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. 



Poor-resourced countries need to pay attention to both the “hard” and “soft” components of quality governance

Subiri Obwogo

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


Discussants of the webinar on “Necessary Components to Governing Quality,” distinguished between the ‘hard’ components of governance such as national policies and strategies, and the ‘soft’ components such as leadership support and developing a culture for improvement. They cited examples of countries that have hard governance components, but have not successfully operationalized these. They concluded that a national quality improvement strategy or policy is not the key to improving quality of care, and countries should instead focus on ‘soft’ components.

What do we mean by innovation in healthcare?

Just as in other modern industries, the term ‘innovation’ in healthcare has become associated with any developments in the field done in new, better, or more effective ways. Innovation—a buzzword lifted from the business, technology, and marketing industries—has recently been used to describe a wide variety of policies, systems, technologies, ideas, services, and products that provide solutions to existing healthcare problems. Notably absent from the discussions around innovation, however, is a clear, common understanding of what the term means.

A clear guide to improving care of mothers and babies in low-resource settings

By: Tamar Chitashvili, Silvia Holschneider, Jorge Hermida, and Nigel Livesley 

There is growing recognition that clinical training and health infrastructure — while essential—are insufficient for improving and sustaining life-saving maternal and newborn health care services in low-resource settings. Instead, broader systems strengthening and continuous quality improvement efforts at the service delivery level are needed to continuously assess gaps in processes and content of care and to plan, test, implement, regularly monitor, refine and institute changes to deliver services correctly and consistently. To respond to this need and help frontline care providers in their continuous quality improvement journey, “Improving Care for Mothers and Babies: A Guide for Improvement Teams” was recently developed through collaborative efforts of the Survive & Thrive Global Development Alliance (S&T GDA).

Top 3 Resources from USAID ASSIST

These were the most viewed resources from the USAID ASSIST website in 2016. Check them out:

1. Kenya Quality Model for Health: A Training Course for the Health Sector

Tools for the South Africa Integrated People-centered Health Services Baseline and Endline Assessments

These tools were used in South Africa for the ASSIST activity on integrated people-centered health services (IPCHS). The baseline report is in review by USAID and should be available soon. The data collections tools may be downloaded below, and include:
Patient interview tool
Provider interview tool

Lessons Learned from Applying Collaborative Improvement Methodologies to Strengthen the Performance and Productivity of HIV Human Resources

Since 2009, the USAID Office of HIV/AIDS has actively supported the application of collaborative improvement methodologies to improve the performance and productivity of HIV service providers, including at the community level. Collaborative improvement engages a large number of teams in applying process improvement to achieve a common objective, using common indicators, and actively fostering sharing of learning and successful practices across all teams to favor large-scale improvement.

Politique Nationale d'Amelioration de la Qualite des Soins et des Services de Sante en Cote d'Ivoire

Le présent document de Politique est le résultat d’un processus de réflexion de plusieurs acteurs et partenaires impliqués dans le domaine de la qualité des soins et services de santé. C’est un outil de promotion de la démarche qualité, destiné aux différents acteurs du système de santé à tous les niveaux de la pyramide sanitaire. Il constitue aussi un document de plaidoyer auprès des partenaires financiers. C'est un document d’orientation qui définit le cadre général du développement de la qualité dans le secteur de la santé.