<p>This study examines the effect of ethical leadership on organizational healthcare excellence, and organizational citizenship behavior is used as an intervening variable. The study explores how ethical leadership components, such as integrity, employee orientation, and ethical direction, are associated with hospital performance excellence, addressing a gap in research on leadership in Middle Eastern healthcare organizations. Data were collected using a standardized questionnaire from 300 King Abdullah Hospital regular employees in Bisha, Saudi Arabia, using simple random sampling. Structural equation modeling aided by Stata was employed to analyze the data. The findings are that ethical leadership affects organizational citizenship behavior and organizational excellence positively with statistically significant effects. organizational citizenship behavior was a poor mediator between excellence and ethical leadership and provided evidence that, besides voluntary employee behavior, ethical leadership also has various other psychological or structural mediators. Amongst the organizational citizenship behavior dimensions, sportsmanship and civic virtue were highly correlated with their underlying construct, and the model fit indices showed that model measurement and structure were good. The strategic benefit of ethical leadership to organizational performance and climate is transferable to healthcare. In terms of managerial suggestion, findings merit the application of reward schemes and leadership development programs that reward ethical behavior and discretionary effort. Such programs are most likely to induce long-lasting excellence in healthcare organizations, particularly in reform-focused environments such as Saudi Arabia. Future research is invited to examine other situation variables and mediator factors influencing the ethical leadership–performance relationship.</p>