Discussion
We found marked changes in several management indicators over 10 months of intervention using a partnership–mentoring model, EHMI, in Ethiopian hospitals. About 60% of the management indicators surveyed showed some improvement
in the domains of human resources, medical records, nursing standards and practice, infection prevention and control, quality management and financial management. Although improvements were not uniform across all hospitals and across all indicators, the EHMI training and mentoring in quality improvement seemed to have a positive overall effect in key areas. This finding is consistent with other research showing that quality improvement efforts can be effective in lower-resource countries , although such work has not been previously conducted in Ethiopia, and in such a wide geography as six regions and two city administrations of the country.
An important aspect of successful healthcare management is the ability of leaders to work collaboratively and effectively with other groups in the system. In the hospital setting, such groups include the RHB or city health bureau and the hospital clinical and administrative staff. Our data suggest that the hospital leaders participating in this intervention were able to improve their relationships with these key constituent groups. These relationships may foster longer-term improvements in the management and integration of the hospital with its regional or city healthcare system.