Background:There is pressure for hospitals to adopt tool that can help them address the challenges facing the delivery of health care services. Quality management systems (QMS) are being adopted for this purpose. However, there is limited studies’ on their effect on patient care. Objectives: To establish the determinants of quality management system uptake in hospital setting and effect of implementing QMS on patient care at MTRH, Eldoret. Methods: This was a cross sectional research which utilized quantitative and qualitative research methods. A sample of 96 nurses chosen by simple random and purposeful sampling and working in a surgical unit were involved. Data was collected using 5 point Likert scale questionnaires, key informants guide and documentary reviews. Results: The aim for ISO certification was to standardize (mean 4.47, p=0.000) and to improve the quality of care (4.25, p=0.000). Critical factors to consider were staff commitment (4.16, p = 0.000) and understanding of ISO standard (4.00, p=0.000). The main challenge faced was increased amount of documentation (4.11, p=0.000). Efficiency in provision of care had improved (mean 3.88, CI 3.75-4.02) especially retrieval of records (mean 4.26, p=0.00), clear work instruction (mean 4.24 p=0.000) and improved documentation (mean 4.13, p=0.00). Patient centered care improved through provision of feedback to clients (3.89, p=0.000) and responding to clients (3.73, p=0.000). Patient safety improved (3.77, CI 3.63-3.90), while there was reduction in medication errors (4.06, p=000) and surgical site infections (4.04, p=0.000). Accessibility (mean 3.27, CI 3.10-3.43) and equity (3.6, CI 3.47-3.75) in provision of care also increased. Documentary review indicated a consistentcustomer satisfaction of 75%, an increase in bed occupancy of 10% but no change in length of stay. Conclusion and recommendations: Quality Management system was implemented in a public hospital with the aim of improving service delivery. Understanding requirements of QMS are critical in its implementation, though one need to overcome increased documentation which is seen as a major challenge. Implementation of QMS improved aspects of care but others had not improved significantly. Use of performance indicators may provide reliable measure of the effect of QMS on quality of care. Key words: Quality management systems, ISO 9001; 2008, quality of care.

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