Ghana''s dominant health care provider, the Ghana Health Service, has been promoting quality initiatives in public hospitals since the mid-1990s without appreciable effect on perceived quality. This work is a case study of two district hospitals with the aim of gaining an insight into why perceived quality in Ghanaian public hospitals remains low despite these initiatives. The literature recognizes patients'' perceptions as a measure of quality. Perceptions in turn are based on expectations, hence the need to identify patients'' expectations and work towards meeting them. Patient expectations are many, varied and changing but can be broadly categorised into staff- patient relationship, hospital-patient relationship and non-relationship expectations. The study found that there were differences between patients and health workers not about what constitute patient expectations, but about whether or not those expectations were being met. Short-term and long- term recommendations are offered for improving quality as measured by patients'' perceptions.