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. 



"I told him to wear gloves, but he did not listen" - The limits of patient awareness in ensuring quality and safety of care

Sonali Vaid

Quality Improvement Consultant, WHO Collaborating Centre for Newborn Care at the All India Institute of Medical Sciences, New Delhi

For the last two years, together with my colleagues, I have been supporting activities in Africa and in Asia focused on improving safe injection practices and ensuring that every injection is given with a new unused syringe and needle in a sterile manner and that patients don’t receive injections unnecessarily where other simpler, safer options are feasible.

Two incidents within my own family brought these problems too close to home.

Last year, while I was based at the project headquarters in Bethesda and my parents were in New Delhi, India, I received a call from my mother informing me that my father had been feeling weak and they had gone to the local clinic where they had given him a ‘glucose drip’ for energy. Duh! Here I am preaching to the world not to use ‘glucose drip’ for ‘energy’ and here is my father receiving an unnecessary IV infusion! Adding insult to injury, my mother tells me that the doctor has left the IV cannula in place overnight so that my father could return to receive another ‘glucose drip’ the next day!