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. 



Improving the quality of maternal and child health services in Latin America: past, present, and future

Jorge Hermida

Senior QI Advisor, MNCH, and Latin America Regional Director, USAID ASSIST Project/URC

In September, I had the pleasure of attending two international maternal and newborn health meetings: the “Integration of Maternal and Newborn Health: In Pursuit of Quality” technical meeting, convening global leaders on promising approaches to integration of care in Boston, Massachusetts, and the Latin America and the Caribbean Newborn Health Alliance Annual Meeting in Bogotá, Colombia. At both conferences, I presented about our work through the USAID ASISST Project to reduce maternal and newborn mortality through increasing access to and quality of care -focusing on high-impact, evidence based maternal and newborn care globally.

While many international organizations have been focused on recommending to countries and health systems the “best” interventions to put in place, the actual process of making it happen in those health systems has not always been a priority. What is needed, in my opinion, is implementation effectiveness- to focus more on the process of actually implementing those best practices, including identifying the main barriers and facilitating factors and the best ways to achieve large scale implementation with an effective level of quality.

My sex worker encounter

Edward Broughton

Director, Research and Evaluation, USAID ASSIST Project/URC

No – this isn’t a kiss-and-tell but names and some details have been slightly changed to protect the innocent and those not exactly so. It is the story of what really happened in Melbourne where I was for the 20th International AIDS Society Conference. This occurred not at the conference, but at the bed-and-breakfast where I was staying.

The case for collaborative improvement

Lani Marquez

Knowledge Management Director, USAID ASSIST Project/URC

Collaborative improvement – an improvement strategy that harnesses the efforts of many teams or sites to work together intensively for a defined period to achieve “breakthrough” improvements in a specific area of care – is getting increasing attention as an effective health care improvement methodology.

ICAP’s quality improvement training program recently featured a webinar by Dr. Lynne Miller Franco, our colleague at EnCompass LLC, presenting findings from an evaluation commissioned by the U.S. Agency for International Development (USAID) to examine the evidence from a large number of collaboratives carried out under USAID’s Quality Assurance and Health Care Improvement projects.

And you think Obamacare is BIG…..

Edward Broughton

Director, Research and Evaluation, USAID ASSIST Project/URC

January 1, 2014 marked the launch of arguably one of the largest public health policy programs in history, though the event itself managed to keep a low profile.

Everyday KM

Lani Marquez

Knowledge Management Director, USAID ASSIST Project/URC

How can knowledge management (KM) improve food and nutrition programming?  Alyssa Lowe of CARE and I posed that question last week at the Food Security and Nutrition (FSN) Network  “Knowledge Sharing” Meeting held July 10-11 in Washington, DC, sponsored by the USAID Food for Peace Office’s  Technical and Operational Performance Support (TOPS) Project.

Improvement science and the FIFA World Cup

Edward Broughton

Director, Research and Evaluation, USAID ASSIST Project/URC

As arguably the largest improvement organization in low and middle income countries, I believe the ASSIST Project ought to offer its technical expertise in improving systems for better results to organizers of the FIFA World Cup. One issue to address, somewhat related to the ASSIST Project’s work in nutrition, is the matter of biting. First, I register my sympathies with Uruguay’s Luis Suarez – I have often found myself very hungry while playing football and been tempted towards anthropophagy with whatever flesh happens to be close by, usually a member of the opposing team.

Distress on a wooden bench – explaining health care improvement and patient outcomes in Nakuru, Kenya

Faith Mwangi-Powell

Chief of Party, Kenya, USAID ASSIST Project/URC

Sitting on a hard wooden bench in Nakuru district hospital’s outpatient department, an eight-month pregnant Nyambura (not her real name) and her husband Julius were very anxious for many reasons.  Since her pregnancy started, she had never been seen by a medical practitioner and never attended any antenatal appointments.  This morning Nyambura had decided to visit the clinic as her normally active fetus had not kicked for several days. She was worried if all was well.  

Why is knowledge sharing now a mainstay of improvement?

M. Rashad Massoud

Director, USAID ASSIST Project/URC

Sharing knowledge and exchanging information is critical to improving health care more so now than ever before. Knowledge management (KM) is a key strategy for fostering “evidence-based quality improvement” in the USAID ASSIST Project.  When working deliberately to improve health care, health care professionals gain insights worth sharing with others and can benefit from the insight of others. Scaling up improvement efforts across large portions of a country’s health system – ASSIST’s mandate – requires that we have systems for capturing learning and transferring that learning across multiple sites and improvement teams.  

Why quality is much more than just dealing with long queues in a dispensary

Eunice Musembi

Improvement Advisor, Kenya, USAID ASSIST Project/URC

Most health facilities in Kenya like Nessuit dispensary in Nakuru County, have few staff in comparison to the number of clients they serve per day, and for a long time the dispensary staff did not know about simple interventions that could help them offer better services to their clients.

‘Even though we wanted to find a way of dealing with the long queues, it was quite a challenge because we did not have structures to help in the smooth flow of clients,’ said Mr Isanda, a nurse in Nessuit dispensary.

Cleaning hands protects patients, in any country of the world

Claire Kilpatrick

Programme Manager, World Health Organization

I recently had the privilege of facilitating a retrospective exercise to gather information on prevention of hospital-acquired infections (HAI) in a Costa Rican paediatric facility for a World Health Organisation (WHO) photo story. The story became front page WHO news on the occasion of the WHO SAVE LIVES: Clean Your Hands global annual day ‘every 5 May’.