This study examines the level of quality initiatives commitment among public hospital managers and its determinants in view of limited study :0 date and a decline in self-initiated quality initiatives activities in Sarawak, Malaysia. This is a cross-sectional study with universal sampling method conducted in all the Z1 public iwspimls in Sarawak. The study population were the senior, middle and lower level managers. The research wal was self-administered structured questionnaire. A total of 382 managers responded, corresponding ta a response irate of 8 7. 2%. As a complement, four focus group discussions were conducted, consisting 31 participants. It was found that the level of quality initiatives commitment 0f managers was generally high (mecm= 4.23, SD=O.45). The regression analysis indicated that empowerment, communication and procedural justice (promotion) accounted for 38.9%, 346% and 1.2% respectively of the variation in commitment level. Dissatisfaction with resources, top management commitment and peer influence are among others being identified by participants of focus groups as important determinants of quality initiatives commitment. It is strongly recommended that there should be greater empowerment of hospital managers, more structured and effective communication, greater transparency in procedure for promotion and commitment of resources to quality efforts.