. (1978). A Realist Theory of Science (2nd ed.). Harvester Press. [Google Scholar] [Crossref]

8. Bhimani, A. (2009). Risk management, corporate governance and management accounting: Emerging interdependencies. Management Accounting Research, 20(1), 2–5. [Google Scholar] [Crossref]

9. Bozeman, B., & Kingsley, G. (1998). Risk culture in public and private organizations. Public Administration Review, 58(2), 109–118. [Google Scholar] [Crossref]

10. Bromiley, P., McShane, M., Nair, A., & Rustambekov, E. (2015). Enterprise risk management: Review, critique, and research directions. Long Range Planning, 48(4), 265–276. [Google Scholar] [Crossref]

11. COSO. (2017). Enterprise Risk Management: Integrating with Strategy and Performance. Committee of Sponsoring Organizations of the Treadway Commission. [Google Scholar] [Crossref]

12. COSO. (2023). Achieving Effective Internal Control over Sustainability Reporting. Committee of Sponsoring Organizations of the Treadway Commission. [Google Scholar] [Crossref]

13. Creswell, J. W. (2018). Research Design: Qualitative, Quantitative and Mixed Methods Approaches (5th ed.). Sage Publications. [Google Scholar] [Crossref]

14. Creswell, J. W., & Plano Clark, V. L. (2018). Designing and Conducting Mixed Methods Research (3rd ed.). Sage Publications. [Google Scholar] [Crossref]

15. Deloitte. (2023). Global Risk Management Survey: The Evolving Role of Risk Culture and Resilience. Deloitte Insights. [Google Scholar] [Crossref]

16. Ee, M. S., Abdullah, A., & Ismail, N. A. (2017). Risk culture and organizational performance in public institutions. Journal of Governance and Regulation, 6(3), 45–53. [Google Scholar] [Crossref]

17. Frigo, M. L., & Anderson, R. J. (2021). Strategic risk management: A foundation for improving enterprise risk management and governance. Journal of Corporate Accounting & Finance, 32(2), 15–28. [Google Scholar] [Crossref]

18. GRZ. (2019). Public Financial Management Reforms Programme Annual Report. Government Printer. [Google Scholar] [Crossref]

19. GRZ. (2021). Risk Management Framework for Public Sector Institutions in Zambia. Ministry of Finance and National Planning. [Google Scholar] [Crossref]

20. Gutshwa, L. (2016). Risk culture maturity in South African public entities. African Journal of Public Affairs, 9(5), 120–133. [Google Scholar] [Crossref]

21. Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate Data Analysis (8th ed.). Cengage Learning. [Google Scholar] [Crossref]

22. Hopkin, P. (2018). Fundamentals of Risk Management (5th ed.). Kogan Page. [Google Scholar] [Crossref]

23. IRM. (2012). Risk Culture: Under the Microscope. Institute of Risk Management. [Google Scholar] [Crossref]

24. McConnell, P. (2013). Systemic operational risk: The importance of risk culture. Journal of Risk Management in Financial Institutions, 6(4), 343–356. [Google Scholar] [Crossref]

25. Mikes, A., & Kaplan, R. S. (2015). When one size doesn’t fit all: Evolving directions in the research and practice of enterprise risk management. Journal of Applied Corporate Finance, 27(1), 37–40. [Google Scholar] [Crossref]

26. Nair, A., Rustambekov, E., McShane, M., & Fainshmidt, S. (2021). Enterprise risk management as a dynamic capability: A systematic review and future directions. Long Range Planning, 54(1), 101–127. [Google Scholar] [Crossref]

27. OECD. (2014). Risk Management and Corporate Governance. OECD Publishing. [Google Scholar] [Crossref]

28. OECD. (2020). Government at a Glance 2020. OECD Publishing. [Google Scholar] [Crossref]

29. OECD. (2023). Government at a Glance 2023. OECD Publishing. [Google Scholar] [Crossref]

30. Palermo, T., Power, M., & Ashby, S. (2022). Navigating institutional complexity: Risk culture in public sector organisations. Accounting, Auditing & Accountability Journal, 35(6), 1458–1483. [Google Scholar] [Crossref]

31. Park, A. (2017). Risk culture and risk management in public sector organisations. Public Money & Management, 37(6), 437–444. [Google Scholar] [Crossref]

32. Power, M. (2009). The risk management of nothing. Accounting, Organizations and Society, 34(6–7), 849–855. [Google Scholar] [Crossref]

33. Power, M., Ashby, S., & Palermo, T. (2013). Risk culture in financial organisations: A research report. London School of Economics and Political Science, 1–65. [Google Scholar] [Crossref]

34. Power, M., Scheytt, T., Soin, K., & Sahlin, K. (2009). Reputational risk as a logic of organizing in late modernity. Organization Studies, 30(2–3), 301–324. [Google Scholar] [Crossref]

35. Saunders, M., Lewis, P., & Thornhill, A. (2019). Research Methods for Business Students (8th ed.). Pearson Education. [Google Scholar] [Crossref]

36. Sheedy, E., Griffin, B., & Barbour, J. (2017). Enterprise risk management, business strategy, and governance. Journal of Risk Research, 20(8), 1070–1090. [Google Scholar] [Crossref]

37. Sheedy, E., & Griffin, B. (2018). Risk governance, structures, culture, and behaviour: A view from the inside. Corporate Governance: An International Review, 26(1), 4–22. [Google Scholar] [Crossref]

38. Silwamba, M. (2022). Risk management integration in Zambian institutions: Evidence from financial and non-financial sectors. Zambia Journal of Business Studies, 14(2), 55–78. [Google Scholar] [Crossref]

39. TBS. (2001). Integrated Risk Management Framework. Treasury Board of Canada Secretariat. [Google Scholar] [Crossref]

40. World Bank. (2022). Enhancing Public Sector Governance and Institutional Resilience in Developing Economies. World Bank Publications. [Google Scholar] [Crossref]

41. Woods, M. (2011). A contingency theory perspective on the risk management control system within Birmingham City Council. Management Accounting Research, 22(1), 69–81. [Google Scholar] [Crossref]

42. Woods, M., & Lewis, G. (2018). The influence of organizational culture on risk management. Journal of Accounting & Organizational Change, 14(3), 337–360. [Google Scholar] [Crossref]

43. Yin, R. K. (2018). Case Study Research and Applications: Design and Methods (6th ed.). Sage Publications. [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar