Improvement Science

The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need, in a comprehensive way, and on an adequate scale.

                                                                                                                                                             -- Margaret Chan, Director General, WHO

Despite an abundance of evidence-based guidelines and consensus on what should be done, many simple, high-impact interventions capable of saving lives and alleviating suffering are not reaching the people who most need them.
Model for Improvement

Adapted from Associates in Process Improvement, 1996

Much of this implementation gap is related to weak health systems and processes of care delivery. The USAID ASSIST Project is designed to address this challenge, achieving better health outcomes and strengthening health systems in USAID-assisted countries, through improvement science

Improvement science is the application of scientific methods to make processes and systems work better.  The fundamental concept of improvement science is that improvement requires change. If a system is not changed, it can only be expected to continue to achieve the same results. In order to achieve a different level of performance, changes must be made to that system in ways that permit it to produce better results.

An equally important concept is that while improvement requires change, not every change is an improvement. Because not every change makes care better, changes must be tested and studied to determine whether the change improves care quality.

This section of the ASSIST Knowledge Portal provides information on improvement methods and tools and resources for building capacity for improvement to help you make changes to improve your own system of care.

We also invite you to browse our database of improvement stories or submit your own story of how you have improved care. 

 

 

ASSIST Zambia NACS Progress Report

In October 2015, the USAID ASSIST Project Zambia team published an 11-page progress report that describes results achieved following the integration of nutrition assessment, counseling, and support (NACS) based on Zambia’s national quality improvement guidelines in eight out of 27 FANTA-supported sites in Kitwe District. Through technical support to the facility teams and capacity building of the district in improvement, ASSIST is strengthening nutrition services for PLHIV.

Key takeaways from the report are:

Quality Improvement Initiatives in the Government of India’s RMNCH+A Strategy: Lessons from Chamba, Himachal Pradesh

ASSIST’s India team started providing QI support in December 2013 to improve services at health facilities in Chamba District in Himachal Pradesh State. Within a few months, the district government saw good, sustained results from QI initiatives for the Government of India’s RMNCH+A program and with ASSIST’s support, the district government has been very active at all levels (facility, district, state) in scaling up QI.

Developing consensus for improvement competencies

Esther Karamagi

Deputy Chief of Party, Uganda, USAID ASSIST Project/URC

Kim Ethier Stover

Senior Improvement Advisor, USAID ASSIST Project/URC

Over the past couple of years, a wide range of stakeholders in East Africa have been involved in developing a framework of core competencies for quality improvement. This process was facilitated by the Regional Centre for Quality of HealthCare and the USAID ASSIST project.  An initial group of stakeholders from Ministries of Health in Kenya, Tanzania, and Burundi, nursing councils in Kenya, Uganda, Rwanda, and Tanzania, and medical and public health training institutions form Kenya, Tanzania, and Uganda gathered to brainstorm core competencies that were needed by health care worker to continuously improve the care they provide. Following the initial development, the framework went through two rounds of Delphi review by experts in quality improvement from the USAID ASSIST project, ICAP/Columbia University, WHO, Path International and the Ministry of Health in Uganda.

Health Profession Councils National Strategic Plan 2015–2020

This strategic plan was developed by the Ministry of Health of Cambodia and the five health professions councils (Medicine, Dentistry, Midwifery, Nursing, and Pharmacy) with support from the USAID ASSIST Project.  The strategic plan is intended to guide the implementation and evaluation of priority improvements for health professions regulation in Cambodia.

Taking stock of USAID's efforts to promote learning

Lani Marquez

Knowledge Management Director, USAID ASSIST Project/URC

USAID LEARN recently convened a day-long event in Washington DC to recognize and celebrate progress in implementing USAID’s collaborating, learning, and adapting (CLA) strategy.  

CLA, which is often referred to in the context of the USAID Program Cycle, is essentially a set of principles and operational processes to enable USAID to become a more effective learning organization and thereby a more effective development organization.  

The event was replete with knowledge management disciples from USAID Washington, some Missions, and a lot of implementing partners.  The event was definitely aimed at the CLA in-crowd—the people who believe that learning is or should be an intrinsic part of development programming and are actively trying to figure out how to build in and use learning processes in our work.

USAID ASSIST Project Annual Performance Monitoring Report FY15

This annual report for the USAID ASSIST Project summarizes the project's accomplishments and results in FY15 supporting the application of modern improvement methods by host country providers and managers in USAID-assisted countries. During FY15, USAID ASSIST provided assistance in 23 countries through field and core funding.

FY15 Results:

Improving Health Care Quality eLearning Course

This course aims to introduce learners to principles and approaches that can help health care workers continually improve the work that they do. It will help to demystify improving health care, its underlying principles, and explain how proven interventions can be incorporated into practice for every patient. The course will focus on process improvement which has a large body of evidence in USAID-supported countries.

New ASSIST eLearning course on the Global Health eLearning Center: Improving Health Care Quality

Kim Ethier Stover

Senior Improvement Advisor, USAID ASSIST Project/URC

This blog post was originally published on the USAID Knowledge for Health Project's website.

Many low- and middle-income countries are following the lead of high-income countries by prioritizing improvement in the quality of care provided by their national and private health systems. Increasingly we see a political will to develop national policies and strategies, but navigating the extensive array of approaches to improve quality can be daunting. Common approaches to improve quality range from training and supervision to standards and guidelines to comprehensive accreditation programs, and all of these approaches have varied costs, results, appropriateness and effectiveness. Often Ministries of Health get conflicting advice about what the best approach is for their country. One of the most important things for them to understand is that no one approach solves all problems. 

Indonesia hospital accreditation process impact evaluation: Midline report

In 2011, USAID Indonesia commissioned the USAID Health Care Improvement Project (HCI) to conduct an evaluation of the impact of current hospital accreditation initiatives in Indonesia. After the baseline assessment, support for the activity was provided through the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project.

ICAP Webinar: Zambia QI National Strategy Development

Online

As part of the “Introduction to Quality Improvement” training course implemented by the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University's Mailman School of Public Health, Ms.Rachael Lungwebungu, Quality Improvement Advisor to the Ministry of Health of Zambia, will lead this webinar on Wednesday, September 30 on the development of the national quality improvement strategy in Zambia.

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