Hospital quality improvement in Ethiopia: a partnership–mentoring model

Background and Objective Quality improvement efforts are increasingly common in the United States; however, their use in developing countries is limited. We sought to evaluate the impact of a large-scale intervention on several key management indicators through hospital quality improvement efforts. Design Pre–post-descriptive study of 14 hospitals in Ethiopia. Setting Six regions and two city administrations in Ethiopia. Participants Hospital leaders and management mentors in participating hospitals. Intervention In collaboration with the Ministry of Health and the Clinton HIV/AIDS Initiative, we implemented a countrywide quality improvement initiative in which 24 mentors with hospital administration experience were placed for 1 year in Ethiopia to work side-by-side with hospital management teams. We also provided a professional development course to enhance quality improvement skills. Main Outcome Measure(s) Presence of 75 key management indicators; reported management skills of hospital leaders by the mentors. Results In pre–post analysis, we found improvement in 45 of the 75 (60%) key management indicators between August 2006 and May 2007. The changes reflected a total of 105 management indicators improved across the 14 hospitals, which equates to a per-hospital mean of 7.5 (standard deviation 5.9) improvements. Reported management skills of hospital leaders improved in several management domains, although their reported confidence in these skills remained largely unchanged. Conclusions Our findings indicate that quality improvement efforts can be effective in improving hospital management in developing countries. Longer follow-up is required to assess the sustainability of the hospital improvements accomplished.