The aim of the study was to identify causes of the inefficiency and ineffectiveness of employees and management at the largest hospital in South Africa, to improve the overall service rendered to patients, and to improve the overall operations of that hospital. An observational study approach was followed for the purpose of this study. As part of this approach, observations of particular areas within this hospital were conducted, questionnaires were distributed to a total of 450 participants both patients and hospital employees. With a response rate of 78%, the questionnaire results were able to allow the researchers to develop an Ishikawa diagram pointing to the root cause of inefficiency and ineffectiveness of employees and management at the largest hospital in South Africa. This paper presents very critical aspects of health care services inefficiency as well as ineffectiveness. Recommendations made from the findings of this study should allow management improve service delivery at this hospital.