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. 



Improving Care for Children Under Five and Pregnant Women Presenting with Fever in Malawi: Guide to Coaching Quality Improvement Teams

Quality improvement (QI) coaching is an important method to provide ongoing support to help teams of health care workers apply QI approaches in their setting. The purpose of this coaching guide is to support district malaria and/or...

Improving Care for Children Under Five and Pregnant Women Presenting with Fever in Malawi: Reference Sheet for Improvement Indicators

Since March 2018, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project has collaborated with the USAID Organized Network of Services for Everyone (ONSE) Project and ONSE’s supported health facilities to help them...

Improving Quality of Care for Children Under Five and Pregnant Women Presenting with Fever in Malawi Facilitator Guide

The purpose of this guide is to help improvement advisors conduct trainings for district level malaria and/or quality improvement coordinators, health care providers and managers to improve quality of care for children under five years of...

Institutionalizing Quality Improvement in Tanzania: A review and a look forward

The USAID Applying Science to Strengthen and Improve Systems (ASSIST) project in Tanzania was tasked to enhance capacity of RHMT/CHMTs in 19 councils in three regions of the Southern Highlands of Tanzania to manage and lead QI efforts. The...

Institutionalizing Quality Improvement in Uganda: Facilitators and Barriers

When improvement methods are institutionalized a healthcare system can be more agile in achieving improved service delivery. Understanding both expressions of institutionalization and pathways for moving toward institutionalized...

Managing Hundreds of Improvement Teams

Recognizing the notable scale of USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project activities and sizable number of improvement teams, which in some cases is close to 1,000 improvement teams managed in one country...

Uganda’s Health Care Quality Improvement Journey

Uganda, a country in East Africa of around 44 million people, represents a unique example of a low-income setting with a long history of national efforts to improve quality of care. Indeed, the current quality movement in Uganda started in...

USAID ASSIST Project Annual Performance Monitoring Report FY18

University Research Co., LLC (URC) and its partners have completed six years of implementation of theUSAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. This report is the sixth Annual Performance Monitoring Report...

Improving TB screening at Nine TB Diagnostic Treatment Units: Tested Changes and guidance from Uganda

In Uganda, ASSIST worked with the MOH and implementing partners to build the capacity of health workers to be able to screen, diagnose, and manage TB to improve TB care services using the continuous quality improvement (QI) model as well...