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


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.

Developing consensus for improvement competencies

Esther Karamagi

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.

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.

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. 

Five takeaways from a KM training in Mali

Feza Kikaya

Communications and Social Media Coordinator, USAID ASSIST Project/URC

In May, I had the privilege of traveling to Bamako, Mali, to co-facilitate a knowledge management (KM) training for our ASSIST Mali team. The two and a half day training involved 19 technical staff that work at the national, regional and district levels in Kayes region and Bougouni district of the Sikasso region. While four of the staff had some background in KM from a training that we held in Cote d’Ivoire a few years prior, the majority of participants entered the training with a clean slate, eager to learn about how to integrate KM into their improvement work.

Introducing the AFRO Guide for Developing National Patient Safety Policy & Strategic Plan

Lopa Basu

US Liaison for the WHO Service Delivery & Safety Department

As conceptual clarity on the Sustainable Development Goals (SDGs) emerges, the health component requires a clear focus on the ‘how to’ of service delivery improvement. The convergence of the world of quality improvement and the world of Universal Health Coverage is vital. 

Why we learned to hate small groups (and what to do about it)

Kate Fatta

Improvement Advisor for Knowledge Management, USAID ASSIST Project/URC

A few months ago, I was visiting my dad, and he, like any parent, asked how work was going. “Now, what are you doing again?” he asked. “I work in knowledge management,” I said and waited for the inevitable “what’s that?” I explained to him how we try to learn from what we are doing and use a variety of conversational, small group techniques to do so. “Ugh, I hate small group work,” he replied, and that was that. I realized that what he said rang true for me, too.

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.