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. 



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.

Lessons Learned from Ghana's Project Fives Alive! A Practical Guide for Designing and Executing Large-Scale Improvement Initiatives

Project Fives Alive! is a partnership between the National Catholic Health Service of Ghana and the Institute for Healthcare Improvement (IHI) in the United States.  Based on seven years of implementation experience scaling up high-impact maternal and child health interventions across Ghana and drawing on extensive interviews of key actors in this large-scale improvement initiative, IHI developed a thoughtful guide that synthesizes the key learning from the Project Fives Alive! Partnership.

Decentralizing TB Services to Improve Access to Treatment in Swaziland

This short report describes the work conducted by University Research Co., LLC (URC) from 2006 to 2014, through the USAID-funded Quality Assurance, Health Care Improvement, and Applying Science to Strengthen and Improve Systems (ASSIST) projects, to support the Swaziland National Tuberculosis Control Programme to decentralize TB services. As a result of the support provided to the Ministry of Health, decentralization of TB services increased from seven basic management units in 2006 to 87 health facilities in 2014.

The ‘improvement methodology’: necessary but insufficient to make improvement in healthcare a nationwide activity

Subiri Obwogo

Senior Quality Improvement Advisor, Kenya, USAID ASSIST Project/URC

I wish to share some thoughts on the question of ‘how not to develop a quality improvement effort’ that was discussed at the just concluded the International Forum on Quality and Safety in Healthcare in London which was held on April 21-24. It was reported that the way Country X went about conducting a national survey of healthcare quality and using the results of the survey as a basis for developing a strategic plan and a national policy for quality improvement was misguided. 

2015 International Forum on Quality and Safety in Health Care

London, England

The International Forum on Quality and Safety in Health Care is the premier international learning event on improving health care. Sponsored by the British Medical Journal and the Institute for Healthcare Improvement, the International Forum aims to improve outcomes for patients and communities, provide practical ideas that can be implemented in the workplace, promote research into quality and safety improvement, foster effective innovation, and connect health care leaders and practitioners worldwide.

A moment of hesitation became a journey of discovery: My experience as an ISQua fellow

John Byabagambi

Improvement Advisor, USAID ASSIST Project/URC

This post was originally published on the ISQua Fellowship's monthly newsletter.

In October 2013 I visited the ISQua Fellowship booth at the 30th ISQua conference in Edinburgh, Scotland. The lady managing the booth was quick to give me information and reading material about the Fellowship. Whereas I was convinced about the information and really did want to sign up for the Fellowship, I was a little hesitant because of the fee. Nonetheless, the 20% discount for registering at the time of the offer was hard to resist, so I signed up.

BMJ Quality Webinar: Sitaram Bhartia's QI Journey

SItaram Bhartia BMJ Quality Webinar

BMJ Quality is pleased to host this webinar featuring three quality leaders from the Sitaram Bhartia Institute of Science and Research -- a 70-bed nonprofit hospital and medical research center in Delhi, India.  They will recount how quality became a game changer at the hospital and how an incident in her practice led one obstetrician-gynecologist to work for lowering caesarean section rates across the hospital.

You must register to participate; space is limited. View the program outline and register at

April 9 2015  11:30am New York | 4:30pm London | 9:00pm Delhi