Quality of care refers to all aspects of treatment that are beneficial to the patient. Process quality is used to mean beneficial aspects that arise during the process of providing healthcare, including the action of health professionals, waiting period, and the clarity of communication. This study uses the principal-agent framework to examine the effect of institutional factors on the quality indicators above in the public health facilities of Ghana. The study utilizes new survey data from malaria outpatients, health workers and administrators from sixty two health facilities in three regions across the country. Ordered logistic regressions and duration estimation were used. The results show that job satisfaction and involvement of health workers in decision making are important for the improvement of process quality. Job satisfaction had a positive effect on all process quality indicators while the involvement of health workers in decision making also had a positive effect on attitude of health workers. Cordial relationship between administration and health workers might have a negative effect on attitude of health workers and waiting period.