It is not easy for all South Africans to access health services and it is often the case that public healthcare facilities are often undersupplied and offer poor quality service to outpatients. The expectations and experiences of outpatients vary considerably and the perception of many is that they would rather not bother to visit a facility. This in itself is highly problematic since those who keep away and who are afflicted with communicable diseases will in all likelihood spread their disease, with what could be dire outcomes. This paper is based on a literature exploratory overview and suggests an ethics paradigm infused with quality excellence, for public service hospitals which it is proposed, require greater moral intensity, leadership, design with strategic focus, effective change management and above all, a culture of engagement with all stakeholders especially outpatients. The postulations in this paper may serve as a basis for building better ethically driven quality into the provision of services in public hospitals in South Africa. The guidelines which are proposed could be used practically in health care provision so as to identify quality gaps and offer concrete solutions for quality improvement in public hospitals.