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. 



The ‘improvement methodology’: necessary but insufficient to make improvement in healthcare a nationwide activity

Subiri Obwogo

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

I wish to share some thoughts on the question of ‘how not to develop a quality improvement effort’ that was discussed at the just concluded the International Forum on Quality and Safety in Healthcare in London which was held on April 21-24. It was reported that the way Country X went about conducting a national survey of healthcare quality and using the results of the survey as a basis for developing a strategic plan and a national policy for quality improvement was misguided. 

A moment of hesitation became a journey of discovery: My experience as an ISQua fellow

John Byabagambi

Improvement Advisor, USAID ASSIST Project/URC

This post was originally published on the ISQua Fellowship's monthly newsletter.

In October 2013 I visited the ISQua Fellowship booth at the 30th ISQua conference in Edinburgh, Scotland. The lady managing the booth was quick to give me information and reading material about the Fellowship. Whereas I was convinced about the information and really did want to sign up for the Fellowship, I was a little hesitant because of the fee. Nonetheless, the 20% discount for registering at the time of the offer was hard to resist, so I signed up.

Common Pitfalls for New Improvement Teams: A Story from New Delhi, India

Listen as Nigel Livesley, Project Director of the ASSIST Project in India, shares a story from a New Delhi hospital in training a new improvement team to provide better and safer care for women during the postpartum period.

There is no end to education

Faith Mwangi-Powell

Chief of Party, Kenya, USAID ASSIST Project/URC

As the USAID ASSIST Project in Kenya enters its third year, I am reminded of the reflections of the Indian speaker, mystic and philosopher, Jiddu Krishnamurti, who once remarked: “There is no end to education.  It is not that you read a book, pass an examination, and finish with education.  The whole of life, from the moment you are born to the moment you die, is a process of learning.”

Pilot of the Hhohho Regional Coordination Agency in Swaziland

PEPFAR’s goal in Swaziland is to provide financial resources and technical support to the Ministry of Health (MOH) to ensure delivery of high-quality services to patients and clients at service delivery sites, while at the same time strengthening the capacity of the health system to achieve this goal in a sustainable way.

Kenya Quality Model for Health: A Training Course for the Health Sector

The promulgation of the Constitution of Kenya on 27 August 2010 was a major milestone towards improving health standards. The chapter on the right to the highest attainable standard of health, as enshrined in the Bill of Rights in the Constitution, has raised citizens’ expectations on improved quality of health service delivery. The social pillar of the Vision 2030 emphasizes the need to improve the overall livelihoods of Kenyans through provision of efficient and high-quality healthcare systems.

Proudly toxic

Edward Broughton

Director-Research and Evaluation, USAID ASSIST/URC

In January, the Institute of Medicine’s “Committee to Support USAID’s Engagement in Health Systems Strengthening” convened an open meeting to discuss methods for improving health care in low- and middle-income countries supported by USAID. I was asked to address the issue of cost-effectiveness analysis (CEA) in improvement.  My basic message was that it’s not easy but that’s no excuse not to try do CEAs as best we can.

Understanding how improvement knowledge should be shared and used

Sidhartha Deka

Program Officer, USAID ASSIST Project/CCP

A culture of knowledge sharing and exchange is fundamental toward institutional success and this is no different when you are trying to improve healthcare.  Through using effective knowledge management (KM) mechanisms, improvement teams and those who support them should be able to articulate the output from changes that they tested.  Did tested changes yield improvement at a site? What changes did not yield improvement? What evidence supports the success of the improvement?

Creative Solutions: A Case Study of Improving Health Care in the Russian Federation

This case study describes how improvements in pregnancy-induced hypertension and neonatal respiratory distress were scaled up in two regions of the Russian Federation using existing leadership structures and champions mentored by Russian and U.S. experts.  The work described was funded by the United States Agency for International Development through the Quality Assurance Project, managed by University Research Co., LLC from 1996-2002.

Improving healthcare through culture, strategy and technique

M. Rashad Massoud

Director, USAID ASSIST Project/URC

Amanda Ottosson

Healthcare Improvement Fellow, USAID ASSIST Project/URC

This entry was originally published in the Arab Health Magazine.

The reality is that healthcare professionals know what and how to deliver quality healthcare. However, this knowledge is often not translating into practice, usually because healthcare delivery processes are not well designed to enable this to happen. Three components are integral to successful healthcare improvement. This article will discuss improving healthcare using Joseph Juran’s quality trilogy (see Figure 1) and briefly describe how these together will lead to improved quality-of-care. This cannot only ensure successful implementation, but also sustainable results and continuous improvement (see Figure 2).