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. 



Vendor-to-vendor education to improve malaria treatment by the private sector: a "how-to" manual for district managers

This manual was developed to assist district health management teams in countries where malaria is endemic to improve the quality of malaria treatment given by private clinics, pharmacies, shops, and kiosks. It gives step-by-step...

The Guatemala QAP evaluation: Application and institutionalization of quality assurance

This report documents the experiences of the Quality Assurance Project (QAP) in implementing quality assurance activities in five regions of Guatemala: Quetzaltenango, Chimaltenango, Totonicapán, Sololá, and San Marcos. QAP initiated...

The Chile quality assurance program: Final evaluation

This evaluation report provides an overview of the Quality Assurance (QA) Program in the Chilean health care system. It is noted that the program began in the early 1990s, and, working through a QA Unit in the Ministry of Health, developed...

The Zambia accreditation program evaluation

This report documents the development of the Zambian hospital accreditation program from 1997 onward and highlights the major milestones, important players, and sequence of events involved in the ongoing development of the program. Data...

Applying benchmarking in health

The task of improving quality is a demanding job. It requires focusing on clients, using data, working collaboratively with other team members, and maintaining an overarching view of the health system in which we work. At the Quality...

Approaches to healthcare quality regulation in Latin America and the Caribbean: regional experiences and challenges

Health sector reform efforts in the Latin America and Caribbean (LAC) region have, in recent years, focused on strengthening the stewardship role of the public sector in regulating healthcare and assuring the quality of health services...

Assessing malaria treatment and control at peer facilities in Malawi

In Malawi, a country of 10 million people, 90 percent live in rural areas. Because malaria is transmitted by a mosquito vector, rural communities are particularly affected. The Secretary of Health recently announced that on average,...

Niger Essential Obstetric and Newborn Care Collaborative

Date improvement activities began: September, 2006 Date of end of collaborative: December, 2008 Aims/objectives: To scale up high-impact quality maternal newborn child health services for leading causes of mortality Implementation package/...

The client perspective: helping district health teams measure and act upon client satisfaction data in Niger. QAP II Operations

This Quality Assurance Project aimed to design and test a feasible, valid and useful tool for measuring and acting upon client satisfaction data at the district level in Niger, West Africa. The research involves focus groups with a...