District hospitals in South Africa play a crucial role in providing healthcare services to underserved populations. However, there is a need for methodological evaluation of their systems and clinical outcomes to improve service delivery. A mixed-methods approach including quantitative data collection via standardised outcome measures and qualitative interviews with healthcare providers. Randomization ensured balanced comparison groups, and data were analysed using linear regression models for continuous variables and logistic regression for categorical outcomes. In the clinical outcomes analysis, we observed a significant improvement in patient recovery times (mean difference = -12 minutes; CI: [-15 to -9]) with intervention compared to control group. The randomized field trial design provided robust evidence of system improvements and positive impacts on clinical performance. The findings suggest that systematic interventions can enhance the efficiency and effectiveness of district hospital operations in South Africa. District hospitals should implement continuous quality improvement programmes based on this study's results to sustain these gains and further improve patient outcomes. district hospitals, randomized field trial, clinical outcomes, statistical models