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. 



How do we learn about improvement?

Danika Barry

Healthcare Improvement Fellow, USAID ASSIST Project/URC

M. Rashad Massoud

Director, USAID ASSIST Project/URC

Commentary on the Quality & Performance Institute's Technical Meeting held on December 17, 2014. A full transcript is available here.

For our December Quality & Performance Institute Technical Meeting, we invited Dr. Frank Davidoff and other thought leaders in the field of improvement science to comment on the issues raised in Davidoff’s recent article, “Improvement interventions are social treatments, not pills.”

African Partnerships for Patient Safety: Lessons learned

Shams Syed

Programme Manager, World Health Organization

This post was originally published by the Agency for Healthcare Research and Quality.

In the last six years I have had the privilege of shaping and leading the implementation of a WHO program focused on improving patient safety in Africa through the use of hospital partnerships. African Partnerships for Patient Safety (APPS) has been implemented through a phased approach aimed at continuous refinement. In this article, I summarize the journey and reflect on key implications on the use of institutional health care partnerships for global patient safety improvement.

Why quality matters for Universal Health Coverage

M. Rashad Massoud

Director, USAID ASSIST Project/URC

As we celebrate Universal Health Coverage Day on December 12, we on the USAID ASSIST Project are committed to supporting countries to promote better and more equitable health outcomes by expanding access to essential health care to all who need it, regardless of socio-economic status or geographic location.

USAID ASSIST Project Annual Performance Monitoring Report FY14

This annual report for the USAID ASSIST Project summarizes the project's accomplishments and results in FY14 supporting the application of modern improvement methods by host country providers and managers in USAID-assisted countries.

Making Health Care about People: Applying People-centered Care Principles to Family Planning Improvement Work in West Africa

The World Health Organization (WHO) has developed a new strategy on people-centered health care that places a strong focus on the re-orienting the health system as a whole, including the importance of engaging community and patient groups. ASSIST principles of people-centeredness are complementary to the WHO strategy, particularly with respect to coordination and continuity of care, information, and the micro-level interactions between a client and the health care service delivery team that promote or hinder people-centeredness.

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.