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. 



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.

International Council of Nurses Conference, Seoul, South Korea

Dr. Massoud at the International Council of Nurses conference in Seoul
USAID ASSIST Director Dr. M. Rashad Massoud addressed the International Council of Nurses (ICN) conference in Seoul, South Korea, June 19-23, 2015, describing applications of the chronic care model and the effect of improvement on nursing productivity and engagement.  He also led a Satellite Symposium on improving health care in low and middle-income countries.  Under the theme of Global Citizen, Global Nursing, the conference brought together thousands of nurses from countries across the world to explore the importance of cross-cultural understanding and global cooperation in nursing.

IBP Consortium Conference in Ethiopia: Scaling Up Family Planning & Reproductive Health Best Practices

This international meeting sponsored the Implementing Best Practices (IBP) Consortium was held in Addis Ababa, Ethiopia, June 15-19, 2015.  The conference, Hands on for Scaling Up Family Planning & Reproductive Health Best Practices: Experience and Challenges from Africa, sought to exchange global and country experiences for scaling up family planning and reproductive health best practices and provide some hands-on application of systematic approaches to scale-up through presentations and case study exercises.

Introducing the AFRO Guide for Developing National Patient Safety Policy & Strategic Plan

Lopa Basu

US Liaison for the WHO Service Delivery & Safety Department

As conceptual clarity on the Sustainable Development Goals (SDGs) emerges, the health component requires a clear focus on the ‘how to’ of service delivery improvement. The convergence of the world of quality improvement and the world of Universal Health Coverage is vital. 

Why we learned to hate small groups (and what to do about it)

Kate Fatta

Improvement Advisor for Knowledge Management, USAID ASSIST Project/URC

A few months ago, I was visiting my dad, and he, like any parent, asked how work was going. “Now, what are you doing again?” he asked. “I work in knowledge management,” I said and waited for the inevitable “what’s that?” I explained to him how we try to learn from what we are doing and use a variety of conversational, small group techniques to do so. “Ugh, I hate small group work,” he replied, and that was that. I realized that what he said rang true for me, too.

Scaling up quality improvement to reduce maternal and child mortality in Lohardaga District, Jharkhand, India

Lohardaga District in Jharkhand State has high rates of infant mortality, and State authorities recognized that the district needed additional support to reduce mortality. The USAID ASSIST Project initially started supporting four facilities to improve routine care of mothers and new-born babies. The facilities’ success in ensuring that nearly all mothers and newborns were receiving quality routine care prompted the district health authorities to scale up quality improvement initiatives to five other health centres and 29 sub-centres.

A Practical Guide for Large-Scale Improvement Projects Using Ghana’s "Project Fives Alive!"

Sodzi Sodzi-Tettey

Senior Technical Director, IHI/Africa and Director, Project Fives Alive!

If Project Fives Alive! (PFA!), the partnership between the Institute for Healthcare Improvement (US) and the National Catholic Health Service (Ghana), had benefited from a practical and easy-to-read manual eight years ago that systematically documented what works (Key Success Factors), likely pitfalls (Key Challenges), and useful lessons (Recommendations), what difference would it have made? 

WHO Hand Hygiene Global Survey

5 Moments for Hand Hygiene

In support of its annual call to action for health workers, SAVE LIVES: Clean Your Hands, and ten years of the WHO Clean Care is Safer Care program, the 2nd WHO Hand Hygiene Self-Assessment Framework Global Survey was launched on 1 June 2015.

The WHO Hand Hygiene Self-Assessment Framework provides a situation analysis of hand hygiene resources, promotion and practices within health-care facilities. After completing the Framework, facilities can also use and adapt the WHO Template Action Plans to implement plans for local improvement based upon the Framework results.  Data submitted through the survey on a confidential online server will help WHO to demonstrate progress with the hand hygiene improvement across the globe and ensure that action in support of patient and health worker safety stays high on everyone’s agenda. Survey responses can be submitted in English, French, Spanish, Italian, and Portuguese.