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. 

 

 

Poor-resourced countries need to pay attention to both the “hard” and “soft” components of quality governance

Subiri Obwogo

Senior Quality Improvement Advisor, Kenya, USAID ASSIST Project/URC

OPINION

Discussants of the webinar on “Necessary Components to Governing Quality,” distinguished between the ‘hard’ components of governance such as national policies and strategies, and the ‘soft’ components such as leadership support and developing a culture for improvement. They cited examples of countries that have hard governance components, but have not successfully operationalized these. They concluded that a national quality improvement strategy or policy is not the key to improving quality of care, and countries should instead focus on ‘soft’ components.

Improving Health Care Quality Course Online Study Group

“Improving Health Care Quality,” are hosting a two-week online study group beginning June 13, 2016 to discuss the practical applications of the course content. The study group will take place virtually via the Global Health eLearning Center.

Integrating Nutrition Services in HIV and TB Care in Mindolo I Clinic in Kitwe, Zambia

With support from the United States Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), health care workers in Kitwe District are improving the quality of nutrition assessment, counseling, and support (NACS). NACS services were not being implemented as part of the daily clinic process, despite health workers being trained in NACS and receiving the necessary tools and job aids.

How do we learn about improving health care

This paper frames the upcoming session at the Salzburg Global Seminar titled, “Better Health Care: How do we learn about improvement?” to be held from July 10-15, 2016.

Supporting Improvement: Harvesting the Global Lessons Learned

M. Rashad Massoud

Director, USAID ASSIST Project/URC

Photo caption: Participants participate in high-level policy seminar at the International Forum for Quality and Safety in Health Care, April 2015.  Photo by Amanda Ottosson, URC.

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.

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