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. 



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.”

Proudly toxic

Edward Broughton

Director, Research and Evaluation, USAID ASSIST Project/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 II, 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? And finally, what kind of “how-to” knowledge should be passed onto other sites to aide their improvement efforts?

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).

How do we learn about improvement?

Danika Barry

Healthcare Improvement Fellow, USAID ASSIST Project/URC

M. Rashad Massoud

Director, USAID ASSIST Project/URC

Commentary on the Quality & Performance Institute's Technical Meeting held on December 17, 2014. A full transcript is available here.

For our December Quality & Performance Institute Technical Meeting, we invited Dr. Frank Davidoff and other thought leaders in the field of improvement science to comment on the issues raised in Davidoff’s recent article, “Improvement interventions are social treatments, not pills.”

African Partnerships for Patient Safety: Lessons learned

Shams Syed

Programme Manager, World Health Organization

This post was originally published by the Agency for Healthcare Research and Quality.

In the last six years I have had the privilege of shaping and leading the implementation of a WHO program focused on improving patient safety in Africa through the use of hospital partnerships. African Partnerships for Patient Safety (APPS) has been implemented through a phased approach aimed at continuous refinement. In this article, I summarize the journey and reflect on key implications on the use of institutional health care partnerships for global patient safety improvement.

Why quality matters for Universal Health Coverage

M. Rashad Massoud

Director, USAID ASSIST Project/URC

As we celebrate Universal Health Coverage Day on December 12, we on the USAID ASSIST Project are committed to supporting countries to promote better and more equitable health outcomes by expanding access to essential health care to all who need it, regardless of socio-economic status or geographic location.

Making care more people-centered

Sarah Smith Lunsford

Senior Improvement Advisor, Research & Evaluation, USAID ASSIST/EnCompass LLC

While it is widely recognized that people-centered care is an essential part of quality health care, what we mean by people-centered care is much harder to define. For the past several months, the ASSIST Project has been grappling with how to integrate a people-centered approach into our improvement work.  Drawing on the literature and frameworks from WHO and others, we have developed five principles to ground our efforts:

A milestone in global efforts to improve health care

James Heiby

Project Officer, USAID ASSIST Project and Medical Officer, Office of Health Systems, USAID

Last month marked the closing of the USAID Health Care Improvement (HCI) Project, the largest global effort to date to improve health care quality in lower- and middle-income countries (LMICs).  A seven-year USAID project that operated in 38 countries, HCI built on earlier USAID-funded projects and the experience of high-income countries to directly examine both clinical and non-clinical health care activities and develop ways to improve them. 

Continuous quality improvement: sustaining improvement

M. Rashad Massoud

Director, USAID ASSIST Project/URC

This post was originally posted on the Global Health Council's website and was adopted from Dr. Massoud's presentation at the World Health Organization’s Scoping Consultation on Strengthening Quality of HIV Clinical Services in Resource-Limited Settings on September 15.

In the last few years, we have increasingly come to realize that we have many high impact interventions and can save lives and alleviate suffering. Unfortunately these interventions are currently not reaching every patient and every client every time they are needed. This blog will discuss identifying the need for improving health care.