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. 



Setting Up a Self-Sustaining Quality Improvement Network in India

In May 2016, Kalawati Saran Children’s Hospital (KSCH) began using QI approaches to improve maternal and newborn care in their facility. This approach was very helpful for them in improving processes of care, and they achieved impressive results in outcomes in a short period of time.

Virtual versus in-person quality improvement coaching support in India: A brief analysis of resource expenditures

In December 2016, ASSIST started providing support to health workers of three hospitals in Meghalaya – a day’s travel from ASSIST’s office in New Delhi. To meet the challenge associated with providing on-site coaching to these facilities, ASSIST began providing virtual coaching to using WhatsApp and phone calls.

Anyone can learn improvement — and here is something to help!

Kim Ethier Stover

Senior Improvement Advisor, USAID ASSIST Project/URC

Silvia Holschneider

Senior Improvement Advisor for Reporting and Deliverables, USAID ASSIST Project

WEBINAR: Quality improvement – wisdom from the field


Improvement efforts across the world yield important lessons and learning that can stimulate changes elsewhere. Documenting and sharing the accumulated wisdom from these improvement efforts is critical in fostering the generation of new knowledge to increase the impact of quality improvement interventions. Opportunities for shared learning and exploration are limited.

Helping project implementers understand evaluation design

Astou Coly

Senior Improvement Advisor, USAID ASSIST Project/URC

Around this time last year, the USAID ASSIST Project met with 60 improvement and research experts, policymakers, and funders from 10 organizations and 28 countries to attend a 5-day meeting in Salzburg on “Better Health Care: How Do We Learn About Improvement?

Why it is Important to Sex-Disaggregate Data in Quality Improvement

The USAID ASSIST Project integrates gender considerations in quality improvement in order to improve outcomes for all — women and men, girls and boys. This video explains a critical part of gender integration in detail: collecting and analyzing sex-disaggregated data.

ISQua Fellowship Webinar: Why standards or training do not fix all problems


We typically try to fix problems in health care by setting standards or training staff. These interventions work for some problems but not for all. In this presentation, ASSIST's Nigel Livesley discussed some types of problems that require different solutions and how to identify these solutions.