Enhancing the quality of health services is a primary objective for health systems globally [1]. High-quality services play an essential role in population health, patient safety, and broader development goals [1]. Previous studies underscore that improving health service quality requires organizational change and a culture of continuous improvement [2]. It depends on organizational and managerial capacities that promote improvement and enable adaptation in complex work environments [3]. Dimensions such as entrepreneurial culture, innovation, and risk-taking shape the internal environment [4-6]. These factors influence how quality initiatives are conceived and adopted. [5,6]. An entrepreneurial culture supports the development of innovations in health services, enhancing the quality of services for patients [7]. The implementation of innovative management systems in hospitals increases efficiency and improves the quality of service for both healthcare workers and patients [8]. Improving the quality of health services in fragile, conflict-affected, and vulnerable settings requires a strategic approach based on innovation [9]. Risk management plays an important role in reducing adverse events and improving service quality [10]. Entrepreneurial leadership improves the quality of health services by motivating employees [11]. Prior studies in resource-constrained settings have highlighted the importance of institutional practices and management systems for quality outcomes [11,12]. A study by Deussom et al. (2022) revealed that strengthened management routines and supervision led to measurable improvements in service delivery [12]. However, a focused examination is needed to clarify how the dimensions of strategic entrepreneurship affect service quality independently and interactively. Addressing this gap is essential for understanding which organizational lever most effectively promotes quality improvement in resource-limited contexts. This study examines the effect of strategic entrepreneurship on health-service quality in Yemeni hospitals by integrating culture, innovation, risk-taking, and leadership into a unified conceptual framework. The study empirically tests these dimensions against multidimensional indicators of service quality. It clarifies their independent and interactive contributions, providing evidence-based guidance to hospital managers and policymakers on prioritizing interventions. This finding supports sustained improvements in patient outcomes and service quality.