Nekemte Specialized Hospital (NSH) has been operating since 1928 and is located in west Ethiopia in Nekemte town, 330 km west of Addis Ababa. NSH is one of the four specialized hospitals in Oromia regional state and Is one of the leading hospital in region and country leading, mentoring and couching other six hospitals on all dimensions of quality of patient care including patient safety . The hospital has a catchment population of 3.5 million people while the setting has not changed in all the years and was originally planned to serve 15,000 people. The hospital is serving around 1000 patients per day in the outpatient and inpatient department providing optimal laboratory, imaging and pharmaceutical services. They have a 24 hours service and about 300 beds in all inpatient departments. There is high load of trauma and fractures from road traffic accident and violence, handled by the one and only orthopedic they have. The operating theatre is one of the busiest theatres in the Oromia region, performing an average of 15 major surgeries every day. The child delivery room is one among the busiest in this area making an average child delivery of 12 per day and they have a neonatal intensive care unit accommodating 25 beds. They also provide services like outpatient psychiatry services, histopathology services, maternal & child health services, inpatient medical, surgical, gynecology and obstetrics, pediatric service, TB clinic and MDR TB Clinic, HIV/ART clinic etc. The hospital has a staff number of about 360 in various areas (117 administrative and supportive staff, 125 nursing, 20 midwifery, 21 laboratory, 16 pharmacy, 2 health planning & evaluation, 4 clinical governance & quality improvement officers, 1 environmental & hygiene expert, 2 biomedical engineers, 3 radiographers, 3 psychiatry professional, 35 general practitioners and 12 specialized physicians); furthermore, the hospital is an official assessment hospital for public health officer and on progress for nursing students.