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. 



Field Trip Around the Room

The field trip is a technique that can be used in a meeting to organize how members of the group discuss several topics and integrate their ideas for how to address them.  It uses small group conversation and successive discussions of the same topic by different groups to help to integrate the ideas of the whole group around specific topics and questions.

After Action Review

After Action Review (AAR) is a brief meeting of team members to reflect on an event or task they have just accomplished. The purpose of the AAR is for the team to learn from its experience in order to take the lessons learned into the next phase of the project or to accomplish the task more effectively the next time it is done. The AAR seeks to help the team develop insights about the event or task and turn that knowledge into action. 

To keep the meeting focused on its purpose, the AAR has a specific format of group discussion around these four questions:

Knowledge Harvest

A Knowledge Harvest is a meeting designed to capture lessons learned from a project or activity after it has been completed. A harvest meeting is intended to bring out the key knowledge acquired through the project or activity and capture it for reuse and for the benefit of future projects.

In the context of a collaborative improvement project, a Harvest Meeting provides the opportunity to consolidate and reflect on the key lessons learned by improvement teams and changes tested that were found to lead to improved outcomes.

Liberating Structures – Guide pratique

’Liberating Structures’ consiste en un certain nombre de processus, de méthodes, de règles et en une infrastructure qui permettent aux personnes de plus facilement se montrer créatives, adaptables, de tirer le meilleur parti des idées des autres et d’obtenir des résultats. Ainsi, par exemple, les musiciens de jazz spécialisés dans ’improvisation se basent sur une certaine forme ou structure musicale… à partir de laquelle ils créent, chacun de façon indépendante mais ensemble.

Synthesizing Learning

A critical task in collaborative improvement is integrating what has been learned across all improvement teams about how to meet the aim of the improvement effort.  Such synthesis of learning involves collecting information about the changes each team tested, making judgments about which changes appear to be most closely associated with improvement (taking into account the experience of all teams), and developing guidance that can help others apply that knowledge to improve care elsewhere.

Learning Interview

The learning interview is a technique for capturing knowledge from an individual.  It can be used in a variety of settings, for example “learning after” from an individual, after an activity has been completed, or “learning during” as part of on-the-job learning while observing an expert at work. Interviewing is a form of dialogue involving a question and answer process which continues until the interviewer feels he/she has reached core knowledge, expressed as future recommendations, based on real experience.

Speed Networking

Speed networking is a simple technique for getting all participants in a meeting to reflect on a question and share their insights with others in small group conversation. Speed networking is a great way to generate energy at the beginning of a meeting by providing an opportunity for everyone to speak early on.

Steps in Speed Networking

Ask everyone to stand up, leave their belongings behind, and move into a space where there is some room for everyone to stand comfortably and still be able to walk around—ideally an open space with no tables or chairs.  

Speed Consulting

Speed consulting is a group technique that draws on the experience of participants to advise another participant on how to address a specific problem or issue.  It uses small group conversation and a fast-paced schedule to focus participants on providing concrete, actionable advice.

Sharing Learning

In supporting collaborative improvement in over 15 countries during the past 25 years, we have come to define sharing learning as a key principle for effective health care improvement. 


Storytelling is an effective way of sharing knowledge between people that incorporates context, emotion, and tacit knowledge. In a short amount of time, a wealth of information with a high level of detail can be expressed. Not only does the listener learn from the story, but the storyteller can gain new insights to what they are describing through the practice of telling their story.