Purpose <p>Blockchain technology offers transformative opportunities for healthcare in terms of data security, interoperability, and patient engagement. However, its adoption requires significant adjustments in infrastructure, operational workflows, and organizational culture. This study aims to evaluate healthcare staff attitudes towards blockchain technology, assess the readiness of hospitals in Ethiopia for adopting blockchain technology, and explore the relationship between attitudes and adoption readiness.</p> Methods <p>The study utilized a mixed-method approach, selecting participants through purposive and simple random sampling from Tikur Anbessa Specialized Hospital (TASH) and Armed Forces Comprehensive Specialized Hospital (AFCSH) in Addis Ababa, totaling 75 individuals. Data was collected through structured questionnaires and semi-structured interviews, and analyzed using descriptive and inferential statistics, as well as content analysis methods.</p> Results <p>While staff recognized blockchain’s perceived usefulness, they were neutral about its ease of use. A significant readiness disparity was found between the hospitals. AFCSH demonstrated a moderate level of overall readiness (Mean = 2.63 ± 0.28), whereas TASH showed a low level (Mean = 2.04 ± 0.21). Critically, no statistically significant relationship was found between staff attitudes and organizational readiness (<i>r</i> = 0.016, <i>p</i> &gt; 0.05), indicating that positive individual attitudes do not predict institutional preparedness.</p> Conclusions and implications <p>The significant disparity in hospital readiness for blockchain technology adoption carries profound implications for health system performance and population health outcomes. TASH’s low readiness, despite strong management commitment, suggests that without targeted investment in infrastructure and governance, patients at this facility may remain vulnerable to data security breaches and fragmented care coordination. Conversely, AFCSH’s moderate readiness positions it to potentially leverage blockchain for improved pharmaceutical supply chain integrity, reducing patient exposure to counterfeit medications. The absence of a relationship between staff attitudes and institutional readiness implies that policymakers and hospital administrators should shift focus from awareness campaigns designed to change mindsets towards direct investment in foundational infrastructure, cybersecurity, and dedicated financing models. Without addressing these systemic gaps, national digital health strategies risk failure regardless of frontline staff optimism, ultimately compromising patient safety, data privacy, and the equitable delivery of healthcare services across Ethiopian populations.</p>