District hospitals in Kenya play a crucial role in healthcare delivery, yet their operational efficiency varies significantly across different districts. A quasi-experimental design was employed with data collected from surveys and administrative records. The study aimed at identifying factors influencing protocol adoption using logistic regression analysis. There is a notable difference (p < 0.05) in the proportion of hospitals adopting protocols over two years, suggesting variations in district-specific healthcare policies impact adoption rates. The quasi-experimental design successfully identified key drivers affecting protocol adoptions but did not reveal uniform reasons across all districts. District health authorities should prioritise training and support programmes to enhance the implementation of medical protocols. district hospitals, healthcare systems, adoption rates, quasi-experimental design, logistic regression Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.