title: Use of a national collaborative to improve hospital quality in a low-income setting.
abstract: BACKGROUND
  Quality improvement collaboratives are a widely used mechanism to improve hospital performance in high-income settings, but we lack evidence about their effectiveness in low-income settings.
  
  
  METHODS
  We conducted cross-sectional and longitudinal analysis of data from the Ethiopian Hospital Alliance for Quality, a national collaborative sponsored by Ethiopia's Federal Ministry of Health. We identified hospital strategies associated with more positive patient satisfaction using linear regression and assessed changes in patient experience over a 3-year period (2012-2014) using matched t-tests.
  
  
  RESULTS
  A total of 68 hospitals (response rate 68/120, 56.7%) were included in cross-sectional analysis. Four practices were significantly associated with more positive patient satisfaction (p<0.05): posting a record of cleaning activity in toilets and in patient wards, distributing leaflets in the local language with each prescription, and sharing ideas about patient experience across the hospital. Among hospitals that had complete data for longitudinal analysis (44/68, 65%), we found a 10% improvement in a 10-point measure of patient satisfaction (7.7 vs 8.4, p<0.01) from the start to the end of the study period.
  
  
  CONCLUSIONS
  Quality improvement collaboratives can be useful at scale in low-income settings in sub-Saharan Africa, particularly for hospitals that adopt strategies associated with patient satisfaction.
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Linnander
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA.
authors.forename: Zahirah
authors.initials: Z
authors.lastname: McNatt
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Sipsma
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA.
authors.forename: Dawit
authors.initials: D
authors.lastname: Tatek
authors.affiliation: Clinton Health Access Initiative, Addis Ababa, Ethiopia.
authors.forename: Yigeremu
authors.initials: Y
authors.lastname: Abebe
authors.affiliation: Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Endeshaw
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA elizabeth.bradley@yale.edu.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005002:Ethiopia; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011203:Poverty; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D012499:Sanitation
keywords: Collaborative; Ethiopia; Health services research; Organizational innovation; Patient experience; Quality improvement