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. 



Health Profession Councils National Strategic Plan 2015–2020

This strategic plan was developed by the Ministry of Health of Cambodia and the five health professions councils (Medicine, Dentistry, Midwifery, Nursing, and Pharmacy) with support from the USAID ASSIST Project.  The strategic plan is intended to guide the implementation and evaluation of priority improvements for health professions regulation in Cambodia.

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.

USAID ASSIST Project Annual Performance Monitoring Report FY15

This annual report for the USAID ASSIST Project summarizes the project's accomplishments and results in FY15 supporting the application of modern improvement methods by host country providers and managers in USAID-assisted countries. During FY15, USAID ASSIST provided assistance in 23 countries through field and core funding.

FY15 Results:

Improving Health Care Quality eLearning Course

This course aims to introduce learners to principles and approaches that can help health care workers continually improve the work that they do. It will help to demystify improving health care, its underlying principles, and explain how proven interventions can be incorporated into practice for every patient. The course will focus on process improvement which has a large body of evidence in USAID-supported countries.

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. 

Indonesia hospital accreditation process impact evaluation: Midline report

In 2011, USAID Indonesia commissioned the USAID Health Care Improvement Project (HCI) to conduct an evaluation of the impact of current hospital accreditation initiatives in Indonesia. After the baseline assessment, support for the activity was provided through the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project.

ICAP Webinar: Zambia QI National Strategy Development


As part of the “Introduction to Quality Improvement” training course implemented by the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University's Mailman School of Public Health, Ms.Rachael Lungwebungu, Quality Improvement Advisor to the Ministry of Health of Zambia, will lead this webinar on Wednesday, September 30 on the development of the national quality improvement strategy in Zambia.

Webinar: Developing and disseminating knowledge products from improvement

Gathering and integrating what is learned about how to improve health and other services from the work of improvement teams is an important activity within quality improvement work, especially with an eye to how that learning can be applied at larger scale.  One way we package that learning is to create knowledge products that retain the insights developed by improvement teams and those who support them.

Increasing facility efficiency by improving triage of antenatal care of pregnant women in FRU Charkhi Dadri, Bhiwani District, Haryana, India

Charkhi Dadri is a First Referral Unit (FRU) in Bhiwani District in Haryana State and one of four facilities in Bhiwani that is being supported by the USAID ASSIST Project. On an average, about 350 to 400 antenatal care (ANC) cases are seen in Charkhi Dadri per month.  The facility’s staff found that the waiting time for pregnant women to receive ANC services was extremely long due to inefficiencies in their triaging. The facility formed team which used quality improvement methods to streamline ANC services.

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.