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. 



Making care more people-centered

Sarah Smith Lunsford

Quality Improvement Advisor, Research & Evaluation, USAID ASSIST/EnCompass LLC

While it is widely recognized that people-centered care is an essential part of quality health care, what we mean by people-centered care is much harder to define. For the past several months, the ASSIST Project has been grappling with how to integrate a people-centered approach into our improvement work.  Drawing on the literature and frameworks from WHO and others, we have developed five principles to ground our efforts:

Market Research Needs Assessment: Understanding Health Care Improvement Information Needs of Key Stakeholders in the Uganda Health System

In an effort to support country-wide learning in improvement initiatives, the USAID ASSIST Project conducted an information needs assessment with government and non-governmental organization (NGO) staff working at the national and district levels of the Ugandan health system from March 2014 to June 2014.

Baseline Assessment of Cambodia Health Professions Regulatory System

The ASSIST Cambodia team completed a baseline assessment of the health professions regulatory system in September 2014.

The objectives of the baseline assessment were to:

How to Guide for Quality Improvement

This guide was developed by The Aurum Institute and the Institute for Healthcare Improvement for the U.S. President's Emergency Plan for AIDS Relief, to guide program implementers on how to improve care quality. The guide consists of 10 modules, covering:

A milestone in global efforts to improve health care

James Heiby

Project Officer, USAID ASSIST Project and Medical Officer, Office of Health Systems, USAID

Last month marked the closing of the USAID Health Care Improvement (HCI) Project, the largest global effort to date to improve health care quality in lower- and middle-income countries (LMICs).  A seven-year USAID project that operated in 38 countries, HCI built on earlier USAID-funded projects and the experience of high-income countries to directly examine both clinical and non-clinical health care activities and develop ways to improve them. 

Improving Health Care: The Results and Legacy of the USAID Health Care Improvement Project

This final report of the USAID Health Care Improvement Project (HCI) summarizes the key accomplishments and learning of this seven-year global technical assistance project of the USAID Office of Health Systems.  Implemented from 2007-2014, HCI provided technical assistance in health care and social service improvement in 38 countries.

Continuous quality improvement: sustaining improvement

M. Rashad Massoud

Director, USAID ASSIST Project/URC

This post was originally posted on the Global Health Council's website and was adopted from Dr. Massoud's presentation at the World Health Organization’s Scoping Consultation on Strengthening Quality of HIV Clinical Services in Resource-Limited Settings on September 15.

In the last few years, we have increasingly come to realize that we have many high impact interventions and can save lives and alleviate suffering. Unfortunately these interventions are currently not reaching every patient and every client every time they are needed. This blog will discuss identifying the need for improving health 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.

Annual Project Reports of the USAID Health Care Improvement Project, FY08-FY14

The Health Care Improvement Project (HC) is the global mechanism of the United States Agency for International Development (USAID) for technical leadership and assistance to improve health care delivery and health workforce capacity and performance in USAID-assisted countries. The project is managed by University Research Co., LLC (URC) through a global task order issued under the USAID Health Care Improvement Indefinite Quantity Contract (IQC).

All Annual Project Reports up to date can be found below. Each narrative reports on the following sections:

  1. Reports on field support-funded country or regional technical assistance (TA) to improve health care
  2. Core-funded activities and results that supported USAID’s Global Health strategic objectives
  3. Activities carried out under the project’s common agenda functions that benefit multiple countries
  4. Achievements against the project's Performance Tracking Plan

My sex worker encounter

Edward Broughton

Director-Research and Evaluation, USAID ASSIST/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.