Introduction <p>Servant leadership, a value-based leadership motivated by the notion that serving is an innermost principle of the servant leader, has become increasingly prevalent as a leadership style in healthcare organizations. Despite the theoretical promises, however, scholars and practitioners lack a deeper understanding of the explanatory mechanisms for servant leadership to favorably shape valued healthcare outcomes. Based on self-determination theory of motivation, this research aims to analyze the mediating effects of work engagement and patient safety culture in the relationship between servant leadership and task performance in Ethiopian public healthcare.</p> Methods <p>A total of 326 matched provider-supervisor responses were collected from multiple units across three large public-sector hospitals in Addis Ababa, Ethiopia. The study employed a quantitative correlational survey design, and the research hypotheses were examined using partial least squares structural equation modeling (PLS SEM).</p> Findings <p>The results disclose that healthcare managers’ servant leadership behavior significantly enhances the task performance of healthcare employees both directly and indirectly via the mediating effects of work engagement and patient safety culture. This relationship was further found to be sequentially mediated, progressing from work engagement to patient safety culture.</p> Conclusion <p>Our study provides novel evidence on the predictive role of healthcare managers’ servant leadership in enhancing task performance through work engagement and patient safety culture. The findings underscore the importance of motivational and cultural mechanisms in optimizing workforce performance within resource-constrained public hospitals in developing countries such as Ethiopia. Moreover, the study offers key insights into how enhancing work engagement and cultivating a robust patient safety culture can serve as effective intervention strategies to improve task performance in public hospital settings.</p>