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. 



What do we mean when we say “quality care”?

M. Rashad Massoud

Director, USAID ASSIST Project/URC

I remember, in the early days of improving health care, I used to spend hours with other quality improvement experts talking about the definitions of quality care and the different methods and approaches to improving it.  Well that’s history.  The science underlying health care improvement is overburdened with multiple terms and jargon describing essentially similar methods and concepts.  This confusion is further compounded by different organizations applying brand names to similar methodologies in order to copyright them.  To do so, they essentially put a twist on existing methods. 

Freudian Slip

Edward Broughton

Director-Research and Evaluation, USAID ASSIST/URC

What do Sigmund Freud and some in the field of improvement have in common? No, this is not the beginning of a Woody Allen joke and I hope the answer is a simple “nothing”. But sometimes when I hear those immersed in improvement say that our work is too complex and nuanced for randomized trials or other rigorous research methodologies, it reminds me of the famous cigar-smoking psychoanalyst.

What exactly is improvement?

M. Rashad Massoud

Director, USAID ASSIST Project/URC

Many low- and middle-income countries are not on track to achieve the Millennium Development Goals (MDGs) by the 2015 target. At first glance, when you look at the WHO MDG Scorecard for health, you will notice that some regions are more on track than others.  But, what is also apparent is that even among those regions that are less on track; they are doing better on some MDG indicators than others. Why are some places able to do well, and others not?

National QI Forum Bringing New Energy to Health Care Improvement in Tanzania

Delphina Ntangeki

Improvement Advisor, KM and Communications, USAID ASSIST Project/URC

The Tanzanian Ministry of Health and Social Welfare (MOHSW) in collaboration with implementing partners launched the first National Quality Improvement Forum in November 2011. It was during this forum that the MOHSW and implementing partners reached a consensus to make the forum an annual event to be held in November every year.

Dr. Nasty: Avoid a Doctor that Treats You Like Dirt

Edward Broughton

Director-Research and Evaluation, USAID ASSIST/URC

Is a nasty doctor bad in other ways? Apparently, if your doctor treats you like dirt, there may be more reason to avoid him or her other than the fact that it’s not good to be treated like dirt – by your doctor or anyone else.

Tetanus Deaths are Preventable

Jude Thaddeus Ssensamba

Quality Improvement Officer, Uganda, USAID ASSIST Project/URC

This post originally appeared as an editorial on the New Vision newspaper in Uganda on Friday, March 21.

In just one week, two people close to me succumbed to tetanus, not counting the New Vision newspaper photographer. These are a few of the notable rising number of people dying from an immunizable disease that can be prevented by simple, affordable health interventions. With rising mortality, it’s time that we acted to improve the quality of health care given to accident, trauma and violence victims.

Listening Better Can Save Lives

Sonali Vaid

Improvement Advisor, USAID ASSIST Project/URC

It was 2008. I was working as an intern at a hospital in New Delhi, India. A young boy, perhaps 13 years old, came in for a blood transfusion. He had thalassemia so was no stranger to the hospital. I was preparing to start the IV line on the back of his left hand; I found a good vein and was about to put the needle in when he interrupted me. He stuck out his right middle finger and told me demurely to put it in the side of the finger. I gently told him – “No, that is not a good place, it is going to hurt there.” He was quiet and let me proceed.

Knowledge Café

A Knowledge Café is a conversational process that is sometimes called World Café.  It is an innovative yet simple methodology for hosting conversations about questions that matter. These conversations link and build on each other as people move between groups, cross-pollinate ideas, and discover new insights into the questions or issues that are important in their work or community.


1-2-4-All is a group process from the Engaging Everyone with Liberating Structures guide that facilitates rich conversation in small groups and then brings the small groups together to integrate their ideas around an important question or issue.

Field Trip Around the Room

The field trip is a technique that can be used in a meeting to organize how members of the group discuss several topics and integrate their ideas for how to address them.  It uses small group conversation and successive discussions of the same topic by different groups to help to integrate the ideas of the whole group around specific topics and questions.