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. 



Materiales para vigilancia neurodesarrollo infantes Nicaragua


El paquete pedagógico es una herramienta para el desarrollo de competencias en el personal de las instituciones prestadoras de servicios de salud y en los estudiantes de las que son formadoras de recursos humanos para el sector salud. Se diseñó con enfoque de mejoramiento continuo de la calidad y está integrada por diseños metodológicos y material didáctico, basado en las normas y protocolos del MINSA, para el estudio de temas priorizados sobre salud materna-infantil, planificación familiar, VIH/Sida y Zika, en las unidades de salud e instituciones formadoras de recursos del sector salud. Los objetivos del paquete pedagógico son:
1.    Contribuir con el desarrollo de competencias en el personal de las unidades de salud, para brindar una atención de calidad y con calidez a la población de Nicaragua, según las normas y protocolos del MINSA.
2.    Fortalecer la institucionalidad y sostenibilidad del mejoramiento continuo de la calidad en la atención en las unidades de salud.
3.    Promover cambios en la planificación docente en relación con las metodologías, a fin de alcanzar aprendizajes significativos para el desarrollo de competencias.
4.    Contribuir con el desarrollo de competencias durante la formación de los recursos del sector salud en las instituciones formadoras.

The pedagogical package is a tool for the developing competencies in health service providers and among medical and nursing students – future health practitioners. It was designed for the study of prioritized topics on maternal and child health, family planning, HIV/AIDS and Zika with a focus on continuous quality improvement. The instructional design and teaching methods and materials are based on standards and protocols of the Nicaraguan Ministry of Health (MINSA) and are intended for use in health facilities and institutions that train health care providers. The objectives of the pedagogical package are:
1.    Contribute to the development of key competencies in the personnel of health facilities to provide high-quality, people-centered care to the population of Nicaragua, per the norms and protocols of the Ministry of Health.
2.    Strengthen the institutionalization and sustainability of continuous quality improvement in health facilities.
3.    Promote changes in instructional design and methods, in order to achieve significant learning for the development of skills.
4.    Contribute to the development of competencies during the training of medical and nursing student during pre-service training.


Improving postpartum care in a large hospital in New Delhi, India

Despite recent progress, the maternal mortality ratio (MMR) in India remains high at 174 per 100 000 live births. Bhagwan Mahavir Hospital (BMH) is a secondary level hospital in New Delhi. In 2013, five women died in BMH’s postpartum ward. In January 2014, a United States Agency for International Development-funded team met with BMH staff to help improve their system for providing postpartum care to prevent maternal deaths. The hospital staff formed a quality improvement (QI) team and, between January and December 2014, collected data, conducted root cause analyses to understand why postpartum women were dying and tested and adapted small-scale changes using plan-do-study-act cycles to delivery safer postpartum care. Changes included reorganising the ward to reduce the time it took nurses to assess women and educating women and their relatives about common danger signs. The changes led to an increase in the number of women who were identified with complications from two out of 1667 deliveries (0.12%) between January and May 2014 to 74 out of 3336 deliveries (2.2%) between July and December 2014. There were no deaths on the postpartum ward in 2014 compared with five deaths in 2013 but the reduction was not sustained after the hospital started accepting sick patients from other hospitals in 2015. QI approaches can improve the efficiency of care and contribute to improved outcomes. Additional strategies are required to sustain improvements.

Improving postpartum care in a large hospital in New Delhi, India

Delivering quality health services: a global imperative for universal health coverage

This documentauthored by WHO, OECD and The World Bankdescribes the essential role of quality in the delivery of health care services. As nations commit to achieving universal health coverage by 2030, there is a growing acknowledgement that optimal health care cannot be delivered by simply ensuring coexistence of infrastructure, medical supplies and health care providers.

Improvement in health care delivery requires a deliberate focus on quality of health services, which involves providing effective, safe, people-centred care that is timely, equitable, integrated and efficient. Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Download the report.